入住认知和功能预测熟练护理康复后身体功能的变化。
Admission Cognition and Function Predict Change in Physical Function Following Skilled Nursing Rehabilitation.
机构信息
Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA; Department of Physical Therapy, University of Delaware, Newark, DE, USA.
Center for Care Delivery and Outcome Delivery Center for Care Delivery & Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
出版信息
J Am Med Dir Assoc. 2024 Jan;25(1):17-23. doi: 10.1016/j.jamda.2023.09.011. Epub 2023 Oct 17.
OBJECTIVES
Many older adults are discharged from skilled nursing facilities (SNFs) at functional levels below those needed for safe, independent home and community mobility. There is limited evidence explaining this insufficient recovery. The purpose of this secondary analysis was to determine predictors of physical function change following SNF rehabilitation.
DESIGN
Secondary analysis of a prospective observational cohort study.
SETTING AND PARTICIPANTS
Across 4 SNFs, data were collected from 698 adults admitted for physical rehabilitation following an acute hospitalization.
METHODS
Physical function recovery was evaluated as change from admission to discharge in Short Physical Performance Battery (SPPB) scores (N = 698) and gait speed (n = 444). Demographic and clinical characteristics collected at admission served as potential predictors of physical function change. Following imputation, a standardized model selection estimator was calculated for predictors per physical function outcome. Predictor estimates and 95% CIs were calculated for each outcome model.
RESULTS
Higher cognitive scores [standardized β (β) = 0.11, 95% CI: 0.0004, 0.20] and higher activities of daily living (ADL) independence at admission (β = 0.22, 95% CI: 0.05, 0.34) predicted greater SPPB change; higher SPPB scores at admission (β = -0.26, 95% CI: -0.35, -0.14) predicted smaller SPPB change. Higher ADL independence at admission (β = 0.17, 95% CI: 0.01, 0.37) predicted greater gait speed change; faster gait speed at admission (β = -0.30, 95% CI: -0.44, -0.15) predicted smaller gait speed change.
CONCLUSIONS AND IMPLICATIONS
Admission cognition, ADL independence, and physical function predicted physical function change following post-hospitalization rehabilitation. Inverse findings for admission physical function and ADL independence predictors suggest independence with ADL is not necessarily aligned with mobility-related function. Findings highlight that functional recovery is multifactorial and requires comprehensive assessment throughout SNF rehabilitation.
目的
许多老年人从熟练护理机构（SNF）出院时的功能水平低于安全、独立的家庭和社区活动能力所需的水平。目前还没有多少证据能够解释这种康复不足的原因。本二次分析的目的是确定 SNF 康复后身体功能变化的预测因素。
设计
前瞻性观察队列研究的二次分析。
地点和参与者
在 4 家 SNF 中，共收集了 698 名因急性住院后进行物理康复而入院的成年人的数据。
方法
身体功能恢复的评估标准是短期身体表现电池（SPPB）评分（n=698）和步态速度（n=444）从入院到出院的变化。入院时收集的人口统计学和临床特征被用作身体功能变化的潜在预测因素。在进行插补后，为每个身体功能结果计算了标准化模型选择估计器。为每个结果模型计算了预测因子估计值和 95%置信区间（CI）。
结果
较高的认知评分（标准化β=0.11，95%CI：0.0004，0.20）和入院时较高的日常生活活动（ADL）独立性（β=0.22，95%CI：0.05，0.34）预测 SPPB 变化较大；入院时较高的 SPPB 评分（β=-0.26，95%CI：-0.35，-0.14）预测 SPPB 变化较小。入院时较高的 ADL 独立性（β=0.17，95%CI：0.01，0.37）预测步态速度变化较大；入院时较快的步态速度（β=-0.30，95%CI：-0.44，-0.15）预测步态速度变化较小。
结论和意义
入院时的认知、ADL 独立性和身体功能预测了住院后康复后的身体功能变化。入院时身体功能和 ADL 独立性预测因素的相反发现表明，ADL 的独立性不一定与与移动能力相关的功能相一致。这些发现强调了功能恢复是多因素的，需要在整个 SNF 康复过程中进行全面评估。
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