Outpatient planning for persons with physical disabilities: a randomized prospective trial of physiatrist alone versus a multidisciplinary team.

Abstract

The purposes of this study were to assess the effect of adding a physiatrist to the usual community management of persons with complex disabilities, and to determine whether there were differences in decision making and patient outcome between evaluations by a physiatrist alone or with a multidisciplinary team in this population. Consecutively referred patients with functional complaints in two of the following areas, mobility, activities of daily living, emotions and cognition, work, or social support, were randomly assigned to a multidisciplinary outpatient team evaluation or physiatrist evaluation in an office setting. Forty persons, 21 team and 19 office, served as subjects. For the entire group, functional assessment scores before and after evaluation were as follows: Barthel index 71.79 versus 76.47 (p < .008) and Frenchay Activities index 9.97 versus 11.32 (p < .05) Wilcoxon Signed Ranks test. Patients quality of life differences were significant (p < .03 or less by Wilcoxon). Most differences between team and physiatrist were not shown to be statistically significant in this small population. Physiatric evaluation, with or without a multidisciplinary team, can improve outpatient functional status and quality of life for persons living in the community with complex disabilities.