Background: Mobility in older adults can be impaired after acute illness or
hospitalization, and the level of severity can be used as a predictor of one’s
ability to return to independent living. Patients are often referred to skilled
nursing facilities in hopes of improving their mobility. We wanted to prove
that rehabilitative services at Skilled Nursing Facilities improve overall
outcomes. Methods: We conducted a retrospective analysis of data from
4612 patients admitted for short-term rehabilitation in a large nursing home
chain in California. Our aim was to determine whether patients’ mobility
scores, as measured by rehabilitative staff, significantly improved by time of
discharge compared to their scores at admission. Mobility scores were rated
from 1 to 6, with 1 being the most dependent on aid and 6 being the most
independent, over a variety of tasks at admission and compared to scores at
discharge. Pearson’s correlations were performed to determine if there were
significant relationships in the data: the Pearson’s correlation coefficient
was used to describe the relationships between patient admission to a skilled
nursing facility and medical improvement upon discharge. Results: The
study demonstrated a statistically significant improvement in patients’
mobility scores upon discharge, with Medicare insured patients showing on
average 57% improvement and Managed Care insured patients showing on average
59% improvement. Additionally, admission scores appeared to be predictive of
the patient’s outcome at discharge. Conclusions: The values and consistency
of improvement support the use of acute rehabilitative services in skilled
nursing facilities. An equation can be formulated that evaluates patients’
estimated mobility statuses upon discharge from facilities based on their
conditions on their arrivals. With this, new interventions can be studied and
compared to the current standard of care by using these measurements. They can
determine if further improvements can be made to increase patient outcomes.
References
[1]
Prusynski, R.A., Gustavson, A.M., Shrivastav, S.R. and Mroz, T.M. (2021) Rehabilitation Intensity and Patient Outcomes in Skilled Nursing Facilities in the United States: A Systematic Review. Physical Therapy, 101, pzaa230.
https://doi.org/10.1093/ptj/pzaa230
[2]
Lenze, E.J., Lenard, E., Bland, M., et al. (2019) Effect of Enhanced Medical Rehabilitation on Functional Recovery in Older Adults Receiving Skilled Nursing Care after Acute Rehabilitation: A Randomized Clinical Trial. JAMA Network Open, 2, e198199. https://doi.org/10.1001/jamanetworkopen.2019.8199
[3]
Verweij, L., van de Korput, E., Daams, J.G., et al. (2019) Effects of Postacute Multidisciplinary Rehabilitation Including Exercise in Out-of-Hospital Settings in the Aged: Systematic Review and Meta-Analysis. Archives of Physical Medicine and Rehabilitation, 100, 530-550. https://doi.org/10.1016/j.apmr.2018.05.010
[4]
Casertano, L.O., Bassile, C.C., Pfeffer J.S., et al. (2022) Utility of the AM-PAC “6 Clicks” Basic Mobility and Daily Activity Short Forms to Determine Discharge Destination in an Acute Stroke Population. The American Journal of Occupational Therapy, 76, No. 4. https://doi.org/10.5014/ajot.2022.047381
[5]
Arling, G., Williams, A.R. and Kopp, D. (2000) Therapy Use and Discharge Outcomes for Elderly Nursing Home Residents. The Gerontologist, 40, 587-595.
https://doi.org/10.1093/geront/40.5.587
[6]
Murray, P., Singer, M., Dawson, N.V., Thomas, C.L. and Cebul, RL. (2003) Outcomes of Rehabilitation Services for Nursing Home Residents. Archives of Physical Medicine and Rehabilitation, 84, 1129-1136.
https://doi.org/10.1016/S0003-9993(03)00149-7
[7]
Downer, B., Reistetter, T.A., Kuo, Y.F., Li, S., Karmarkar, A., Hong, I., Goodwin, J.S. and Ottenbacher, K.J. (2021) Relationship between Nursing Home Compare Improvement in Function Quality Measure and Physical Recovery after Hip Replacement. Archives of Physical Medicine and Rehabilitation, 102, 1717-1728.e7.
https://doi.org/10.1016/j.apmr.2021.03.012
[8]
Flanagan, J. and Boltz, M. (2023) Postacute Rehabilitation in Patients with and without Dementia. Annals of Long-Term Care.
Kucienski, J.E. (2017) Improving Mobility for Older Adults in the Acute Rehabilitation Setting. PhD Thesis, University of Massachusetts Amherst, Amherst, 1-35.
[11]
Kerber, K.A., Skolarus, L.E., Feng, C. and Burke, J.F. (2020) Validation of Medicare Rehabilitation Functional Assessments in Routine Care. JAMA Network Open, 3, e204702. https://doi.org/10.1001/jamanetworkopen.2020.4702
[12]
Mindrila, D. and Balentyne, P. (2017) Scatterplots and Correlation.
https://www.westga.edu/academics/research/vrc/assets/docs/scatterplots_and_correlation_notes.pdf
[13]
van Dartel, D., Vermeer, M., Folbert, E.C., et al. (2021) Early Predictors for Discharge to Geriatric Rehabilitation after Hip Fracture Treatment of Older Patients. Journal of the American Medical Directors Association, 22, 2454-2460.
https://doi.org/10.1016/j.jamda.2021.03.026