Interruptions to rehabilitation in a geriatric rehabilitation unit: associated factors and consequences

Mas, Miquel Àngel; Renom, Anna; Vázquez, Olga Castro; Miralles, Ramón; Bayer, Antony James; Cervera, A.M.

doi:10.1093/ageing/afp010

Cited by 13 publications

(16 citation statements)

References 20 publications

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“…Using this approach, the denominator is the number of days of rehabilitation therapy, from start to finish, regardless of where it is provided [ 9 ]. In our sample, BI-adm had a mean value of 28 points, similar to that obtained by other authors in similar settings [ 24 , 25 , 29 ].…”

Section: Discussionsupporting

confidence: 89%

“…In the hospital setting, REI value is highly dependent on the length of the hospital stay. This must be taken into account because length of stay can be influenced by comorbid conditions that may interrupt rehabilitation [ 16 , 29 ] and by individual variables (social, personal, or family issues) that are not directly related to rehabilitation therapy [ 25 , 28 ]. To avoid this potentially confounding factor, some authors have suggested that REI should be calculated on the basis of the entire period during which the patient receives rehabilitation therapy.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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Background: Rehabilitation 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. Methods: Prospective, 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. Results: Greater 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.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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“…Readmission to acute care (RTAC) from inpatient rehabilitation is not uncommon and can have a negative impact on rehabilitation effectiveness . Internationally, the RTAC rates from inpatient rehabilitation facilities (IRFs) range from 8% to 40% .…”

Section: Introductionmentioning

confidence: 99%

Predictors of Readmission to Acute Care from Inpatient Rehabilitation: An Integrative Review

McKechnie

Pryor

McKechnie

et al. 2019

PM&R

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Readmission to acute care (RTAC) from inpatient rehabilitation can have negative consequences for individuals and associated financial costs are increasing. Consequently, preventing avoidable RTAC represents a target for improvement in quality of care. The aim of this integrative review was to identify predictors of RTAC from inpatient rehabilitation. A systematic search of MEDLINE, EMBASE, ProQuest, and CINAHL databases was used. Thematic analysis was used to examine extracted data. Strong evidence indicating that the principal predictors of RTAC are lower functional status on admission to rehabilitation, a more severe injury and a higher number of comorbidities was identified in this review. This is despite the heterogeneous nature of impairment groups and factors/measures examined. However, the relevance of some predictors of RTAC (such as patient demographics, invasive devices and primary diagnoses) may be dependent on rehabilitation setting, impairment group or time between rehabilitation admission and RTAC (eg, below 3 vs 30 days). Consequently, findings of this integrative review highlight that RTAC is a complex, multifactorial patient issue with a complex interplay between the predictors and reasons for RTAC.

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“…Focussing on another aspect of the process of rehabilitation, a study conducted in other geriatric rehabilitation unit in Catalonia (26) found that patients with incontinence or pressure sores on admission were found to be at greater risk of interruption of the rehabilitation therapy and of carrying a poor prognosis, with less than one in four patients able to be discharged home from the unit. Hence, it was concluded that these patients might benefit from extra monitoring in order to improve the efficiency of rehabilitation programmes and discharge planning.…”

Section: Does the Presence Of Pressure Ulcers Entail "High Risk Of Nementioning

confidence: 99%

Does the presence Pressure Ulcers entail “high risk of negative outcomes” in geriatric rehabilitation? Results from a retrospective cohort study

Santaeugènia

Mas

Tarazona-Santabalbina

et al. 2017

Nutr Hosp

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Santaeugènia SJ, Mas MÀ, Tarazona-Santabalbina FJ, Alventosa AM, García M, Monterde A, Gutiérrez A, Cunill J. Does the presence of pressure ulcers entail "high risk of negative outcomes" in geriatric rehabilitation? Results from a retrospective cohort study. ResumenObjetivo: se realizó un estudio de cohorte retrospectivo para evaluar la prevalencia de úlceras por presión (PRU) en pacientes mayores ingresados en una unidad de rehabilitación geriátrica de postagudos (atención intermedia) e investigar el impacto de la presencia de PrU en los resultados clínicos del proceso de rehabilitación. Métodos: se estudiaron 668 pacientes ingresados de forma consecutiva, de enero de 2010 a diciembre de 2011. Se evaluó el impacto de la presencia de PrU en el momento del ingreso en relación a los siguientes resultados de salud: destino final, estado funcional, mortalidad y duración de la estancia en la unidad de rehabilitación. Resultados: la prevalencia de PrU en el momento del ingreso fue del 16%. Los pacientes con PrU tenían mayor edad, más presencia de discapacidad y tenían una mayor prevalencia de condiciones complejas, incluyendo desnutrición y deterioro cognitivo. En el análisis bivariado se encontró que los pacientes con PrU al ingreso presentaron un peor resultado final (%): alta a domicilio (69,2 vs. 82,5), ingreso en unidades de larga estancia (14 vs. 6,4), reingreso hospitalario (8,4 vs. 6,2) y fallecimiento (8,4 vs. 4,8); p < 0,001, y un peor índice de Barthel al momento del alta (57 frente a 83); p < 0,001, con mayor duración de la estancia en la unidad (61 frente a 53 días); p 0,004. En el análisis multivariante, la presencia de PrU en el momento del ingreso, se asoció como variable predictora negativa de retorno a domicilio, así como predictora negativa respecto a la ganancia funcional al alta de la unidad postagudos. Conclusiones: las PrUs fueron prevalentes y tuvieron un impacto negativo en los resultados clínicos de nuestra unidad geriátrica, como destino de alta, ganancia funcional y duración de la estancia, en pacientes vulnerables. AbstractAim: A retrospective cohort study was performed in order to evaluate the prevalence of pressure ulcers (PrUs) in older patients admitted to a geriatric rehabilitation unit of a postacute care hospital and to investigate the impact of the presence of PrUs on clinical outcomes of the rehabilitation process. Methods: We studied 668 post-acute patients consecutively attended, from January 2010 to December 2011. The effect of having PrUs at admission was evaluated based on its impact on outcomes: final destination, functional status, mortality and length of stay in the rehabilitation unit. Results: PrUs prevalence at admission was 16%. Patients with PrUs were older, more disabled and had more complex conditions, including malnutrition and cognitive impairment. In the bivariate analysis, we found patients with PrUs at admission had worst final outcome (%): discharge home (69.2 vs. 82.5), discharge long term care setting (14 vs. 6.4), discharge acute care (8.4 vs. 6.2) and dea...

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Interruptions to rehabilitation in a geriatric rehabilitation unit: associated factors and consequences

Cited by 13 publications

References 20 publications

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

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

Predictors of Readmission to Acute Care from Inpatient Rehabilitation: An Integrative Review

Does the presence Pressure Ulcers entail “high risk of negative outcomes” in geriatric rehabilitation? Results from a retrospective cohort study

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