Predictors of Functional Change in a Skilled Nursing Facility Population.
Allison M Gustavson, Jason R Falvey, Jeri E Forster and 1 others
PMID 28650398WHAT IT FOUND
No measured factor predicted lower-extremity function change, severe disability at discharge, or slow walking at discharge in 140 skilled nursing facility patients. 87% improved meaningfully, but 69% had severe disability, and higher depression scores tracked with smaller gait-speed gains.
Key findings
01No measured factor met the a priori criterion for inclusion in final models of change in SPPB, severe disability at discharge, or slow gait speed at discharge.
02For change in gait speed, only PHQ-9 was included in the final model; each one-point increase in PHQ-9 was associated with a 0.02 decrease in gait speed change.
03Average SPPB rose from 2.5 to 5.4 points and gait speed from 0.4 to 0.6 m/s, but 69% still had SPPB scores indicative of severe disability and 57% still had slow gait speed at discharge.
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
This was one skilled nursing facility with 140 analysed patients, so the results may not generalise. Only patients who received physical therapy were included. No predictor met the a priori criterion for final models of change in SPPB, severe disability, or slow gait speed, so the study did not identify actionable predictors for those outcomes. The gait-speed model had an adjusted R2 of 0.19, meaning it captured little of the variation in change. The study used electronic records and had missing data due to inconsistent clinical recording. It did not collect complications such as infection or abnormal laboratory values that may have affected function. It did not know which patients were being actively treated for depression. It did not know function before hospital admission, which may have shaped the evaluation score. It had no follow-up after the skilled nursing facility stay. The results and discussion report different discharge disability percentages: 69% and 57% in the results, but 72% and 64% in the discussion.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that treating depression will improve gait speed. This was an observational study in one skilled nursing facility, and no measured factor met criteria for change in SPPB, severe disability, or slow gait speed.