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Factors and trade-offs with rehabilitation effectiveness and efficiency in newly disabled older persons

CHOW P; CHEN A; CHEONG JY; FONG NP; CHAN KM; TAN BY; MENON E; EE CH; LEE KK; KOH JL; KOH GC
ARCH PHYS MED REHABIL , 2014, vol. 95, n° 8, p. 1510-1520
Doc n°: 170179
Localisation : Documentation IRR

D.O.I. : http://dx.doi.org/DOI:10.1016/j.apmr.2014.03.020
Descripteurs : HE4 - EVALUATION DE LA REEDUCATION READAPTATION, MA - GERONTOLOGIE
Article consultable sur : http://www.archives-pmr.org

OBJECTIVE: To determine the factors for rehabilitation effectiveness (REs) and
rehabilitation efficiency (REy) among newly disabled older persons and if there
is any trade-off between REs and REy. DESIGN: Retrospective cohort study.
SETTING: Rehabilitation hospitals. PARTICIPANTS: Patients (N=8828) aged >/=65
years admitted for inpatient rehabilitation from 1996 to 2005. INTERVENTIONS: Not
applicable. MAIN OUTCOME MEASURES: Independent factors affecting REs and REy were
determined. The median rank ratios of REs to REy for each admission Barthel Index
(BI) unit and number of days of stay were generated. The ideal ranges of
admission BI score and length of stay (LOS) that corresponded to the REs to REy
median rank ratio of 1 (both REs and REy optimized) were identified. RESULTS:
Factors associated with poorer REs and REy were older age, Malay ethnicity,
delayed admission, admission diagnosis of amputation, and comorbidities of
dementia and stroke. An increase of 10 in admission BI score was associated with
an increase of 3.47% in REs but a decrease of 1.1 per 30 days in REy; and an
increase in LOS of 2.7 days was associated with an increase of 28% in REs but a
decrease of 5.2 per 30 days in REy. A trade-off relation between REs and REy with
respect to admission functional status and LOS was observed. The range, which
optimized both REs and REy, was 50 to 59 units for admission BI score and 37 to
46 days for LOS. CONCLUSIONS: There are trade-offs between REs and REy with
respect to admission functional status and LOS. Clinicians, policymakers,
patients, and other stakeholders should be aware of such trade-offs when they
make joint policy decisions about rehabilitation services.
CI - Copyright (c) 2014 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS

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