Purpose: Understanding predictors of discharge outcomes from geriatric rehabilitation is most important for goal definition and the optimal planning of discharge and further needs such as home modifications and community support. Functional status at admission to rehabilitation has been found to be one of the most valid predictor of discharge destination. Yet the specific components of patients' functioning predicting decline in living situation are not known. The International Classification of Functioning, Disability and Health provides a framework to comprehensively describe limitations in functioning and relevant environmental factors [1]. It facilitates the description and classification of all aspects of function and health in individuals independent of a specific instrument [2, 3]. The objective of this study was to examine impairment or limitation in ICF categories as potential predictors of geriatric patients' change of their previous living conditions after inpatient rehabilitation.
Methods: The study population consisted of a convenience sample of all patients being admitted to an geriatric rehabilitation hospital providing early post-acute care. The data were collected by interview within the first 14 days after admission with a standardized questionnaire comprising sociodemographic variables, gender, date of birth, data of the event leading to rehabilitation, data of the interview, discharge destination and 243 categories of the second level of the ICF. The ICF is divided into four components, Body functions, Body structures, Activities and Participation and Environmental factors. Living situation was defined as declined if the patient was discharged home but needed more additional help than before or if the patient who prior to his acute event was living independently was discharged into a nursing home. Since the ICF provides a multitude of variables giving information on all aspects of functional health, non-parametric classification trees were used to predict decline in living situation. Two different classification trees were built, tree1 including sociodemographic factors, Body Functions and Activities and Participation, tree2 including sociodemographic factors, Body Function, Activities and Participation, and Environmental Factors.
Result: 126 patients with a mean age of 80 (median 81, range 62 to 98), 68% female, were included. 52% of the patients experienced decline in living situation after discharge. In both classification trees, patients who were unable to move, even with assistance of equipment, had a high probability of decline in living situation. Tree1 correctly classified 69% of the sample using six variables, tree2 correctly classified 75% of the sample using five variables. Main variables of tree2 predicting decline of living situation were indifference towards media services, impaired heart functions, not being able to move around using equipment, and indifference towards attitudes of strangers and architecture and construction services.
Discussion: In addition to mobility parameters environmental factors could be identified indicating decline in living situation in geriatric patients after an acute event or illness. The advantages of the classification tree approach over traditional regression models are that it is able to deal with a large amount of variables, is well suited for nominal data, identifies complicated interactions between variables and yields clear and understandable results. Using the ICF and practical tools such as the ICF Core Sets will stimulate research for a better understanding of functioning, disability and health.
References:
1 World Health Organization. International Classification of Functioning, Disability and Health: ICF. Geneva: WHO, 2001.
2 Stucki G, Cieza A, Ewert T, Kostanjsek N, Chatterji S, Üstün TB. Application of the International Classification of Functioning, Disability and Health (ICF) in clinical practice. Disabil Rehabil. 2002;24:281–2.
3 Grill E, Ewert T, Chatterji S, Kostanjsek N, Stucki G. ICF Core Set development for the acute hospital and early post-acute rehabilitation facilities. Disabil Rehabil 2005; 27:361–6.
