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

Abstract

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.

One minute sit‐to‐stand test is an alternative to 6MWT to measure functional exercise performance in COPD patients

“…7 It is a good predictor of functional status and mortality 8 and it is strongly correlated to activities of daily living in COPD patients. 17 It was previously used in elderly people to evaluate their functional status and it is based on another common daily activity. 13 As it requires a familiarization test and takes time, many more practical alternative tests were proposed.…”

“…Moreover, it can be completed by frail patients similarly to 6MWT. 17 It was previously used in elderly people to evaluate their functional status and it is based on another common daily activity. 18 Moreover, to stand up from a chair is a key component associated to impairments, activity limitations and participation restriction related to the International Classification of Functioning, Disability and Health from WHO.…”

Treatment in a Geriatric Day Hospital improve individualized outcome measures using Goal Attainment Scaling

“…Therefore no single baseline measure appears to predict overall GDH performance [31] or longer term maintenance of improvements. While this finding may seem discouraging from a patient selection perspective, it also suggests that adaptive interventions such as the GDH, can effectively serve a wide range of people.…”

Quantification of Resource Utilization to Obtain Functional Recovery in Strokes

“…Second, this study lacked information regarding the severity of cognitive impairment, the onset time of CVD, and other motor or cognitive scales that are often utilized in health service research [4]. The Japanese Stroke Databank (JSD) has separately collected such clinically informative data and we may be able to obtain more meaningful fi ndings using the administrative database in combination with the JSD [23].…”

“…Disease manageManuscript accepted for publication August 19, 2011 a ment is a major focus of research for disease prevention, quality of care in acute care settings, and rehabilitation allocation after acute onset of these illnesses [3][4][5]. Among them, CVD has been a major cause of death and disability and produces socioeconomic burdens on patients, their families, and on society.…”