Patients undergoing subacute rehabilitation have accurate expectations of their health-related quality of life at discharge

Abstract

BackgroundExpectations held by patients and health professionals may affect treatment choices and participation (by both patients and health professionals) in therapeutic interventions in contemporary patient-centered healthcare environments. If patients in rehabilitation settings overestimate their discharge health-related quality of life, they may become despondent as their progress falls short of their expectations. On the other hand, underestimating their discharge health-related quality of life may lead to a lack of motivation to participate in therapies if they do not perceive likely benefit. There is a scarcity of empirical evidence evaluating whether patients’ expectations of future health states are accurate. The purpose of this study is to evaluate the accuracy with which older patients admitted for subacute in-hospital rehabilitation can anticipate their discharge health-related quality of life.MethodsA prospective longitudinal cohort investigation of agreement between patients’ anticipated discharge health-related quality of life (as reported on the EQ-5D instrument at admission to a rehabilitation unit) and their actual self-reported health-related quality of life at the time of discharge from this unit was undertaken. The mini-mental state examination was used as an indicator of patients’ cognitive ability.ResultsOverall, 232(85%) patients had all assessment data completed and were included in analysis. Kappa scores ranged from 0.42-0.68 across the five EQ-5D domains and two patient cognition groups. The percentage of exact correct matches within each domain ranged from 69% to 85% across domains and cognition groups. Overall 40% of participants in each cognition group correctly anticipated all of their self-reported discharge EQ-5D domain responses.ConclusionsPatients admitted for subacute in-hospital rehabilitation were able to anticipate their discharge health-related quality of life on the EQ-5D instrument with a moderate level of accuracy. This finding adds to the foundational empirical work supporting joint treatment decision making and patient-centered models of care during rehabilitation following acute illness or injury. Accurate patient expectations of the impact of treatment (or disease progression) on future health-related related quality of life is likely to allow patients and health professionals to successfully target interventions to priority areas where meaningful gains can be achieved.

Modification in self-rated health in patients discharged by a geriatric rehabilitation ward

“…More, statistical modeling supports the plausibility of our results. Subacute rehabilitation patients feel accurate expectations of their health-related quality of life at discharge [32]. Further, we previously showed that customer satisfaction is realistically related to reasonably attainable functional as well as clinical outcomes [33], consistently with the majority of the literature [34][35][36][37].…”

Patients Undergoing Subacute Physical Rehabilitation following an Acute Hospital Admission Demonstrated Improvement in Cognitive Functional Task Independence

“…In this context, patients also undertake multidisciplinary assessments of their abilities to complete functional tasks required for daily living; the Functional Independence Measure [ 17 , 18 ] (including both Cognitive (FIM Cognitive) and Motor (FIM Motor) performance items) is perhaps the most frequently used measure for this purpose in clinical geriatric rehabilitation settings [ 5 , 19 ]. It is intended that a period of inpatient rehabilitation will give patients experiencing physical debility the best chance of avoiding a need to be discharged to long-term residential aged care and improve their discharge health-related quality of life [ 3 , 5 , 20 ]. However, with increasing demand for beds in specialized geriatric rehabilitation units, it is likely that demand will exceed supply at some facilities.…”

“…Previous studies have demonstrated that patients with or without reduced Cognitive functioning on admission to subacute inpatient rehabilitation have considerable potential to improve their physical functioning and quality of life [ 5 , 20 – 22 ]. Although, at least, one study among hip fracture patients [ 12 ] and another among stroke patients [ 13 ] receiving rehabilitation has indicated that better Cognitive functioning at admission (as measured on the FIM Cognitive score) may be predictive of a better outcome from rehabilitation.…”

Development and Validation of the Ankle Fracture Outcome of Rehabilitation Measure (A-FORM)

“…39,41,42,51 This information can enhance patient-centered care by targeting interventions to priority problem areas indicated by the patient, and by evaluating whether these interventions have a meaningful impact from the perspective of the patient. 40,51 The aforementioned Cochrane review 30 identified a range of patient-reported outcome measures that have been used in the context of ankle fracture rehabilitation. 6,8,16,19,30,37,42,45,64 However, it has been suggested that these outcome measures lack a methodologically robust content foundation for use as ankle fracture-specific, patient-reported outcomes to evaluate quality-of-life impacts experienced by people recovering from this condition.…”