Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.
Tan Tock Seng Hospital, Singapore, Singapore.
Disabil Rehabil. 2022 May;44(10):1790-1801. doi: 10.1080/09638288.2020.1820587. Epub 2020 Sep 22.
Advanced cancer and/or respiratory disease threaten a person's independence in activities of daily living (ADL). Understanding how disability develops can help direct appropriate and timely interventions.
To identify different trajectories and associations of disability in ADL and appraise its measurement.
Medline, Embase, PsychINFO, and CINAHL databases were searched for cohort studies with measures of disability in ADL in advanced cancer or respiratory disease at three or more timepoints. Data were narratively synthesized to produce a typology of disability trajectories and a model of factors and outcomes associated with increasing disability.
Of 5702 publications screened, 11 were included. Seventy-four disability trajectories were categorized into typologies of unchanging ( = 20), fluctuating ( = 21), and increasing disability ( = 33). Respiratory disease did not predict any particular disability trajectory. Advanced cancer frequently followed trajectories of increasing disability. Factors associated with increasing disability included: frailty, multi-morbidity, cognitive impairment, and infection. Increased disability led to recurrent hospital admissions, long-term care, and/or death. Methodological limitations included use of non-validated measures.
Increasing disability trajectories in advanced cancer and/or respiratory disease is related to potentially modifiable personal and environmental factors. We recommend future studies using validated disability instruments.Implications for rehabilitationDisability in activities of daily living (ADL) is a common unmet need in advanced cancer or respiratory disease and represents an important outcome for patients, caregivers and health and social care services.Trajectories of ADL disability can be categorized into increasing, fluctuating, and unchanging disability, which could help planning of rehabilitation services in advanced cancer or respiratory disease.Increasing disability in advanced cancer or respiratory disease relates to personal and environmental factors as well as bodily impairments, which can all be modifiable by intervention.This review highlights implications for the measurement of ADL disability in advanced cancer or respiratory disease and recommends use of validated measures of ADL to understand what factors can be modified through rehabilitation interventions.
晚期癌症和/或呼吸系统疾病会威胁到人们日常生活活动（ADL）的独立性。了解残疾的发展过程有助于指导进行适当和及时的干预。
确定 ADL 中残疾的不同轨迹和关联，并评估其测量方法。
在 Medline、Embase、PsychINFO 和 CINAHL 数据库中检索了 3 个或更多时间点测量晚期癌症或呼吸系统疾病患者 ADL 残疾的队列研究。对数据进行了叙述性综合，以生成残疾轨迹的分类法和与残疾程度增加相关的因素和结果模型。
在筛选出的 5702 篇文献中，有 11 篇被纳入。74 条残疾轨迹被分类为不变（ = 20）、波动（ = 21）和逐渐增加的残疾（ = 33）。呼吸系统疾病并不能预测任何特定的残疾轨迹。晚期癌症通常遵循逐渐增加残疾的轨迹。与残疾程度增加相关的因素包括：虚弱、多种合并症、认知障碍和感染。残疾程度的增加导致了反复住院、长期护理和/或死亡。方法学上的局限性包括使用非验证性的措施。
晚期癌症和/或呼吸系统疾病中 ADL 残疾的增加轨迹与潜在可改变的个人和环境因素有关。我们建议未来的研究使用验证后的残疾工具。
日常生活活动（ADL）中的残疾是晚期癌症或呼吸系统疾病中常见的未满足需求，也是患者、护理人员以及医疗和社会保健服务的重要结果。ADL 残疾轨迹可以分为逐渐增加、波动和不变的残疾，这有助于规划晚期癌症或呼吸系统疾病中的康复服务。晚期癌症或呼吸系统疾病中残疾程度的增加与个人和环境因素以及身体损伤有关，这些因素都可以通过干预来改变。本综述强调了在晚期癌症或呼吸系统疾病中 ADL 残疾测量的意义，并建议使用验证后的 ADL 测量工具来了解哪些因素可以通过康复干预来改变。
