Background
Methods
Search strategy
Study selection
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patients with a mean (or if not provided, a median) age of 65 years or older, who were admitted to an inpatient rehabilitation unit;
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factors potentially influencing discharge destination of these patients were measured within a week after admission to the rehabilitation unit;
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discharge location (home discharge versus non home discharge) was assessed as an outcome measure.
Data extraction and analysis
Methodological quality of identified studies
Results
Included studies
Methodological quality
Author | Year | A*
| B**
| C | D | E | F | Total(12) |
---|---|---|---|---|---|---|---|---|
Berges [29] | 2008 | 1 | 2 | 1 | 1 | 1 | 1 | 7 |
Chang [9] | 2008 | 1 | 2 | 1 | 1 | 1 | 1 | 7 |
Chin [10] | 2008 | 2 | 2 | 1 | 1 | 1 | 1 | 8 |
Graham [7] | 2008 | 1 | 2 | 1 | 1 | 1 | 1 | 7 |
Hershkovitz [30] | 2007 | 1 | 2 | 2 | 1 | 1 | 1 | 8 |
Kay [22] | 2010 | 2 | 2 | 2 | 2 | 1 | 1 | 10 |
Kurichi [31] | 2010 | 1 | 2 | 1 | 1 | 1 | 1 | 7 |
New [23] | 2013 | 1 | 2 | 2 | 2 | 1 | 1 | 9 |
Sansone [27] | 2007 | 1 | 2 | 2 | 2 | 1 | 1 | 9 |
Siebens [32] | 2002 | 1 | 2 | 1 | 1 | 1 | 1 | 7 |
Vincent [33] | 2006 | 1 | 2 | 2 | 1 | 0 | 1 | 7 |
Vincent [25] | 2006 | 2 | 2 | 2 | 2 | 0 | 1 | 9 |
Vincent [26] | 2006 | 2 | 2 | 1 | 2 | 1 | 1 | 9 |
Vincent [24] | 2007 | 2 | 2 | 2 | 2 | 0 | 1 | 9 |
Vincent [34] | 2008 | 0 | 2 | 1 | 0 | 0 | 2 | 5 |
Vincent [35] | 2009 | 0 | 2 | 1 | 1 | 0 | 1 | 5 |
Vincent [14] | 2010 | 0 | 2 | 1 | 1 | 0 | 1 | 5 |
Yan [28] | 2013 | 1 | 2 | 2 | 2 | 1 | 1 | 9 |
Data extraction
Author, year, Country [Reference Number] | Study design | Sample characteristics (n, age, gender) | Primary diagnosis | Rehabilitation setting | Discharge destination |
---|---|---|---|---|---|
Bergés et al., 2008, United States [29] | Retrospective cohort study |
n = 63,793; mean age = 71.7; 66.5 % female | Hip replacement | Inpatient rehabilitation facilities | Home vs. not home |
Chang et al., 2008, United States [9] | Retrospective cohort study |
N = 9,240a; mean age = 78.8; 47 % female | Traumatic brain injury | Inpatient rehabilitation facilities | Home vs. not home |
Chin et al., 2008; Hong Kong [10] | Prospective cohort study |
n = 303, mean age = 82, 70 % female | Hip fracture | Inpatient rehabilitation hospital | Home vs. not home |
Graham et al., 2008; United States [7] | Retrospective cohort study |
N = 42,479; mean age = 82.2; 31.4 % female | Hip fracture | Inpatient rehabilitation facilities | Home vs. not home |
Hershkovitz et al.,2007; Israel [30] | Prospective cohort study |
N = 133; mean age = 80; 79.7 % female | Hip fracture | Rehabilitation unit of a geriatric hospital | Home vs. nursing home |
Kay et al., 2010; United States [22] | Retrospective cohort study |
N = 1,645, mean age = 70; 57.1 % female | Non-traumatic spinal cord injury | Inpatient rehabilitation facility | Residence vs. nursing home |
Kurichi et al., 2013; United States [31] | Retrospective observational study |
N = 1,480b, mean age = 66.8; 100 % male | Lower extremity amputation | Veterans Affairs Medical Centers | Home vs. not home |
New, 2007; Australia [23] | Retrospective, 3-year case series |
N = 70, mean age = 65; 54.3 % female | Non-traumatic spinal cord injury | Tertiary medical unit | Home vs. not home |
Sansone et al., 2002; United States [27] | Retrospective study |
N = 143, median age = 70; 39.9 % female | Cardiac patients | Public acute long-term care hospital | Home vs. not home |
Siebens et al., 2012, United States [32] | Multi-site prospective observational cohort study |
N = 224; mean age = 76.8; 78 % female | Hip fracture | 9 skilled nursing facilities and 11 inpatient rehabilitation facilities | Home vs. not home |
Vincent et al., 2006; United States [33] | Retrospective study |
N = 332, mean age = 70.6; 63.6 % female | Total hip arthroplasty | Inpatient rehabilitation hospital | Home vs. not home |
Vincent et al., 2006; United States [25] | Retrospective study |
N = 424; mean age = 70.7; 70 % female | Total knee arthroplasty | Inpatient rehabilitation hospital | Home vs. not home |
Vincent et al., 2006; United states [26] | Retrospective study |
N = 402; mean age = 70.8; 62.9 % female | Total hip arthroplasty | Inpatient rehabilitation hospital | Home vs. not home |
Vincent et al., 2007; United States [24] | Retrospective, comparative study |
N = 146; mean age = 70.8; 70.1 % female | Total knee arthroplasty | Inpatient rehabilitation hospital | Home vs. not home |
Vincent et al., 2008; United States [34] | Retrospective study |
N = 23,649, mean age = 70.2; Female = 67 % | Total hip or knee arthroplasty | Inpatient rehabilitation facility | Home vs. not home |
Vincent et al., 2009; United States [35] | Retrospective, comparative study |
N = 1,947, mean age = 71; female = 70.5 % | Total hip arthroplasty | Inpatient rehabilitation facilities | Home vs. not home |
Vincent et al., 2010; United States [14] | Multicenter, retrospective study |
N = 5,421, mean age = 69.8; 68.6 % female | Total knee arthroplasty | 15 Inpatient rehabilitation facilities | Home vs. not home |
Yan et al., 2013; United States [28] | Retrospective study |
N = 119; mean age = 67.4; 5.9 % female | Total knee arthroplasty/bilateral knee surgery/total hip arthroplasty | Inpatient rehabilitation in a Veterans Affairs Medical Center | Home vs. not home |
Influencing factor | Study | Influencing factor specified | Discharge destination | Result | Interpretation |
---|---|---|---|---|---|
Age | Bergés et al., 2008 [29] | Higher age | Home vs. institution | OR = 0.97 (0.97–0.98)* | Higher age is related to fewer home discharges |
Chang et al., 2008 [9] | Each 1 year increase in age | Home vs. institution | OR = 0.99 (0.99–1.00) | Higher age is not related to discharge disposition | |
Chin et al., 2008 [10] | Age ≥ 80 years | Institution vs. home | OR = 1.92 (1.04–3.57)* | Higher age is related to discharge to an institution | |
New, 2007 [23] | Higher age | Home vs. institution | Wilkinson-rank sum test; p =0.01* | Higher age is related to fewer home discharges | |
Sansone et al., 2002 [27] | Age | Home vs. institution | OR = 1.05 (0.99–1.09) | Age is not related to discharge disposition | |
Siebens et al., 2012 [32] | Higher age | Home vs. institution | OR = 0.92 (0.87–0.96)* | Higher age is related to fewer home discharges | |
Vincent et al., 2006 [33] | Age group <85 vs. ≥85 | Home vs. institution |
χ
2; p < 0.05* | Higher age is related to fewer home discharges | |
Vincent et al., 2008 [34] | Age group <85 vs. ≥85 | Non-home vs. home | OR = 3.63(3.37–3.89)‡ | Higher age is related to fewer home discharges | |
Yan et al., 2013 [28] | Younger age | Home vs. not home | MANOVA; p = 0.04* | Younger age is related to home discharge | |
Ethnicity | Bergés et al., 2008 [29] | Black vs. white | Home vs. institution | OR = 1.23 (1.07–1.41)* | Black race is related to home discharge |
Hispanic vs. white | OR = 1.51 (1.15–1.99)* | Hispanic race is related to home discharge | |||
Asian vs. white | OR = 1.67 (0.93–3.00) | Asian race is not related to discharge disposition | |||
Chang et al., 2008 [9] | Black vs. white | Home vs. institution | OR = 2.00 (1.55–2.59)* | Black race is related to home discharge | |
OR = 2.24 (1.66–3.02)* | Hispanic race is related to home discharge | ||||
Hispanic vs. white | |||||
Graham et al., 2008 [7] | Non-Hispanic black vs. white | Home vs. institution | OR = 2.02 (1.77–2.32)* | Non-Hispanic Black race is related to home discharge | |
Hispanic vs. white | OR = 1.90 (1.64–2.19)* | Hispanic race is related to home discharge | |||
Asian vs. white | OR = 2.07 (1.55–2.78)* | Asian race is related to home discharge | |||
Siebens et al., 2012 [32] | Nonwhite vs. white | Home vs. institution | OR = 4.34 (0.86–21.79) | Nonwhite race is not related discharge disposition | |
Marital status | Bergés et al., 2008 [29] | Married vs. not-married | Home vs. institution | OR = 2.42 (2.24–2.61)* | Being married is related to home discharge |
Chang et al., 2008 [9] | Not-married vs. married | Home vs. institution | OR = 0.45 (0.40–0.51)* | Being not-married is related to fewer home discharges | |
Kurichi et al., 2013 [30] | Married vs. not-married | Home vs. institution | OR = 1.51 (1.14–1.99)** | Being married is related to home discharge | |
Functional status | Chin et al., 2008 [10] | Admission FIM score <75 | Institution vs. home | OR = 4.68 (2.23–9.82)* | Lower functional status at admission is related to discharge to an institution |
Sansone et al., 2002 [27] | Admission FIM score ≤71vs admission FIM score >72 | Home vs. institution | OR = 0.91 (0.85–0.96)*** | Lower functional status at admission is related to fewer home discharges | |
Yan et al., 2013 [28] | Admission FIM score | Home vs. institution | MANOVA p = 0.00*** | Higher functional status at admission is related to home discharge | |
Cognition | Chin et al., 2008 [10] | Admission AMT <6 | Institution vs. home | OR = 1.60 (0.87–2.96) | Impaired cognitive function at admission is not related to discharge disposition |
Hershkovitz et al., 2007 [30] | MMSE score | Home vs. nursing home | OR = 1.11 (1.03–1.20)* | Higher cognitive functional level is related to home discharge | |
Siebens et al., 2012 [32] | Cognitive FIM at admission | Home vs. institution | OR = 1.06 (1.01–1.11)* | Better cognitive function at admission is related to home discharge | |
Depression | Hershkovitz et al., 2007 [30] | Presence of depression | Home vs. nursing home | OR = 0.30 (0.11–0.84)* | The presence of depression is related to fewer home discharges |
Kurichi et al., 2013 [31] | Presence of depression | Home vs. institution | OR = 0.63 (0.40–0.98)* | The presence of depression is related to fewer home discharges | |
Clinical severity of illness | Siebens et al., 2012 [32] | Lower maximum severity | Home vs. institution | OR = 0.95 (0.93–0.97) *** | Lower severity of illness calculated by the CSI is related to home discharge |
Treatment-level procedures | Kurichi et al., 2013 [31] | Ongoing active cardiac pathology (yes vs. no) | Home vs. institution | OR = 0.55 (0.37–0.81)** | Treatment level procedure is related to home discharge |
Pre-hospital living situation | Yan et al., 2013 [28] | Lives alone vs. lives with someone | Home vs. institution | Fisher’s Exact Text: p = 0.35 | Living alone is not related to discharge disposition |
Hershkovitz et al., 2007 [30] | Presence of a caregiver at home | Home vs. nursing home | OR = 8.88 (1.76–44.9)* | The presence of a caregiver at home is related to home discharge | |
Gender | Bergés et al., 2008 [29] | Male vs. female | Home vs. institution | OR = 1.08 (1.01–1.17)* | Male gender is related to home discharge |
Chang et al., 2008 [9] | Male vs. female | Home vs. institution | OR = 0.85 (0.75–0.96)* | Male gender is related to fewer home discharges | |
Kay et al., 2010 [22] | Male vs. female; etiology degenerative spinal disorders | Community-based residence vs. nursing home | OR = 1.00 (0.50–1.99) | Gender is not related to discharge disposition | |
OR = 0.98 (0.39–2.45) | Gender is not related to discharge disposition | ||||
Male vs. female; etiology malignant tumor | OR = 0.73 (0.22–2.49) | Gender is not related to discharge disposition | |||
Male vs. female; etiology vascular ischemia | |||||
New, 2007 [23] | Male vs. female | Home vs. not home |
χ
2; p = 0.00** | Female gender is related to fewer home discharges | |
Sansone et al., 2002 [27] | Male vs. female | Home vs. institution | OR = 1.01 (0.35–2.95) | Gender is not related to discharge disposition | |
Vincent et al., 2006 [33] | Female vs. male | Home vs. institution |
χ
2; p < 0.05* | Female gender is related to fewer home discharges | |
Yan et al., 2013 [28] | Male vs. female | Home vs. institution | Fisher’s Exact Test; p = 0.27 | Male gender is not related to discharge disposition | |
Comorbidity | Berges et al., 2008 [29] | One or more | Home vs. institution | OR = 1.14 (0.83–1.57) | The presence of one or more comorbidities is not related to discharge disposition |
Chang et al., 2008 [9] | 1–3 > 3 | Home vs. institution | OR = 1.09 (0.73–1.63) | The presence of one or more comorbidities is not related to discharge disposition | |
OR = 1.35 (0.95–1.93) | |||||
Chin et al., 2008 [10] | CVA or Parkinsonism | Institution vs. home | OR = 1.18 (0.56–2.51) | The presence of CVA or Parkinsonism as a comorbidity is not related to discharge disposition | |
Kurichi et al., 2013 [31] | Congestive heart failure | Home vs. institution | OR = 0.62 (0.45–0.85)** | The presence of congestive heart failure as a comorbidity is associated with fewer home discharges | |
Sansone et al., 2002 [27] | 1 or more vs. 0 | Home vs. institution | OR = 1.13 (0.37–3.38) | The presence of a comorbidity is not associated with discharge disposition | |
Yan et al., 2013 [28] | Number of comorbidities | Home vs. institution | MANOVA p = 0.32 | The number of comorbidities is not associated with discharge disposition | |
Type of surgery | Chin et al., 2008 [10] | Arthroplasty vs. Closed Reduction Internal Fixation (CRIF) | Institution vs. home | OR = 0.99 (0.56–1.73) | Fracture management is not related to discharge disposition |
Vincent et al., 2006 [26] | Home discharge in the primary total hip arthroplasty (THA) group vs. the revision THA group | Home vs. institution | Kruskal-Wallis; p < 0.00*** | Type of surgery in hip arthroplasty patients is related to home discharge | |
Vincent et al., 2006 [25] | Home discharge in the primary total knee arthroplasty (TKA) group vs. the revision TKA group | Home vs. institution | Kruskal-Wallis; p < 0.00*** | Type of surgery in knee arthroplasty patients is related to home discharge | |
Vincent et al., 2008 [34] | Bilateral joint procedures (THA + TKA) or unilateral joint procedures | Home vs. institution | OR = 0.76 (0.49–1.01) | The type of joint procedure is not related to discharge disposition | |
Postoperative complications | Chin et al., 2008 [10] | Chest infection or urinary tract infection | Institution vs. home | OR = 1.44 (0.56–3.69) | The postoperative complications chest infection or urinary tract infection are not related to discharge disposition |
Kurichi et al., 2013 [31] | Local significant infection at amputation | Home vs. institution | OR = 0.57 (0.39–0.83)** | Postoperative complications are related to fewer home discharges | |
Admission weight-bearing status | Siebens et al., 2012 [32] | Weight bearing as tolerated (WBAT) vs. restricted weight bearing (RWB) after hip fracture | Home vs. institution | OR = 2.58 (0.99–6.70) | Admission status “weight bearing as tolerated” is not related to discharge disposition |
Hematocrit value | Vincent et al., 2010 [14] | Very low hematocrit (Hct <30 %) vs. low Hct (30–36 % women; 30–41 % men) vs. normal Hct (>36 % women; >41 % men) | Home vs. institution |
χ
2; p > 0.05 | Hematocrit value is not related to discharge disposition |
Distance | Yan et al., 2013 [28] | Distance from inpatient rehabilitation facility in miles | Home vs. institution | MANOVA p = 0.09 | The distance from the inpatient rehabilitation facility is not related to discharge disposition |
Length of Stay in acute setting | Chin et al., 2008 [10] | >7 days | Institution vs. home | OR = 1.05 (0.59–1.87) | The length of stay in the acute setting is not related to discharge disposition |
Obesity | Vincent et al., 2007 [24] | BMI <30 kg/m2 vs. BMI ≥30 kg/m2
| Home vs. institution |
χ
2; p >0.05 | Obesity is not related to discharge disposition |
Vincent et al., 2008 [34] | BMI ≥ 50 kg/m2 vs. BMI <50 kg/m2
| Home vs. institution | OR = 0.97 (0.71–1.23) | BMI is not related to discharge disposition | |
Vincent et al., 2009 [35] | BMI <25 kg/m2 vs. BMI 25–29.9 kg/m2vs BMI 30–40 kg/m2 vs. BMI >40 kg/m2
| Home vs. institution |
χ
2; p >0.05 | BMI is not related to discharge disposition | |
Yan et al., 2013 [28] | Difference in BMI between home discharge and not home discharge | Home vs. institution | MANOVA p = 0.78 | BMI is not related to discharge disposition | |
Pain | Chin et al., 2008 [10] | VAS pain scale at admission ≥4 | Institution vs. home | OR = 0.61 (0.33–1.13) | Higher pain score at admission is not related to discharge disposition |
Pre-fracture mobility status | Chin et al., 2008 [10] | Dependent or non-walker | Institution vs. home | OR = 1.84 (0.94–3.60) | Pre-fracture dependent mobility status is not related to discharge disposition |
Pressure sore | Chin et al., 2008 [10] | Pressure sore at admission to rehabilitation | Institution vs. home | OR = 1.10 (0.44–2.73) | The presence of a pressure sore at admission is not related to discharge disposition |
Primary insurance | Chang et al., 2008 [9] | Private vs. Medicare | Home vs. institution | OR = 1.01 (0.81–1.25) | The type of primary insurance is not related to discharge disposition |
Medicaid vs. Medicare | OR = 1.01 (0.45–2.28) | ||||
Other vs. Medicare | OR = 1.23 (0.70–2.17) | ||||
Smoking history | Sansone et al., 2002 [27] | Smoker vs. non-smoker | Home vs. institution | OR = 3.17 (0.86–11.63) | Smoking history is not related to discharge disposition |