Analyzing Change in Recovery Patterns in the Year After Acute Hospitalization
Presented as a poster to the American Congress of Rehabilitation Medicine and American Society of Neurorehabilitation, September 28–October 1, 2006, Boston, MA.
Abstract
Prvu Bettger JA, Coster WJ, Latham NK, Keysor JJ. Analyzing change in recovery patterns in the year after acute hospitalization.
Objective
To examine trajectories of recovery and change in patterns of personal care and instrumental functional activity performance to determine whether different assessment interval designs within a 12-month period yield different estimates of improvement and decline after acute hospitalization and inpatient rehabilitation.
Design
Secondary analysis of a 12-month prospective cohort study.
Setting
Transition to the community.
Participants
Adults (N=419) admitted to acute care and receiving inpatient rehabilitation for a neurologic, lower-extremity musculoskeletal, or medically complex condition.
Interventions
Not applicable.
Main Outcome Measures
Improvement, no change, and decline as measured by the personal care and instrumental scale of the Activity Measure for Post-Acute Care.
Results
Assessment at the end of a single 12-month follow-up assessment interval showed that over 60% of the participants improved. In contrast, analysis of 2 fixed-length 6-month assessment intervals revealed an almost 40% decrease in the proportion who improved from 6 to 12 months. Fewer participants continued to improve in the time periods further from the acute hospitalization and the proportion of subjects who declined increased from 21.4% to 31.2% to 38.0% over the 3 consecutive assessment intervals (baseline to 1mo, 1−6mo, 6−12mo). Only 58 (19.7%) participants continued on the same path of recovery from baseline to 12 months (9.8% improved over all 3 consecutive time periods, 3.1% made no change, 6.8% declined).
Conclusions
Examination of change over shorter compared with longer assessment intervals revealed considerable variability in the trajectories of recovery. Research is needed to determine the appropriate frequency and timing for measuring and monitoring function and recovery after an acute hospitalization.
aDepartment of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA
bDepartment of Occupational Therapy and Rehabilitation Counseling, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA
cDepartment of Physical Therapy and Athletic Training, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA
dHealth and Disability Institute, Boston University, Boston, MA.
Reprint requests to Janet A. Prvu Bettger, ScD, TRS, 3615 Chestnut St, #334, Philadelphia, PA 19104-2676
Supported in part by the National Institute of Child Health and Human Development, National Center for Medical Rehabilitation Research (post-doctoral fellowship no. T32-HD-007425), and the National Institute of Disability and Rehabilitation Research, U.S. Department of Education (grant no. H133B990005).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
ABSTRACT