Article

The purpose of this study is to describe improvement in activities of
daily living (ADL) and gait speed, and associated factors in subjects receiving
home-based rehabilitation after hospital admission for heart failure. METHODS: A
total of 1,055 patients (mean age 82 +/- 8 years SD) receiving post-admission
home care services for heart failure. Subjects were included if they were
referred for home-care rehabilitation after inpatient admission with ICD-9 code
indicating heart failure at inpatient discharge, primary home care, or co-morbid
diagnosis on admission Outcome and Assessment Information Set version-C
(OASIS-C). Change in total ADL score was described and adjusted for significant
baseline factors/covariates using a generalized linear model. Factors predictive
of exceeding the ADL score Minimal Detectable Change (MDC) were identified with
multiple variable logistic regression. RESULTS: Mean change in total ADL score
from admission to discharge was 1.6 +/- 1.2, the mean change for gait speed was
0.17 +/- 0.21 m/s, and the minimum detectable change (MDC) (1.3) was exceeded by
57% of subjects. Improvement in mean ADL score was significantly predicted by
age, baseline total ADL score, baseline gait speed score, cognitive-behavioral
status, and living situation (R(2) = 42%). CONCLUSIONS: Patients with heart
failure receiving home-based rehabilitation services make significant
improvements in ADL function and gait performance. Greater ADL improvements are
associated with younger age, faster gait speed at baseline, and greater
impairment of baseline ADL scores. Age, baseline gait speed, and ADL composite
score are significantly related to making a change beyond measurement error in
ADL change score.

Langue : ANGLAIS