Importance and evaluation of comorbidity in rehabilitation

Giaquinto, Salvatore; Palma, Enzo; Maiolo, Ilario; Piro, Maria; Roncacci, Sabina; Sciarra, Alessandro; Vittoria, E.

doi:10.1080/096382801750143643

Cited by 20 publications

(2 citation statements)

References 12 publications

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“…Comorbidity is often considered in studies that assess rehabilitation outcomes as they can affect health service utilization [ 6 ] and functional outcomes [ 7 ]. Examples of common indexes used to measure comorbidities include the Charlson Comorbidity Index (CCI) [ 8 ] and Elixhauser Index [ 9 ] and more complex case-mix risk adjustment models that include comorbidity information such as the Centers for Medicare and Medicaid Service (CMS) Comorbidity Tiers [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

A systematic review protocol for measuring comorbidity in inpatient rehabilitation for non-traumatic brain injury

2015

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BackgroundComorbidity can affect health-care utilization and outcomes, and the results and interpretation of risk adjustment studies that attempt to predict rehabilitation utilization and outcomes are influenced by the choice of comorbidity measurement. Although the identification of an appropriate measurement has been conducted in some populations and outcomes, this information is currently lacking for the non-traumatic brain injury (nTBI) population in inpatient rehabilitation settings. As such, this is a systematic review protocol to survey the methods used to measure comorbidities in the rehabilitation setting for patients with nTBI.Methods/designMEDLINE, MEDLINE In-Process, Embase, The Cochrane Database of Systematic Reviews, PsycINFO, and Health and Psychosocial Instruments will be systematically searched using the concepts ‘nTBI,’ ‘comorbidity,’ and ‘rehabilitation.’ Grey matters and the reference list of eligible articles will also be searched. Study selection will be performed independently by two reviewers based on predetermined eligibility criteria through two rounds of screening using, first, the title and abstract, followed by full-text. Extracted information will include study purpose, design, and setting; data source and type; outcomes variables; statistical methods; comorbidity measurement method, rationale, justification, or validation; and results involving comorbidity. The data will be tabulated and narratively synthesized. Meta-analyses will be performed if appropriate.Systematic review registrationThis protocol has not been registered with PROSPERO.DiscussionThis protocol provides a systematic method for surveying current practice as well as monitoring the progress on comorbidity measurement methodology and effects of comorbidity on rehabilitation outcomes for patients with nTBI. The selection of an appropriate comorbidity measurement method has implications for the interpretation of both descriptive and risk adjustment studies, and thus, the validity of evidence used to inform planning and delivery of services.Electronic supplementary materialThe online version of this article (doi:10.1186/2046-4053-4-14) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

A systematic review protocol for measuring comorbidity in inpatient rehabilitation for non-traumatic brain injury

2015

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“…A widely used index is the Cumulative Illness Rating Scale (CIRS), which has been shown to be a good indicator of the health status and outcome (risk of death) of hospitalized patients 6. The CIRS is structured into 13 domains related to different body systems/functions; each of these domains is evaluated by assigning an increasing severity rating ranging from 1 to 5 7…”

Section: Introductionmentioning

confidence: 99%

Inpatient rehabilitation outcome: a matter of diagnosis?

Bejor

Ramella

Toffola

et al. 2013

NDT

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BackgroundPatients with comorbidities are becoming more and more common in Italian rehabilitative wards. These comorbidities are considered a major problem for inpatient rehabilitation, due to the fact that they cause longer lengths of stay, higher costs, and lower functional results.MethodsTo investigate the possible relationships between comorbidity, functional impairment, age, and type of discharge in patients hospitalized in postacute rehabilitation facilities, we planned an observational study. A total of 178 consecutive inpatients (average age: 78 years [range: 39–99]) from postacute rehabilitation facilities were recruited. Primary diagnosis, comorbidity rating (Cumulative Illness Rating Scale – Geriatric version, CIRS-G) and functional impairment score (Functional Independence Measure, FIM™) were evaluated at admission. The FIM™ rating was also assessed at hospital discharge.ResultsA total of 178 of the 199 enrolled patients completed the rehabilitation treatment (89.4%). The average length of stay was 46 ± 24 days. CIRS-G showed an average comorbidity score for each patient of 4.45 ± 1.69. The average FIM™ rating was 79 ± 24.88 at admission, and 91.9 ± 25.7 at discharge. Diagnosis at admission (grouped according to the International Classification of Diseases 9-CM) seemed to correlate with functional results, since lower rehabilitative efficiency was obtained for patients who had a history of stroke.ConclusionThe number and type of comorbidities (CIRS-G) in rehabilitation inpatients do not seem to affect functional outcomes of treatment. The determining factor for a lower level of functional recovery seems to be the diagnosis at admission.

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Impact of osteoarthritis on rehabilitation for persons with hip fracture

Nguyen-Oghalai¹,

Ottenbacher²,

Granger³

et al. 2006

Arthritis & Rheumatism

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Objective. To determine the impact of osteoarthritis (OA) on length of rehabilitation stay, Functional Independence Measure (FIM Instrument) ratings at discharge and followup, functional gain, and percentage of patients discharged home. Methods. We conducted a retrospective cohort analysis using a national registry of US medical rehabilitation inpatients. We obtained standardized data for all patients admitted after a hip fracture between 1994 and 2001. Our primary analytical method was multiple regression analysis. Outcome variables were length of stay, FIM Instrument ratings at discharge and followup, functional gain, and percentage of patients discharged home. The predictor variable was the presence of OA. Covariates were age, sex, race/ethnicity, other comorbidity, admission FIM ratings, total hip replacement, and time to followup. Results. We studied 1,953 patients with OA and 11,441 patients without OA admitted to inpatient rehabilitation facilities after hip fracture. Mean ؎ SD length of stay for patients with OA was 18.1 ؎ 10.0 days versus 16.5 ؎ 8.9 days for those without OA (P < 0.01). After adjusting for age, sex, race/ethnicity, comorbidity, admission FIM ratings, and total hip replacement, OA was associated with a longer rehabilitation stay (1.4 days; P < 0.01) and slightly higher discharge FIM ratings; however, OA was not associated with lower weekly rehabilitation gain, followup FIM ratings, and percentage discharged home. Conclusion. Persons with hip fracture and OA had longer inpatient rehabilitation length of stay than persons without OA, but there were similarities in weekly rehabilitation gain and percentage discharged home.

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Importance and evaluation of comorbidity in rehabilitation

Cited by 20 publications

References 12 publications

A systematic review protocol for measuring comorbidity in inpatient rehabilitation for non-traumatic brain injury

A systematic review protocol for measuring comorbidity in inpatient rehabilitation for non-traumatic brain injury

Inpatient rehabilitation outcome: a matter of diagnosis?

Impact of osteoarthritis on rehabilitation for persons with hip fracture

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