Barnes Carol, Conner Douglas, Legault Lil, Reznickova Nora, Harrison-Felix Cynthia
Continuing Care Department, Kaiser Permanente, Aurora, CO 80014, USA.
Arch Phys Med Rehabil. 2004 Oct;85(10):1602-7. doi: 10.1016/j.apmr.2004.02.025.
To examine the outcomes of patients with varying levels of cognitive impairment who received rehabilitation in skilled nursing facilities (SNFs).
A retrospective analysis of the records of people admitted to SNFs for rehabilitation.
Seven SNFs in Colorado.
Community-dwelling persons (N=7159), 65 years of age and older, admitted for rehabilitation after a hospitalization or decline in function between May 1998 and May 2002. Interventions Not applicable.
Cognitive impairment was assessed using a 4-level categorization of the FIM instrument cognitive score at admission. Functional gain was measured using the FIM. Community discharge was measured as the proportion of patients discharged to home, board and care, or assisted living facility. Rehabilitation progress was measured as the number of FIM points gained per day.
Significant functional gains were made during rehabilitation in motor and cognitive FIM scores, regardless of cognitive impairment. The most cognitively impaired patients required more rehabilitation intervention, achieved less FIM gain, and were less likely to be discharged to the community. The strongest predictors of FIM gain were the amount of therapy hours and admission cognitive FIM score. The strongest predictors of discharge to the community were the discharge total FIM score and age. The strongest predictors of adequate rehabilitation progress were medical complexity and admission cognitive FIM score.
Patients with cognitive impairment were able to recover function with rehabilitation intervention. Patients with a more serious cognitive impairment received more rehabilitation intervention than patients with less impairment. Outcomes were predicted by admission and rehabilitation measures that were qualitatively different from other discharge outcomes. Health care professionals need to consider these factors as they create a rehabilitation plan of care for patients with cognitive impairment.
研究在专业护理机构（SNFs）接受康复治疗的不同认知障碍水平患者的治疗结果。
对入住SNFs接受康复治疗的患者记录进行回顾性分析。
科罗拉多州的七所SNFs。
1998年5月至2002年5月期间因住院或功能衰退后入住SNFs接受康复治疗的65岁及以上社区居民（N = 7159）。干预措施不适用。
入院时使用FIM工具认知评分的4级分类评估认知障碍。使用FIM测量功能改善情况。以出院回家、入住寄宿与护理机构或辅助生活设施的患者比例衡量社区出院情况。以每天获得的FIM分数衡量康复进展。
无论认知障碍程度如何，康复期间运动和认知FIM评分均有显著功能改善。认知障碍最严重的患者需要更多的康复干预，FIM得分增加较少，出院返回社区的可能性也较小。FIM得分增加的最强预测因素是治疗时长和入院时的认知FIM评分。出院返回社区的最强预测因素是出院时总的FIM评分和年龄。康复进展充分的最强预测因素是医疗复杂性和入院时的认知FIM评分。
认知障碍患者通过康复干预能够恢复功能。认知障碍较严重的患者比障碍较轻的患者接受了更多的康复干预。入院和康复措施可预测结果，这些结果在性质上与其他出院结果不同。医疗保健专业人员在为认知障碍患者制定康复护理计划时需要考虑这些因素。
