Journal of the American Medical Directors Association
JAMDA OnlineReview ArticleAssessment of Comorbidity Burden and its Association With Functional Rehabilitation Outcome After Stroke or Hip Fracture: A Systematic Review and Meta-Analysis
Section snippets
Search Strategy
This meta-analysis was conducted following A Measurement Tool to Assess Systematic Reviews and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) (Appendices A and B).15, 16, 17 A systematic search of publications was carried out in the following electronic databases: PubMed (Medline), Embase, The Cochrane Library (CENTRAL), Web of Science, and CINAHL from the earliest record to March 4, 2016. The search strategy was designed under the supervision of an experienced
Study Selection
The database search identified 2910 articles, and 1514 articles were identified by using other sources. After removing the duplicates, 2551 articles were screened for eligibility of which 20 met all criteria. Reasons for exclusion are reported in the PRISMA flowchart (Appendix E).
Studies that assessed comorbidity using the Tier ranking system were excluded after discussion with 2 other reviewers (W.A. and R.vB.).20, 21 This system was developed by the Centers for Medicare and Medicaid Services
Main Findings
This review supports the hypothesis that preexisting comorbidity is negatively associated with functional rehabilitation outcome. This relation becomes more evident when comorbidity is assessed by indicating the severity of present comorbidities.
In the studied patient populations, we detected 4 comorbidity indexes: the CharlsonCI, the LiuCI, the COM-SI, and the CIRS(G) scored as total, cumulative, or severity index. The LiuCI and COM-SI were specifically designed for use in a rehabilitation
Conclusions
There seems to be insufficient evidence that assessing comorbidity helps predicting the functional prognosis if current comorbidity indexes are used. This review adds new insights in emphasizing the severity of comorbidity to assist in estimating their functional prognosis after acute illnesses such as stroke or hip fracture. More research is needed to investigate whether a brief and practical index that captures individual impact of comorbidity, is feasible, reliable, and valid for use in
Acknowledgments
The authors thank J.W. Schoones, medical information specialist from the Leiden University Medical Center (LUMC) for his supervision regarding the design of the search strategy. The corresponding author (AK) had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
References (49)
- et al.
Selecting Patients for Rehabilitation
J Am Med Dir Assoc
(2015) - et al.
Stroke rehabilitation. 2. Comorbidities and complications
Arch Phys Med Rehabil
(1994) - et al.
A functional diagnostic complexity index for rehabilitation medicine: Measuring the influence of many diagnoses on functional independence and resource use
ArchP hys Med Rehabil
(2000) - et al.
Predictors of rehabilitation outcomes: A comparison of Israeli and Italian geriatric post-acute care (PAC) facilities using the minimum data set (MDS)
J Am Med Dir Assoc
(2007) - et al.
Outcomes at 12 months in a population of elderly patients discharged from a Rehabilitation Unit
J Am Med Dir Assoc
(2008) - et al.
Predictors of rehabilitation outcome among frail elderly patients living in the community
J Am Med Dir Assoc
(2009) - et al.
How to measure comorbidity: A critical review of available methods
J Clin Epidemiol
(2003) Measurement and impact of comorbidity in older cancer patients
Crit Rev Oncol Hemato
(2000)- et al.
Meta-analysis in clinical trials
Control Clin Trials
(1986) - et al.
Regional variation in stroke rehabilitation outcomes
Arch Phys Med Rehabil
(2014)
Impact of comorbidities on stroke rehabilitation outcomes: Does the method matter?
Arch Phys Med Rehabil
Comorbidity measures for stroke outcome research: A preliminary study
Arch Phys Med Rehabil
Effect of rehabilitation site on functional recovery after hip fracture
Arch Phys Med Rehabil
Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases
J Clin Epidemiol
The effect of co-morbidity on the rehabilitation process in elderly patients after hip fracture
Arch Gerontol Geriatr
Stroke rehabilitation outcome variation in Veterans Affairs rehabilitation units: Accounting for case-mix
Arch Phys Med Rehabil
Validation of the Charlson Comorbidity Index for predicting functional outcome of stroke
Arch Phys Med Rehabil
The development of a comorbidity index with physical function as the outcome
J Clin Epidemiol
Prognostic factors for ambulation and activities of daily living in the subacute phase after stroke. A systematic review of the literature
Clin Rehabil
The influence of comorbidities and complications on discharge function in stroke rehabilitation inpatients
EuraMedicophys
Early prediction of outcome of activities of daily living after stroke: A systematic review
Stroke
What predicts a poor outcome in older stroke survivors? A systematic review of the literature
Disabil Rehabil
Comparative assessment of three different indices of multimorbidity for studies on health-related quality of life
Health Qual Life Outcomes
Measures of multimorbidity and morbidity burden for use in primary care and community settings: A systematic review and guide
Ann Fam Med
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This work was supported by Laurens, nursing care organization in Rotterdam.
The authors declare no conflicts of interest.