Rehabilitation services have grown tremendously in the United States over the past 2 decades. Rules originally designed to guide Medicare reimbursement policies have had substantial effects in shaping the design of clinical services. This article traces the development of the most significant federal rules regarding rehabilitation, outlines the existing empirical evidence to support these rules, and discusses an agenda for research to improve the evidence for future policy development.
Centers for Medicare & Medicaid Services. Health care system facts and figures and 2002 data compendium. Retrieved September 1, 2003, from www.cms.gov/researchers.
2.
Department of Health and Human Services CfMaMSC. Changes to the criteria for being classified as an inpatient rehabilitation facility; final rule. Fed Regist2004;69(89):25751-25776.
3.
Fein R.Medical care medical costs. Cambridge, MA: Harvard University Press; 1986.
4.
Fox DM. Power and illness. Berkeley: University of California Press; 1993.
5.
Centers for Medicare & Medicaid Services. Medicare hospital manual. Retrieved May 1, 2004, from http://www.cms.hhs.gov/manuals/10_hospital/ho211.asp%23_1_2.
6.
U.S. Department of Health and Human Services, Health Care Financing Administration. Medicare hospital manual transmittal no. 313. September 198225:9-24m.2.
7.
Johnston MV, Miller LS. p Cost-effectiveness of the Medicare three-hour regulation. Arch Phys Med Rehabil1986;67(9):581-585.
8.
Centers for Medicare & Medicaid Services. Medicare benefit policy manual. Retrieved February 9, 2005, from http://www.cms.hhs.gov/manuals/102_policy/bp102c15.pdf.
9.
Department of Health and Human Services HCFAH. Medicare program; prospective payment system and consolidated billing for skilled nursing facilities. Final rule. Fed Regist1999;64(146):41644-41683.
10.
Department of Health and Human Services HCFAH. Medicare program; prospective payment system for inpatient rehabilitation facilities. Final rule. Fed Regist2001;66(152):41315-41430.
11.
MedPAC. A data book: healthcare spending and the Medicare program (June 2004). Retrieved August 5, 2004, from www.medpac.gov.
12.
Buchanan JL, Rumpel JD, Hoenig H.Charges for out-patient rehabilitation: growth and differences in provider types. Arch Phys Med Rehabil1996;77(4):320-328.
13.
Health Care Financing Administration R.Medicare and Medicaid statistical sourcebook 2001. Washington, DC: Health Care Financing Administration; 2001.
14.
Weingarten S, Riedinger MS, Sandhu M, et al.Can practice guidelines safely reduce hospital length of stay? Results from a multicenter interventional study. Am J Med1998;105(1):33-40.
15.
Jorgensen HS, Kammersgaard LP, Houth J, et al.Who benefits from treatment and rehabilitation in a stroke Unit? A community-based study. Stroke2000;31(2):434-439.
16.
Patel A, Knapp M, Perez I, Evans A, Kalra L.Alternative strategies for stroke care: cost-effectiveness and cost-utility analyses from a prospective randomized controlled trial. Stroke2004;35(1):196-203.
17.
Brainin M, Olsen TS, Chamorro A, et al.Organization of stroke care: education, referral, emergency management and imaging, stroke units and rehabilitation. European Stroke Initiative. Cerebrovasc Dis2004;17 (Suppl 2):1-14.
18.
Serruys PW, Unger F, Sousa JE, et al.Comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease. N Engl J Med2001;344(15):1117-1124.
19.
DeJong G, Horn SD, Gassaway JA, Slavin MD, Dijkers MP. Toward a taxonomy of rehabilitation interventions: using an inductive approach to examine the “black box” of rehabilitation. Arch Phys Med Rehabil2004;85(4):678-686.
20.
Sherrington C, Lord SR, Herbert RD. A randomized controlled trial of weight-bearing versus non-weight-bearing exercise for improving physical ability after usual care for hip fracture. Arch Phys Med Rehabil2004;85(5):710-716.
21.
Munin MC, Rudy TE, Glynn NW, Crossett LS, Rubash HE. Early inpatient rehabilitation after elective hip and knee arthroplasty. JAMA1998;279(11):847-852.
22.
Roos EM. Effectiveness and practice variation of rehabilitation after joint replacement. Curr Opin Rheumatol2003;15(2):160-162.
23.
Rossi MD, Hasson S.Lower-limb force production in individuals after unilateral total knee arthroplasty. Arch Phys Med Rehabil2004;85(8):1279-1284.
24.
Munin MC, Kwoh CK, Glynn N, Crossett L, Rubash HE. Predicting discharge outcome after elective hip and knee arthroplasty. Am J Phys Med Rehabil1995;74(4):294-301.
25.
Forrest G, Fuchs M, Gutierrez A, Girardy J.Factors affecting length of stay and need for rehabilitation after hip and knee arthroplasty. J Arthroplasty1998;13(2):186-190.
26.
Shepperd S, Harwood D, Jenkinson C, Gray A, Vessey M, Morgan P.Randomised controlled trial comparing hospital at home care with inpatient hospital care. I: three month follow up of health outcomes. BMJ1998;316(7147):1786-1791.
27.
Richards SH, Coast J, Gunnell DJ, Peters TJ, Pounsford J, Darlow MA. Randomised controlled trial comparing effectiveness and acceptability of an early discharge, hospital at home scheme with acute hospital care. BMJ1998;316(7147):1796-1801.
28.
Coast J, Richards SH, Peters TJ, Gunnell DJ, Darlow MA, Pounsford J.Hospital at home or acute hospital care? A cost minimisation analysis. BMJ1998;316(7147):1802-1806.
29.
Shepperd S, Harwood D, Gray A, Vessey M, Morgan P.Randomised controlled trial comparing hospital at home care with inpatient hospital care. II: cost minimisation analysis. BMJ1998;316(7147):1791-1796.
30.
Rajan RA, Pack Y, Jackson H, Gillies C, Asirvatham R.No need for outpatient physiotherapy following total knee arthroplasty: a randomized trial of 120 patients. Acta Orthop Scand2004;75(1):71-73.
31.
Moffet H, Collet JP, Shapiro SH, Paradis G, Marquis F, Roy L.Effectiveness of intensive rehabilitation on functional ability and quality of life after first total knee arthroplasty: a single-blind randomized controlled trial. Arch Phys Med Rehabil2004;85(4):546-556.
32.
Hokby A, Reimers A, Laflamme L.Hip fractures among older people: do marital status and type of residence matter?Public Health2003;117(3):196-201.
33.
Roder F, Schwab M, Aleker T, Morike K, Thon KP, Klotz U.Proximal femur fracture in older patients—rehabilitation and clinical outcome. Age Ageing2003;32(1):74-80.
34.
Hannan EL, Magaziner J, Wang JJ, et al.Mortality and locomotion 6 months after hospitalization for hip fracture: risk factors and risk-adjusted hospital outcomes. JAMA2001;285(21):2736-2742.
35.
Magaziner J, Lydick E, Hawkes W, et al.Excess mortality attributable to hip fracture in white women aged 70 years and older. Am J Public Health1997;87(10):1630-1636.
36.
Boockvar KS, Halm EA, Litke A, et al.Hospital readmissions after hospital discharge for hip fracture: surgical and nonsurgical causes and effect on outcomes. J Am Geriatr Soc2003;51(3):399-403.
37.
Cameron ID, Handoll HH, Finnegan TP, Madhok R, Langhorne P.Co-ordinated multidisciplinary approaches for inpatient rehabilitation of older patients with proximal femoral fractures. Cochrane Database Syst Rev2001(3):CD000106.
38.
Naglie G, Tansey C, Kirkland JL, et al.Interdisciplinary inpatient care for elderly people with hip fracture: a randomized controlled trial. CMAJ2002;167(1):25-32.
39.
Kramer AM, Steiner JF, Schlenker RE, et al.Outcomes and costs after hip fracture and stroke. A comparison of rehabilitation settings. JAMA1997;277(5):396-404.
40.
Crotty M, Whitehead C, Miller M, Gray S.Patient and caregiver outcomes 12 months after home-based therapy for hip fracture: a randomized controlled trial. Arch Phys Med Rehabil2003;84(8):1237-1239.
41.
Binder EF, Brown M, Sinacore DR, Steger-May K, Yarasheski KE, Schechtman KB. Effects of extended out-patient rehabilitation after hip fracture: a randomized controlled trial. JAMA2004;292(7):837-846.
42.
Anderson C, Rubenach S, Mhurchu CN, Clark M, Spencer C, Winsor A.Home or hospital for stroke rehabilitation? Results of a randomized controlled trial: I: health outcomes at 6 months. Stroke2000;31(5):1024-1031.
43.
Anderson C, Mhurchu CN, Rubenach S, Clark M, Spencer C, Winsor A.Home or hospital for stroke rehabilitation? Results of a randomized controlled trial: II: cost minimization analysis at 6 months. Stroke2000;31(5):1032-1037.
44.
Rundek T, Nielsen K, Phillips S, Johnston KC, Hux M, Watson D.Health care resource use after acute stroke in the Glycine Antagonist in Neuroprotection (GAIN) Americas trial. Stroke2004;35(6):1368-1374.
45.
Bohannon RW, Lee N.Association of physical functioning with same-hospital readmission after stroke. Am J Phys Med Rehabil2004;83(6):434-438.
46.
Heinemann AW, Hamilton B, Linacre JM, Wright BD, Granger C.Functional status and therapeutic intensity during inpatient rehabilitation. Am J Phys Med Rehabil1995;74(4):315-326.
47.
Alexander H, Bugge C, Hagen S.What is the association between the different components of stroke rehabilitation and health outcomes?Clin Rehabil2001;15(2):207-215.
48.
Sunderland A, Tinson DJ, Bradley EL, Fletcher D, Langton Hewer R, Wade DT. Enhanced physical therapy improves recovery of arm function after stroke. A randomised controlled trial. J Neurol Neurosurg Psychiatry1992;55(7):530-535.
49.
Kwakkel G, Kollen BJ, Wagenaar RC. Long term effects of intensity of upper and lower limb training after stroke: a randomised trial. J Neurol Neurosurg Psychiatry2002;72(4):473-479.
50.
Winstein CJ, Rose DK, Tan SM, Lewthwaite R, Chui HC, Azen SP. A randomized controlled comparison of upper-extremity rehabilitation strategies in acute stroke: a pilot study of immediate and long-term outcomes. Arch Phys Med Rehabil2004;85(4):620-628.
51.
Bhogal SK, Teasell R, Speechley M.Intensity of aphasia therapy, impact on recovery. Stroke2003;34(4):987-993.
52.
Pulvermuller F, Neininger B, Elbert T, et al.Constraint-induced therapy of chronic aphasia after stroke. Stroke2001;32(7):1621-1626.
53.
Taub E, Morris DM. Constraint-induced movement therapy to enhance recovery after stroke. Curr Atheroscler Rep2001;3(4):279-286.
54.
Dobkin B.The clinical science of neurologic rehabilitation. 2nd ed.Oxford, UK: Oxford University Press; 2003.
55.
Bland ST, Pillai RN, Aronowski J, Grotta JC, Schallert T.Early overuse and disuse of the affected forelimb after moderately severe intraluminal suture occlusion of the middle cerebral artery in rats. Behav Brain Res2001;126(1-2):33-41.
56.
Paolucci S, Antonucci G, Grasso MG, et al.Early versus delayed inpatient stroke rehabilitation: a matched comparison conducted in Italy. Arch Phys Med Rehabil2000;81(6):695-700.
57.
Wertz RT, Weiss DG, Aten JL, et al.Comparison of clinic, home, and deferred language treatment for aphasia. A Veterans Administration Cooperative Study. Arch Neurol1986;43(7):653-658.
58.
Ward NS, Brown MM, Thompson AJ, Frackowiak RS. The influence of time after stroke on brain activations during a motor task. Ann Neurol2004;55(6):829-834.
59.
Legg L, Langhorne P.Rehabilitation therapy services for stroke patients living at home: systematic review of randomised trials. Lancet2004;363(9406):352-356.
60.
Ivey FM, Womack CJ, Kulaputana O, Dobrovolny CL, Wiley LA, Macko RF. A single bout of walking exercise enhances endogenous fibrinolysis in stroke patients. Med Sci Sports Exerc2003;35(2):193-198.
61.
Macko RF, Smith GV, Dobrovolny CL, Sorkin JD, Goldberg AP, Silver KH. Treadmill training improves fitness reserve in chronic stroke patients. Arch Phys Med Rehabil2001;82(7):879-884.
62.
Duncan P, Studenski S, Richards L, et al.Randomized clinical trial of therapeutic exercise in subacute stroke. Stroke2003;34(9):2173-2180.
63.
Boser K, Weinrich M, McCall D.Maintenance of oral production in agrammatic aphasia: verb tense morphology training. Neurorehabil Neural Rep2000;14:105-118.
64.
Teasell RW, Kalra L.What’s new in stroke rehabilitation. Stroke2004;35(2):383-385.
65.
Reding MJ, Potes E.Rehabilitation outcome following initial unilateral hemispheric stroke. Life table analysis approach. Stroke1988;19(11):1354-1358.
66.
Patel AT, Duncan PW, Lai SM, Studenski S.The relation between impairments and functional outcomes poststroke. Arch Phys Med Rehabil2000;81(10):1357-1363.
67.
Jorgensen HS, Nakayama H, Raaschou HO, Vive-Larsen J, Stoier M, Olsen TS. Outcome and time course of recovery in stroke. Part I: outcome. The Copenhagen Stroke Study. Arch Phys Med Rehabil1995;76(5):399-405.
68.
Duncan PW, Goldstein LB, Horner RD, Landsman PB, Samsa GP, Matchar DB. Similar motor recovery of upper and lower extremities after stroke. Stroke1994;25(6):1181-1188.
69.
Basso A, Capitani E, Vignolo LA. Influence of rehabilitation on language skills in aphasic patients. A controlled study. Arch Neurol1979;36(4):190-196.
70.
Weinrich M, Shelton JR, Cox DM, McCall D.Remediating production of tense morphology improves verb retrieval in chronic aphasia. Brain Lang1997;58(1):23-45.
71.
Gross CG. Neurogenesis in the adult brain: death of a dogma. Nat Rev Neurosci2000;1(1):67-73.
72.
Cramer SC. Functional magnetic resonance imaging in stroke recovery. Phys Med Rehabil Clin N Am2003;14(1 Suppl):S47-S55.
73.
Wittenberg GF, Chen R, Ishii K, et al.Constraint-induced therapy in stroke: magnetic-stimulation motor maps and cerebral activation. Neurorehabil Neural Rep2003;17(1):48-57.
74.
Goldstein LB. Pharmacotherapy in stroke rehabilitation. Adv Neurol2003;92:447-450.
75.
Marciniak CM, Sliwa JA, Spill G, Heinemann AW, Semik PE. Functional outcome following rehabilitation of the cancer patient. Arch Phys Med Rehabil1996;77(1):54-57.
76.
Katsura H, Kanemaru A, Yamada K, Motegi T, Wakabayashi R, Kida K.Long-term effectiveness of an inpatient pulmonary rehabilitation program for elderly COPD patients: comparison between young-elderly and old-elderly groups. Respirology2004;9(2):230-236.
77.
Fishman A, Martinez F, Naunheim K, et al.A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med2003;348(21):2059-2073.
78.
Finnerty JP, Keeping I, Bullough I, Jones J.The effectiveness of outpatient pulmonary rehabilitation in chronic lung disease: a randomized controlled trial. Chest2001;119(6):1705-1710.
79.
Mador MJ, Bozkanat E, Aggarwal A, Shaffer M, Kufel TJ. Endurance and strength training in patients with COPD. Chest2004;125(6):2036-2045.
80.
Johnson MF, Kramer AM, Lin MK, Kowalsky JC, Steiner JF. Outcomes of older persons receiving rehabilitation for medical and surgical conditions compared with hip fracture and stroke. J Am Geriatr Soc2000;48(11):1389-1397.
81.
Khan MM, Tsai WC, Kung PT. Biased enrollment of Medicare beneficiaries in HMO plans—implications for Medicare costs. J Health Care Finance2002;28(4):43-57.
82.
Wholey DR, Burns LR, Lavizzo-Mourey R.Managed care and the delivery of primary care to the elderly and the chronically ill. Health Serv Res1998;33(2 Pt Ii):322-353.
83.
Davidson SM, Davidson H, Miracle-McMahill H, et al.Utilization of services by chronically ill people in managed care and indemnity plans: implications for quality. Inquiry2003;40(1):57-70.
84.
Master R, Dreyfus T, Connors S, Tobias C, Zhou Z, Kronick R.The Community Medical Alliance: an integrated system of care in Greater Boston for people with severe disability and AIDS. Manag Care Q1996;4(2):26-37.
85.
Stuart M, Weinrich M.Integrated health system for chronic disease management: lessons learned from France. Chest2004;125(2):695-703.
86.
Reginster JY, Gillet P, Ben Sedrine W, et al.Direct costs of hip fractures in patients over 60 years of age in Belgium. Pharmacoeconomics1999;15(5):507-514.
87.
Wiktorowicz ME, Goeree R, Papaioannou A, Adachi JD, Papadimitropoulos E.Economic implications of hip fracture: health service use, institutional care and cost in Canada. Osteoporos Int2001;12(4):271-278.
88.
Hauer K, Specht N, Schuler M, Bartsch P, Oster P.Intensive physical training in geriatric patients after severe falls and hip surgery. Age Ageing2002;31(1):49-57.
89.
Laloux P.Cost of acute stroke. A review. Acta Neurol Belg2003;103(2):71-77.
90.
Claesson L, Gosman-Hedstrom G, Johannesson M, Fagerberg B, Blomstrand C.Resource utilization and costs of stroke unit care integrated in a care continuum: a 1-year controlled, prospective, randomized study in elderly patients: the Goteborg 70+ Stroke Study. Stroke2000;31(11):2569-2577.
91.
Payne KA, Huybrechts KF, Caro JJ, Craig Green TJ, Klittich WS. Long term cost-of-illness in stroke: an international review. Pharmacoeconomics2002;20(12):813-825.
92.
Dobkin B.The economic impact of stroke. Neurology1995;45(2 Suppl 1):S6-S9.
93.
Lamb SE, Ferrucci L, Volapto S, Fried LP, Guralnik JM. Risk factors for falling in home-dwelling older women with stroke: the Women’s Health and Aging Study. Stroke2003;34(2):494-501.
94.
Ramnemark A, Nilsson M, Borssen B, Gustafson Y.Stroke, a major and increasing risk factor for femoral neck fracture. Stroke2000;31(7):1572-1577.
