Dataset Information

Relationship of Age And Mobility Levels During Physical Rehabilitation With Clinical Outcomes in Critical Illness.

ABSTRACT:

Objective

To determine whether age, mobility level, and change in mobility level across the first 3 physical rehabilitation sessions associate with clinical outcomes of patients who are critically ill.

Design

Retrospective, observational cohort study.

Setting

Medical Intensive Care Unit (MICU).

Participants

Hospitalized adults (n = 132) who received 3 or more, consecutive rehabilitation sessions in the MICU.

Interventions

Not applicable.

Measurements and main results

Sample included 132 patients with 60 (45%) classified as younger (18-59 years) and 72 (55%) as older (60+ years). The most common diagnosis was sepsis/septicemia (32.6%). Older relative to younger patients had a significantly slower rate of improvement in ICU Mobility Scale (IMS) scores across rehabilitation sessions (mean slope coefficient 0.3 vs 0.6 points, P<.001), were less likely to be discharged to home (30.6% vs 55.0%, P=.005), and were more likely to die within 12 months (41.7% vs 25.0%, P=.046). Covariate-adjusted models indicated greater early improvement in IMS scores were associated with discharge home (P=.005). Longer time to first rehabilitation session, lower initial IMS scores, and slower improvement in IMS scores were associated with increased ICU days (all P<.03).

Conclusion

Older age and not achieving the mobility milestone of sitting at edge of bed or limited progression of mobility across sessions is associated with poor patient outcomes. Our findings suggest that age and mobility level contribute to outcome prognostication, and can aide in clinical phenotyping and rehabilitative service allocation.

SUBMITTER: Mayer KP

PROVIDER: S-EPMC10757188 | biostudies-literature | 2023 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Relationship of Age And Mobility Levels During Physical Rehabilitation With Clinical Outcomes in Critical Illness.

Mayer Kirby P KP Silva Susan S Beaty Amanda A Davenport Anne A Minniti Melissa M Dorn Sara Uribe SU White Lane S LS Sabol Valerie K VK Pastva Amy M AM

Archives of rehabilitation research and clinical translation 20231010 4

<h4>Objective</h4>To determine whether age, mobility level, and change in mobility level across the first 3 physical rehabilitation sessions associate with clinical outcomes of patients who are critically ill.<h4>Design</h4>Retrospective, observational cohort study.<h4>Setting</h4>Medical Intensive Care Unit (MICU).<h4>Participants</h4>Hospitalized adults (n = 132) who received 3 or more, consecutive rehabilitation sessions in the MICU.<h4>Interventions</h4>Not applicable.<h4>Measurements and ma ...[more]

PMID: 38163032

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Project description:ObjectivesMedicare beneficiaries recovering from a critical illness are increasingly being discharged home instead of to post-acute care facilities. Rehabilitation services are commonly recommended for intensive care unit (ICU) survivors; however, little is known about the frequency and dose of home-based rehabilitation in this population.DesignRetrospective analysis of 2012 Medicare hospital and home health (HH) claims data, linked with assessment data from the Medicare Outcomes and Assessment Information Set.SettingParticipant homes.ParticipantsMedicare beneficiaries recovering from an ICU stay longer than 24 hours, who were discharged directly home with HH services within 7 days of discharge and survived without readmission or hospice transfer for at least 30 days (n = 3,176).MeasurementsCount of rehabilitation visits received during HH care episode.ResultsA total of 19,564 rehabilitation visits were delivered to ICU survivors over 118,145 person-days in HH settings, a rate of 1.16 visits per week. One-third of ICU survivors received no rehabilitation visits during HH care. In adjusted models, those with the highest baseline disability received 30% more visits (rate ratio [RR] = 1.30; 95% confidence interval [CI] = 1.17-1.45) than those with the least disability. Conversely, an inverse relationship was found between multimorbidity (Elixhauser scores) and count of rehabilitation visits received; those with the highest tertile of Elixhauser scores received 11% fewer visits (RR = .89; 95% CI = .81-.99) than those in the lowest tertile. Participants living in a rural setting (vs urban) received 6% fewer visits (RR = .94; 95% CI = .91-.98); those who lived alone received 11% fewer visits (RR = .89; 95% CI = .82-.96) than those who lived with others.ConclusionOn average, Medicare beneficiaries discharged home after a critical illness receive few rehabilitation visits in the early post-hospitalization period. Those who had more comorbidities, who lived alone, or who lived in rural settings received even fewer visits, suggesting a need for their consideration during discharge planning. J Am Geriatr Soc 68:1512-1519, 2020.

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Dataset Information

Relationship of Age And Mobility Levels During Physical Rehabilitation With Clinical Outcomes in Critical Illness.

Objective

Design

Setting

Participants

Interventions

Measurements and main results

Conclusion

Publications

Relationship of Age And Mobility Levels During Physical Rehabilitation With Clinical Outcomes in Critical Illness.

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