Social Indicators Research

, Volume 77, Issue 1, pp 79–93 | Cite as

Does Change in Functional Performance Affect Quality of Life in Persons with Orthopaedic Impairment?

  • Glenn V. Ostir
  • Ivonne-Marie Berges
  • Pamela M. Smith
  • David Smith
  • Janida L. Rice
  • Kenneth J. Ottenbacher
Article
Accepted:

Abstract

Background and Purpose: Examine the association between change in functional status and quality of life for individuals with orthopaedic impairments approximately 90 days after discharge from in-patient medical rehabilitation. Methods: A retrospective study from 2001 to 2002 using information from the IT HealthTrack database. The study included 3751 individuals with orthopaedic impairments aged 40 or older discharged from in-patient medical rehabilitation. Primary measures included motor and cognition functional status and quality of life. Data analyses included descriptive statistics, χ2 analysis, and cumulative logit models. Results: The sample was 49.4% female and 81.1% non-Hispanic white. Most patients reported high levels of quality of life after hospital discharge. Change in functional status showed a significant association with quality of life with and without adjustment for possible confounding factors. Each one-point increase in total Functional Independence Measure (FIM) score was associated with an 8% increased odds ratio (OR 1.08, 95% CI: 1.07–1.09) of higher quality of life. Each one-point increase in motor and cognition FIM score was associated with an 8% (OR 1.08, 95% CI: 1.07–1.09) and 29% (OR 1.29, 95% CI: 1.24–1.35) increased odds ratio of higher quality of life, respectively. Of the 6 FIM domains, self care (OR 1.05, 95% CI: 1.03–1.06) and locomotion (OR 1.07, 95% CI: 1.03–1.11) were significantly associated with higher quality of life. Conclusions: Among individuals with orthopaedic impairments, a positive change in functional status was significantly associated with higher quality of life. The findings suggest the potential value of rehabilitation programs that focus on improving functional status.

Keywords

Functional Independence Measure Medical Rehabilitation Increase Odds Ratio Functional Independence Measure Score Inpatient Rehabilitation Facility 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Bernstein, D., Kleinman, L., Barker, C.M., Revicki, D.A., Green, J. 2002‘Relationship of health-related quality of life to treatment adherence and sustained response in chronic hepatitis C patients’Hepatology35704708CrossRefGoogle Scholar
  2. Bombardier, C., Ware, J., Russell, I.J., Larson, M., Chalmers, A., Read, J.L. 1986‘Auranofin therapy and quality of life in patients with rheumatoid arthritis Results of a multicenter trial’American Journal of Medicine81565578CrossRefGoogle Scholar
  3. Bowling, A. 1997Measuring Health: A Review of Quality of Life Measurement ScalesOpen University PressPhiladelphia, PAGoogle Scholar
  4. Brandt, E.M., Pope, A. 1997Enabling America: Assessing the role of Rehabilitation Science and EngineeringNational Academy PressWashington, DCGoogle Scholar
  5. Carter, G.M., J.L. Buchanan, T. Donyo, M. Inkelas and K.L. Spritzer: 1997, ‘A prospective payment system for inpatient rehabilitation’. Project memo (Final 31 Aug 95- 3 Jul 97) (NTIS Order Number PB98–106024) (RAND/UCLA/Harvard Center for Health Care Financing Policy Research, Santa Monica, CA).Google Scholar
  6. Carter, G.M., Buntin, M.B., Hayden, O., Kawata, J., Paddock, S.M., Relles, D.A., Ridgeway, G.K., Totten, M., Wynn, B.O. 2002Analysis for the initial implementation of the inpatient rehabilitation facility prospective payment system (Document MR-1500-CMS; NTIS Order Number ADA404816)RAND CorporationSanta Monica, CAGoogle Scholar
  7. Cella, D., Nowinski, C.J. 2002‘Measuring quality of life in chronic illness: The functional assessment of chronic illness therapy measurement system’Archives of Physical Medicine and Rehabilitation83S10S17CrossRefGoogle Scholar
  8. Cleary, P.D., McNeil, B.J. 1988‘Patient satisfaction as an indicator of quality care’Inquiry252536Google Scholar
  9. Con, A.H., Linden, W., Thompson, J.M., Ignaszewski, A. 1999‘The psychology of men and women recovering from coronary artery bypass surgery’Journal of Cardiopulmonary Rehabilitation19152161CrossRefGoogle Scholar
  10. Connelly, J.E., Phillbrick, J.T., Smith, G.R.,Jr., Kaiser, D.L., Wymer, A. 1989‘Health perceptions of primary care patients and the influence on health care utilization’Medical Care27S99S109Google Scholar
  11. Croog, S.H., Levine, S., Testa, M.A., Brown, B., Bulpitt, C.J., Jenkins, C.D., Klerman, G.L., Williams, G.H. 1986‘The effects of antihypertensive therapy on the quality of life’The New England Journal of Medicine31416571664CrossRefGoogle Scholar
  12. Deutsch, A., Fiedler, R.C., Granger, C.V., Russell, C.F. 2002‘The Uniform Data System for Medical Rehabilitation report of patients discharged from comprehensive medical rehabilitation programs in 1999’American Journal of Physical Medicine and Rehabilitation81133142CrossRefGoogle Scholar
  13. Diener, E. 1984‘Subjective well-being’Psychological Bulletin95542575CrossRefGoogle Scholar
  14. Dijkers, M. 1997‘Measuring quality of life’Fuhrer, M.J. eds. Assessing Medical Rehabilitation Practices: The Promise of Outcomes ResearchP.H. Brookes PubBaltimore, MD153180Google Scholar
  15. Dodds, T.A., Martin, D.P., Stolov, W.C., Deyo, R.A. 1993‘A validation of the functional independence measurement and its performance among rehabilitation inpatients’Archives of Physical Medicine and Rehabilitation74531536CrossRefGoogle Scholar
  16. Dull, V.T., Lansky, D., Davis, N. 1994‘Evaluating a patient satisfaction survey for maximum benefit’The Joint Commission Journal on Quality Improvement20444453Google Scholar
  17. Goldring, A.B., Taylor, S.E., Kemeny, M.E., Anton, P.A. 2002‘Impact of health beliefs, quality of life, and the physician-patient relationship on the treatment intentions of inflammatory bowel disease patients’Health Psychology21219228CrossRefGoogle Scholar
  18. Granger, C.V., Cotter, A.C., Hamilton, B.B., Fiedler, R.C. 1993‘Functional assessment scales: A study of persons after stroke’Archives of Physical Medicine and Rehabilitation74133138Google Scholar
  19. Hall, J.A., Dornan, M.C. 1990‘Patient sociodemographic characteristics as predictors of satisfaction with medical care: A meta-analysis’Social Science and Medicine30811818CrossRefGoogle Scholar
  20. Hamilton, B.B., Granger, C.V., Sherwin, F.S. 1987‘A uniform national data system for medical rehabilitation’Fuhrer, M.J. eds. Rehabilitation Outcomes: Analysis and MeasurementBrookesBaltimore, MDGoogle Scholar
  21. Hamilton, B.B., Laughlin, J.A., Fiedler, R.C., Granger, C.V. 1994‘Interrater reliability of the 7-level functional independence measure (FIM)’Scandinavian Journal of Rehabilitation Medicine26115119Google Scholar
  22. Heinemann, A.W., Bode, R., Cichowski, K.C., Kan, E. 1997‘Measuring patient satisfaction with medical rehabilitation’Journal of Rehabilitation Outcomes Measurement15265Google Scholar
  23. Heinemann, A.W., Linacre, J.M., Wright, B.D., Hamilton, B.B., Granger, C. 1994‘Prediction of rehabilitation outcomes with disability measures’Archives of Physical Medicine and Rehabilitation75133143CrossRefGoogle Scholar
  24. Hibbard, J.H. 2003‘Engaging health care consumers to improve the quality of care’Medical Care41I61I70Google Scholar
  25. Idler, E., Angel, R. 1990‘Self-rated health and mortality in the NHANES-1 epidemiologic follow-up study’American Journal of Public Health72446452CrossRefGoogle Scholar
  26. Institute of Medicine: 2001, Crossing the Quality Chasm: A New Health System for the 21st Century, (National Academy Press. Washington, DC)Google Scholar
  27. JCAHO: 1994, Guidelines for Establishing and Evaluating Outcomes in Clinical Settings, Washington DC: Joint Commission on Accreditation of Healthcare OrganizationsGoogle Scholar
  28. Jones, N., S.L. Jones and N.A. Miller: 2004, The Medicare health outcomes survey program: Overview, context, and near-term prospects. Health and Quality of Life Outcomes [On-line]. Available at: www.hqlo.com. Accessed on September 27, 2004Google Scholar
  29. Keepnews, D. 2004‘Using patient satisfaction data to improve home healthcare’Journal for Healthcare Quality2649Google Scholar
  30. Keith, R.A. 1998‘Patient satisfaction and rehabilitation services’Archives of Physical Medicine and Rehabilitation7911221128CrossRefGoogle Scholar
  31. Keyes, C.L., Shmotkin, D., Ryff, C.D. 2002‘Optimizing well-being: The empirical encounter of two traditions’Journal of Personality and Social Psychology8210071022CrossRefGoogle Scholar
  32. Krause, J.S., Sternberg, M., Lottes, S., Maides, J. 1997‘Mortality after spinal cord injury: An 11-year prospective study’Archives of Physical Medicine and Rehabilitation78815821CrossRefGoogle Scholar
  33. Mehnert, T., Krauss, H.H., Nadler, R., Boyd, M. 1990‘Correlates of life satisfaction in those with disabling conditions’Rehabilitation Psychology35317CrossRefGoogle Scholar
  34. National Advisory Board on Medical Rehabilitation Research: 1993, Research plan for the National Center for Medical Rehabilitation Research (NIH Publication No. 93–3509), Bethesda, MD: US Department of Health and Human ServicesGoogle Scholar
  35. Nunes, M.I. 2001‘The relationship between quality of life and adherence to treatment’Current Hypertension Reports3462465Google Scholar
  36. O’Boyle, C.A., Waldron, D. 1997‘Quality of life issues in palliative medicine’Journal of Neurology244S18S25CrossRefGoogle Scholar
  37. Ottenbacher, K.J., Gonzales, V.A., Smith, P.M., Illig, S.B., Fiedler, R.C., Granger, C. V. 2001‘Satisfaction with medical rehabilitation in patients with cerebrovascular impairment’American Journal of Physical Medicine and Rehabilitation80876884CrossRefGoogle Scholar
  38. Ottenbacher, K.J., Hsu, Y., Granger, C.V., Fiedler, R.C. 1996‘The reliability of the functional independence measure: A quantitative review’Archives of Physical Medicine and Rehabilitation7712261232CrossRefGoogle Scholar
  39. Robinson, R.G., Murata, Y., Shimoda, K. 1999‘Dimensions of social impairment and their effect on depression and recovery following stroke’International Psychogeriatrics11375384CrossRefGoogle Scholar
  40. Ryff, C.D., Singer, B. 1996‘Psychological well-being: Meaning, measurement, and implications for psychotherapy research’Psychotherapy and Psychosomatics651423CrossRefGoogle Scholar
  41. Seeman, T.E., Charpentier, P.A., Berkman, L.F., Tinetti, M.E., Guralnik, J.M., Albert, M., Blazer,  D., Rowe, J.W. 1994‘Predicting changes in physical performance in a high-functioning elderly cohort: MacArthur studies of successful aging’Journal of Gerontology49M97108Google Scholar
  42. Segal, M.E., Gillard, M., Schall, R. 1996‘Telephone and in-person proxy agreement between stroke patients and caregivers for the functional independence measure’American Journal of Physical Medicine and Rehabilitation75208212CrossRefGoogle Scholar
  43. Silver, R.L., Wortman, C.B., Klos, D.S. 1982‘Cognitions, affect, and behavior following uncontrollable outcomes: A response to current human helplessness research’Journal of Personality50480514CrossRefGoogle Scholar
  44. Smith, P.M., Illig, S.B., Fiedler, R.C., Hamilton, B.B., Ottenbacher, K.J., Fielder, R.C. 1996‘Intermodal agreement of follow-up telephone functional assessment using the Functional Independence Measure in patients with stroke’Archives of Physical Medicine and Rehabilitation77431435CrossRefGoogle Scholar
  45. Steiber, S.R., Krowinski, W.J. 1990Measuring and Managing Patient SatisfactionAmerican Hospital PublisherChicago, ILGoogle Scholar
  46. Stewart, B.J., Archbold, P.G. 1992‘Nursing intervention studies require outcome measures that are sensitive to change Part 1’Research in Nursing & Health15477481Google Scholar
  47. Stewart, B.J., Archbold, P.G. 1993‘Nursing intervention studies require outcome measures that are sensitive to change Part 2’Research in Nursing & Health167781Google Scholar
  48. Stineman, M.G., Hamilton, B.B., Granger, C.V., Goin, J.E., Escarce, J.J., Williams, S.V. 1994‘Four methods for characterizing disability in the formation of function related groups’Archives of Physical Medicine and Rehabilitation7512771283Google Scholar
  49. Tooth, L.R., Ottenbacher, K.J., Smith, P.M., Illig, S.B., Linn, R.T., Gonzales, V.A., Granger, C.V. 2003‘Effect of functional gain on satisfaction with medical rehabilitation after stroke’American Journal of Physical Medicine and Rehabilitation82692699CrossRefGoogle Scholar
  50. Tulsky, D.S., Rosenthal, M. 2002‘Quality of life measurement in rehabilitation medicine: Building an agenda for the future’Archives of Physical Medicine and Rehabilitation83S1S3CrossRefGoogle Scholar
  51. UBFA: 2001, Appendix A: Impairment Group Codes. Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI) Training Manual [On-line]. Available from Centers for Medicare & Medicaid Services (CMS) website at: http://www.cms.gov/providers/irfpps/irfpai.asp. Accessed on March 23, 2004
  52. UDSMR: 1997, The Guide for the Uniform Data Set for Medical Rehabilitation (including the FIM™ instrument), Version 5.1. Buffalo, NY: AuthorGoogle Scholar
  53. Whiteneck, G.G. 1997‘Disablement outcomes in geriatric rehabilitation. Report Group D’Medical Care35JS4547CrossRefGoogle Scholar
  54. Whiteneck, G.G., Fougeyrollas, P., Gerhart, K.A. 1997‘Elaborating the model of disablement’Fuhrer, M.J. eds. Assessing Medical Rehabilitation Practices: The Promise of Outcomes ResearchP.H. BrookesBaltimore, MD91102Google Scholar
  55. Whyte, J. 1998‘Enabling America: A report from the Institute of Medicine on rehabilitation science and engineering’Archives of Physical Medicine and Rehabilitation7914771480CrossRefGoogle Scholar
  56. Wilkerson, D., Shen, D., Duhaime, M. 1998Performance Indicators for Rehabilitation Programs. Version 1The Rehabilitation Accreditation Commission (CARF)1 Tucson, AZGoogle Scholar

Copyright information

© Springer 2006

Authors and Affiliations

  • Glenn V. Ostir
    • 1
    • 2
    • 3
  • Ivonne-Marie Berges
    • 1
    • 3
  • Pamela M. Smith
    • 4
  • David Smith
    • 4
  • Janida L. Rice
    • 5
  • Kenneth J. Ottenbacher
    • 1
    • 5
  1. 1.Sealy Center on AgingUniversity of Texas Medical BranchGalvestonUSA
  2. 2.Division of Geriatrics, Department of MedicineUniversity of Texas Medical BranchGalvestonUSA
  3. 3.Department of Preventive Medicine and Community HealthUniversity of Texas Medical BranchGalvestonUSA
  4. 4.IT HealthTrackBuffaloUSA
  5. 5.Division of Rehabilitation SciencesUniversity of Texas Medical BranchGalvestonUSA

Personalised recommendations