1
|
Hara R, Todayama N, Tabata T, Mukai T, Hatanaka Y, Watanabe M, Kuwazawa M, Hironaka S, Kawate N, Furuya J. Association between oral health status and functional independence measure on admission in convalescent hospitalized patients. BMC Oral Health 2024; 24:63. [PMID: 38195416 PMCID: PMC10777547 DOI: 10.1186/s12903-023-03667-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/14/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Oral health management has become increasingly important for acute inpatients. Older patients often require extended periods of medical care, and oral health management is necessary in the convalescent period following the acute period. During the convalescent period, oral health management remains unclear as convalescent hospitals have limited dental resources, and effective dental care must be provided if the objective of hospitalization is to improve life functions. This study aimed to clarify the relationship between daily functioning and oral health status at the time of admission to a convalescent hospital to aid in improving daily functioning in the convalescent period. METHODS We included patients admitted to the rehabilitation department of a specific convalescent hospital from January to December 2021. A total of 375 patients were included in the study, with complete data records. At admission, we gathered information from the medical records, including the patient's age, sex, primary disease, Charlson Comorbidity Index, Mini Nutritional Assessment Short-Form (MNA-SF), Functional Oral Intake Scale (FOIS), Functional Independence Measure (FIM), number of teeth, and Oral Health Assessment Tool (OHAT). Statistical analysis was conducted using SPSS Ver. 27, with a significance level of 5%. RESULTS The mean age of the 375 participants (189 men and 186 women) was 75.0 ± 12.1 years (range, 42-97 years), and over 80% were > 65 years. About 30% of major diseases could be attributed to strokes and fractures, followed by spinal cord and spine diseases. In non-stroke patients, multiple regression analysis using FIM motor, FIM cognitive, and FIM and OHAT total scores as objective variables showed that higher total scores of MNA-SF, FOIS, and lower modified Rankin Scale and OHAT were significantly associated with better FIMs. Lower OHAT scores were significantly associated with lower FOIS and MNA-SF scores, male sex, having fewer teeth, and poor dietary patterns. CONCLUSIONS The convalescent period is an opportune time to provide intensive dental care due to the generally stable condition and extended hospital stay. Our results suggest that oral health management, such as dysphagia rehabilitation and denture treatment, is important for maintaining and improving independence, a key objective of convalescent rehabilitation, and malnutrition improvement.
Collapse
Affiliation(s)
- Ryuzo Hara
- Department of Oral Function Management, Graduate School of Dentistry, Showa University, Ota, Tokyo, Japan
| | - Naoki Todayama
- Department of Oral Function Management, Graduate School of Dentistry, Showa University, Ota, Tokyo, Japan
| | - Tomohiro Tabata
- Department of Oral Function Management, Graduate School of Dentistry, Showa University, Ota, Tokyo, Japan
| | - Tomoko Mukai
- Division of Oral Function Management, Department of Oral Health Management, School of Dentistry, Showa University, Ota, Tokyo, Japan
| | - Yukiko Hatanaka
- Division of Oral Function Management, Department of Oral Health Management, School of Dentistry, Showa University, Ota, Tokyo, Japan
| | - Masataka Watanabe
- Division of Oral Function Management, Department of Oral Health Management, School of Dentistry, Showa University, Ota, Tokyo, Japan
| | - Miki Kuwazawa
- Division of Oral Function Management, Department of Oral Health Management, School of Dentistry, Showa University, Ota, Tokyo, Japan
- Fujigaoka Hospital Hospitaly Dentistry, Yokohama, Kanagawa, Japan
| | - Shouji Hironaka
- Department of Hygiene and Oral Health, School of Dentistry, Showa University, Shinagawa, Tokyo, Japan
| | - Nobuyuki Kawate
- Department of Rehabilitation Medicine, School of Medicine, Showa University, Shinagawa, Tokyo, Japan
| | - Junichi Furuya
- Department of Oral Function Management, Graduate School of Dentistry, Showa University, Ota, Tokyo, Japan.
- Division of Oral Function Management, Department of Oral Health Management, School of Dentistry, Showa University, Ota, Tokyo, Japan.
| |
Collapse
|
2
|
Pommerich UM, Stubbs PW, Eggertsen PP, Fabricius J, Nielsen JF. Regression-based prognostic models for functional independence after postacute brain injury rehabilitation are not transportable: a systematic review. J Clin Epidemiol 2023; 156:53-65. [PMID: 36764467 DOI: 10.1016/j.jclinepi.2023.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND AND OBJECTIVES To identify and summarize validated multivariable prognostic models for the Functional Independence Measure® (FIM®) at discharge from post-acute inpatient rehabilitation in adults with acquired brain injury (ABI). METHODS This review was conducted based on the recommendations of the Cochrane Prognosis Methods Group and adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases were systematically searched in May 2021 and updated in April 2022. Main inclusion criteria were: a) adult patients with ABI, b) validated multivariable prognostic model, c) time of prognostication within 1-week of admission to post-acute rehabilitation, and d) outcome was the FIM® at discharge from post-acute rehabilitation. RESULTS The search yielded 3,169 unique articles. Three articles fulfilled the inclusion criteria, accounting for n = 6 internally and n = 2 externally validated prognostic models. Discrimination was estimated as an area under the curve between 0.76 and 0.89. Calibration was deemed to be assessed insufficiently. The included models were judged to be of high risk of bias. CONCLUSION Current prognostic models for the FIM® in post-acute rehabilitation for patients with ABI lack the methodological rigor to support clinical use outside the development setting. Future studies addressing functional independence should ensure appropriate model validation and conform to uniform reporting standards for prognosis research.
Collapse
Affiliation(s)
- Uwe M Pommerich
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark.
| | - Peter W Stubbs
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Ultimo 2007, Australia
| | - Peter Preben Eggertsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark
| | - Jesper Fabricius
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark
| | - Jørgen Feldbæk Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark
| |
Collapse
|
3
|
Shogenji M, Yoshida M, Sumiya K, Shimada T, Ikenaga Y, Ogawa Y, Hirako K, Sai Y. Relationship between Bowel/Bladder Function and Discharge in Older Stroke Patients in Convalescent Rehabilitation Wards: A Retrospective Cohort Study. Prog Rehabil Med 2022; 7:20220028. [PMID: 35663118 PMCID: PMC9126742 DOI: 10.2490/prm.20220028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/10/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives : Many stroke patients experience motor and cognitive dysfunctions that make living at home challenging. We aimed to identify the factors associated with hospital discharge to home in older stroke patients in convalescent rehabilitation wards where intensive and comprehensive inpatient rehabilitation are performed following acute-phase treatment. Methods : A retrospective cohort study was conducted among 1227 older stroke patients registered in the database of the Council of Kaga Local Stroke Network, Japan, between 2015 and 2019. Patients’ basic characteristics, discharge destination, type and severity of stroke, cognitive status, and activities of daily living (ADL) including continence were evaluated. Results : The proportion of subjects discharged to home was 62.3%. The mean hospital stay in the home discharge group was shorter than that in the non-home discharge group (111 days vs. 144.6 days, P <0.001). The following factors were associated with discharge to home: age (adjusted odds ratio [AOR]: 2.801, 95% confidence interval [CI] [1.473, 2.940]; P <0.001), sex (AOR: 1.513, 95% CI [1.112, 2.059]), stroke type (AOR: 1.426, 95% CI [1.013, 2.007]), low cognitive status (AOR: 3.750, 95% CI [2.615, 5.379]), low level of bladder control (AOR: 2.056, 95% CI [1.223, 3.454]), and low level of bowel control (AOR: 2.823, 95% CI [1.688, 4.722]). Conclusions : Age, sex, stroke type, cognitive function, and ADL scores for bladder and bowel control were associated with discharge to home. Improving continence management regarding both voiding and defecation may be a promising care strategy to promote hospital discharge to home in older stroke patients.
Collapse
Affiliation(s)
- Miho Shogenji
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Mikako Yoshida
- Department of Women’s Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Koyomi Sumiya
- Department of Clinical Pharmacokinetics, Graduate School of Medical Sciences, Kanazawa University, Ishikawa, Japan
| | - Tsutomu Shimada
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, Ishikawa, Japan
| | - Yasunori Ikenaga
- Department of Rehabilitation Medicine, Yawata Medical Center, Ishikawa, Japan
| | - Yoru Ogawa
- Department of Pharmacy, Komatsu Municipal Hospital, Ishikawa, Japan
| | - Kohei Hirako
- Frontier Science and Social Co-creation Initiative, Kanazawa University, Ishikawa, Japan
| | - Yoshimichi Sai
- Department of Hospital Pharmacy, University Hospital, Kanazawa University, Ishikawa, Japan
| |
Collapse
|
4
|
Cormier DJ, Frantz MA, Rand E, Stein J. Physiatrist referral preferences for postacute stroke rehabilitation. Medicine (Baltimore) 2016; 95:e4356. [PMID: 27537563 PMCID: PMC5370790 DOI: 10.1097/md.0000000000004356] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/13/2016] [Accepted: 07/03/2016] [Indexed: 11/26/2022] Open
Abstract
This study was intended to determine if there is variation among physiatrists in referral preferences for postacute rehabilitation for stroke patients based on physician demographic characteristics or geography.A cross-sectional survey study was developed with 5 fictional case vignettes that included information about medical, social, and functional domains. Eighty-six physiatrist residents, fellows, and attendings were asked to select the most appropriate postacute rehabilitation setting and also to rank, by importance, 15 factors influencing the referral decision. Chi-square bivariate analysis was used to analyze the data.Eighty-six surveys were collected over a 3-day period. Bivariate analysis (using chi-square) showed no statistically significant relationship between any of the demographic variables and poststroke rehabilitation preference for any of the cases. The prognosis for functional outcome and quality of postacute facility had the highest mean influence ratings (8.63 and 8.31, respectively), whereas location of postacute facility and insurance had the lowest mean influence ratings (5.74 and 5.76, respectively).Physiatrists' referral preferences did not vary with any identified practitioner variables or geographic region; referral preferences only varied significantly by case.
Collapse
Affiliation(s)
- David J. Cormier
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons
- Division of Rehabilitation Medicine, Weill Cornell Medical College
- New York-Presbyterian Hospital, New York, NY
| | - Megan A. Frantz
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons
- Division of Rehabilitation Medicine, Weill Cornell Medical College
- New York-Presbyterian Hospital, New York, NY
| | - Ethan Rand
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons
- Division of Rehabilitation Medicine, Weill Cornell Medical College
- New York-Presbyterian Hospital, New York, NY
| | - Joel Stein
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons
- Division of Rehabilitation Medicine, Weill Cornell Medical College
- New York-Presbyterian Hospital, New York, NY
| |
Collapse
|