Latham Nancy K, Jette Diane U, Warren Reg L, Wirtalla Christopher
Health and Disability Research Institute, Boston University, Boston, MA 02215, USA.
Arch Phys Med Rehabil. 2006 Jan;87(1):111-6. doi: 10.1016/j.apmr.2005.08.121.
To examine the rate of functional change in 2 domains, activities of daily living (ADLs) and mobility, over 2 time periods during hip fracture rehabilitation.
Retrospective analysis of data contained in an administrative dataset.
Seventy skilled nursing facilities (SNFs).
People (N=351) receiving rehabilitation in SNFs from March 1998 to February 2003 after hip fractures.
Not applicable.
Rate of change in scores in the ADL and mobility domains of the FIM instrument during 2 time intervals of rehabilitation.
The rate of functional change across 2 time intervals was constant for mobility (mean change in FIM points per day, .46 vs .49), but declined in the second time period for ADLs (mean change in FIM points per day, .55 vs .41). Executive function, length of stay (LOS), and medical complexity were related to rate of change in mobility, and baseline ADLs, executive function, living setting, and LOS were related to rate of change in ADLs. There was an interaction between rehabilitation phase and baseline mobility. People with lower baseline mobility had an increased rate of change during the second interval (mean change in FIM points per day, .41 vs .55), whereas those with higher baseline mobility had a decreased rate of change (mean change in FIM points per day, .50 vs .43).
The pattern of functional change over time differed for ADL and mobility domains, and for specific groups of patients. The results have implications for goal setting and discharge planning.
研究髋部骨折康复期间两个时间段内日常生活活动（ADL）和活动能力这两个领域的功能变化率。
对管理数据集中的数据进行回顾性分析。
70家熟练护理机构（SNFs）。
1998年3月至2003年2月在SNFs接受髋部骨折康复治疗的患者（N = 351）。
不适用。
在两个康复时间段内，FIM工具中ADL和活动能力领域得分的变化率。
两个时间段内活动能力的功能变化率保持恒定（FIM评分每天的平均变化，分别为0.46和0.49），但ADL在第二个时间段下降（FIM评分每天的平均变化，分别为0.55和0.41）。执行功能、住院时间（LOS）和医疗复杂性与活动能力的变化率相关，而基线ADL、执行功能、生活环境和LOS与ADL的变化率相关。康复阶段和基线活动能力之间存在交互作用。基线活动能力较低的患者在第二个时间段内变化率增加（FIM评分每天的平均变化，分别为0.41和0.55），而基线活动能力较高的患者变化率下降（FIM评分每天的平均变化，分别为0.50和0.43）。
ADL和活动能力领域随时间的功能变化模式不同，特定患者群体也是如此。这些结果对目标设定和出院计划具有启示意义。
