Background
Methods
Study design and setting
Measures and data collection procedures
Patient characteristics
Assessment of relevant goals and self-rating of functional abilities from the patients` perspective
Item | Content | ICF chapters and categories | ICF Codes |
---|---|---|---|
1. Mobility | Motor functions | Mobility; Changing and maintaining body positions | d410 d415 |
2. Lower extremity muscle power function | Motor functions | Neuro-musculoskeletal and movement-related functions; using the legs and feet to exert a force on an object to move it away; getting into and out of a seated position | b7303 d435 d410 |
3. Fine hand use | Motor functions | Mobility; Grasp small objects with fingers and hands and pick up small objects (for example coins), button clothes | d440 |
4. Walking | Motor functions | Mobility; walking short or long distances without walking aids | d450 d460 |
5. Walking around with walking aid | Motor functions | Mobility; walking short or long distances by using specific devices like walker or walking sticks | d465 |
6. Personal hygiene | Self-care | Self-care; Washing oneself Caring for body parts; Toileting | d510 d520 d530 |
7. Dressing | Self-care | Self-care; putting on or taking off clothes and footwear | d540 |
8. Eating and drinking | Self-care | Self-care; Eating and Drinking without any help and without any difficulty | d550 d560 |
9. Household tasks | Domestic life | Domestic life; preparing simple meals and doing housework; wash dishes, cleaning cooking area and utensils; | d6300 d6340 |
10. Physical endurance | Motor functions | Functions of the cardiovascular, haematological, immunological and respiratory systems; functions of physical endurance, aerobic capacity, stamina and fatigability | b455 |
11. Pain | Sensory functions | Sensory functions and pain; sensations of generalized or localized pain in one or more body part, | b280 |
12. Mood/ Depressive symptoms | Psychological wellbeing | Mental functions; regulation and range of sadness, lability of emotion | b152 |
13. Anxiety, fear of falling | Psychological wellbeing | Mental functions; functions of appropriateness of anxiety, fear of falling | b152 |
14. Handling stress and psychological demands | Psychological wellbeing | General tasks and demands; Handling stress and psychological demands | d240 |
15. Memory and attention | Cognition | Mental functions; concentration; sustaining and shifting attention Registering, storing and retrieving information; short- and long-term memory; remembering; | b140 b144 |
16. Family relations | Social relationship | Interpersonal interactions and relationships; parent-child and child-parent relationships, sibling and extended family relationships | d760 |
17. Informal social relationships | Social relationship | Interpersonal interactions and relationships; entering into relationships with others, such as casual relationships with people living in the same community or residence, friends, neighbours | d750 |
18. Knowledge about acute and chronic illnesses | Self-care | Self-care; maintaining one’s health | d5702 |
19. Knowledge about medication, assistive products | Self-care | Self-care; maintaining one’s health | d5702 |
Objective measures of functional abilities
Data analysis
Results
Participants
Characteristic | Value |
---|---|
Age, years, mean ± SD | 83.9 ± 5.9 |
Gender, female, % | 81.1 |
Mini-Mental State Examination (MMSE) Score (0–30), median (IQR) | 22 (20–24) |
Living arrangement before admission, n, % | |
Institutionalized | 12 (11.3) |
Community dwelling | 94 (88.7) |
Number of medications, n, mean ± SD | 9.4 ± 3.2 |
Clinical frailty scale, Score (1–9), median (IQR) | 6 (5–6) |
Admission main diagnosis, n, % | |
Orthopedic impairment | 41 (38) |
Cerebrovascular disease | 22 (20) |
Heart disease | 17 (16) |
Other internal disease | 13 (12) |
Miscellaneous | 14 (13) |
Geriatric Depression Scale (GDS) Score (0–15), median (IQR) | 4 (2–5) |
Barthel Activity of Daily Living (ADL) Score (0–100), median (IQR) | 60 (44–70) |
Length of stay during geriatric rehab, days, median (IQR) | 20 (19–26) |
Assessment of relevant goals
Semi-structured goal-assessment
Goals grouped by ICF chapters |
n (%)
| ICF codes and categories |
---|---|---|
Mobility | 72 (50) | |
Mobility and Balance | 12 | d410, 415 changing and maintaining body positions, d420 transferring oneself |
Moving around | 21 | d460, 465 Moving around in different locations |
Walking | 31 | d450 Walking, d4502 Walking on different surfaces d4501 Walking long distances |
Stair climbing (80 steps) | 2 | d4551 Climbing |
Driving a car | 2 | d475 Driving |
Mobility of hand and arm | 2 | d445 Hand and arm use |
Swimming | 2 | d4554 Swimming |
Domestic life | 6 (4) | |
Gardening | 1 | d6505 Taking care of plants outdoors |
To do the housework | 4 | d630 Preparing meals, d640 Doing housework |
Sewing | 1 | d6500 Making and repairing clothes |
Self-care | 5 (3) | |
Toileting | 3 | d530 Toileting |
Bathing, showering | 1 | d510 Washing oneself |
Putting on or taking off clothes | 1 | d540 Dressing |
Relationship | 2 (1) | |
To socialize | 2 | d750, d760 Informal and family relationship |
General tasks and demands | 2 (1) | |
To recharge one’s battery to carry out and manage everyday tasks | 2 | d240 handling stress |
Communication | 1 (< 1) | |
Communicate with others by language | 1 | d330 speaking |
Mental functions | 2 (1) | |
Regulation of depressive symptoms | 1 | b152 Emotional functions |
Memory, cognition | 1 | b144 Memory functions |
Sensory function and pain | 13 (9) | |
Sensation of generalized or localized pain | 7 | b280 Pain |
Visual functions | 1 | b210 Seeing functions |
Dizziness | 5 | b240 Dizziness and vertigo |
Functions of the cardiovascular system | 4 (3) | |
Physical endurance, fatigability | 4 | b455 Exercise tolerance functions |
Neuromusculoskeletal and movement related functions | 2 (1) | |
Handgrip | 2 | b730 Muscle power functions |
Support and relationship | 2 (1) | |
Organize support and care for the post-hospitalization phase | 2 | e340 Personal care providers and personal assistants |
Goals unrelated to ICF coding | 32 (22) | |
General health/ convalescence | 10 | Not definable |
Autonomy/ returning home | 22 | Not definable |
Structured goal-assessment
Self-ratings of functional abilities
Goal area/Item | Category of self-rating (%) | Median (Min-Max) | ||||
---|---|---|---|---|---|---|
0 | 1 | 2 | 3 | 4 | ||
Walking | 4.0 | 15.0 | 7.0 | 20.0 | 54.0 | 4 (0–4) |
Household tasks | 10.6 | 18.8 | 12.9 | 17.6 | 40.0 | 3 (0–4) |
Mobility | 11.9 | 29.7 | 18.8 | 30.7 | 8.9 | 2 (0–4) |
Lower extremity strength | 11.9 | 26.9 | 30.7 | 23.8 | 6.9 | 2 (0–4) |
Taking on and off clothes | 25.5 | 22.4 | 24.5 | 15.3 | 12.2 | 2 (0–4) |
Walking around with equipment | 37.8 | 23.50 | 17.3 | 12.2 | 9.2 | 1 (0–4) |
Physical endurance | 19.8 | 30.2 | 29.2 | 15.6 | 5.2 | 1 (0–4) |
Handling stress and psychological demands | 26.9 | 28.9 | 27.8 | 11.8 | 4.3 | 1 (0–4) |
Pain | 43.9 | 20.4 | 13.3 | 19.4 | 3.1 | 1 (0–4) |
Personal hygiene | 28.0 | 32.0 | 21.0 | 16.0 | 3.0 | 1 (0–4) |
Knowledge about acute and chronic illnesses | 46.2 | 26.9 | 21.5 | 4.3 | 1.1 | 1 (0–4) |
Fine hand use | 48.9 | 28.7 | 17.0 | 4.3 | 1.1 | 1 (0–4) |
Mood/ Depressive symptoms | 32.0 | 42.3 | 12.4 | 12.4 | 1.0 | 1 (0–4) |
Memory and attention | 26.8 | 45.4 | 16.5 | 11.3 | 0.0 | 1 (0–3) |
Knowledge about medication, assistive products | 52.4 | 18.3 | 15.9 | 7.3 | 6.1 | 0 (0–4) |
Anxiety, fear of falling | 52.0 | 26.5 | 11.2 | 8.2 | 2.0 | 0 (0–4) |
Eating and drinking | 63.6 | 23.2 | 5.1 | 6.1 | 2.0 | 0 (0–4) |
Informal social relationships | 77.1 | 17.7 | 4.2 | 1.0 | 0.0 | 0 (0–3) |
Family relations | 85.9 | 6.5 | 4.3 | 3.3 | 0.0 | 0 (0–3) |
Relationship between self-ratings and objective measures
Clinical Measure | All | Category of self-rating | JT p-value |
rho
| ||||
---|---|---|---|---|---|---|---|---|
0 | 1 | 2 | 3 | 4 | ||||
MOTOR FUNCTIONS | ||||||||
HABAM, score | ||||||||
n | 100 | 11 | 30 | 19 | 31 | 9 | < 0.001 | −0.43** |
Median | 38 | 46 | 49.5 | 33 | 33 | 29 | ||
IQR | 29–50 | 35–58 | 36–53 | 28–47 | 26–42 | 21–29 | ||
POMA Balance, score | ||||||||
n | 99 | 11 | 30 | 18 | 31 | 9 | < 0.001 | −0.46** |
Median | 11 | 14 | 13 | 10 | 7 | 5 | ||
IQR | 6–14 | 11–15 | 11–14 | 5–13 | 4–12 | 2–7 | ||
LOWER EXTERMITY MUSCLE STRENGTH | ||||||||
5 chair rise, s | ||||||||
n | 61 | 11 | 21 | 16 | 10 | 3 | 0.001 | 0.41** |
Median | 15.6 | 11.5 | 15.6 | 17.0 | 17.6 | 15.9 | ||
IQR | 12.6–20.4 | 10.7–12.6 | 13.5–18.2 | 14.3–22.3 | 14.7–22.2 | 12.9–26.7 | ||
1-RM, kg | ||||||||
n | 90 | 12 | 24 | 27 | 21 | 6 | 0.005 | −0.30** |
Median | 80 | 135 | 80 | 70 | 70 | 50 | ||
IQR | 60–130 | 85–190 | 65–105 | 50–130 | 60–110 | 40–70 | ||
WALKING | ||||||||
TuG, s | ||||||||
n | 78 | 4 | 15 | 7 | 20 | 31 | < 0.001 | 0.73** |
Median | 21.9 | 8.2 | 15.9 | 17.7 | 21.3 | 34.8 | ||
IQR | 16.1–30.8 | 7.8–10.6 | 11.2–19.6 | 14.0–23.8 | 16.8–25.4 | 26.0–41.9 | ||
GaitRite, speed cm/s | ||||||||
n | 86 | 4 | 15 | 7 | 20 | 39 | < 0.001 | −0.83** |
Median | 64.3 | 171.3 | 88.2 | 73.2 | 65.3 | 47.3 | ||
IQR | 45.0–84.8 | 139.2–176.2 | 75.6–135.4 | 60.1–96.9 | 57.9–78.4 | 27.4–65.8 | ||
PERSONAL HYGIENE | ||||||||
BI “Personal Hygiene”, score | 0.005 | −0.29** | ||||||
n | 99 | 27 | 32 | 21 | 16 | 3 | ||
0, n (%) | 17 (17.2) | 0 (.) | 7 (21.9) | 3 (14.3) | 6 (37.5) | 1 (33.3) | ||
5, n (%) | 82 (82.8) | 27 (100) | 25 (78.1) | 18 (85.7) | 10 (62.5) | 2 (66.7) | ||
TAKING ON AND OFF CLOTHES | ||||||||
BI “Dressing”, score | ||||||||
n | 98 | 25 | 22 | 24 | 15 | 12 | < 0.001 | −0.44** |
0, n (%) | 21 (21.4) | 2 (8) | 4 (18.2) | 4 (16.7) | 5 (33.3) | 6 (50) | ||
5, n (%) | 55 (56.1) | 11 (44) | 12 (54.5) | 16 (66.7) | 10 (66.7) | 6 (50) | ||
10, n (%) | 22 (22.4) | 12 (48) | 6 (27.3) | 4 (6.7) | 0 (.) | 0 (.) | ||
EATING AND DRINKING | ||||||||
BI “Feeding”, score | ||||||||
n | 98 | 62 | 23 | 5 | 6 | 2 | 0.002 | −0.31** |
0, n (%) | 1 (1) | 0 (.) | 0 (.) | 0 (.) | 1 (16.7) | 0 (.) | ||
5, n (%) | 39 (39.8) | 19 (30.6) | 12 (52.2) | 2 (40) | 4 (66.7) | 2 (100) | ||
10, n (%) | 58 (59.2) | 43 (69.4) | 11 (47.8) | 3 (60) | 1 (16.7) | 0 (.) |
Influence of cognitive status
Clinical measure | All | Category of self-rating | JT p-value |
rho
| |||||
---|---|---|---|---|---|---|---|---|---|
0 | 1 | 2 | 3 | 4 | |||||
MOTOR FUNCTIONS | |||||||||
HABAM, score | |||||||||
MMSE 17–22 |
n
| 53 | 6 | 17 | 6 | 19 | 5 | 0.002 | −0.44** |
Median | 33 | 40.5 | 50 | 28.5 | 33 | 21 | |||
IQR
| 28–50 | 35–50 | 39–53 | 28–33 | 26–46 | 17–29 | |||
MMSE 23–26 |
n
| 47 | 5 | 13 | 13 | 12 | 4 | 0.004 | −0.42** |
Median | 40.5 | 50 | 47 | 33 | 32.5 | 41 | |||
IQR
| 29–53 | 46–58 | 36–53 | 32–47 | 24.5–40 | 25–53 | |||
POMA Balance, score | 0.002 | −0.43** | |||||||
MMSE 17–22 |
n
| 52 | 6 | 17 | 5 | 19 | 5 | ||
Median | 10 | 12 | 13 | 5 | 8 | 5 | |||
IQR
| 5–13.5 | 7–14 | 12–15 | 4–8 | 2–12 | 2–6 | |||
MMSE 23–26 |
n
| 47 | 5 | 13 | 13 | 12 | 4 | 0.001 | −0.47** |
Median | 11 | 14 | 12 | 11 | 6 | 9 | |||
IQR
| 6–14 | 14–15 | 11–14 | 7–14 | 4.5–11 | 2.5–14 | |||
LOWER EXTERMITY MUSCLE STRENGTH | |||||||||
5 chair rise, s | |||||||||
MMSE 17–22 |
n
| 29 | 5 | 13 | 8 | 2 | 1 | 0.155 | 0.26 |
Median | 14.1 | 12.6 | 15.2 | 15.1 | 15.5 | 26.7 | |||
IQR
| 11.8–19.1 | 10.7–14.1 | 13.1–18.0 | 11.6–21.3 | 11.8–19.1 | 26.7 | |||
MMSE 23–26 |
n
| 32 | 6 | 8 | 8 | 8 | 2 | 0.021 | 0.42* |
Median | 16.0 | 11.4 | 16.3 | 17.5 | 18.4 | 14.4 | |||
IQR
| 13.8–20.6 | 11.0–11.8 | 15.5–19.4 | 16.3–25.9 | 14.9–24.1 | 12.9–15.9 | |||
1-RM, kg | |||||||||
MMSE 17–22 |
n
| 48 | 6 | 16 | 16 | 8 | 2 | 0.295 | −0.16 |
Median | 90 | 135 | 80 | 80 | 80 | 90 | |||
IQR
| 60–135 | 90–180 | 60–105 | 60–125 | 60–130 | 60–120 | |||
MMSE 23–26 |
n
| 42 | 6 | 8 | 11 | 13 | 4 | 0.009 | −0.40** |
Median | 70 | 145 | 80 | 60 | 70 | 40 | |||
IQR
| 50–120 | 80–210 | 70–105 | 30–130 | 50–110 | 30–55 | |||
WALKING | |||||||||
TuG, s | < 0.001 | 0.84** | |||||||
MMSE 17–22 |
n
| 38 | 1 | 11 | 3 | 7 | 16 | ||
Median | 21.9 | 7.9 | 13.4 | 14.0 | 23.7 | 35.0 | |||
IQR
| 14.0–31.3 | 7.9 | 11.2–18.3 | 12.4–15.4 | 21.4–26.3 | 27.5–40.1 | |||
MMSE 23–26 |
n
| 40 | 3 | 4 | 4 | 13 | 15 | < 0.001 | 0.58** |
Median | 22.0 | 8.6 | 19.0 | 21.9 | 20.9 | 34.7 | |||
IQR
| 17.6–30.3 | 7.8–12.7 | 14.5–30.8 | 18.9–26.8 | 16.1–22.6 | 23.2–45.2 | |||
GaitRite, speed, cm/s | |||||||||
MMSE 17–22 |
n
| 42 | 1 | 11 | 3 | 7 | 20 | < 0.001 | −0.70** |
Median | 67.7 | 170.2 | 93.8 | 96.9 | 60.3 | 48.9 | |||
IQR
| 47.3–89.7 | 170.2 | 80.5–135.5 | 85.0–103.6 | 50.4–89.7 | 31.6–62.5 | |||
MMSE 23–26 |
n
| 44 | 3 | 4 | 4 | 13 | 19 | < 0.001 | −0.54** |
Median | 64.3 | 172.3 | 77.9 | 62.5 | 66.2 | 44.8 | |||
IQR
| 44.9–76.7 | 108.1–180.1 | 62.4–107.8 | 56.8–69.0 | 62.5–77.6 | 27.4–67.3 | |||
PERSONAL HYGIENE | |||||||||
BI “Personal Hygiene”, score | |||||||||
MMSE 17–22 |
n
| 52 | 12 | 21 | 10 | 7 | 2 | 0.126 | −0.22 |
0, n (%) | 9 (17.3) | 0 (.) | 5 (23.8) | 1 (10) | 2 (28.6) | 1 (50) | |||
5, n (%) | 43 (82.7) | 12 (100) | 16 (76.2) | 9 (90) | 5 (71.4) | 1 (50) | |||
MMSE 23–26 |
n
| 47 | 15 | 11 | 11 | 9 | 1 | 0.016 | -0,35* |
0, n (%) | 8 (17.0) | 0 (.) | 2 (18.2) | 2 (18.2) | 4 (44.4) | 0 (.) | |||
5, n (%) | 39 (83.0) | 15 (100) | 9 (81.8) | 9 (81.8) | 5 (55.6) | 1 (100) | |||
TAKING ON AND OFF CLOTHES | |||||||||
BI “Dressing”, score | |||||||||
MMSE 17–22 |
n
| 51 | 13 | 13 | 12 | 6 | 7 | 0.031 | −0.30* |
0, n (%) | 12 (23.5) | 2 (15.4) | 3 (23.1) | 2 (16.7) | 2 (33.3) | 3 (42.9) | |||
5, n (%) | 32 (62.7) | 7 (53.8) | 8 (61.5) | 9 (75.0) | 4 (66.7) | 4 (57.1) | |||
10, n (%) | 7 (13.7) | 4 (30.8) | 2 (15.4) | 1 (8.3) | 0 (.) | 0 (.) | |||
MMSE 23–26 |
n
| 47 | 12 | 9 | 12 | 9 | 5 | < 0.001 | −0.60** |
0, n (%) | 9 (19.1) | 0 (.) | 1 (11.1) | 2 (16.7) | 3 (33.3) | 3 (60) | |||
5, n (%) | 23 (48.9) | 4 (33.3) | 4 (44.4) | 7 (58.3) | 6 (66.7) | 2 (40) | |||
10, n (%) | 15 (31.9) | 8 (66.7) | 4 (44.4) | 3 (25) | 0 (.) | 0 (.) | |||
EATING AND DRINKING | |||||||||
BI “Feeding”, score | |||||||||
MMSE 17–22 |
n
| 52 | 30 | 16 | 2 | 4 | 0 | 0.062 | −0.26 |
0, n (%) | 1 (1.9) | 0 (.) | 0 (.) | 0 (.) | 1 (25) | 0 (.) | |||
5, n (%) | 23 (44.2) | 11 (36.7) | 9 (56.3) | 1 (50) | 2 (50) | 0 (.) | |||
10, n (%) | 28 (53.8) | 19 (63.3) | 7 (43.8) | 1 (50) | 1 (25) | 0 (.) | |||
MMSE 23–26 |
n
| 46 | 32 | 7 | 3 | 2 | 2 | 0.018 | −0.35* |
0, n (%) | 0 (.) | 0 (.) | 0 (.) | 0 (.) | 0 (.) | 0 (.) | |||
5, n (%) | 16 (34.8) | 8 (25) | 3 (42.9) | 1 (33.3) | 2 (100) | 2 (100) | |||
10, n (%) | 30 (65.2) | 24 (75) | 4 (57.1) | 2 (66.7) | 0 (.) | 0 (.) |