Department of Health Services, Policy and Practice, Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA.
Warren Alpert School of Medicine of Brown University, Providence, Rhode Island, USA.
PM R. 2022 Apr;14(4):417-427. doi: 10.1002/pmrj.12644. Epub 2021 Jun 28.
Older adults comprise an increasingly large proportion of patients with traumatic brain injury (TBI) receiving care in inpatient rehabilitation facilities (IRF). However, high rates of comorbidities and evidence of declining preinjury health among older adults who sustain TBI raise questions about their ability to benefit from IRF care.
To describe the proportion of older adults with TBI who exhibited minimal detectable change (MDC) and a minimally clinically important difference (MCID) in motor function from IRF admission to discharge; and to identify characteristics associated with clinically meaningful improvement in motor function and better discharge functional status.
This retrospective cohort study used Medicare administrative data probabilistically linked to the National Trauma Data Bank to estimate the proportion of patients whose motor function improved during inpatient rehabilitation and identify factors associated with meaningful improvement in motor function and motor function at discharge.
Inpatient rehabilitation facilities in the United States.
Fee-for-service Medicare beneficiaries with TBI.
Minimal Detectable Change (MDC) and Minimally Clinically Important Difference (MCID) in the Functional Independence Measure motor (FIM-M) score from admission to discharge, and FIM-M score at IRF discharge.
From IRF admission to discharge 84% of patients achieved the MDC threshold, and 68% of patients achieved the MCID threshold for FIM-M scores. Factors associated with a higher probability of achieving the MCID for FIM-M scores included better admission motor and cognitive function, lower comorbidity burden, and a length of stay longer than 10 days but only among individuals with lower admission motor function. Older age was associated with a lower FIM-M discharge score, but not the probability of achieving the MCID in FIM-M score.
Older adults with TBI have the potential to improve their motor function with IRF care. Baseline functional status and comorbidity burden, rather than acute injury severity, should be used to guide care planning.
在接受住院康复治疗的创伤性脑损伤（TBI）患者中，老年人所占比例越来越大。然而，老年人在发生 TBI 后常患有多种合并症，且伤前健康状况呈下降趋势，这引起了人们对他们能否从住院康复治疗中获益的质疑。
描述 TBI 老年人在从住院康复治疗入院到出院期间运动功能表现出最小可检测变化（MDC）和最小临床重要差异（MCID）的比例；并确定与运动功能有临床意义改善和更好出院功能状态相关的特征。
本回顾性队列研究使用医疗保险管理数据与国家创伤数据银行进行概率链接，以估计患者在住院康复期间运动功能改善的比例，并确定与运动功能有意义改善和出院时运动功能相关的因素。
美国的住院康复治疗机构。
接受 TBI 治疗的医疗保险付费受益人。
从入院到出院期间功能独立性测量运动（FIM-M）评分的 MDC 和 MCID，以及在住院康复治疗机构出院时的 FIM-M 评分。
从住院康复治疗入院到出院，84%的患者达到了 FIM-M 评分的 MDC 阈值，68%的患者达到了 MCID 阈值。与更有可能达到 FIM-M 评分 MCID 相关的因素包括入院时更好的运动和认知功能、更低的合并症负担，以及住院时间超过 10 天，但仅在入院运动功能较低的个体中。年龄较大与出院时的 FIM-M 评分较低相关，但与 FIM-M 评分达到 MCID 的可能性无关。
TBI 老年人有通过住院康复治疗改善其运动功能的潜力。应根据基线功能状态和合并症负担，而不是急性损伤严重程度来指导治疗计划。
