Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA.
Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
J Am Med Dir Assoc. 2019 Aug;20(8):1001-1006. doi: 10.1016/j.jamda.2018.12.014. Epub 2019 Feb 6.
To identify home care clients with substantial functional deficits who had capacity to improve and, thus, for whom recovery goals should be articulated.
Retrospective longitudinal analysis of an international home care database.
523,907 persons receiving home care, having 2 assessments, on average, 8 months apart.
Recovery algorithm variables included counts of dependencies of activities of daily living (ADL) and instrumental ADL (IADL) tasks, hospitalization in the last 30 days, functional decline in the last 90 days, and self-belief in one's capacity to improve. Primary dependent variable was improvement in the IADL-ADL Functional Hierarchy Scale.
The Recovery Algorithm has 7 graded levels: the top 3 represent approximately 9% of home care clients, whereas the bottom level (where recovery is least likely to occur) includes 60% of home care clients (many with higher counts of extensive ADL or IADL dependencies). The improvement rates rise from 6.9% to 47.2% across the 7 levels of the algorithm. This relationship between change in IADL-ADL Functional Hierarchy Scale scores and Recovery Algorithm levels remained strong across age categories and cognitive performance levels. Higher rates of improvement occurred for persons who received physical therapy.
CONCLUSIONS/IMPLICATIONS: The Recovery Algorithm is based on a mix of positive risk indicators and the person's challenged baseline functional status. For persons with higher scores on the algorithm, recovery is expected and should be considered in care plan goals. In addition, use of physical therapy increases the probability of recovery.
确定有能力改善且功能严重缺陷的居家护理客户，并为其制定康复目标。
对国际居家护理数据库进行回顾性纵向分析。
523907 名接受居家护理的人员，平均每 8 个月接受两次评估。
康复算法变量包括日常生活活动（ADL）和工具性日常生活活动（IADL）任务的依赖项计数、过去 30 天内的住院情况、过去 90 天内的功能下降情况以及对自己改善能力的自我信念。主要因变量是 IADL-ADL 功能层次量表的改善情况。
康复算法有 7 个分级水平：前 3 级约占居家护理客户的 9%，而最低级（康复最不可能发生的水平）包括 60%的居家护理客户（许多人有更多的广泛的 ADL 或 IADL 依赖）。从算法的 7 个级别来看，改善率从 6.9%上升到 47.2%。IADL-ADL 功能层次量表评分的变化与康复算法水平之间的这种关系在各个年龄组和认知表现水平上都保持较强。接受物理治疗的患者改善率更高。
结论/意义：康复算法基于积极风险指标和个人基线功能障碍的综合情况。对于算法得分较高的患者，预期会有康复，并应在护理计划目标中考虑到这一点。此外，物理治疗的使用增加了康复的可能性。
