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Changes in disability levels among older adults experiencing adverse events in postacute rehabilitation care: a prospective observational study.

Gacto-Sánchez M, Medina-Mirapeix F, Navarro-Pujalte E, Escolar-Reina P - Medicine (Baltimore) (2015)

Bottom Line: Regarding all 4 disability levels ("no limitation," "mild," "moderate," "severe," and "complete disability"), a total of 159 participants experienced an improvement at discharge (126 participants progressed 1 level, whereas 33 improved 2 disability levels), 56 made no change, and no participants experienced a decline.The odds of undergoing a change in any disability level between admission and discharge decreases by 68% (1-0.32) when patients experience fall-related events (odds ratio [OR] = 0.32, 95% confidence interval [CI] = 0.11-0.97, P = 0.041) and increases for individuals with musculoskeletal conditions (OR = 3.91, 95% CI = 1.34-11.38, P = 0.012).Further studies should evaluate disability over time after discharge to obtain a better sense of how transient or permanent the associated disability may be.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Physical Therapy (MGS), EUSES University School, University of Girona, Girona, Spain; Department of Physical Therapy (FMM, PER), University of Murcia, Murcia, Spain; and Department of Education (ENP), Region of Murcia, Murcia, Spain.

ABSTRACT
This study aimed to assess the relationship between adverse events (AEs) and changes in the levels of disability from admission to discharge during inpatient rehabilitation programs. A prospective cohort study was conducted among a cohort of inpatients (216 older adults) admitted to a rehabilitation unit. The occurrences of any AE were reported. The level of disability regarding mobility activities was estimated using the disability qualifiers from the International Classification of Functioning, Disability, and Health. Changes in the levels of disability between admission and discharge were assessed. Baseline-measured covariates were also selected. Regarding all 4 disability levels ("no limitation," "mild," "moderate," "severe," and "complete disability"), a total of 159 participants experienced an improvement at discharge (126 participants progressed 1 level, whereas 33 improved 2 disability levels), 56 made no change, and no participants experienced a decline. The occurrence of fall-related events and the diagnostic group (musculoskeletal system) are specific predictive factors of change in the level of disability. The odds of undergoing a change in any disability level between admission and discharge decreases by 68% (1-0.32) when patients experience fall-related events (odds ratio [OR] = 0.32, 95% confidence interval [CI] = 0.11-0.97, P = 0.041) and increases for individuals with musculoskeletal conditions (OR = 3.91, 95% CI = 1.34-11.38, P = 0.012). Our findings suggest that increased efforts to prevent the occurrence of these AEs, together with early interventions suited to the diagnosis of the affected system, may have a positive influence on the improvement of disability. Further studies should evaluate disability over time after discharge to obtain a better sense of how transient or permanent the associated disability may be.

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Proportion of the sample exhibiting patterns of change for the specified disability levels at admission.
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Figure 1: Proportion of the sample exhibiting patterns of change for the specified disability levels at admission.

Mentions: Figure 1 displays the change in disability levels for each level at admission. It illustrates the proportion of participants whose level did not change, those who improved 1 disability level (ie, from “severe” to “moderate,” for instance), and those who improved 2 levels (ie, from “severe” to “mild,” for example). Participants with mild and complete disability displayed a lower percentage of change. In contrast, participants with severe and moderate disability demonstrated a greater level of change, with a higher proportion of participants improving 1 level. Regarding all 4 disability levels, a total of 159 participants experienced an improvement pattern (126 participants progressed 1 level, while 33 improved 2 disability levels), 56 made no change, and no participants demonstrated a decline. Consequently, at discharge, 2 (0.9%) of the participants had complete disability, while severe disability was present in 25 participants (11.6%). A total of 106 participants (49.3%) had a moderate disability level, whereas 81 participants (37.7%) reported mild levels. One (0.4%) of the participants reported no disability.


Changes in disability levels among older adults experiencing adverse events in postacute rehabilitation care: a prospective observational study.

Gacto-Sánchez M, Medina-Mirapeix F, Navarro-Pujalte E, Escolar-Reina P - Medicine (Baltimore) (2015)

Proportion of the sample exhibiting patterns of change for the specified disability levels at admission.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554150&req=5

Figure 1: Proportion of the sample exhibiting patterns of change for the specified disability levels at admission.
Mentions: Figure 1 displays the change in disability levels for each level at admission. It illustrates the proportion of participants whose level did not change, those who improved 1 disability level (ie, from “severe” to “moderate,” for instance), and those who improved 2 levels (ie, from “severe” to “mild,” for example). Participants with mild and complete disability displayed a lower percentage of change. In contrast, participants with severe and moderate disability demonstrated a greater level of change, with a higher proportion of participants improving 1 level. Regarding all 4 disability levels, a total of 159 participants experienced an improvement pattern (126 participants progressed 1 level, while 33 improved 2 disability levels), 56 made no change, and no participants demonstrated a decline. Consequently, at discharge, 2 (0.9%) of the participants had complete disability, while severe disability was present in 25 participants (11.6%). A total of 106 participants (49.3%) had a moderate disability level, whereas 81 participants (37.7%) reported mild levels. One (0.4%) of the participants reported no disability.

Bottom Line: Regarding all 4 disability levels ("no limitation," "mild," "moderate," "severe," and "complete disability"), a total of 159 participants experienced an improvement at discharge (126 participants progressed 1 level, whereas 33 improved 2 disability levels), 56 made no change, and no participants experienced a decline.The odds of undergoing a change in any disability level between admission and discharge decreases by 68% (1-0.32) when patients experience fall-related events (odds ratio [OR] = 0.32, 95% confidence interval [CI] = 0.11-0.97, P = 0.041) and increases for individuals with musculoskeletal conditions (OR = 3.91, 95% CI = 1.34-11.38, P = 0.012).Further studies should evaluate disability over time after discharge to obtain a better sense of how transient or permanent the associated disability may be.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Physical Therapy (MGS), EUSES University School, University of Girona, Girona, Spain; Department of Physical Therapy (FMM, PER), University of Murcia, Murcia, Spain; and Department of Education (ENP), Region of Murcia, Murcia, Spain.

ABSTRACT
This study aimed to assess the relationship between adverse events (AEs) and changes in the levels of disability from admission to discharge during inpatient rehabilitation programs. A prospective cohort study was conducted among a cohort of inpatients (216 older adults) admitted to a rehabilitation unit. The occurrences of any AE were reported. The level of disability regarding mobility activities was estimated using the disability qualifiers from the International Classification of Functioning, Disability, and Health. Changes in the levels of disability between admission and discharge were assessed. Baseline-measured covariates were also selected. Regarding all 4 disability levels ("no limitation," "mild," "moderate," "severe," and "complete disability"), a total of 159 participants experienced an improvement at discharge (126 participants progressed 1 level, whereas 33 improved 2 disability levels), 56 made no change, and no participants experienced a decline. The occurrence of fall-related events and the diagnostic group (musculoskeletal system) are specific predictive factors of change in the level of disability. The odds of undergoing a change in any disability level between admission and discharge decreases by 68% (1-0.32) when patients experience fall-related events (odds ratio [OR] = 0.32, 95% confidence interval [CI] = 0.11-0.97, P = 0.041) and increases for individuals with musculoskeletal conditions (OR = 3.91, 95% CI = 1.34-11.38, P = 0.012). Our findings suggest that increased efforts to prevent the occurrence of these AEs, together with early interventions suited to the diagnosis of the affected system, may have a positive influence on the improvement of disability. Further studies should evaluate disability over time after discharge to obtain a better sense of how transient or permanent the associated disability may be.

Show MeSH