Should patients with severe cognitive impairment be offered rehabilitation after acute illness?

Abstract

OBJECTIVES: To evaluate the outcomes of rehabilitation in patients with moderate to severe cognitive impairment and clarify whether such patients benefit from rehabilitation. METHODS: We performed a prospective cohort study of 116 patients (70F), mean age 86.3 (SD 6.4) in a rehabilitation unit for older people in the UK. Group 1: 89 patients with moderate cognitive impairment (MMSE 11–20) and Group 2: 27 patients with severe cognitive impairment (MMSE 0–10). Each patient had a personalised rehabilitation plan dependent on the patients’ abilities with formal input from physiotherapists, physiotherapy assistants and occupational therapists and informal therapy from nursing staff. Barthel activity of daily living score (BS) was recorded on admission and discharge as well as length of stay and discharge destination. RESULTS: Of the home discharges in Group 1, 32/37 (86.5%) patients improved their BS compared to 10/28 (35.7%) of placement discharges (p = 0.0001). In Group 2, 6/6 (100%) home discharges showed an improvement compared to 3/7 (42.8%) patients discharged to placement (p = 0.07). In both groups a discharge home required an improvement in at least three Barthel domains (BD). In Group 1 a discharge home was associated with significant different improvement in BDs than a placement discharge (3.27 v 1.86: p = 0.007). A similar pattern was noted for severe dementia patients (3.5 v 1.14; p = 0.1). Improvement in BDs can happen regardless of the level of impairment on admission. CONCLUSION: Patients with moderate /severe dementia demonstrated significant improvements in BS and BDs which translated into home discharges.