Academic Hospital São Francisco de Assis, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
BMC Geriatr. 2010 Nov 3;10:82. doi: 10.1186/1471-2318-10-82.
The optimal patient selection of frail elderly persons undergoing rehabilitation in Geriatric Day Hospital (GDH) programs remains uncertain. This study was done to identify potential predictors of rehabilitation outcomes for these patients.
This study is a retrospective cohort analysis of patients admitted to the rehabilitation program of our GDH, in Montreal, Canada, over a five year period. The measures considered were: Barthel Index, Older Americans Resources and Services, Folstein Mini Mental Status Exam, Timed Up & Go (TUG), 6-minute walk test (6 MWT), Gait speed, Berg Balance, grip strength and the European Quality of life - 5 Dimensions. Successful improvement with rehabilitation was defined as improvement in three or more tests of physical function. Logistic regression analysis using the Bayesian Information Criterion (BIC) was employed to select the optimal model for making predictions of rehabilitation success.
A total of 335 patients were studied, but only 233 patients had a complete data set suitable for the predictive model. Average age was 81 years and patients attended the GDH an average of 24 visits. Significant changes were found in several measures of physical performance for many patients ranging from improved gait speed in 21.3% to improved TUG in 62.7% of the cohort. Fifty-eight percent of patients attained successful improvement with rehabilitation by our criteria. This group was characterized by lower test scores on admission. Using BIC, the best predictor model was the 6 MWT [OR: 0.994 per meter walked (95% CI: 0.990-0.997)].
The GDH rehabilitation program is effective in improving patients' physical performance. Although no single measure was found to be sufficiently predictive to help target candidates appropriately, the 6 MWT showed a trend to significance. Further research will be done to elucidate the utility of a composite 'rehab appropriateness index' and the role of International Classification of Function concepts for targeting frail elderly to GDH rehabilitation services.
在老年日间医院（GDH）康复计划中，虚弱的老年患者的最佳患者选择仍不确定。本研究旨在确定这些患者康复结果的潜在预测因素。
这是一项对在加拿大蒙特利尔的 GDH 康复计划中接受治疗的患者进行的回顾性队列分析。考虑的措施包括：巴氏指数、美国老年人资源和服务、Folstein 简易精神状态检查、计时起立行走测试（TUG）、6 分钟步行测试（6MWT）、步态速度、伯格平衡、握力和欧洲生活质量-5 维度。康复后改善定义为三项或更多身体功能测试的改善。使用贝叶斯信息准则（BIC）的逻辑回归分析用于选择最佳模型，以预测康复成功。
共研究了 335 名患者，但只有 233 名患者有完整的数据集适合预测模型。平均年龄为 81 岁，患者平均在 GDH 就诊 24 次。许多患者的身体表现的几个测量值都有显著变化，从 21.3%的患者步态速度提高到 62.7%的患者 TUG 提高。根据我们的标准，58%的患者康复后获得了成功的改善。这组患者的特点是入院时的测试分数较低。使用 BIC，最佳预测模型是 6MWT[每米行走的 OR：0.994（95%CI：0.990-0.997）]。
GDH 康复计划可有效改善患者的身体机能。尽管没有单一措施被发现具有足够的预测能力来适当定位候选人，但 6MWT 显示出有意义的趋势。将进一步研究阐明综合“康复适宜性指数”的效用以及国际功能分类概念在将虚弱的老年人定位到 GDH 康复服务中的作用。
