Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora.
Denver Veterans Affairs Medical Center, Rocky Mountain Mental Illness Research, Education and Clinical Center, Denver, Colorado.
J Geriatr Phys Ther. 2019 Jul/Sep;42(3):189-195. doi: 10.1519/JPT.0000000000000137.
Inability to obtain sufficient gains in function during a skilled nursing facility (SNF) stay impacts patients' functional trajectories and susceptibility to adverse events. The purpose of this study was to identify predictors of functional change in patients temporarily residing in an SNF following hospitalization.
One hundred forty patients admitted to a single SNF from the hospital who had both evaluation and discharge measures of physical function documented were included. Data from the Minimum Data Set 3.0 and electronic medical record were extracted to record clinical and demographic characteristics. The Short Physical Performance Battery (SPPB) was administered by rehabilitation therapists at evaluation and discharge. The SPPB consists of balance tests, gait speed, and a timed 5-time sit-to-stand test.
The Patient Health Questionnaire (PHQ-9) Screening Tool for Depression was the only significant predictor of change in gait speed over an SNF stay. Eighty-seven percent of patients achieved a clinically meaningful change in the SPPB of 1 point or greater from evaluation to discharge, with 78% demonstrating a clinically meaningful change of 0.1 m/s or greater on gait speed. However, 69% of patients demonstrated SPPB scores of 6 points or less and 57% ambulated less than 0.65 m/s at the time of discharge from the SNF, which indicates severe disability.
Poor physical function following an SNF stay places older adult at significant risk for adverse events including rehospitalization, future disability, and institutionalization. Understanding the predictors of functional change from evaluation to discharge may direct efforts toward developing innovative and effective interventions to improve function trajectories for older adults following an acute hospitalization.
在疗养院（SNF）停留期间无法获得足够的功能增益会影响患者的功能轨迹和易患不良事件的风险。本研究的目的是确定在因住院而临时入住 SNF 的患者中，功能变化的预测因素。
共纳入 140 名从医院转入单一 SNF 的患者，这些患者在入住 SNF 期间有评估和出院时的身体功能测量数据。从最低数据集 3.0 和电子病历中提取数据，以记录临床和人口统计学特征。康复治疗师在评估和出院时进行短体力量表（SPPB）测试。SPPB 由平衡测试、步态速度和定时 5 次坐立站起测试组成。
患者健康问卷（PHQ-9）抑郁筛查工具是 SNF 停留期间步态速度变化的唯一显著预测因素。87%的患者在 SPPB 评估到出院期间取得了 1 分或更大的临床显著变化，其中 78%的患者在步态速度上取得了 0.1 米/秒或更大的临床显著变化。然而，69%的患者在出院时 SPPB 评分为 6 分或更低，57%的患者行走速度低于 0.65 米/秒，这表明严重残疾。
SNF 停留后身体功能不佳使老年患者面临严重的不良事件风险，包括再次住院、未来残疾和机构化。了解从评估到出院期间功能变化的预测因素，可能有助于为急性住院后的老年人制定创新和有效的干预措施，以改善他们的功能轨迹。
