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Goonan R, Mohandoss E, Marston C, Kay J, De Silva AP, Maier AB, Reijnierse E, Klaic M. Is there a relationship between 'getting up and dressed' and functional and physical outcomes in geriatric rehabilitation inpatients? A quasi-experimental study. Clin Rehabil 2024; 38:119-129. [PMID: 37644886 DOI: 10.1177/02692155231197510] [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] [Indexed: 08/31/2023]
Abstract
OBJECTIVES To evaluate the physical and functional outcomes of the 'Ending Pyjama Paralysis' intervention in an inpatient geriatric rehabilitation unit. DESIGN Quasi-experimental mixed-methods design nested within the 'REStORing health of acutely unwell adulTs' (RESORT) prospective, observational, longitudinal cohort of geriatric rehabilitation inpatients study. SETTING Geriatric rehabilitation wards in a major metropolitan public hospital between June 2019 and March 2020. INTERVENTION The 'Ending Pyjama Paralysis' movement originated in the UK. Its aim was to encourage patients to 'Get up, Get dressed and Get moving' to reduce hospital-associated functional decline. However, the physical and functional benefits of this campaign have not yet been evaluated. The 'Ending Pyjama Paralysis' was adopted as an integrated intervention on two out of four geriatric rehabilitation wards. The two control wards received usual care. MAIN MEASURES Physical measures included the Short Physical Performance Battery, and functional measures included the Katz Index of Independence in Activities of Daily Living and Lawton and Brody's Instrumental Activities of Daily Living, which were completed on admission and discharge. A linear mixed-effects model was used to analyse the results. RESULTS A total of 833 admissions were included in this study. Of these, 512 patients were in the control group, and 321 were in the intervention group. There were no significant differences in both physical and functional measures between the intervention and control groups. CONCLUSION The 'Ending Pyjama Paralysis' campaign did not result in enhanced functional or physical benefits in geriatric rehabilitation inpatients in this setting when applied in addition to usual care.
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Affiliation(s)
- Rose Goonan
- Allied Health, The Royal Melbourne Hospital, Melbourne, Australia
| | - Edward Mohandoss
- Allied Health, The Royal Melbourne Hospital, Melbourne, Australia
| | - Celia Marston
- Allied Health, The Royal Melbourne Hospital, Melbourne, Australia
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Jaqueline Kay
- Allied Health, The Royal Melbourne Hospital, Melbourne, Australia
| | - Anurika Priyanjali De Silva
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- MISCH (Methods and Implementation Support for Clinical and Health research Hub), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Department of Internal Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore, Singapore
| | - Esmee Reijnierse
- Department of Rehabilitation Medicine, Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia
| | - Marlena Klaic
- Allied Health, The Royal Melbourne Hospital, Melbourne, Australia
- Melbourne School of Health Science, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
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Furuta H, Mizuno K, Unai K, Ebata H, Yamauchi K, Watanabe M. Transitions of Activities of Daily Living Status among Inpatients with Subacute Stroke: A Latent Class Approach. Prog Rehabil Med 2023; 8:20230039. [PMID: 37937214 PMCID: PMC10625998 DOI: 10.2490/prm.20230039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/18/2023] [Indexed: 11/09/2023] Open
Abstract
Objectives This study investigated the transition patterns of activities of daily living (ADL) status based on the Functional Independence Measure (FIM) motor and cognitive items in patients who experienced subacute stroke. Methods In this single-site, retrospective investigation, 1592 FIM samples were collected during the hospitalization of 373 stroke patients who were admitted between April 2018 and March 2020. FIM item levels were transformed from seven to three (FIM1-2, Complete Dependence; FIM3-5, Modified Dependence; FIM6-7, Independence). FIM samples were classified by latent class modeling into six latent ADL states based on the independence levels of FIM motor and cognitive items. We created an ADL status transition diagram based on the FIM sample's probability of belonging to each status at different hospitalization timepoints. Results Transition diagrams for each ADL status at admission revealed distinct patterns. In two ADL statuses for which patients required full assistance in FIM motor items, the patients remained motor-dependent without achieving independence on discharge. In contrast, patients in transition from the other four ADL statuses largely achieved independence in motor items by the time of discharge. The time required to reach higher ADL status varied according to the initial ADL status at admission; the slowest improvement was observed in statuses initially classified as needing the most assistance, whereas many patients achieved transition within 3 months from admission. Conclusions Based on the characteristics of patient ADL status and timing of its changes, the classification of ADL status and visualization of ADL transition can contribute to improved treatment.
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Affiliation(s)
- Hiroaki Furuta
- Department of Rehabilitation Therapy, Saiseikai
Higashikanagawa Rehabilitation Hospital, Yokohama, Japan
- Department of Rehabilitation Therapy, Saiseikai Kanagawaken
Hospital, Yokohama, Japan
| | - Katsuhiro Mizuno
- Department of Rehabilitation Medicine, Saiseikai
Higashikanagawa Rehabilitation Hospital, Yokohama, Japan
- Department of Rehabilitation Medicine, Keio University
School of Medicine, Tokyo, Japan
- Department of Rehabilitation Medicine, Tokai University
School of Medicine, Isehara, Japan
| | - Kei Unai
- Department of Rehabilitation Medicine, Keio University
School of Medicine, Tokyo, Japan
- Hatsudai Rehabilitation Hospital, Tokyo, Japan
| | - Hiroki Ebata
- Department of Rehabilitation Medicine, Saiseikai
Higashikanagawa Rehabilitation Hospital, Yokohama, Japan
- Department of Rehabilitation Medicine, Keio University
School of Medicine, Tokyo, Japan
| | - Keita Yamauchi
- Graduate School of Health Management, Keio University,
Fujisawa, Japan
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Tolley APL, Reijnierse EM, Maier AB. Characteristics of geriatric rehabilitation inpatients based on their frailty severity and change in frailty severity during admission: RESORT. Mech Ageing Dev 2022; 207:111712. [PMID: 35905797 DOI: 10.1016/j.mad.2022.111712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/28/2022] [Accepted: 07/23/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Frailty is prevalent amongst geriatric inpatients and worsens clinical outcomes. Determinants of admission frailty and changes in frailty severity are potential targets for intervention. OBJECTIVE To identify characteristics associated with frailty severity at admission and change in frailty severity during geriatric rehabilitation. METHODS The observational, prospective, longitudinal inception cohort REStORing health of acutely unwell adulTs (RESORT) includes geriatric rehabilitation inpatients. Demographic, medical, nutritional, functional, and psychological characteristics were analysed according to admission Clinical Frailty Scale. Linear and multinomial logistic regression prediction models identified admission characteristics predicting change in frailty severity during rehabilitation. RESULTS A total 1716 inpatients (median age [IQR] 83.4 [77.7-88.6] years, 56.4 % females) were included. Poorer admission medical, nutritional, functional, and psychological status was associated with more severe frailty. Cardiac admissions, higher Cumulative Illness Rating Scale, greater number of medications, and better Short Physical Performance Battery at admission predicted improved frailty severity. Admission cognitive impairment, delirium, higher Charlson Comorbidity Index, and Hospital Anxiety and Depression Scale anxiety predicted worsened frailty severity. Explained variation was low. CONCLUSIONS Frailer geriatric rehabilitation inpatients have more complicated disease and impaired nutritional, physical, and psychological markers. Admission cognitive impairment, delirium, comorbidity, and anxiety predict worsening frailty during rehabilitation, and require prompt management.
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Affiliation(s)
- Alec P L Tolley
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Esmee M Reijnierse
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia; Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia; Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands; Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore.
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Soh CH, Lim WK, Maier AB. Predictors for the Transitions of Poor Clinical Outcomes Among Geriatric Rehabilitation Inpatients. J Am Med Dir Assoc 2022; 23:1800-1806. [PMID: 35760091 DOI: 10.1016/j.jamda.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/09/2022] [Accepted: 05/22/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To investigate the associations of morbidity burden and frailty with the transitions between functional decline, institutionalization, and mortality. DESIGN REStORing health of acutely unwell adulTs (RESORT) is an ongoing observational, longitudinal inception cohort and commenced on October 15, 2017. Consented patients were followed for 3 months postdischarge. SETTING AND PARTICIPANTS Consecutive geriatric rehabilitation inpatients admitted to geriatric rehabilitation wards. METHODS Patients' morbidity burden was assessed at admission using the Charlson Comorbidity Index (CCI) and Cumulative Illness Rating Scale (CIRS). Frailty was assessed using the Clinical Frailty Scale (CFS) and modified Frailty Index based on laboratory tests (mFI-lab). A multistate model was applied at 4 time points: 2 weeks preadmission, admission, and discharge from geriatric rehabilitation and 3 months postdischarge, with the following outcomes: functional decline, institutionalization, and mortality. Cox proportional hazards regression was applied to investigate the associations of morbidity burden and frailty with the transitions between outcomes. RESULTS The 1890 included inpatients had a median age of 83.4 (77.6-88.4) years, and 56.3% were female. A higher CCI score was associated with a greater risk of transitions from preadmission and declined functional performance to mortality [hazard ratio (HR) 1.28, 95% CI 1.03-1.59; HR 1.32, 95% CI 1.04-1.67]. A higher CIRS score was associated with a higher risk of not recovering from functional decline (HR 0.80, 95% CI 0.69-0.93). A higher CFS score was associated with a greater risk of transitions from preadmission and declined functional performance to institutionalization (HR 1.28, 95% CI 1.10-1.49; HR 1.23, 95% CI 1.04-1.44) and mortality (HR 1.12, 95% CI 1.01-1.33; HR 1.11, 95% CI 1.003-1.31). The mFI-lab was not associated with any of the transitions. None of the morbidity measures or frailty assessment tools were associated with the transitions from institutionalization to other outcomes. CONCLUSIONS AND IMPLICATIONS This study demonstrates that greater frailty severity, assessed using the CFS, is a significant risk factor for poor clinical outcomes and demonstrates the importance of implementing it in the geriatric rehabilitation setting.
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Affiliation(s)
- Cheng Hwee Soh
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Wen Kwang Lim
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia; Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore.
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