Admission Cognition and Function Predict Change in Physical Function Following Skilled Nursing Rehabilitation

Area of Science:

• Gerontology
• Rehabilitation Medicine
• Physical Therapy

Background:

• Many older adults experience insufficient functional recovery in skilled nursing facilities (SNFs), impacting their ability to return home safely.
• Limited evidence exists to explain the factors contributing to this inadequate recovery post-hospitalization.
• Understanding predictors of physical function change is crucial for optimizing rehabilitation outcomes.

Purpose of the Study:

• To identify predictors of physical function change in older adults undergoing rehabilitation in SNFs.
• To analyze the relationship between admission characteristics and functional recovery (SPPB scores and gait speed).

Main Methods:

• Secondary analysis of a prospective observational cohort study involving 698 adults across 4 SNFs.
• Physical function was assessed using Short Physical Performance Battery (SPPB) scores and gait speed from admission to discharge.
• Standardized model selection estimators were used to determine predictors of physical function change.

Main Results:

• Higher admission cognitive scores and activities of daily living (ADL) independence predicted greater improvement in SPPB scores.
• Higher admission SPPB scores predicted smaller SPPB score changes, indicating less room for improvement.
• Admission ADL independence predicted greater gait speed improvement, while faster admission gait speed predicted smaller gait speed changes.

Conclusions:

• Cognition, ADL independence, and baseline physical function are key predictors of functional recovery post-SNF rehabilitation.
• The inverse relationship between admission physical function/ADL independence and recovery suggests that initial independence does not always correlate with mobility gains.
• Comprehensive assessment and tailored interventions throughout SNF stays are essential for maximizing functional recovery in older adults.