Structured community-based inpatient rehabilitation of older patients is better than standard primary health care rehabilitation – an open comparative study

Abstract

Purpose: To compare the outcome of multi-disciplinary, structured rehabilitation of older patients in a district inpatient rehabilitation centre (Model 1) versus standard primary health care rehabilitation (Model 2). Method: Open, prospective, comparative observational study. Totally 302 patients, 202 in Model 1 and 100 in Model 2, aged ≥65 years, with stroke, osteoarthritis, hip fracture or other chronic diseases, considered to have a rehabilitation potential. Referred from district hospital, nursing- or own homes. Outcomes: Primary: Sunnaas ADL Index (SI). Secondary: Umeaa Life Satisfaction Checklist (LSC). Cognitive (MMSE), emotional (SCL-10) and marital status, residence, length of rehabilitation and hours/week care services. Follow-up 3 months after end of rehabilitation. Results: Patients in Model 1 improved and persisted 1.9 points higher in SI (CI (1.0, 2.8), p < 0.001) compared to Model 2, with 2.4 weeks shorter rehabilitation (CI (1.6, 3.1), p < 0.001). LSC indicated similar satisfaction within both models. Fewer Model 1 patients received home care services >3 h/week (OR = 0.6 CI (0.4, 0.8), p = 0.002). Cognitive status predicted the SI gain positively, and level of care services negatively, in both models. Conclusions: Disabled older patients increase their independency significantly more within shorter time upon structured, multi-disciplinary rehabilitation in a district inpatient centre compared to standard primary health care rehabilitation.

Implications for Rehabilitation

• Multi-disciplinary, structured primary health care-based inpatient rehabilitation of older people in a dedicated district rehabilitation centre can give improved and sustained independency and should be preferred to standard primary health care rehabilitation in short-term beds in nursing homes.

• The district centre rehabilitation concept may be an interesting model in societies challenged by increasing needs of rehabilitation in an ageing population.

Keywords::

• Activities of daily living
• community rehabilitation
• elderly
• outcomes

Acknowledgement

We thank statistician Ingvild Dalen for advices on statistical analyses.

Declaration of Interest: The Norwegian Medical Association’s foundation for quality improvement and patient safety provided financial support to the data collection of Model 2.