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Rehabilitation after lower limb injury: development of a predictive score (RALLI score)
Dominique M Rouleau1, Alexandre Place1, Mélanie Bérubé1
1From the Department of Orthopaedic Surgery (Rouleau) and the Département de Recherche en Orthopédie (Bérubé, Laflamme), Hôpital du Sacré-Coeur de Montréal, Montreal, Que. (Rouleau); and the Faculty of Medicine (Place) and the Department of Physiotherapy (Feldman), Université de Montréal, Montreal, Que.
Background:
The purpose of our study was to identify the risk factors associated with the need for inpatient rehabilitation after lower limb injury to develop a predictive scoring tool for early identification of such patients.
Methods:
We followed a prospective cohort of patients admitted to a level 1 trauma centre. Data were collected through chart review and a self-administered questionnaire on sociodemographics, patient living environment, pretrauma status, injury and treatment received. We compared patients who were discharged home with those going to rehabilitation after acute care. Analysis consisted of bivariate comparisons and logistic regression.
Results:
Our study included 160 patients with a mean age of 56 years. A total of 40% were discharged to an inpatient rehabilitation centre. Factors associated with inpatient rehabilitation were low preinjury physical health status, concomitant injury of the upper limbs, bilateral lower limb injury, the use of a walking aid before injury, head injury and femur or pelvic fractures. We created a predictive score using the top 3 risk factors: upper limb injury, bilateral lower limb injury and presence of femoral or pelvic fractures. The chance of needing inpatient rehabilitation rose from 14% with 0 factors to 47% with 1 factor and 96% with 2 factors.
Conclusion:
Rehabilitation planning should begin for patients exhibiting at least of 3 risk factors at the time of admission to acute care. Prospective validation of the tool is needed, but it has the potential to orient the multidisciplinary team's decision on rehabilitation needs postdischarge.
