Zuccarino Sara, Fattore Giovanni, Vitali Silvia, Antronaco Gino, Frigerio Simona, Colombo Mauro
Institute of Management and Department EMbeDS, Management and Health Laboratory, Scuola Superiore Sant'Anna, Pisa, Italy.
Social and Political Sciences Department, Università Bocconi, Milan, Italy; CERGAS-SDA, Università Bocconi, Milan, Italy.
Arch Gerontol Geriatr. 2020 Nov/Dec;91:104218. doi: 10.1016/j.archger.2020.104218. Epub 2020 Aug 5.
Retrospective observational study aiming at testing whether different education levels in older adults are associated with the rehabilitation outcome.
The study planned to cover all patients of over 65 rehabilitated from 2015 to 2017 at Golgi-Redaelli, a large government-funded rehabilitation Institute in Northern Italy comprising of three centers. Different administrative datasets were linked to investigate the factors associated with the functional outcome. The cohort resulted in 2,486 older adults for whom information on education and rehabilitation outcome was available.
Rehabilitation outcome was measured with the Barthel Index testing the ability in basic activities of daily living and the Tinetti Performance Oriented Mobility Assessment measuring stability and walking. Multiple linear and logistic regression models were run controlling for rehabilitation setting and center of care, age, gender, cognitive functioning and comorbidity.
Education resulted negatively associated with functional recovery. Patients with at least 8 years of education improved 2.24 point less in Barthel Index (out of100) and 0.70 points less in Tinetti Performance Oriented Mobility Assessment (out of 28) than the less educated patients. Results confirmed the importance of cognitive functioning in predicting rehabilitation outcome in older patients.
Different mechanisms can explain an unexpected negative association between education and rehabilitation outcome, when possible inequalities in access to care are controlled for by study design (the cohort was admitted to a NHS-funded institute). Additional studies are needed to confirm our results and to test more specific hypotheses about the degree of effectiveness of rehabilitation across socio-economic groups.
进行回顾性观察研究，旨在检验老年人不同教育水平是否与康复结果相关。
该研究计划涵盖2015年至2017年在意大利北部一家由政府资助的大型康复机构戈尔吉 - 雷代利康复的所有65岁以上患者，该机构由三个中心组成。链接不同的行政数据集以调查与功能结果相关的因素。该队列产生了2486名老年人，可获得其教育和康复结果的信息。
康复结果通过巴氏指数进行测量，以测试日常生活基本活动能力，以及采用Tinetti以性能为导向的移动性评估来测量稳定性和步行能力。运行多元线性和逻辑回归模型，控制康复环境、护理中心、年龄、性别、认知功能和合并症。
教育与功能恢复呈负相关。接受至少8年教育的患者在巴氏指数（满分100分）中的改善比受教育程度较低的患者少2.24分，在Tinetti以性能为导向的移动性评估（满分28分）中少0.70分。结果证实了认知功能在预测老年患者康复结果中的重要性。
当研究设计控制了可能存在的医疗服务获取不平等情况时（该队列患者入住的是由英国国家医疗服务体系资助的机构），不同机制可以解释教育与康复结果之间意外的负相关关系。需要进一步的研究来证实我们的结果，并检验关于不同社会经济群体康复效果程度的更具体假设。
