Achieving a minimally important difference in physical function during pediatric inpatient rehabilitation
Achieving a minimally important difference in physical function during pediatric inpatient rehabilitation
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DOI：
10.1097/mrr.0b013e3282fb7d03
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发表时间：
2008-09-01
影响因子：
1.7
通讯作者：
Ludlow, Larry H.
中科院分区：
文献类型：
--
作者：
Dumas, Helene M.;Haley, Stephen M.;Ludlow, Larry H.
我们的目标是检查在住院康复期间身体功能达到最小重要差异（MID）的儿童的比例，并确定与MID实现相关的因素。在美国东北部的一家儿科康复医院，连续452例住院患者，通过从出院评分中减去儿科残疾评估量表（PEDI）自我护理和移动功能技能以及护理人员协助入院评分来计算变化评分，然后评估MID。Logistic回归分析用于确定人口统计学和临床变量对每个PEDI量表MID的预测作用。超过55%的儿童获得了MID。实现MID的儿童比例最高的是移动功能技能（78%）和照顾者协助（67%）。入院时年龄较大（> 10岁）的儿童在所有量表上获得MID的机会更大。此外，与实现MID相关的是住院时间更长，入院PEDI评分更低，以及脑损伤的诊断。超过一半的儿童在身体功能方面达到了M I D。在这个儿科住院康复中心，年龄较大的脑损伤儿童在入院时功能能力较低，并且能够延长住院时间，以便安全，有计划地出院，最有可能实现MID。确定最有可能取得功能进步的儿童可以帮助项目管理人员和临床医生为住院治疗设定现实的功能目标和期望。
Our objectives were to examine the proportion of children who achieved a minimally important difference (MID) in physical function during inpatient rehabilitation and to identify factors related to achievement of MID. For a consecutive series of 452 inpatient admissions to a pediatric rehabilitation hospital in the northeastern United States, change scores were calculated by subtracting Pediatric Evaluation of Disability Inventory (PEDI) self-care and mobility functional skills and caregiver assistance admission scores from discharge scores and then evaluated for MID. Logistic regression analyses were used to determine the contributions of demographic and clinical variables as predictors of MID for each PEDI scale. More than 55% of the children achieved MID. The highest proportion of children achieving MID was in mobility functional skills (78%) and caregiver assistance (67%). Children who were older at admission (> 10 years) had a greater chance of achieving MID on all scales. In addition, associated with achieving MID were longer length of stay, lower admission PEDI score, and a diagnosis of brain injury. More than half of all children admitted achieved M I D in physical function. In this pediatric inpatient rehabilitation center, older children with brain injury who have low functional abilities at admission, and are able to extend their length of stay for a safe, planned discharge are most likely to achieve MID. Identifying children who are most likely to make functional progress can help program administrators and clinicians set realistic functional goals and expectations for an episode of inpatient care.