Factors associated with change in activities of daily living performance in home health care patients with diabetes.
Katelyn E Webster-Dekker, Yvonne Lu, Susan M Perkins and 5 others
PMID 39153463WHAT IT FOUND
Home health patients with diabetes improved ADL performance, and only 3% did not improve.
Black patients and those with bowel incontinence or ostomy improved less, while surgical wounds, pain, confusion, better prior function, and caregiver training needs were linked to greater improvement.
Key findings
01The mean ADL change score was 3.8, indicating improvement, and only 3% of patients (n=41) did not improve.
02Black or African American race was associated with less ADL improvement than White race.
03Surgical wound, pain interfering with activity, confusion, better prior functioning, and caregiver need for training/support were associated with greater ADL improvement, while bowel incontinence or ostomy was associated with less improvement.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for RNs
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What it does not show
The records came from one home health agency in Alabama, Florida, and Mississippi, so results may not apply outside the Southern United States. This was a retrospective secondary analysis of existing records, so it cannot show that any factor caused better or worse ADL improvement. The OASIS-D data did not include full information on insurance, comorbidities, or diabetes-specific variables such as neuropathy. The authors could not examine many other possible contributors, including socioeconomic disadvantage, urban versus rural residence, social engagement, health behaviors, and adherence to home health interventions. A clinically meaningful change has not been established for the composite ADL score, so the size of the mean change is hard to interpret. The model explained a relatively small amount of the variation in ADL improvement. Confusion and shortness of breath changed significance when influential outliers were removed, so these associations are not stable. Patients who already had the maximum ADL score at start of care or who were transferred to an inpatient facility were excluded, which limits the range of patients represented.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that any factor caused better or worse ADL improvement. This was an observational secondary analysis of home health records, not a tested intervention, and the authors could not examine many possible contributors, including social, economic, and behavioral factors.