Rehabilitation improves health outcomes, reduces disability and improves quality of life. There is a significant and emerging body of international evidence to support the benefit and cost effectiveness of specialist rehabilitation services within a modern health service. The demand for rehabilitation services is growing with changes in populations and with the advances in health care and new interventions and technology. Our overall aim is to explore the outcomes and clinical characteristics of adults who are admitted to a rehabilitation hospital in the Midwest region of Ireland during admission, at the time of their discharge and at 6 months.
Rehabilitation is a dynamic and critical component of the therapeutic continuum and one that is essential if patients are to regain or maintain their life roles, health status and quality of life after serious illness or injury. The World Health Organisation (WHO) recommends in its definition that priority is given to ensure access, for those in need, to appropriate, timely, affordable and high-quality rehabilitation interventions. Life expectancy is improving and the population of older persons is growing with increased demand for specialist rehabilitation services. This population is at increased risk for functional decline and increased demand for healthcare services. With older adults accounting for up to 24% of all ED attendees and an anticipated rise in this number, this places increased strain on the healthcare system The aim of this study is to establish the demographic and clinical characteristics of adults in the Midwest referred, assessed and treated in St Ita's Rehabilitation Hospital in the Mid- West of lreland. This study will inform on resource requirements of our rehabilitation facilities to ensure that the complexity of the patients are matched by the resources provided. We will also explore the benefits of rehabilitation across a broad range of conditions and evaluate the outcomes for patients including patient reported measures.
Study Type
OBSERVATIONAL
Enrollment
100
School of Allied Health, University of Limerick
Limerick, Munster, Ireland
RECRUITINGIncidence of functional decline
The number of participants who experience functional decline or do not as measured by the Barthel Index (BI). Functional decline is defined as a net decrease in the number of activities of daily living performed independently as measured by the self-reported BI. The sum of all of the 10 subscales of the BI ranges from 0-20 points where a higher score indicates increased independence.
Time frame: Baseline
Incidence of functional decline
The number of participants who experience functional decline or do not as measured by the Barthel Index (BI). Functional decline is defined as a net decrease in the number of activities of daily living performed independently as measured by the self-reported BI. The sum of all of the 10 subscales of the BI ranges from 0-20 points where a higher score indicates increased independence.
Time frame: From the date on inception into the study until the date of discharge from hospital, assessed up to 6 months
Incidence of Functional Decline
The number of participants who experience functional decline or do not as measured by the Barthel Index (BI). Functional decline is defined as a net decrease in the number of activities of daily living performed independently as measured by the self-reported BI. The sum of all of the 10 subscales of the BI ranges from 0-20 points where a higher score indicates increased independence.
Time frame: 6 Months
Healthcare use
Number of services that participants were in receipt of following discharge from rehabilitation services including; GP visits, unplanned Emergency Department attendance, Outpatient appointments.
Time frame: 6 Months
Polypharmacy level
Potentially inappropriate prescribing (PIP) and potentially omitted medications (POM) using the STOP START criteria. The STOPP/START Screening tools are based on the STOPP/START Prescription criteria which consist of a set of inappropriate combinations of medicines and disease (STOPP) and a set of recommended treatments for given conditions (START). There are 80 STOPP and 34 START criteria and they are grouped by physiological system e.g. cardiovascular.
Time frame: Baseline
Polypharmacy level
potentially inappropriate prescribing (PIP) and potentially omitted medications (POM) using the STOP START criteria. The STOPP/START Screening tools are based on the STOPP/START Prescription criteria which consist of a set of inappropriate combinations of medicines and disease (STOPP) and a set of recommended treatments for given conditions (START). There are 80 STOPP and 34 START criteria and they are grouped by physiological system e.g. cardiovascular.
Time frame: From the date on inception into the study until the date of discharge from hospital, assessed up to 6 months
Polypharmacy level
potentially inappropriate prescribing (PIP) and potentially omitted medications (POM) using the STOP START criteria. The STOPP/START Screening tools are based on the STOPP/START Prescription criteria which consist of a set of inappropriate combinations of medicines and disease (STOPP) and a set of recommended treatments for given conditions (START). There are 80 STOPP and 34 START criteria and they are grouped by physiological system e.g. cardiovascular.
Time frame: 6 Months
Frailty
Participants will be reviewed at time of discharge from rehabilitation services as to level of frailty using both the clinical frailty scale (CFS) and the identification of seniors at risk (ISAR) frailty screening tools. Both the clinical frailty scale and identification of seniors at risk were recorded at admission and again at discharge to evaluate change in frailty status over the hospital stay. The combination of tools will aim to enable examination of how initial risk screening interacts with frailty status to influence long-term functional trajectories. Higher scores on both the clinical frailty scale and identification of seniors at risk indicate higher levels of frailty and are often associated with worse outcomes. The clinical frailty scale is a 9 point rating scale (1-9) with 9 indicating the highest level of frailty (terminally ill), the identification of seniors at risk is a 6 item screening tool with a score of 2 or greater indicating increased risk of frailty.
Time frame: From the date on inception into the study until the date of discharge from hospital, assessed up to 6 months
Frailty
Participants will be reviewed at time of discharge from rehabilitation services as to level of frailty using both the clinical frailty scale (CFS) and the identification of seniors at risk (ISAR) frailty screening tools. Both the Clinical frailty scale and Identification of seniors at risk were recorded at 6 month follow up to evaluate change in frailty status over the hospital stay. The combination of tools will aim to enable examination of how initial risk screening interacts with frailty status to influence long-term functional trajectories. Higher scores on both the clinical frailty scale and identification of seniors at risk indicate higher levels of frailty and are often associated with worse outcomes. The clinical frailty scale is a 9 point rating scale (1-9) with 9 indicating the highest level of frailty (terminally ill), the identification of seniors at risk is a 6 item screening tool with a score of 2 or greater indicating increased risk of frailty.
Time frame: 6 months
Quality of life (EuroQoL-5 dimension 5 level questionnaire)
A questionnaire to evaluate participants health-related quality of life, assessing five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Higher scores indicate higher perception of health related quality of life. Index score (0-1) with 1 being the best and visual analogue scores (0-100) with 100 being the highest rating of overall health.
Time frame: Baseline
Quality of life (EuroQoL-5 dimension 5 level questionnaire)
A questionnaire to evaluate participants health-related quality of life, assessing five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Higher scores indicate higher perception of health related quality of life. Index score (0-1) with 1 being the best and visual analogue scores (0-100) with 100 being the highest rating of overall health.
Time frame: From the date on inception into the study until the date of discharge from hospital, assessed up to 6 months
Quality of life (EuroQoL-5 dimension 5 level questionnaire)
A questionnaire to evaluate participants health-related quality of life, assessing five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Index score (0-1) with 1 being the best and visual analogue scores (0-100) with 100 being the highest rating of overall health.
Time frame: 6 Months
Nursing Home Admission
Number of participants who were admitted to a nursing home or residential care facility following discharge from rehabilitation services.
Time frame: 6 Months
Mortality
The number of participants who died following discharge from rehabilitation services.
Time frame: 6 Months
Falls
Number of falls sustained post discharge from rehabilitation services.
Time frame: 6 Months
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