急性住院康复可改善病情复杂患者的功能，且不受合并症影响。

Acute Inpatient Rehabilitation Improves Function Independent of Comorbidities in Medically Complex Patients.

作者信息

Zhang Shangming, Lin Dan, Wright Megan E, Swallow Nicole

机构信息

Department of Physical Medicine and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.

Department of Public Health Sciences, Penn State University College of Medicine, Hershey, Pennsylvania.

出版信息

Arch Rehabil Res Clin Transl. 2022 Jan 12;4(2):100178. doi: 10.1016/j.arrct.2022.100178. eCollection 2022 Jun.

DOI:10.1016/j.arrct.2022.100178

PMID:35756989

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9214302/

Abstract

OBJECTIVES

(1) To evaluate the benefits of acute inpatient rehabilitation for a medically complex patient population and (2) to assess the effect of comorbid conditions on rehabilitation outcomes.

DESIGN

Retrospective cohort study.

SETTING

Freestanding inpatient rehabilitation facility.

PARTICIPANTS

A total of 270 medically complex adult patients including those with cardiac, pulmonary, and orthopedic conditions, with mean age of 73.6 years; 52.6% were female and 47.4% were male (N=270).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Functional Independence Measure (FIM) gain, FIM efficiency, rehabilitation length of stay (RLOS), home discharge rate, and readmission to acute care (RTAC).

RESULTS

Among 270 medically complex patients, mean total FIM gain, mean RLOS, and mean FIM efficiency with SD were 26.0±13.6 points, 12.6±5.9 days, and 2.3±1.6, respectively. A total of 71.9% of patients were discharged to home, 12.2% for RTAC, and 15.9% to a skilled nursing facility (SNF). Hypertension (HTN) was the only comorbidity significantly associated with FIM gain (53.7% [total FIM gain ≥27] vs 67.2% [total FIM gain <27]; =.024) and FIM efficiency (53.3% [FIM efficiency ≥2.12] vs 67.4% [FIM efficiency <2.12]; .025), independent of age, body mass index, sex, race, ethnicity, insurance type, and Charlson Comorbidity Index. The 5 most common reasons for RTAC were cardiac, pulmonary, acute blood loss anemia, infection, and neurologic conditions.

CONCLUSIONS

Among 270 medically complex patients, 71.9% were discharged to home, 15.9% to an SNF, and 12.2% for RTAC with a mean RLOS 12.6 days, mean total FIM gain of 26 points, and mean FIM efficiency of 2.3, which were all better than those of all admissions at our facility in 2018. Furthermore, RLOS, total FIM gain and FIM efficiency in this study were all better than their corresponding eRehabData weighted national benchmarks (RLOS, 15.82 days; FIM gain, 25.57; FIM efficiency, 2.13) for a total of 202,520 discharges in 2018. These findings support acute inpatient rehabilitation for this patient population. With the exception of HTN, no medical comorbidities or demographic variables were associated with rehabilitation outcomes.

摘要

目的

（1）评估急性住院康复对病情复杂的患者群体的益处，以及（2）评估共病对康复结局的影响。

设计

回顾性队列研究。

地点

独立的住院康复机构。

参与者

总共270名病情复杂的成年患者，包括患有心脏、肺部和骨科疾病的患者，平均年龄为73.6岁；52.6%为女性，47.4%为男性（N = 270）。

干预措施

不适用。

主要结局指标

功能独立性测量（FIM）得分增加、FIM效率、康复住院时间（RLOS）、家庭出院率和再次入住急性护理（RTAC）。

结果

在270名病情复杂的患者中，平均FIM总得分增加、平均RLOS和平均FIM效率及标准差分别为26.0±13.6分、12.6±5.9天和2.3±1.6。共有71.9%的患者出院回家，12.2%再次入住急性护理，15.9%入住专业护理机构（SNF）。高血压（HTN）是唯一与FIM得分增加（53.7%[FIM总得分≥27]对67.2%[FIM总得分<27]；P = 0.024）和FIM效率（53.3%[FIM效率≥2.12]对67.4%[FIM效率<2.12]；P = 0.025）显著相关的共病，不受年龄、体重指数、性别、种族、民族、保险类型和查尔森共病指数的影响。RTAC的5个最常见原因是心脏、肺部、急性失血性贫血、感染和神经系统疾病。

结论

在270名病情复杂的患者中，71.9%出院回家，15.9%入住SNF，12.2%再次入住急性护理，平均RLOS为12.6天，平均FIM总得分增加26分，平均FIM效率为2.3，均优于我们机构2018年的所有入院患者。此外，本研究中的RLOS、FIM总得分增加和FIM效率均优于其相应的eRehabData加权全国基准（RLOS，15.82天；FIM得分增加，25.57；FIM效率，2.13），2018年共有202,520例出院。这些发现支持对该患者群体进行急性住院康复。除HTN外，没有医疗共病或人口统计学变量与康复结局相关。