Patient-Reported Outcomes in Functioning Following Nursing Home or Inpatient Rehabilitation.
Adam Simning, Thomas V Caprio, Christopher L Seplaki and 3 others
PMID 30056009WHAT IT FOUND
Among older Medicare beneficiaries who reported nursing home or inpatient rehabilitation, 33.4% said their functioning did not improve.
Lower education, difficulty with complex daily tasks, less than 1 month of total rehab, and no outpatient rehab were linked to reporting no improvement.
Key findings
0133.4% weighted percent reported no improvement in functioning during rehabilitation treatment.
02Compared with college graduates, Medicare beneficiaries with a high school education or less had greater odds of reporting no improvement (odds ratio 2.17, 95% confidence interval 1.08 to 4.36).
03IADL impairment, primary condition other musculoskeletal or cardiovascular, total rehabilitation under 1 month, and not receiving outpatient rehabilitation were associated with reporting no improvement.
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 sample was relatively small: 479 participants overall and 443 in the adjusted analysis, so it may miss differences. The outcome was patient-reported change in functioning, not an objective test, and the paper does not say how it relates to clinical assessments. Nursing home, hospital-based, and rehabilitation facility settings were grouped together, so results cannot be applied separately to each setting. Many variables were self- or proxy-reported, and medical conditions may be under-reported. Duration of rehabilitation may be partly caused by patients improving, so associations with short duration are not proof that short rehabilitation caused no improvement. The study could not examine dose, severity of dysfunction, goals met, or facility characteristics.
Declared interests
The authors declare that they have no conflict of interests. The supplied article metadata lists NIH extramural research support, but the text does not name a specific funder.
The easy way to misread this
Do not read these associations as proof that longer rehabilitation or outpatient services cause better function. The study is observational, used patient-reported improvement rather than objective testing, and could not separate patient characteristics, setting, and service delivery.