Outcomes of rehabilitation in older people â€“ functioning and cognition are the most important predictors: An inception cohort study

Cameron, Ian D.; Schaafsma, Frederieke; Wilson, Sandy J.; Baker, Wesley B.; Buckley, Stephen J.

doi:10.2340/16501977-0901

Cited by 21 publications

(25 citation statements)

References 22 publications

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“…As in other series that have used the FIM alone, the admission FIM + FAM score was the strongest predictor of outcome [22,23], and other authors have also noted the influence of baseline cognitive function on outcome [22,24]. In this series, functional gains during rehabilitation (as measured by change in total FIM + FAM) were significantly predicted by both the level of cognitive impairment on admission and by change in physical impairment (as measured by the NIS).…”

Section: Discussionsupporting

confidence: 61%

The Neurological Impairment Scale: reliability and validity as a predictor of functional outcome in neurorehabilitation

Turner-Stokes

Thu

Williams

et al. 2013

Disability and Rehabilitation

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PurposeTo examine the construct validity and inter-rater reliability of the Neurological Impairment Scale (NIS) and compare ratings by medical and multidisciplinary teams in a mixed neurorehabilitation sample. To assess its concurrent and predictive validity as a predictor of outcome and functional gains during inpatient rehabilitation.MethodsThe NIS was rated in a consecutive cohort of patients (n = 428) recruited from nine specialist neurorehabilitation units in London. Dimensionality and internal consistency were explored through principal components analysis with Varimax rotation. Inter-rater reliability and the relationship between NIS and functional outcome (UK Functional Assessment Measure (FIM + FAM)) were analysed in a sub-sample (n = 94) from one centre.ResultsFactor analysis identified two principal domains (“Physical” and “Cognitive”) together accounting for 35% of the variance: their Cronbach’s alpha values were 0.76 and 0.67, respectively. Inter-rater reliability was excellent for overall scores between doctors (ICC = 0.95 (95% CI = 0.91–0.97)) and acceptable between the medical and multidisciplinary team (ICC = 0.92 (95% CI = 0.88–0.95)). Change in NIS-physical score predicted 29% of the variance in functional gain (FIM + FAM change).ConclusionThese findings provide the first formal evidence for the validity and reliability of the NIS as a measure of neurological impairment for use in general neuro-rehabilitation settings. Its further application and exploration are now warranted.Implications for RehabilitationThe extent of neurological recovery occurring during rehabilitation can make an important contribution to functional gains. In order to interpret measurement of functional outcome, we need to be able to identify changes at the level of impairment.Many of the available tools to measure severity of impairment are condition specific. The Neurological Impairment Scale (NIS) was developed for use across a broad range of disabling conditions alongside the UK FIM+FAM.This first formal examination of its psychometric properties provides evidence for its scalability, reliability and validity.The NIS has potential to provide useful information for case-mix adjustment and as a predictor of functional gain in general neurorehabilitation settings.

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Section: Discussionsupporting

confidence: 61%

The Neurological Impairment Scale: reliability and validity as a predictor of functional outcome in neurorehabilitation

Turner-Stokes

Thu

Williams

et al. 2013

Disability and Rehabilitation

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“…to treatment) objectively measurable [14,20]. This is of particular importance for monitoring the progress of patients´ functional health status as one of the most important predictors of morbidity and mortality next to depression [42-44]. The ADLib-cardio, as an instrument sensitive to change, might also help to further examine the bi-directional relationship between ADL and depression.…”

Section: Discussionmentioning

confidence: 99%

Development and calibration of an item bank for the assessment of activities of daily living in cardiovascular patients using Rasch analysis

Baumeister

Abberger

Haschke

et al. 2013

Health and Quality of Life Outcomes

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BackgroundTo develop and calibrate the activities of daily living item bank (ADLib-cardio) as a prerequisite for a Computer-adaptive test (CAT) for the assessment of ADL in patients with cardiovascular diseases (CVD).MethodsAfter pre-testing for relevance and comprehension a pool of 181 ADL items were answered on a five-point Likert scale by 720 CVD patients, who were recruited in fourteen German cardiac rehabilitation centers. To verify that the relationship between the items is due to one factor, a confirmatory factor analysis (CFA) was conducted. A Mokken analysis was computed to examine the double monotonicity (i.e. every item generates an equivalent order of person traits, and every person generates an equivalent order of item difficulties). Finally, a Rasch analysis based on the partial credit model was conducted to test for unidimensionality and to calibrate the item bank.ResultsResults of CFA and Mokken analysis confirmed a one factor structure and double monotonicity. In Rasch analysis, merging response categories and removing items with misfit, differential item functioning or local response dependency reduced the ADLib-cardio to 33 items. The ADLib-cardio fitted to the Rasch model with a nonsignificant item-trait interaction (chi-square=105.42, df=99; p=0.31). Person-separation reliability was 0.81 and unidimensionality could be verified.ConclusionsThe ADLib-cardio is the first calibrated, unidimensional item bank that allows for the assessment of ADL in rehabilitation patients with CVD. As such, it provides the basis for the development of a CAT for the assessment of ADL in patients with cardiovascular diseases. Calibrating the ADLib-cardio in other than rehabilitation cardiovascular patient settings would further increase its generalizability.

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“…According to our experience the ability of initiative and to take instructions were the cognitive features of greatest importance for successful rehabilitation. Several studies identify cognitive status as a predictor of rehabilitation outcomes [25,26]. …”

Section: Discussionmentioning

confidence: 99%

Independence, institutionalization, death and treatment costs 18 months after rehabilitation of older people in two different primary health care settings

Johansen

Lindbak

Stanghelle

et al. 2012

BMC Health Serv Res

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BackgroundThe optimal setting and content of primary health care rehabilitation of older people is not known. Our aim was to study independence, institutionalization, death and treatment costs 18 months after primary care rehabilitation of older people in two different settings.MethodsEighteen months follow-up of an open, prospective study comparing the outcome of multi-disciplinary rehabilitation of older people, in a structured and intensive Primary care dedicated inpatient rehabilitation (PCDIR, n=202) versus a less structured and less intensive Primary care nursing home rehabilitation (PCNHR, n=100). Participants: 302 patients, disabled from stroke, hip-fracture, osteoarthritis and other chronic diseases, aged ≥65years, assessed to have a rehabilitation potential and being referred from general hospital or own residence. Outcome measures: Primary: Independence, assessed by Sunnaas ADL Index(SI). Secondary: Hospital and short-term nursing home length of stay (LOS); institutionalization, measured by institutional residence rate; death; and costs of rehabilitation and care. Statistical tests: T-tests, Correlation tests, Pearson’s χ2, ANCOVA, Regression and Kaplan-Meier analyses.ResultsOverall SI scores were 26.1 (SD 7.2) compared to 27.0 (SD 5.7) at the end of rehabilitation, a statistically, but not clinically significant reduction (p=0.003 95%CI(0.3-1.5)). The PCDIR patients scored 2.2points higher in SI than the PCNHR patients, adjusted for age, gender, baseline MMSE and SI scores (p=0.003, 95%CI(0.8-3.7)). Out of 49 patients staying >28 days in short-term nursing homes, PCNHR-patients stayed significantly longer than PCDIR-patients (mean difference 104.9 days, 95%CI(0.28-209.6), p=0.05). The institutionalization increased in PCNHR (from 12%-28%, p=0.001), but not in PCDIR (from 16.9%-19.3%, p= 0.45). The overall one year mortality rate was 9.6%. Average costs were substantially higher for PCNHR versus PCDIR. The difference per patient was 3528€ for rehabilitation (p<0.001, 95%CI(2455–4756)), and 10134€ for the at-home care (p=0.002, 95%CI(4066–16202)). The total costs of rehabilitation and care were 18702€ (=1.6 times) higher for PCNHR than for PCDIR.ConclusionsAt 18 months follow-up the PCDIR-patients maintained higher levels of independence, spent fewer days in short-term nursing homes, and did not increase the institutionalization compared to PCNHR. The costs of rehabilitation and care were substantially lower for PCDIR. More communities should consider adopting the PCDIR model.Trial registrationClinicaltrials.gov ID NCT01457300

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Outcomes of rehabilitation in older people â€“ functioning and cognition are the most important predictors: An inception cohort study

Abstract: Functional status on admission to a rehabilitation facility has stronger predictive value than type of impairment for rehabilitation outcome for older people. Cognitive impairment may have a small adverse effect on rehabilitation outcome.

Cited by 21 publications

References 22 publications

The Neurological Impairment Scale: reliability and validity as a predictor of functional outcome in neurorehabilitation

The Neurological Impairment Scale: reliability and validity as a predictor of functional outcome in neurorehabilitation

Development and calibration of an item bank for the assessment of activities of daily living in cardiovascular patients using Rasch analysis

Independence, institutionalization, death and treatment costs 18 months after rehabilitation of older people in two different primary health care settings

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