Achieving a minimally important difference in physical function during pediatric inpatient rehabilitation

Area of Science:

• Pediatric Rehabilitation
• Physical Medicine
• Disability Studies

Background:

• Inpatient rehabilitation is crucial for pediatric functional recovery.
• Defining meaningful functional gains, such as a minimally important difference (MID), is essential for evaluating care effectiveness.
• The Pediatric Evaluation of Disability Inventory (PEDI) is a key tool for assessing pediatric functional skills.

Purpose of the Study:

• To determine the proportion of children achieving MID in physical function during inpatient rehabilitation.
• To identify demographic and clinical factors predicting MID achievement in pediatric rehabilitation.
• To inform goal-setting and expectations for pediatric inpatient rehabilitation episodes.

Main Methods:

• Analysis of 452 consecutive inpatient admissions to a pediatric rehabilitation hospital.
• Calculation of change scores using the Pediatric Evaluation of Disability Inventory (PEDI) for self-care, mobility, and caregiver assistance.
• Logistic regression analyses to identify predictors of MID achievement for each PEDI scale.

Main Results:

• Over 55% of children achieved MID in physical function.
• Higher proportions achieved MID in mobility functional skills (78%) and caregiver assistance (67%).
• Factors associated with achieving MID included older age at admission, longer length of stay, lower admission PEDI scores, and a diagnosis of brain injury.

Conclusions:

• More than half of children achieve meaningful functional improvement in inpatient rehabilitation.
• Older children with brain injuries and lower initial functional abilities, benefiting from extended stays, are most likely to achieve MID.
• Identifying predictors of functional progress aids clinicians and administrators in setting realistic rehabilitation goals.