Discharge Barthel Index Scores Research Articles

Prognostic factors for discharge to home and residing at home 12months after hip fracture: an Anoia hip study.

Hip fracture is often associated with loss of physical function and institutionalization. The aim of this study is to describe the prognostic factors for discharge to home and residing there 12months after a hip fracture. A prospective study that includes patients aged ≥ 69years that live at home before the fracture, admitted from June 1st, 2010, to May 31st, 2013. We registered the demographic data, presurgical function and cognitive assessment, surgical waiting time, type of fracture and complications during hospitalization. We included 273 patients (mean age 84.8 ± 6.1years; 80% women), 130 (47.6%) were discharged directly to their own home. The predictors of discharge to home were a lower Geriatrics Dementia Scale score (OR 1.42; 95% CI 1.17-1.71; p < 0.001), a higher Barthel Index score at discharge (OR 1.07; 95% CI 1.05-1.10; p < 0.001) and a longer hospital stay (OR 1.14; 95% CI 1.02-1.27; p = 0.019). At 12months, 169 (63.5%) were still residing at home. Predictors of residing at home 12months after the hip fracture were age (OR 1.07; 95% CI 1.02-1.12; p = 0.010), the discharge Barthel Index score (OR 0.96; 95% CI 0.94-0.98; p < 0.001), the Geriatrics Dementia Scale score (OR 1.27; 95% CI 1.05-1.52; p = 0.013), the surgical waiting time (OR 3.42; 95% CI 1.077-10.89; p = 0.037) and Charlson comorbidity index (OR 1.27; 95% CI 1.05-1.55; p = 0.016). Prognostic factors for discharging to home and remaining there 12months after a hip fracture are those that reflect a better health condition prior to the fracture and better functionality at the hospital discharge for hip fracture.

Motor recovery of stroke patients after rehabilitation: one-year follow-up study

Purpose To investigate motor recovery of stroke patients 1 year after rehabilitation. Materials and Methods A cross-sectional study of 192 stroke patients discharged from rehabilitation wards in nine tertiary hospitals was conducted. Motor recovery was assessed using the Brunnstrom motor recovery stages (BMRS), at 6 and 12 months after discharge. Factors related to the BMRS of the hand, arm and leg were analyzed. Results The mean age of patients was 62.2 years (57.3% male). Significantly more patients presented improvement of at least one BMRS of the hand, arm and leg compared with those with decreasing BMRS (p < 0.001). The percentage of patients with BMRS III– VI at 6 months was greater than that at discharge, but the recovery at 12 months was slightly higher than that at 6 months. It seems that motor recovery from stroke was near maximal at six months. Regarding the factors related to motor recovery, only lengths of stay (LOS) <30 d during the first admission and Barthel index at discharge ≥10 were related to the improvement of BMRS of the hand, arm and leg on multivariate analysis. Additionally, no complication at discharge was associated with the improvement of BMRS of the leg. Conclusions Approximately half of our stroke patients had motor improvement of at least one stage of BMRS at one year. Motor recovery after stroke at the end of the first year was associated with shorter LOS during the first admission, higher discharge Barthel index score and absence of complications at discharge.

Socio-demographic and Clinical Profile of Admissions to Community Hospitals in Singapore from 1996 to 2005: A Descriptive Study

Little data is available on community hospital admissions. We examined the differences between community hospitals and the annual trends in sociodemographic characteristics of all patient admissions in Singaporean community hospitals over a 10- year period from 1996 to 2005. Data were manually extracted from medical records of 4 community hospitals existent in Singapore from 1996 to 2005. Nineteen thousand and three hundred and sixty patient records were examined. Chisquare test was used for univariate analysis of categorical variables by type of community hospitals. For annual trends, test for linear by linear association was used. ANOVA was used to generate beta coefficients for continuous variables. Mean age of all patient admissions has increased from 72.8 years in 1996 to 74.8 years in 2005. The majority was Chinese (88.4%), and female (58.1%) and admissions were mainly for rehabilitation (88.0%). Almost one third had foreign domestic workers as primary caregivers and most (73.5%) were discharged to their own home. There were significant differences in socio-demographic profile of admissions between hospitals with one hospital having more patients with poor social support. Over the 10-year period, the geometric mean length of stay decreased from 29.7 days (95% CI, 6.4 to 138.0) to 26.7 days (95% CI, 7.5 to 94.2), and both mean admission and discharge Barthel Index scores increased from 41.0 (SD = 24.9) and 51.8 (SD = 30.0), respectively in 1996 to 48.4 (SD = 24.5) and 64.2 (SD = 27.3) respectively in 2005. There are significant differences in socio-demographic characteristics and clinical profile of admissions between various community hospitals and across time. Understanding these differences and trends in admission profiles may help in projecting future healthcare service needs.

Different Meta-Analysis Methods, Different Answers: The Case of Exercise for Older Acute Medical Patients

The aim of this study was to illustrate the potential for confounding when interpreting group mean data from systematic reviews for a heterogeneous participant population. A case report comparing the results obtained from a Coch- rane review and meta-analysis compared to an individual patient data (IPD) meta-analysis was conducted. Participants were 396 older patients admitted to a general medical ward at two acute public hospitals. For the intervention group, an exercise program was provided for 20-30 minutes twice per day in addition to usual care. The control group received usual hospital care. The primary outcome measure was changed in Barthel Index scores between hospital admission and discharge. Meta-analysis of group mean data provided evidence that additional exercise for older medical patients does not significantly improve Barthel Index scores at hospital discharge (fixed effects model, 0.17 (-0.06 to 0.40) I 2 = 0%). Re- sults of IPD meta-analysis indicated that additional exercise significantly improved discharge Barthel Index scores for pa- tients who required assistance to ambulate at hospital admission (coefficient for group 5.4 (1.38 to 9.40), p=0.01) but not for those who were non ambulant or independently ambulant at hospital admission. This case report provides an example where performing meta-analysis using group mean data for heterogeneous populations can result in effective interventions being discarded.

Construct validity and sensitivity of an instrument commonly used to assess the clinical effectiveness of rehabilitative care

Objectives to examine the construct validity and sensitivity of the Barthel Index (BI) and, thus, to assess its utility as an outcome measure in stroke rehabilitation. Design comparison of BI scores with qualitative assessment of functional status for a cohort of patients recovering from a first stroke. Setting re-analysis of data arising in an acute hospital setting (care of the elderly and medical units) as a result of a nursing and midwifery audit initiative, funded by the Welsh Office. Participants 23 patients with discharge BI scores greater than or equal to 16/20. (12 men, 11 women. Age range 55–89.) Main outcome measure within subject comparison of BI scores, with numbers and types of impairment and/or disability as defined by the International Classification of Impairment, Disability and Handicap. Results for this cohort of patients there was no direct relationship between BI score and numbers of identified impairments and disabilities. Patients with similar BI scores had different patterns of impairment. Patients with similar change scores had different patterns of improvement. Patients with maximum BI scores on discharge had residual impairments and disabilities. Conclusions the construct that BI measures is not clearly defined. Therefore, the meaning of BI scores, in terms of patient functional ability, is unclear, and its construct validity is questionable. Its sensitivity is not demonstrated as it has a definite ceiling effect. There is a need to approach outcome measurement for complex areas, such as stroke rehabilitation, in a way that clearly specifies the construct being studied and allows individual progress and support needs to be assessed.

リハビリテーション専門病院における脳卒中後遺症患者の検討

A retrospective analysis of 312 stroke patients (200 men, 112 women; average age 65) admitted to Yamaguchi Rehabilitation Hospital during the past three years showed the following results. 1) After an average period of stay of 244 days 225 patients were discharged to home, general hospitals, extended care facilities, or nursing homes. 2) The group of patients over 80 years of age at admission had a lower ratio of home returns than in other groups (p less than 0.01). 3) Patients who returned home had higher scores not only on discharge Barthel index scores but on admission Barthel index scores, compared with other discharged patients (p less than 0.01). 4) The higher the admission Barthel index score, the shorter the period of stay (p less than 0.01). Concerning discharge Barthel index scores, patients who stayed over two years had lower scores than patients who stayed less than two years (p less than 0.01). The results of this analysis suggest the importance of determining goals and programs taking admission Barthel index scores as well as other available factors into consideration for patients with stroke admitted to rehabilitation institutions.

Prospective cognitive assessment of stroke patients before inpatient rehabilitation. The relationship of the Neurobehavioral Cognitive Status Examination to functional improvement.

Prospective studies establish cognitive status as an important determinant of post-stroke rehabilitation success. The Neurobehavioral Cognitive Status Examination (NCSE) briefly assesses cognition in the ability areas of language, constructions, memory, calculation and reasoning. The NCSE, as well as the commonly used Mini-Mental State Examination and Albert's Test, were administered to 38 stroke patients before inpatient rehabilitation to determine the extent to which they predict rehabilitation outcome. Rehabilitation outcome was measured as the difference between initial and discharge Barthel Index score. The NCSE was shown to be a more sensitive indicator of impairment than the Mini-Mental State Examination and Albert's Test, especially in subsections of orientation and memory (X2 = 8.690, df = 1, P less than 0.005; X2 = 13.348, df = 1, P less than 0.001, respectively). Stepwise multiple regression revealed that attention, calculations and judgement were in association the best predictors of improvement in the Barthel Index scores. Therefore, the NCSE provides both a rapid and sensitive measure of cognitive function and it appears to predict functional status change as a result of inpatient stroke rehabilitation.

Predicting discharge status at commencement of stroke rehabilitation.

We discuss the functional ability of all 258 surviving patients with first stroke referred for inpatient comprehensive rehabilitation in Brisbane, Australia, during 1984 and derive an equation to predict the discharge Barthel Index score from characteristics assessed at admission to comprehensive rehabilitation. A boundary condition limiting improvement for patients with high admission Barthel Index scores and the lesser improvement observed for low-scoring patients indicate that the relation between initial and discharge Barthel Index scores is nonlinear. A quadratic equation including initial Barthel Index score and six other independent variables selected by stepwise regression analysis explained 61% of the variance in discharge Barthel Index scores.