Absolute Functional Gain Research Articles

Effect of Ward-dedicated Physical Therapy Staffing on Outcomes among General Medical Patients in an Acute Hospital: A Difference-in-difference Analysis.

The study aimed to examine the effect of dedicated physical therapy (PT) staffing on the outcomes of patients admitted to a general medical ward with acute cholangitis. This retrospective observational study was conducted in an 865-bed tertiary-care hospital in Japan. Patients with acute cholangitis between September 2015 and August 2017 were enrolled. Patients admitted to a ward with dedicated PT staffing were included in the dedicated group, while those admitted to a ward without dedicated PT staffing were included in the non-dedicated group. Each group was further divided into pre-dedicated and post-dedicated period based on September 1, 2016, at which PT staffing was implemented. The primary outcome was absolute functional gain (AFG), which was defined as the difference between Barthel index at discharge and that at admission. A difference-in-difference analysis was conducted to examine the changes in AFG associated with ward-dedicated PT staffing. We identified 456 patients with acute cholangitis. Complete case analysis was applied, resulting in 252 patients in the final analysis. Patients were assigned to the dedicated group in the pre-dedicated period (n = 66) and post-dedicated period (n = 52), and to the non-dedicated group in the pre-dedicated period (n = 60) and post-dedicated period (n = 74). The adjusted difference-in-difference estimator was 17.1 (95% confidence interval: 5.6 to 28.5, p = 0.003) for AFG. Ward-dedicated PT staffing may improve the AFG of general medical patients in an acute hospital. Ward-dedicated PT staffing should be among the strategies utilized in the acute care process.

Association of the FRAIL scale with rehabilitation outcomes in the community hospital setting.

Frailty is associated with adverse health outcomes and can be measured using the FRAIL scale. In Singapore, its use has been studied in tertiary hospitals but not in community hospitals. A tool to predict rehabilitation outcomes would allow for better risk stratification and allocation of resources. We aimed to determine whether the FRAIL scale is associated with rehabilitation outcomes in patients admitted to the community hospital setting, where post-acute care and rehabilitation are primarily delivered. This was a retrospective cohort study. The FRAIL scale was utilised to screen 560 older adults who were admitted to a community hospital for rehabilitation. Data were analysed to determine the relationship between baseline characteristics and frailty status, with rehabilitation outcome measures of absolute functional gain, rehabilitation effectiveness, rehabilitation efficiency, length of stay and discharge destination. The combined score of the FRAIL scale showed significant negative association with absolute functional gain (P < 0.001), rehabilitation effectiveness (P < 0.001) and rehabilitation efficiency (P < 0.001), whereas it was positively associated with increased length of stay (P < 0.05) and a need for continued support in increased care settings (P < 0.001). Individual components of the FRAIL scale, in particular, the 'fatigue', 'ambulation' and 'loss of weight' components, appeared to be highly associated with rehabilitation effectiveness and efficiency, especially among pre-frail patients. The utility of the FRAIL scale as an indicator of frailty status and its association with rehabilitative outcomes in the post-acute care setting were demonstrated. Moreover, the FRAIL scale may better predict the rehabilitative progress of pre-frail patients.

Use of the Frailty Tools Fi Mds and Fi Rockwood to Predict Outcomes of Inpatient Rehabilitation after Proximal Hip Fracture

Background Among factors which affect the outcome of rehabilitation after hip fracture, the role of pre-fracture frailty has not been defined. Objective To assess the impact of frailty on rehabilitation outcome in elderly persons with proximal hip fracture. Setting Geriatric rehabilitation center. Design Retrospective observational study. Subjects Forty consecutive patients with proximal hip fracture. Methods The following parameters were calculated: FI-MDS frailty index, Rockwood Clinical Frailty Scale (FI Rockwood), Functional Independence Measure (FIM) on discharge, absolute functional gain (ΔFIM), length of stay (LOS), and FIM gain per day (ΔFIM/LOS). FIM discharge ≥90 and motor FIM discharge &gt;58 indicated success in rehabilitation. Results There were 31 women and 9 men, mean age 80 years. The mean pre-fracture FI MDS was 10 points (SD 5.8) out of 58 possible, the mean FI Rockwood score was 3 (SD 1.7) out of 7 possible. The mean admission FIM was 76.6 (SD 16), the mean discharge FIM was 92.7 (SD 19.3), mean LOS 22.5 days (SD 9.7), mean ΔFIM/LOS 0.8 (SD 0.6). Pre-fracture frailty was associated with worse outcome of rehabilitation: FI MDS predicted discharge FIM ≥90 with OR 0.86, p 0.012; FI Rockwood predicted discharge FIM ≥90 with OR 0.68, p 0.027; FI MDS predicted discharge motor FIM &gt;58 with OR 0.91, p 0.07; FI Rockwood predicted discharge motor FIM &gt;58 with OR 0.71, p 0.027. Conclusions Though pre-fracture frailty correlated with FIM on discharge, neither frailty tool was specific enough to predict success in rehabilitation and the necessary length of rehabilitation. Translating frailty scores in tools adequate for clinical decision making remains an aim for future studies.

Effect of intravenous iron on functional outcomes in hip fracture: a randomised controlled trial.

to determine the safety and effect of intravenous iron sucrose on functional outcomes, delirium, nosocomial infections and transfusion requirements in older patients with hip fracture. single-centre randomised, double-blind, placebo-controlled clinical trial. orthogeriatric share care service at an academic tertiary care hospital. A total of 253 patients were recruited: 126 patients were assigned to intravenous iron and 127 to placebo. on days 1, 3 and 5 after admission, the iron group received 200mg Venofer® (iron sucrose) in 100ml saline and the placebo group 100ml saline. The primary outcome was absolute functional gain, considered as Barthel index (BI) at discharge minus BI on admission. Secondary outcomes included incidence of postoperative delirium according to the confusion assessment method, proportion of patients recovering prior functional status at 3months, postoperative transfusion requirements, haemoglobin at 3months, incidence of nosocomial infections and safety. the median participant age was 87 (interquartile range, 82.5-91.5) years. Most patients were female (72.7%), and the median previous BI was 81(59-95). No significant effect of intravenous iron was observed for the primary outcome: the median AFG score was 17.1 points (4.8-23.3) in the intravenous iron group and 16 points (6-26) in the placebo group (P = 0.369). No significant treatment effects were observed for other functional outcomes or secondary end points. while we found no impact of intravenous iron sucrose on functional recovery, incidence of postoperative delirium, transfusion requirements, haemoglobin at 3months, mortality and nosocomial infections rates in older patients with hip fracture, we did find that the intervention was safe.

Impact of delirium on short-term outcomes in hip fracture patients under a program of approach to delirium.

We aimed to investigate the impact of delirium on short-term outcomes in hip fracture patients. Special attention was given to patients with delirium and dementia. A prospective observational cohort study was carried out in hip fracture patients aged ≥70 years who were admitted to a hospital unit where a multicomponents approach to delirium is established for all patients. Our population was split into delirium (n = 212) and non-delirium cohort (n = 171) according to the Confusion Assessment Method. Patients with a previous diagnosis of dementia in an outpatient appointment were also assessed within the delirium cohort. The utility of the rehabilitation was measured with the Absolute Functional Gain index. A total of 383 patients were entered into the study. The median age was 86 years, and most patients were women (78.8%). Delirium patients were older, presented a lower previous Barthel Index (BI), had higher rates of dementia and came more frequently from nursing homes. Comparative analysis did not show differences in mortality, complications, length of stay or walking ability between the cohorts. However, lower BI on discharge, lower Absolute Functional Gain and the presence of nosocomial infections were found more frequently in the delirium cohort. In multivariate analysis, only the BI on discharge (P = 0.010) was lower in delirium patients. Within the delirium cohort, those suffering from dementia had worse BI on discharge (P = 0.017) and lower Absolute Functional Gain (P = 0.019). Delirium was not associated with mortality, walking ability, length of stay and clinical complications in hip fracture patients. BI on discharge was the only short-term outcome affected. In the delirium cohort, those suffering from dementia showed worse rehabilitation results. Geriatr Gerontol Int 2020; 20: 130-137.

Nutritional Status and Functional Outcomes in Older Adults Admitted to Geriatric Rehabilitations: The SAFARI Study

Objective: Evidence about the role of nutritional status (NS) on functional outcomes (FO) after rehabilitation in older adults is scarce. Our aim was to analyze the association between NS and FO in older adults admitted to geriatric rehabilitation units.Methods: The Sarcopenia And Function in Aging Rehabilitation (SAFARI) multicenter study enrolled patients aged ≥65 years admitted to geriatric rehabilitation units in Italy and Spain. FO were absolute and relative functional gain (AFG-RFG) in Barthel Index (BI) at 1 and 3 months after admission. The association between NS (Mini Nutritional Assessment–Short Form) and FO was explored using linear regression and mixed models, adjusted for potential confounders. Analyses were then stratified for diagnosis at admission.Results: We included 415 patients (mean age 81.4 years [SD: 7.7]; 67% female; 9.4% malnourished [MN], 42.7% at risk of malnutrition [RM], and 48% well nourished [WN]). Admission diagnoses were hip fracture (39.5%), elective orthopedic surgery (EOS) (29.5%), and stroke (31%). In an adjusted linear mixed model, MN and RM participants had lower BI compared to WN (MN: β: −8.47, p = 0.023; RM: β: −5.22, p = 0.031), and differences between groups remained stable over time. After stratification for admission diagnosis, only MN patients admitted after EOS had worse FO, both at 30 days (AFG: β adjusted: −13.54, p < 0.001; RFG: β: −32, p < 0.001) and 3 months (AFG: β adjusted: −17.79, p < 0.001; RFG: β: −26.77, p = 0.002).Conclusions: In our sample, poor NS is associated with worse BI in older adults admitted to geriatric rehabilitation units; in patients undergoing EOS, MN is associated with worse FO. Our results documented for the first time the importance of assessing nutritional status before EOS.

25(OH) vitamin D and functional outcomes in older adults admitted to rehabilitation units: the safari study.

Vitamin D (25(OH)D) deficiency is highly prevalent in older people, and it is associated with poor muscular strength and physical performance. Its impact on functional outcomes during geriatric rehabilitation has been poorly studied. We aim to analyze the association between 25(OH)D and functional recovery in geriatric rehabilitation units. We conducted a prospective multi-center cohort study including patients ≥ 65years old admitted to 3 geriatric rehabilitation units in Italy and Spain, after orthopedic events or stroke. Outcomes were absolute functional gain (AFG, discharge-admission Barthel index) and ability to walk (AW) at 3months after admission. The association between 25(OH)D quartiles (Q1-Q2-Q3-Q4) and outcomes was explored using linear or logistic regression models. We included 420 patients (mean age = 81.2years [SD = 7.7], 66.4% females, mean 25(OH)D concentration = 13.5ng/ml [SD = 8.7]) (to convert to nmol/l multiply by 2.496). A non-linear relationship between 25(OH)D and AFG was found, with a stronger association for 25(OH)D levels < 16ng/ml. Compared to Q1 (25(OH)D ≤ 6ng/ml), participants in Q3 (25(OH)D 11.5-18.2ng/ml) had the best AFG and AW (mean AFG [SD], Q1 = 28.9 [27.8], Q2 = 32.5 [23.5], Q3 = 43.1 [21.9], Q4 = 34.5 [29.3], R2 = 7.3%; AW, Q1-Q2 = 80%, Q3 = 91%, Q4 = 86%). Regression models adjusted for potential confounders confirmed these results (AGF Q2, β = 2.614, p = 0.49; Q3, β = 9.723, p < 0.01; Q4, β = 4.406, p = 0.22; AW Q2, OR [95% CI] = 1.84 [0.67-5.33]; Q3, OR [95% CI] = 4.01 [1.35-13.48]; Q4, OR [95% CI] = 2.18 [0.81-6.21]). In our study, 25(OH)D concentration showed a positive association with functional outcomes at 3months. The association is stronger below the usual cutoff for "deficiency." Dosage of 25(OH)D concentration may help identify geriatric rehabilitation patients at risk for a worse functional recovery.

INTEGRATING NEUROSCIENCE INTO PSYCHIATRIC TRAINING IN THE UNITED KINGDOM: THE ROYAL COLLEGE OF PSYCHIATRISTS GATSBY/WELLCOME NEUROSCIENCE PROJECT

To investigate whether postoperative voluntary energy intake (EI) affects functional recovery with hip fracture during the acute phase.Prospective cohort study.Three acute care hospitals.Hip fracture patients (N=200) who were consecutively admitted to 3 acute hospitals because of falling.Not applicable.Patients were stratified into 3 groups based on the ratio of measured EI to estimated total energy expenditure (TEE) as inadequate (EI/TEE<0.7), intermediate (0.7≤EI/TEE<1), and adequate (EI/TEE≥1) groups. The functional status was evaluated using the motor domain of a FIM. We calculated efficiency based on the motor FIM scores (change in postoperative motor FIM scores/length of the rehabilitation period) to assess the beneficial effect of rehabilitation.The median hospital stay was 24 days. The inadequate group comprised 73 (36.5%) patients (median EI/TEE, 0.54; interquartile range, 0.42-0.64); intermediate group comprised 92 (46.0%) patients (median EI/TEE, 0.87; interquartile range, 0.78-0.94), and adequate group comprised 35 (17.5%) patients (median EI/TEE, 1.10; interquartile range, 1.04-1.15). Absolute functional gain (AFG) and efficiency of motor FIM gain (EFG) scores were higher in the adequate group than in the others (P<.01). After adjustment for potential confounders, a significant association between postoperative EI/TEE group and logarithm of EFG scores was observed to persist (inadequate group, standardized β =−0.14; reference: adequate group; P=0.03; R2 for the entire model =0.25).Postoperative EI that is less than 70% of TEE diminishes functional recovery with hip fracture.

Frailty Related Factors as Predictors of Functional Recovery in Geriatric Rehabilitation: The Sarcopenia And Function in Aging Rehabilitation (SAFARI) Multi-Centric study.

Frailty-related characteristics, such as sarcopenia, malnutrition and cognitive impairment, are often overlooked, both in clinical practice and research, as potential contributors to functional recovery during geriatric rehabilitation. The aim of the study was to identify frailty-related characteristics associated with functional recovery in a cohort of post-orthopedic surgery and post-stroke older adults. Multi-centric cohort study. Participanst and Settings: Patients over 65 years, admitted to three geriatric rehabilitation units, in Spain and Italy, after an orthopedic event or a stroke, from December 2014 to May 2016. The Absolute Functional Gain (AFG) defined as the difference between Barthel Index score at discharge and at admission, and the Relative Functional Gain (RFG) that represents the percentage of recovery of the function lost due to the event, were selected as outcomes. Both outcomes were analyzed as continuous and dichotomous variables. Analyses were also stratified as diagnostic at admission. We enrolled 459 patients (mean age±SD=80.75±8.21 years), 66.2% women, 69.5% with orthopedic conditions and with a length of stay of 28.8±9.1 days. Admission after a stroke (Odds Ratio=0.36, 95% Confidence Interval=0.22-0.59]) and a better functional status at admission (OR=0.96, 95% CI=0.94-0.97), were associated with a lower likelihood of AFG, while a better pre-event Barthel index (OR=1.03 for each point in score, 95% CI=1.01-1.04), being able to walk (OR=2.07, 95% CI=1.16-3.70), and a better cognitive status at admission (OR=1.05, 95% CI=1.01-1.09), were associated with a higher chance of AFG. Post-stroke patients with delirium at admission had a re-duced chance of AFG (OR=0.25, 95% CI=0.07-0.91]). Patients admitted after an ortho-pedic event with better pre-event functional status (OR=1.04, 95% CI=1.02-1.06) and able to walk at admission (OR=2.79, 95% CI=1.29-6.03]) had an increased chance of AFG. Additionally, in both diagnostics groups, a better handgrip strength increased the chance of RFG. Among frailty-related variables, physical, cognitive and muscular function at admission could be relevant for functional improvement during geriatric reha-bilitation. If confirmed, this data might orient targeted interventions.

Inadequate Postoperative Energy Intake Relative to Total Energy Requirements Diminishes Acute Phase Functional Recovery From Hip Fracture

ObjectiveTo investigate whether postoperative voluntary energy intake (EI) affects functional recovery with hip fracture during the acute phase. DesignProspective cohort study. SettingThree acute care hospitals. ParticipantsHip fracture patients (N=200) who were consecutively admitted to 3 acute hospitals because of falling. InterventionsNot applicable. Main Outcome MeasuresPatients were stratified into 3 groups based on the ratio of measured EI to estimated total energy expenditure (TEE) as inadequate (EI/TEE<0.7), intermediate (0.7≤EI/TEE<1), and adequate (EI/TEE≥1) groups. The functional status was evaluated using the motor domain of a FIM. We calculated efficiency based on the motor FIM scores (change in postoperative motor FIM scores/length of the rehabilitation period) to assess the beneficial effect of rehabilitation. ResultsThe median hospital stay was 24 days. The inadequate group comprised 73 (36.5%) patients (median EI/TEE, 0.54; interquartile range, 0.42-0.64); intermediate group comprised 92 (46.0%) patients (median EI/TEE, 0.87; interquartile range, 0.78-0.94), and adequate group comprised 35 (17.5%) patients (median EI/TEE, 1.10; interquartile range, 1.04-1.15). Absolute functional gain (AFG) and efficiency of motor FIM gain (EFG) scores were higher in the adequate group than in the others (P<.01). After adjustment for potential confounders, a significant association between postoperative EI/TEE group and logarithm of EFG scores was observed to persist (inadequate group, standardized β =−0.14; reference: adequate group; P=0.03; R2 for the entire model =0.25). ConclusionsPostoperative EI that is less than 70% of TEE diminishes functional recovery with hip fracture.

Functional Outcomes in Moderate-to-Severe Traumatic Brain Injury Survivors.

Introduction:We aimed to analyze the functional outcomes based on the admission characteristics in individuals with moderate-to-severe traumatic brain injury (TBI) over a 5-year period.Methods:A retrospective cohort study was conducted to assess the cognitive, physical, and functional outcomes based on traditional and novel metrics used in potential outcome prediction.Results:A total of 201 participants were enrolled with a mean age of 31.9 ± 11.9 years. Glasgow Coma Score (GCS) at emergency department did not correlate with the functional independence measure (FIM) score or Ranchos Los Amigos (RLA) scores at discharge. The absolute functional gain was significantly higher in individuals who sustained TBI with RLA 4–5 (34.7 ± 18.8 vs. 26.5 ± 15.9, P = 0.006). Participants with RLA 4–5 on admission to rehabilitation showed good correlation with the absolute FIM gain. On multivariate regression analysis, only age (odds ratio 0.96; 95% confidence interval: 0.93–0.98; P = 0.005) was found to be the independent predictor of good functional outcome.Conclusions:Initial GCS is not a predictor of functional outcome in individuals who sustained TBI. Consideration of age and development of novel functional measures might be promising to predict the outcomes in individuals with moderate-to-severe TBI.

Predictors for rehabilitation outcome in Asian geriatric hip fracture patients.

To identify predictors for rehabilitation outcome in Asian geriatric hip fracture patients. Records of 153 consecutive Asian patients aged 61 to 99 years who underwent surgery for hip fracture and were followed up for at least one year were reviewed. They were stratified into 4 agegroups: 60-69 years (n=27), 70-79 years (n=70), 80-89 years (n=50), and ≥90 years (n=6). Any comorbidity, regardless of severity, was recorded. Pre-injury and postoperative functional status was evaluated using the 36-item Short Form Health Survey. Relative functional gain (RFG) is equal to absolute functional gain (physical component summary [PCS] score at one year minus PCS score at 6 weeks) divided by the maximum potential gain (maximum PCS score minus PCS score at 6 weeks). RFG of <0.5 and ≥0.5 is defined as poor and good rehabilitation outcome, respectively. In univariate analysis, age 80-89 years (p=0.026), arthritis (p=0.082), and hypercholesterolaemia (p=0.014) were predictors for RFG. In multivariate analysis, age 80-89 years (p=0.016) remained a predictor for poor RFG, and hypercholesterolaemia remained a predictor for good RFG. Poor rehabilitation outcome was associated with patient age of 80-89 years; an orthogeriatric approach may be beneficial in optimising rehabilitation outcome in elderly hip fracture patients.

Three measures of physical rehabilitation effectiveness in elderly patients: a prospective, longitudinal, comparative analysis.

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.

Rehabilitation impact indices and their independent predictors: a systematic review

ObjectivesTo (1) identify all available rehabilitation impact indices (RIIs) based on their mathematical formula, (2) assess the evidence for independent predictors of each RII and (3) propose a nomenclature system...

Relationship between admission albumin levels and rehabilitation outcomes in older patients

The relationship between serum albumin level and rehabilitation outcome in older patients has not been fully explored. This study investigated this association in older Chinese patients. We studied 1604 patients in two geriatric convalescence hospitals. Admission albumin levels (g/l) were measured and segregated into three groups: <30 g/l; 30 to <35 g/l; ≥35 g/l. Absolute functional and motor gain were determined by Barthel index (BI) and elderly mobility scale (EMS) and expressed as BI efficacy and EMS efficacy. BI and EMS efficiency were deduced by the efficacy divided by the length of hospital stay (LOS). Satisfactory motor and functional outcomes were defined as discharge EMS ≥ 15 and BI ≥ 75. Significant improvement in EMS and BI scores across all 3 albumin groups on discharge was observed, with lower scores in low albumin groups. The EMS and BI efficacy were the same in 3 albumin groups. However, EMS and BI efficiency were higher in the high albumin groups. Admission albumin was not independent predictors for satisfactory motor and functional outcomes. For satisfactory motor outcome (EMS ≥ 15), female gender ( p = 0.0004), age ( p = 0.0009) and urinary incontinence ( p = 0.0076) were negative predictors while living at home ( p = 0.0028), admission EMS ( p < 0.001) and BI score ( p = 0.0004) were positive predictors. For satisfactory functional outcome (BI ≥ 75), age ( p = 0.015) and urinary incontinence ( p < 0.001) were negative predictors while female gender ( p = 0.0024), LOS ( p = 0.033), C-MMSE ( p < 0.001), admission EMS ( p = 0.003) and BI ( p < 0.001) were positive predictors. Admission albumin levels were related to functional and motor efficiency, but not with absolute functional and motor gain. Albumin was not an independent predictor for satisfactory motor and functional outcome.

The impact of cognitive impairment at admission on short-term functional outcome of elderly hip fracture patients

The number of patents with dementia increases among hip fracture patients. Cognitive dysfunction is defined as a premorbid state which is potentionally negatively related to short-term functional outcome. To assess the relationship between cognitive status on admission and functional gain during an early rehabilitation period in elderly hip fracture patients. Forty-five elderly patients with surgically treated hip fracture were examined. Cognitive status was assessed by the Mini Mental State Examination (MMSE) at admission; functional status was assessed by the motor subscale of Functional Independence Measure (FIM) at admission and before discharge, while absolute functional gain was determined by the motor FIM gain (FIM discharge- FIM admission). Absolute functional gain was analyzed in respect to cognitive status. Both cognitively impaired and cognitively intact hip fracture patients exhibited overall FIM motor improvements, as well as functional gains in specific FIM motor areas (p < 0.01). Absolute functional gain, however, was higher in 1) cognitively intact compared to cognitively impaired patients (p < 0.01), and 2) cognitively moderately impaired patients compared to severely cognitively impaired patients (p < 0.01). No difference in functional gain was detected between the patients with moderately cognitively impaired compared to the cognitive intact patients (p > 0.05). The systematic use of MMSE identifies cognitively impaired hip fracture patients, and effectively predicts their short-term functional outcome. A higher admission cognitive status is related to a more favourable short-term rehabilitation outcome. In spite of cognitive impairment, elderly patients with hip fracture can benefit from participation in rehabilitation programmes. The systematic identification of cognitively impaired hip fracture patients at admission facilitates optimal treatment and rehabilitation, and thus enables the best achievable outcome to be reached.

Rehabilitation of Older Chinese Patients With Different Cognitive Functions: How Do They Differ in Outcome?

Luk JK, Chiu PK, Chu LW. Rehabilitation of older Chinese patients with different cognitive functions: how do they differ in outcome? Objective To examine the effect of cognition on functional and motor gain in older Chinese patients undergoing geriatric inpatient rehabilitation. Design A retrospective cohort study. Setting Geriatric rehabilitation units of 2 convalescence hospitals in Hong Kong. Participants Older Chinese patients (N=778). Interventions Comprehensive geriatric assessment and inpatient rehabilitation by a multidisciplinary team. Main Outcome Measures Cognitive status was assessed with the Cantonese version of the Mini-Mental State Examination (C-MMSE). We measured the absolute functional gain and motor gain by using the Barthel Index and Elderly Mobility Scale (EMS) and expressed it as Barthel Index efficacy and EMS efficacy. Relative efficacy was assessed by the Montebello Rehabilitation Factor Score (MRFS). Relative efficiency was deduced by relative efficacy divided by the hospital length of stay (LOS). Results There were significant differences in the total Barthel Index and EMS on admission and at discharge, with lower discharge scores in low C-MMSE groups. The change of Barthel Index (Barthel Index efficacy) and EMS (EMS efficacy) during rehabilitation did not differ among different C-MMSE groups. Significant differences were observed in Barthel Index MRFS efficacy and efficiency as well as EMS MRFS efficacy and efficiency in different cognitive groups; those with better cognitive function had better results. Multivariate analysis showed that LOS (odds ratio [OR]=1.02, P=.002) and diagnosis of musculoskeletal problems (OR=2.24, P=.007) were positive predictors for a Barthel Index MRFS efficacy of .25 or higher. C-MMSE was not an independent predictor for a Barthel Index MRFS efficacy of .25 or higher. LOS (OR=1.02, P=.003), admission C-MMSE (OR=1.04, P=.001), body mass index (OR=1.05, P=.006), and diagnosis of musculoskeletal disorders (OR=1.75, P=.04) were significant positive predictors for an EMS MRFS efficacy of .25 or higher, whereas urinary incontinence was a negative predictor for EMS MRFS efficacy (OR=0.69, P=.04). Conclusions There was a strong association between admission cognition and relative change in functional and motor efficacy and efficiency. Cognitive function was not associated with absolute functional and motor gain. Cognitive function was an independent predictor for satisfactory mobility outcome but not for functional outcome. Older patients with impaired cognitive function could still benefit from rehabilitation.

Factors Affecting Short-Term Rehabilitation Outcomes of Disabled Elderly Patients With Proximal Hip Fracture

Hershkovitz A, Kalandariov Z, Hermush V, Weiss R, Brill S. Factors affecting short-term rehabilitation outcomes of disabled elderly patients with proximal hip fracture. Objective To identify factors associated with postacute rehabilitation outcome of disabled elderly patients with proximal hip fracture. Setting Geriatric rehabilitation center. Participants One hundred thirty-three older patients. Interventions Not applicable. Main Outcome Measures FIM instrument, motor FIM score, absolute functional gain on the FIM and motor FIM scores, relative functional gain on the FIM and motor FIM scores, rate of improvement on the FIM and motor FIM scores, proportion of patients discharged to home, and length of stay (LOS). Results Mean FIM score improved by 14 points (22%) with a functional gain rate of .56 point per day. No significant differences ( P>.05) were found between weight-bearing and non–weight-bearing patients regarding the above outcome measures. Functionally independent and cognitively intact patients achieved significantly better score changes and rates of improvement and showed a higher ability to extract their rehabilitation potential than dependent and cognitively impaired patients. Their LOSs were significantly shorter. Patients with latency time (time delay from fracture to operation) of more than 5 days and patients with a history of stroke had significantly longer LOSs. Mini-Mental State Examination score, albumin levels on admission, and prefracture functional status were the most important parameters associated with FIM discharge scores ( r=.756) and relative functional gain on the FIM ( r=.583). Depression was the most important factor associated with LOS in patients with weight-bearing instructions on admission. The presence of a caregiver was the significant predictive value variable for returning home. Conclusions Cognitive function, nutritional status, preinjury functional level, and depression were the most important prognostic factors associated with rehabilitation success of older patients with proximal hip fracture. Of these, depression and nutritional status are correctable, and early intervention may improve rehabilitation outcome.

The association between patients' cognitive status and rehabilitation outcome in a geriatric day hospital

Purpose. To assess whether and to what extent cognitive status affects functional gain in mobility and extended activities of daily living (ADL) in patients admitted to a geriatric day hospital.Methods. During 2003, 135 older patients admitted to a rehabilitation day hospital were evaluated by the Mini Mental State Examination (MMSE) and the Cognitive Functional Independence Measure (FIM). On admission and at discharge, they were assessed by the Nottingham Extended ADL Index (NEAI) and the Timed Get Up and Go test (TUG).Results. Orthopedic and stroke patients achieved significant functional gain in mobility regardless of their cognitive status. Nevertheless, cognitively intact stroke patients achieved higher admission and discharge NEAI scores, manifesting greater absolute functional gain than cognitively impaired patients. The patients' ability to extract their rehabilitation potential was significantly better.Conclusions. Cognitively impaired patients can improve in mobility and performance of extended ADL during day hospital rehabilitation. Evaluation of the patients' cognitive status may enable the multidisciplinary team to develop suitable individual programs and better allocate resources. Cognitively intact stroke patients may benefit from extended rehabilitation treatment compared to impaired stroke patients as they are more capable of utilizing their potential to achieve independence in daily tasks.

Rehabilitation outcome of elderly patients with hip fracture and cognitive impairment

Purpose: To assess the association between cognitive status and functional gain during a rehabilitation programme for elderly patients with hip fracture.Method: Prospective study in a hospital geriatric rehabilitation unit. Sixty-one consecutive patients were studied: 28 with cognitive impairment (age 87.6 ± 7.2 years, Mini Mental State Examination (MMSE) score 11.25 ± 5.9), 23 with possible cognitive impairment (age 83.9 ± 6.8 years, MMSE 22.65 ± 1.6) and 10 without cognitive impairment (age 77.6 ± 7.4 years, MMSE 29.5 ± 0.9). Cognitive status was assessed with the MMSE and admission and discharge functional status with the Functional Independence Measure (FIM). Functional gain was calculated by absolute FIM gain (admission FIM minus discharge FIM), relative (to maximum potential) FIM gain with the Montebello Rehabilitation Factor Score (MRFS) and analysis of covariance of the FIM (ANCOVA).Results: Patients without cognitive impairment had significantly higher admission FIM and discharge FIM. Cognitive status was not significantly associated with absolute functional gain. The adjusted (age, gender, sensory impairment, nutritional status, comorbidity and treatment) MRFS score of cognitively impaired patients was significantly lower (p < 0.03). However, the functional gain related to baseline functional status (ANCOVA) was not significantly different between the groups.Conclusions: In spite of cognitive impairment, elderly patients with hip fracture can benefit from participation in rehabilitation programmes.