The Influence of Multimorbidity on Rehabilitation Outcomes in Stroke and Amputation

2.50
Hdl Handle:
http://hdl.handle.net/10755/621923
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
The Influence of Multimorbidity on Rehabilitation Outcomes in Stroke and Amputation
Other Titles:
Quality Improvement Outcomes
Author(s):
Buijck, Bianca Ivonne
Lead Author STTI Affiliation:
Rho Chi-at-Large
Author Details:
Bianca Ivonne Buijck, PhD, MScN, RN, Professional Experience: 2015-present: lecturer university of applied sciences LOI 2013-present: managing director Rotterdam Stroke Service 2014-2015: project manager oncology and palliative care: Laurens 2008-present: researcher Nijmegen University (geriatric rehabilitation) 2011-2013: reseacher Topcare Apeldoorn (Huntington's disease and Korsakov Syndrome) 1988-2013: nurse, head of department, policy employee, researcher (dementia) 2008-2011: researcher Zorgboog (geriatric rehabilitation) 2008-present: freelancer. Writing, education, member of boards, quality inspector. Author Summary: I am the managing director the Rotterdam Stroke Service, the largest and oldest stroke service in the Netherlands. I am responsible for the coordination of research, education and practice that is being organized in the RSS.
Abstract:

Purpose:

Multimorbidity is highly prevalent in older patients who rehabilitate in skilled nursing facilities (SNFs). In these SNFs, nurses have an important role in the rehabilitation process of patients. Although the high prevalence of multimorbidity, studies aimed at identifying determinants of outcome in elderly patients with multimorbidity that rehabilitate after stroke or lower limb amputation (LLA) in SNFs, are scarce. Therefore, this study aimed to investigate the influence of multimorbidity on rehabilitation outcomes in stroke and LLA.

Methods:

The Geriatric Rehabilitation in AMPutation and Stroke (GRAMPS) study is a prospective, multicentre, cross sectional study in 15 SNFs. Univariate, and multivariate logistic and linear regression analyses were used to identify multimorbidity as independently related determinant of rehabilitation outcomes, such as postural imbalance (for stroke), and prosthetic use and timed-up-and-go test (for LLA).

Results:

186 patients with stroke and 46 patients with LLA were included in the study. Multimorbidity was present in 34% of the stroke patients and 53% of the patients with LLA. The stroke patients with multimorbidity differed from the patients without multimorbidity with respect to age, proprioception, and vibration sense, but not for any of the cognitive tests, muscle strength, or sitting balance. Patients with multimorbidity had, on average, lower scores on outcome measures. In linear regression analyses, both balance and walking abilities were best explained by multimorbidity, muscle strength, and the interaction between muscle strength and static sitting balance (overall explained variance 66% and 67%, respectively). In LLA patients multimorbidity was not independently related to prosthetic use.

Being able to ambulate independently, and having a transtibial amputation (rather than a higher level of amputation), without phantom pain, determined prosthetic use (R2=56%), while cognitive abilities, low amputation level, and pre-operative functional abilities were independently associ­ated with the timed-up-and-go test test (R2=82%).

Conclusion:

Multimorbidity was independently related to postural imbalance after stroke in patients admitted for rehabilitation in SNFs, but surprisingly multimorbidity had no significant role on rehabilitation outcomes of patients with LLA, even though other authors found an associa­tion between multimorbidity and prosthetic use. However, multimorbidity was evenly distributed between patients with, and patients without, a prosthesis. Therefore, it could not give an independent contribution to prosthetic use. Because the presence of multiple chronic diseases influences the performance of stroke and LLA patients during rehabilitation in het SNF, it is important that nurses have insight in rehabilitation outcome.

Keywords:
amputation; multimorbidity; stroke
Repository Posting Date:
19-Jul-2017
Date of Publication:
19-Jul-2017
Other Identifiers:
INRC17R04
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleThe Influence of Multimorbidity on Rehabilitation Outcomes in Stroke and Amputationen_US
dc.title.alternativeQuality Improvement Outcomesen
dc.contributor.authorBuijck, Bianca Ivonneen
dc.contributor.departmentRho Chi-at-Largeen
dc.author.detailsBianca Ivonne Buijck, PhD, MScN, RN, Professional Experience: 2015-present: lecturer university of applied sciences LOI 2013-present: managing director Rotterdam Stroke Service 2014-2015: project manager oncology and palliative care: Laurens 2008-present: researcher Nijmegen University (geriatric rehabilitation) 2011-2013: reseacher Topcare Apeldoorn (Huntington's disease and Korsakov Syndrome) 1988-2013: nurse, head of department, policy employee, researcher (dementia) 2008-2011: researcher Zorgboog (geriatric rehabilitation) 2008-present: freelancer. Writing, education, member of boards, quality inspector. Author Summary: I am the managing director the Rotterdam Stroke Service, the largest and oldest stroke service in the Netherlands. I am responsible for the coordination of research, education and practice that is being organized in the RSS.en
dc.identifier.urihttp://hdl.handle.net/10755/621923-
dc.description.abstract<p><sub><strong>Purpose:</strong></sub></p> <p><sub>Multimorbidity is highly prevalent in older patients who rehabilitate in skilled nursing facilities (SNFs). In these SNFs, nurses have an important role in the rehabilitation process of patients. Although the high prevalence of multimorbidity, studies aimed at identifying determinants of outcome in elderly patients with multimorbidity that rehabilitate after stroke or lower limb amputation (LLA) in SNFs, are scarce. Therefore, this study aimed to investigate the influence of multimorbidity on rehabilitation outcomes in stroke and LLA.</sub></p> <p><strong style="vertical-align: sub; font-size: 10pt;">Methods:</strong></p> <p><sub>The Geriatric Rehabilitation in AMPutation and Stroke (GRAMPS) study is a prospective, multicentre, cross sectional study in 15 SNFs.<em> </em></sub><sub>Univariate, and multivariate logistic and linear regression analyses were used to identify multimorbidity as independently related determinant of rehabilitation outcomes, such as postural imbalance (for stroke), and prosthetic use and timed-up-and-go test (for LLA).</sub></p> <p><strong style="vertical-align: sub; font-size: 10pt;">Results:</strong></p> <p><sub>186 patients with stroke and 46 patients with LLA were included in the study. Multimorbidity was present in 34% of the stroke patients and 53% of the patients with LLA. The stroke patients with multimorbidity differed from the patients without multimorbidity with respect to age, proprioception, and vibration sense, but not for any of the cognitive tests, muscle strength, or sitting balance. Patients with multimorbidity had, on average, lower scores on outcome measures. In linear regression analyses, both balance and walking abilities were best explained by multimorbidity, muscle strength, and the interaction between muscle strength and static sitting balance (overall explained variance 66% and 67%, respectively). In LLA patients multimorbidity was not independently related to prosthetic use.</sub></p> <p><sub>Being able to ambulate independently, and having a transtibial amputation (rather than a higher level of amputation), without phantom pain, determined prosthetic use (R2=56%), while cognitive abilities, low amputation level, and pre-operative functional abilities were independently associ­ated with the timed-up-and-go test test (R2=82%).</sub></p> <p><strong style="vertical-align: sub; font-size: 10pt;">Conclusion:</strong></p> <p><sub>Multimorbidity was independently related to postural imbalance after stroke in patients admitted for rehabilitation in SNFs, but surprisingly multimorbidity had no significant role on rehabilitation outcomes of patients with LLA, even though other authors found an associa­tion between multimorbidity and prosthetic use. However, multimorbidity was evenly distributed between patients with, and patients without, a prosthesis. Therefore, it could not give an independent contribution to prosthetic use. Because the presence of multiple chronic diseases influences the performance of stroke and LLA patients during rehabilitation in het SNF, it is important that nurses have insight in rehabilitation outcome.</sub></p>en
dc.subjectamputationen
dc.subjectmultimorbidityen
dc.subjectstrokeen
dc.date.available2017-07-19T14:15:14Z-
dc.date.issued2017-07-19-
dc.date.accessioned2017-07-19T14:15:14Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.