Effect of Early Rehabilitation Treatment on Activities of Daily Living in Patients Receiving Conservative Treatment for Vertebral Compression Fracture

Abstract

Objectives : Vertebral compression fractures are common among older people. Currently, knowledge of the effects of early rehabilitation treatment on the recovery of activities of daily living (ADL) in older patients who receive conservative treatment for these fractures is limited. Using the instrumental variable (IV) method, we examined the effects on ADL at discharge of a delay in initiating rehabilitation treatment. Methods: In this retrospective cohort study, data from the Japanese Diagnosis Procedure Combination database were analyzed. The subjects were patients with vertebral compression fracture who had undergone rehabilitation treatment during their hospitalization between 2014 and 2019 in one of the 29 acute-care hospitals in Yamagata Prefecture. We analyzed data from 1706 patients (mean age, 82.1 years). The independent variable was the number of days between hospital admission and the start of rehabilitation treatment, and the outcome was the Barthel index (BI) score at discharge. An IV method was applied, with adjustments for covariates, including demographics and functional status at admission. Results: Most patients started rehabilitation treatment within 3 days of hospital admission. Our IV method showed that the interval between hospital admission and the start of rehabilitation treatment was significantly associated with the BI score at discharge. The coefficient was −2.71 (95% confidence interval [CI]: −5.06 to −0.35). Conclusions: A delay in initiating rehabilitation treatment had a negative effect on ADL at discharge. This result emphasizes the importance of including early rehabilitation treatment in acute care, as recommended by several existing guidelines for the treatment of orthopedic diseases.

Impact of body mass index on outcomes of inpatients with vertebral compression fractures in Japan: A retrospective cohort study

“…Strategies to promote weight gain in underweight patients through nutritional management are important for improving functional outcomes, and preventing prolonged hospitalization and readmission for VCFs. Early and convalescent rehabilitation for patients with VCFs effectively improved ADL and increased skeletal muscle mass 21,35,40 . In the present study, most patients were undergoing rehabilitation.…”

“…Early and convalescent rehabilitation for patients with VCFs effectively improved ADL and increased skeletal muscle mass. 21,35,40 In the present study, most patients were undergoing rehabilitation. In addition to rehabilitation, nutritional support might be required to improve ADL in underweight patients with VCFs.…”

“…Pain, for which data were missing in the present study, might be a factor that affects BI gain 20 . The degree of pain and ADL dependency were associated with ambulance admissions 21‐23 . Nursing home residents have a higher rate of low BMI, which also affects ADL and, thus, was used as an adjusting factor 24 .…”

“…20 The degree of pain and ADL dependency were associated with ambulance admissions. [21][22][23] Nursing home residents have a higher rate of low BMI, which also affects ADL and, thus, was used as an adjusting factor. 24 To identify the causal effects of exposure (BMI) on the desired outcome (BI gain and length of hospital stay), we used DAGitty and confirmed that it blocked all non-causal pathways, but not causal pathways, between exposure and outcome.…”

Prediction of Walking Independence in Older Women with Vertebral Compression Fracture Using Phase Angle: A Preliminary Study Using Propensity Score

“…This study analyzed the association between PhA and the ability to walk independently in older adults with VCF. Several factors have been reported to be associated with improved activities of daily living in patients with VCF, including early rehabilitation, 18 , 19 ) physical activity, 20 ) and increased SMI 21 ) ; however, no studies have focused on walking independence in these patients.…”