Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.736
5-Year Impact Factor – 2.135
Index Copernicus  – 168.52
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

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Advances in Clinical and Experimental Medicine

2010, vol. 19, nr 6, November-December, p. 755–764

Publication type: original article

Language: English

Cognitive Impairment, Depressive Symptoms and the Efficacy of Physiotherapy in Elderly People Undergoing Rehabilitation in a Nursing Home Facili

Zaburzenia poznawcze i objawy depresyjne a skuteczność fizjoterapii osób starszych usprawnianych w warunkach długoterminowej hospitalizacji zakładu opiekuńczo-leczniczego

Joanna Szczepańska-Gieracha1,, Joanna Kowalska1,, Iwona Malicka1,, Joanna Rymaszewska1,2,

1 Department of Physiotherapy, University School of Physical Education, Wroclaw, Poland

2 Division of Consultation-Liaison Psychiatry & Behavioral Medicine Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland

Abstract

Objectives. The aim of this study was to assess factors affecting the efficacy of three months of physiotherapy carried out in nursing home (NH) conditions.
Material and Methods. The study involved 71 patients undergoing rehabilitation in a NH. The mean age was 77.4 (± 7.3) years; 81.7% were women; 25.4% had had orthopedic injuries; 56.3% had had a stroke; and 18.3% were patients with chronic diseases. The Mini Mental State Examination (MMSE) was used to test the patients’ state of cognitive function. The Geriatric Depression Scale (GDS-15) was used to determine their mood, and the Barthel Index (BI) was used to assess their functional status. The efficacy of physiotherapy (EP) was specified after each month of physiotherapy (EP1, EP2, EP3).
Results. Cognitive impairments (MMSE < 24) were found in 73% of the patients, and symptoms of depression (GDS > 5) in 65% of the patients. The average BI score upon admission to the facility was 38.6 (± 20.2), and after three months it was 59.2 (± 24.5) (p < 0.00001). The average EP3 was 20.6 (± 15.0). In the case of 31% of the patients, EP3 was very low: 4.8 (± 3.6). A significant relationship was revealed between EP3 and MMSE (p = 0.00113), EP3 and GDS (p = 0.01223), EP3 and diagnosis (p = 0.0106) as well as EP3 and EP1 (p < 0.00001).
Conclusion. An increased risk of physiotherapy failure in NH conditions was observed in patients with profound cognitive impairments (MMSE < 11) and severe depressive symptoms (GDS > 10). The strongest rehabilitation progress in the NH was observed among patients undergoing rehabilitation due to orthopedic injuries. The best and the most precise prognostic factor for the outcome of physiotherapy after a three-month NH stay is the effectiveness of physiotherapy after one month of hospitalization. A lack of an improvement in functional status after the first month of rehabilitation could indicate a need for the standard model of rehabilitation to be modified, or for the patient to be transferred to a specialized rehabilitation unit.

Streszczenie

Cel pracy. Ocena czynników wpływających na skuteczności 3-miesięcznej fizjoterapii prowadzonej w warunkach HN.
Materiał i metody. Badania przeprowadzono w zakładzie opiekuńczo-leczniczym (NH). Do badań włączono 71 osób: średnia wieku wynosiła 77,4 (± 7,3) lat; 81,7% stanowiły kobiety, 25,4% to osoby po urazach ortopedycznych, 56,3% pacjenci po przebytym udarze mózgu, a 18,3% seniorzy usprawniani z powodu chorób przewlekłych wieku podeszłego. Badano stan funkcji poznawczych i nastrój za pomocą Mini Mental State Examination (MMSE) i Geriatric Depression Scale (GDS-15) oraz stan funkcjonalny za pomocą Barthel Index (BI). Określono skuteczność fizjoterapii (EP) po każdym miesiącu rehabilitacji (EP1, EP2, EP3).
Wyniki. Zaburzenia funkcji poznawczych (MMSE < 24) stwierdzono w przypadku 73% badanych, objawy depresji (GDS > 5) u 65%. Średni wynik BI przy przyjęciu na oddział wyniósł 38.6 (± 20,2), a po trzech miesiącach hospitalizacji wzrósł istotnie do 59,2 (± 24,5) (p < 0,00001). Średnia skuteczność fizjoterapii (EP3) wyniosła 20.6 (± 15,0). Niską skuteczność fizjoterapii osiągnęło 31% (n = 22) badanej grupy. Wykazano istotną zależność pomiędzy EP3 i MMSE (p = 0,00113), EP3 i GDS (p = 0,01223), EP3 i rozpoznaniem (p = 0,0106) oraz EP3 i EP1 (p < 0,00001).
Wnioski. Zwiększone ryzyko niepowodzenia fizjoterapii w warunkach NH obserwuje się u pacjentów z głębokimi zaburzeniami poznawczymi (MMSE < 11) oraz nasilonymi objawami depresji (GDS > 10). Największą szansę na pomyślny przebieg procesu usprawniania w NH mają osoby rehabilitowanie z powodu urazów ortopedycznych. Najlepszym i najbardziej trafnym czynnikiem prognostycznym rezultatów fizjoterapii w NH jest skuteczność fizjoterapii po miesiącu hospitalizacji. Brak poprawy stanu funkcjonalnego po pierwszym miesiącu pobytu w NH jest wskazaniem do modyfikacji przyjętego modelu usprawniania lub przeniesienia pacjenta do specjalistycznego oddziału rehabilitacyjnego.

Key words

elderly patients, efficacy of physiotherapy, long-term care unit

Słowa kluczowe

wiek podeszły, skuteczność fizjoterapii, opieka długoterminowa

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