J. Thomas1
1NHS Fife, Dunfermline, United Kingdom
Background: Collection of physical and quality of life (QoL) outcomes was routine in an Older Peoples Assessment and Rehabilitation Centre (ARC) until March 2020 when the service was paused due to COVID 19. These measures have customarily been used to inform service improvements but the pause in service allowed a full stocktake of outcomes over a 5-year period.
Purpose: These past outcomes will be used to benchmark the pre-COVID service model to allow future evaluation of the current service delivery model which had to be significantly changed due to COVID restrictions.
The aims were to
The aims were to
- understand the characteristics of people referred to an ARC before a COVID related service delivery change
- appraise the outcomes of attending an ARC
- evaluate the need for both physical and quality of life measures to be collected
Methods: Outcome measures for patients who completed their outpatient rehabilitation in the ARC between 2014 and 2019 were evaluated using a descriptive analysis and compared to cut points and minimal clinically important differences (MCID). Correlations which might imply a redundancy in measuring both physical and QoL measures were calculated using a Spearman’s coefficient.
Results: 686 patients had measures recorded on assessment and discharge in gait speed and grip strength (physical measures) and the EQ5D (QoL measure). The mean age was 80 (54 – 103) and the mean overall length of attendance was 103 days.
94% of patients had a low gait speed on assessment (<0.8m/s), which might indicate physical frailty. This reduced to 79% on discharge from the ARC. 46% of patients improved their gait speed by more than the MCID of 0.12m/s.
85% of patients had low grip strength on assessment (< 16kg for women and <27kg for men), which might indicate sarcopenia. This reduced to 81% on discharge. 15.5% of patients improved their grip strength by more than the MCID of 5kg.
93% of patients had a lower QoL score than population norms on assessment (<0.81 index score on EQ5D). This reduced to 82% on discharge. 36% of patients improved their QoL index score by more than the MCID of 0.18.
There was no strong correlation between the overall EQ5D index score and gait speed on assessment (Spearman r= 0.335) or the mobility sub section and gait speed on assessment (Spearman r= 0.307).
94% of patients had a low gait speed on assessment (<0.8m/s), which might indicate physical frailty. This reduced to 79% on discharge from the ARC. 46% of patients improved their gait speed by more than the MCID of 0.12m/s.
85% of patients had low grip strength on assessment (< 16kg for women and <27kg for men), which might indicate sarcopenia. This reduced to 81% on discharge. 15.5% of patients improved their grip strength by more than the MCID of 5kg.
93% of patients had a lower QoL score than population norms on assessment (<0.81 index score on EQ5D). This reduced to 82% on discharge. 36% of patients improved their QoL index score by more than the MCID of 0.18.
There was no strong correlation between the overall EQ5D index score and gait speed on assessment (Spearman r= 0.335) or the mobility sub section and gait speed on assessment (Spearman r= 0.307).
Conclusions: People attending the ARC are overwhelmingly presenting with significant levels of physical frailty, probable sarcopenia and below age related norms of quality of life.
A brief period of input of around 3 months resulted in clinically meaningful improvements in gait speed and health related quality of life. Grip strength did not show the same level of change and a longer period of input might be required to demonstrate clinically meaningful changes.
A brief period of input of around 3 months resulted in clinically meaningful improvements in gait speed and health related quality of life. Grip strength did not show the same level of change and a longer period of input might be required to demonstrate clinically meaningful changes.
Implications: There is a need to assess both physical and QoL measures, as they appear to measure distinct aspects of people’s function.
Comparisons can be made to establish if there has been a change both in the characteristics of patients referred and outcomes following a new model of rehabilitation input enforced by COVID related changes.
Comparisons can be made to establish if there has been a change both in the characteristics of patients referred and outcomes following a new model of rehabilitation input enforced by COVID related changes.
Funding acknowledgements: NA
Keywords:
Outcomes
Quality of Life
Outcomes
Quality of Life
Topics:
Older people
Community based rehabilitation
Service delivery/emerging roles
Older people
Community based rehabilitation
Service delivery/emerging roles
Did this work require ethics approval? No
Reason: Caldicott approval was sought and obtained for use of the already collected and anonymised data to be used for service evaluation purposes.
All authors, affiliations and abstracts have been published as submitted.
