Comparing Comorbidity Indices to Predict Post-Acute Rehabilitation Outcomes in Older Adults.
Amit Kumar, James E Graham, Linda Resnik and 4 others
PMID 27149597WHAT IT FOUND
Five standard comorbidity indices added almost no predictive value for discharge function or community return in older rehab patients.
Admission functional status and demographics explained most variance, suggesting clinicians should prioritize current ability over diagnosis lists.
Key findings
01Adding comorbidity indices to base models explained only 0.1% to 3.3% of additional variance in discharge self-care, mobility, and cognition scores.
02Comorbidity indices did not improve the ability to predict whether patients were discharged to the community versus an institution.
03The Functional Comorbidity Index, which was hypothesized to be the strongest predictor, did not outperform other indices in predicting rehabilitation outcomes.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study only included patients with stroke, lower extremity fracture, or lower extremity joint replacement, so findings may not apply to other rehabilitation populations. The analysis used administrative Medicare data, which is subject to coding and reporting errors. The study did not use weighted composite scores for the comorbidity indices, instead treating each condition as a separate indicator, which may not reflect the clinical severity of specific conditions.
Declared interests
The study was supported by the U.S. Government and the National Institutes of Health (Extramural). No commercial funding or author conflicts of interest were reported in the provided text.
The easy way to misread this
Do not conclude that comorbidities are irrelevant to rehabilitation outcomes. The study shows that standard administrative indices do not predict outcomes well in this specific analysis, not that a patient's medical complexity has no impact on their recovery or discharge.