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Abstract
BackgroundRehabilitation success is measured by instruments that assess performance of activities of daily living. Guidelines on the use and choice of these instruments are lacking. The present study aimed to analyse prognostic indicators of physical rehabilitation effectiveness in elderly patients according to three rehabilitation impact indices.MethodsProspective, longitudinal study in a post-acute care unit. The study included rehabilitation-eligible deconditioned elderly in-patients prospectively admitted to post-acute care (n = 685, aged 83.2 ± 8.3 years, mean length of stay 15 ± 9.2 days).Data Collection: Premorbid health status variables (PHSV): age, sex, comorbidity (Charlson index), medical history (heart failure, pulmonary disease, cerebrovascular disease, dementia), previous living situation and pre-admission functional status (premorbid Lawton and Barthel indices). Admission health status variables (AHSV): main diagnoses, referral source, physical (Barthel-adm) and cognitive function (Pfeiffer test), undernutrition and dysphagia.Outcome Measures: Absolute functional gain (AFG, admission-to-discharge Barthel change), relative functional gain (RFG, achieved percentage of potential gain) and rehabilitation efficiency index (REI, AFG over length of stay). Univariate analysis considered these parameters, along with PHSV and AHSV. Multivariate logistic regression analysis was performed for AFG ≥20, RFG ≥35 % and REI ≥ 0.50.ResultsGreater AFG was associated with 14 variables, 8 PHSV (57.1 %) and 6 AHSV (42.8 %); greater RFG with 9 variables, 3 PHSV (33.3 %) and 6 AHSV (66.6 %); and REI with 9 variables, 4 PHSV (44.4 %) and 5 AHSV (55.5 %). Mean AFG value was 34.5 ± 15.8 in patients who achieved complete recovery (RFG 100 %, n = 189, 27.5 %) and 35.3 ± 15.0 (p = 0.593) in the remaining patients (n = 311, 45.4 %). In multivariate analysis, only Barthel-adm was related to all three rehabilitation impact indices.ConclusionsBoth premorbid and acute-process variables have a greater impact on AFG and REI, compared to RFG. Although AFG gives information about the degree of reduction in dependence, it does not provide clinical information about post-rehabilitation functional status (mean AFG values did not differ between patients with and without complete recovery). A future implication for evaluating rehabilitation effectiveness in elderly patients is to recommend RFG corrected by premorbid Barthel score, which is less affected by previous health conditions, as the optimum method to assess the degree to which maximum potential improvement was achieved.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-015-0138-5) contains supplementary material, which is available to authorized users.
Highlights
Elderly patients admitted to hospitals, whether for acute or decompensated chronic disease, often present with loss of functional capacity that can lead to dependency and disability [1,2,3]
Many predictors of functional recovery have been described in elderly patients [9, 10] but varied according to patient complexity and population characteristics, which may affect functional improvement and the time required to achieve it
The specific aims of this study were to assess the application of these Rehabilitation Impact Indices (RIIs) in hospitalized elderly patients with impaired functional capacity, to identify differences between the results obtained by the three RIIs, and to discuss ways to ensure their accurate and appropriate use
Summary
Patients admitted to hospitals, whether for acute or decompensated chronic disease, often present with loss of functional capacity that can lead to dependency and disability [1,2,3] This complicates recovery from an acute episode, impeding return to their previous living situation and requiring physical rehabilitation and additional health care resources post-discharge [4,5,6,7,8]. This should coincide with the maximum score on the evaluation instrument; in elderly patients, premorbid status may not reach this maximum score In these cases, a modified parameter has been used, and called “the RFG corrected for premorbid functional status” or the “corrected Heinemann index” [15]. The present study aimed to analyse prognostic indicators of physical rehabilitation effectiveness in elderly patients according to three rehabilitation impact indices
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