Trajectories of Life-Space Mobility After Hospitalization

Brown, Cynthia J.; Roth, David L.; Allman, Richard M.; Sawyer, Patricia; Ritchie, Christine S.; Roseman, Jeffrey M.

doi:10.7326/0003-4819-150-6-200903170-00005

Cited by 167 publications

(189 citation statements)

References 39 publications

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“…Further research on the progeric hypothesis must, however, explain the unexpected null findings with regard to self-reported falls. It is not clear whether this null result is caused by limitations in self-report for this outcome, unmeasured behavioral adaptation to the limits of sarcopenia (48), or other mechanisms.…”

Section: Discussionmentioning

confidence: 83%

Spurious Inferences about Long-Term Outcomes

Iwashyna

Netzer

Langa

et al. 2012

Am J Respir Crit Care Med

111

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Rationale: Survivors of critical illness suffer significant limitations and disabilities. Objectives: Ascertain whether severe sepsis is associated with increased risk of so-called geriatric conditions (injurious falls, low body mass index [BMI], incontinence, vision loss, hearing loss, and chronic pain) and whether this association is measured consistently across three different study designs. Methods: Patients with severe sepsis were identified in the Health and Retirement Study, a nationally representative cohort interviewed every 2 years, 1998 to 2006, and in linked Medicare claims. Three comparators were used to assess an association of severe sepsis with geriatric conditions in survivors: the prevalence in the United States population aged 65 years and older, survivors' own pre-sepsis levels assessed before hospitalization, or survivors' own pre-sepsis trajectory. Measurements and Main Results: Six hundred twenty-three severe sepsis hospitalizations were followed a median of 0.92 years. When compared with the 65 years and older population, surviving severe sepsis was associated with increased rates of low BMI, injurious falls, incontinence, and vision loss. Results were similar when comparing survivors to their own pre-sepsis levels. The association of low BMI and severe sepsis persisted when controlling for patients' pre-sepsis trajectories, but there was no association of severe sepsis with injurious falls, incontinence, vision loss, hearing loss, and chronic pain after such controls. Conclusions: Geriatric conditions are common after severe sepsis. However, severe sepsis is associated with increased rates of only a subset of geriatric conditions, not all. In studying outcomes after acute illness, failing to measure and control for both preillness levels and trajectories may result in erroneous conclusions.Keywords: severe sepsis; long-term outcomes; geriatric conditions; cohort studies; trajectory bias A substantial body of research has demonstrated that survivors of critical illness face extensive physical, psychological, cognitive, and social deficits in the aftermath of their critical illness (1). For example, survivors of acute respiratory distress syndrome (ARDS) have prolonged 6-minute walk times, executive dysfunction, other neuropsychiatric deficits, and diminished ability to return to work (2-13). Numerous studies have found quality of life among survivors of critical illness (14, 15), severe sepsis (16,17), and ARDS (4-8, 13, 18) to be abnormally low.Patients surviving critical illness have limitations and disabilities somewhat characteristic of an older adult population. Rubenfeld recently postulated a "progeric hypothesis" that the sequelae of critical illness mirror accelerated aging (19). This hypothesis suggests that severe sepsis may be associated with the development of so-called geriatric conditions (15,20,21). These are conditions common among older adults, multifactorial in etiology, and associated with disability, often contributing to decreased quality of life (20-23). The followin...

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Section: Discussionmentioning

confidence: 83%

Spurious Inferences about Long-Term Outcomes

Iwashyna

Netzer

Langa

et al. 2012

Am J Respir Crit Care Med

111

View full text Add to dashboard Cite

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“…Scores for our sample indicated their life space was greater than that of older persons who used Correlation is significant at the .001 level (2-tailed) ambulatory or used a wheelchair. The LSA has been characterized as a participation measure in the literature 13,27,28 and could fulfill a need for outcome measures appropriate for persons with SCI regardless of their means of mobility. 29 Life wheeled mobility, either manual (LSA = 46.99) 16 or power (LSA = 33), 14 but smaller than that reported for a population-based study of persons aged 15 to 90 years (LSA = 98.3).…”

Section: Resultsmentioning

confidence: 99%

Life Space Assessment in Spinal Cord Injury

Lanzino

Sander

Mansch

et al. 2016

Topics in Spinal Cord Injury Rehabilitation

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Objectives: To examine the Life Space Assessment (LSA) in persons with spinal cord injury (SCI), exploring its psychometric properties, differences between persons with cervical versus thoracolumbar injuries, and cutoff score differentiating a restricted from an unrestricted life space. Method: We conducted a test-retest reliability study in a community setting involving 50 persons with SCI (25 injured above C7, 25 injured below T1). Data were collected in 2 phone interviews approximately 9 days apart using the LSA. Results: Mean LSA scores were 66 ± 25 (n = 50): 62 ± 23 for the cervical group, and 70 ± 25 for the thoracolumbar group. Scores were not significantly different between phone interviews [t (49) = 0.379, p = .706] or between groups [t (48) = -1.214, p = .231]. Test-retest reliability intraclass correlation coefficient (ICC) was 0.876 (95% CI, 0.792-0.928). Spearman's rho correlations between the LSA and Reintegration to Normal Living Index total and subscores ranged from .509 to .538 (p < .001). LSA scores were normally distributed. The minimum detectable change was approximately 23 points. A cutoff score of 78.5 (sensitivity 76.9%, specificity 81.1%) differentiated between persons with a restricted from an unrestricted life space if equipment and personal assistance were not needed for mobility. If equipment was needed, the cutoff score was found to be 49 (sensitivity of 90%, specificity of 90%). Conclusions: The LSA is a reliable and valid measure of life space in persons with SCI and can be used to identify persons with a restricted life space who may be at increased risk of mobility disability.

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“…26 Loss of independence, decreased functional ability and restricted activity all seem to bear poorly on recovery after discharge. [27][28][29][30] Although frailty or vulnerability before becoming ill may affect outcomes after discharge, patients in hospital may also experience an acquired, transient period of risk for adverse events that is harmful in addition to the stress of the acute illness. This "posthospital syndrome" is a multidimensional construct that incorporates sleep deprivation, cognitive stress, poor nutrition and physical pain.…”

Section: Discussionmentioning

confidence: 99%