Menezes KV1, Auger C2, Rodrigues de Souza Menezes W3, Mauricio de Carvalho AC4, Bastos Tavares L4, Oliveira Guerra R4
1Universidade Federal do Rio Grande do Norte, Physiotherapy, Natal, Brazil, 2University of Montreal, Montreal, Canada, 3Universidade Potiguar, Natal, Brazil, 4Universidade Federal do Rio Grande do Norte, Natal, Brazil
Background: Loss of function during hospitalization is associated to a wide range of risk factors. In-hospital mobility has received particular attention due to its important relation to loss of functional capacity. Short Physical Performance Battery (SPPB) has been used to evaluate mobility and some studies examined the predictive value of SPPB after hospitalization. A relationship between SPPB score at discharge and the risk of subsequent loss of functional capacity, rehospitalization and death was observed, where patients with lower score were at highest risk. Despite the extensive findings about the predictive value of SPPB after discharge, no results were found regarding its predictive value during hospitalization in older adults.
Purpose: To evaluate if SPPB assessed at admission is predictive of loss in functional capacity during hospitalization of older adults.
Methods: A cohort prospective study was conducted at a University Hospital in Brazil between January 1, 2014 and April 30, 2015. Older adults were assessed at two distinct moments (admission and discharge) regarding personal risk factors including age, gender, domestic life activities (Instrumental activities of daily living - IADL, Lawton and Brody's scale), cognition (Leganés test) and depression (Geriatric Depression Scale - GDS-15). Hospital-related risk factors included in-hospital mobility (SPPB) and surgery. The dependent outcome functional capacity was assessed with the Katz scale. To determine if SPPB at admission could predict loss of functional capacity during hospitalization, a receiver-operating characteristic (ROC) curve was performed and Area under the curve (AUC) was calculated. Logistic binary regression models were used to identify predictors of loss in functional capacity. Model 1 only contained SPPB. Model 2 SPPB was combined with age, gender, IADL, cognition, depression and surgery. Data were entered into the Statistical Package for Social Sciences (SPSS) 18.0.
Results: From all patients, 1191 were enrolled with a mean age of 70.0 (±7.34). SPPB cutoff point of 6.5 (AUC = .603) at admission identified 593 (49.8%) patients at risk for loss of functional capacity. In logistic regression, low SPPB at admission (cut-off 6.5) significantly increased the odds of functional capacity (p 0.001, OR 1.8, 95% CI = 1.5-2.5) at discharge. Model 1 explained 22 to 32% of the variance in functional capacity. Model 2 explained 49% to 71% of the variance, and three variables (SPPB, gender and surgery) had a significant contribution to loss in functional capacity. SPPB 6.5 increased the odds to present loss of functional capacity during hospitalization by 80% (OR 1.8; 95% CI =1.3-2.4), being a woman increased the odds by 40% (OR 1.4; 95% CI = 1.0-1.8) and having no surgery doubled the odds of decline at discharge when controlling for the other variables (OR 2.0; 95% CI = 1.4-2.8).
Conclusion(s): We conclude that SPPB can predict loss of functional capacity in hospitalized older adults. Combining SPPB, gender and surgical status improved the detection of cases at risk of functional loss.
Implications: A simple set of measures can identify patients at risk for functional capacity decline during hospitalisation and may help to target early interventions that maintain or improve functioning at discharge.
Keywords: Hospital, mobility, functioning
Funding acknowledgements: Coordination for the Improvement of Higher Education Personnel (CAPES) and Fonds de recherche Québec - santé.
Purpose: To evaluate if SPPB assessed at admission is predictive of loss in functional capacity during hospitalization of older adults.
Methods: A cohort prospective study was conducted at a University Hospital in Brazil between January 1, 2014 and April 30, 2015. Older adults were assessed at two distinct moments (admission and discharge) regarding personal risk factors including age, gender, domestic life activities (Instrumental activities of daily living - IADL, Lawton and Brody's scale), cognition (Leganés test) and depression (Geriatric Depression Scale - GDS-15). Hospital-related risk factors included in-hospital mobility (SPPB) and surgery. The dependent outcome functional capacity was assessed with the Katz scale. To determine if SPPB at admission could predict loss of functional capacity during hospitalization, a receiver-operating characteristic (ROC) curve was performed and Area under the curve (AUC) was calculated. Logistic binary regression models were used to identify predictors of loss in functional capacity. Model 1 only contained SPPB. Model 2 SPPB was combined with age, gender, IADL, cognition, depression and surgery. Data were entered into the Statistical Package for Social Sciences (SPSS) 18.0.
Results: From all patients, 1191 were enrolled with a mean age of 70.0 (±7.34). SPPB cutoff point of 6.5 (AUC = .603) at admission identified 593 (49.8%) patients at risk for loss of functional capacity. In logistic regression, low SPPB at admission (cut-off 6.5) significantly increased the odds of functional capacity (p 0.001, OR 1.8, 95% CI = 1.5-2.5) at discharge. Model 1 explained 22 to 32% of the variance in functional capacity. Model 2 explained 49% to 71% of the variance, and three variables (SPPB, gender and surgery) had a significant contribution to loss in functional capacity. SPPB 6.5 increased the odds to present loss of functional capacity during hospitalization by 80% (OR 1.8; 95% CI =1.3-2.4), being a woman increased the odds by 40% (OR 1.4; 95% CI = 1.0-1.8) and having no surgery doubled the odds of decline at discharge when controlling for the other variables (OR 2.0; 95% CI = 1.4-2.8).
Conclusion(s): We conclude that SPPB can predict loss of functional capacity in hospitalized older adults. Combining SPPB, gender and surgical status improved the detection of cases at risk of functional loss.
Implications: A simple set of measures can identify patients at risk for functional capacity decline during hospitalisation and may help to target early interventions that maintain or improve functioning at discharge.
Keywords: Hospital, mobility, functioning
Funding acknowledgements: Coordination for the Improvement of Higher Education Personnel (CAPES) and Fonds de recherche Québec - santé.
Topic: Outcome measurement; Critical care
Ethics approval required: Yes
Institution: University Hospital Onofre Lopes
Ethics committee: Ethics Committee of University Hospital Onofre Lopes
Ethics number: 496.645/2013
All authors, affiliations and abstracts have been published as submitted.
