How can we improve targeting of frail elderly patients to a geriatric day-hospital rehabilitation program?

BMC Geriatrics

Research Article

Silvia RM Pereira¹  Lawrence Joseph²  Jose A Morais³  Wendy Chiu³  Stephanie Chevalier³  Alyson Turner³  Allen R Huang³ 

[1] Academic Hospital São Francisco de Assis - Federal University of Rio de Janeiro, Avenida Presidente Vargas, 2863 Cidade Nova, 22250-040, Rio de Janeiro, Brazil;Division of Clinical Epidemiology, McGill University Health Center, Royal Victoria Hospital, 687 Pine Avenue West, Room R4.27, H3A 1A1, Montreal, Quebec, Canada;Division of Geriatric Medicine, McGill University Health Centre, Royal Victoria Hospital, 687 Pine Avenue West, Room M8.12, H3A 1A1, Montreal, Quebec, Canada;

关键词: Grip Strength;    Bayesian Information Criterion;    Gait Speed;    Mini Mental Status Exam;    Rehabilitation Outcome;   

DOI  :  10.1186/1471-2318-10-82

 received in 2010-02-01, accepted in 2010-11-03,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundThe optimal patient selection of frail elderly persons undergoing rehabilitation in Geriatric Day Hospital (GDH) programs remains uncertain. This study was done to identify potential predictors of rehabilitation outcomes for these patients.MethodsThis study is a retrospective cohort analysis of patients admitted to the rehabilitation program of our GDH, in Montreal, Canada, over a five year period. The measures considered were: Barthel Index, Older Americans Resources and Services, Folstein Mini Mental Status Exam, Timed Up & Go (TUG), 6-minute walk test (6 MWT), Gait speed, Berg Balance, grip strength and the European Quality of life - 5 Dimensions. Successful improvement with rehabilitation was defined as improvement in three or more tests of physical function. Logistic regression analysis using the Bayesian Information Criterion (BIC) was employed to select the optimal model for making predictions of rehabilitation success.ResultsA total of 335 patients were studied, but only 233 patients had a complete data set suitable for the predictive model. Average age was 81 years and patients attended the GDH an average of 24 visits. Significant changes were found in several measures of physical performance for many patients ranging from improved gait speed in 21.3% to improved TUG in 62.7% of the cohort. Fifty-eight percent of patients attained successful improvement with rehabilitation by our criteria. This group was characterized by lower test scores on admission. Using BIC, the best predictor model was the 6 MWT [OR: 0.994 per meter walked (95% CI: 0.990-0.997)].ConclusionsThe GDH rehabilitation program is effective in improving patients' physical performance. Although no single measure was found to be sufficiently predictive to help target candidates appropriately, the 6 MWT showed a trend to significance. Further research will be done to elucidate the utility of a composite 'rehab appropriateness index' and the role of International Classification of Function concepts for targeting frail elderly to GDH rehabilitation services.

【 授权许可】

Unknown   
© Pereira et al; licensee BioMed Central Ltd. 2010. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.