The association of patient-reported improvement and rehabilitation characteristics with mortality.
Adam Simning, Thomas V Caprio, Sarah L Szanton and 2 others
PMID 31296405WHAT IT FOUND
Older adults who reported their function got worse during rehabilitation had significantly higher odds of dying within a year compared to those who improved.
This risk persisted even after accounting for age, sex, and health conditions, suggesting patient-reported outcomes can help identify high-risk patients.
Key findings
01Patients reporting worsening function had higher mortality odds than those reporting improvement, even after adjusting for demographics and health status.
02Rehabilitation setting was associated with mortality in unadjusted analyses but not in fully adjusted models.
03Male sex, living alone, ADL impairment, and cardiovascular conditions were associated with increased mortality odds in the fully adjusted model.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for RNs
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What it does not show
The study relies on self-report for rehabilitation receipt and functional status, which is subject to recall bias. The sample size for the multivariable analyses was relatively small (n=1,188), limiting the ability to examine subgroups. The study could not determine the timing of rehabilitation relative to death, so it is unclear if the reported worsening function preceded the death or was concurrent with terminal decline. Proxy respondents were used for some participants, which may affect the accuracy of patient-reported outcomes. The study did not capture the specific type or intensity of rehabilitation provided.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not interpret the high odds ratio for worsening function as a direct causal link where therapy failure causes death. The wide confidence intervals and observational nature suggest this is a marker of poor prognosis rather than a proven mechanism, and it does not account for the specific clinical reasons why those patients did not improve.