Aging Clinical and Experimental Research

, Volume 29, Issue 4, pp 729–736 | Cite as

The association between patient participation and functional gain following inpatient rehabilitation

  • Sara Morghen
  • Alessandro Morandi
  • Andrew A. Guccione
  • Michela Bozzini
  • Fabio Guerini
  • Roberto Gatti
  • Francesco Del Santo
  • Simona Gentile
  • Marco Trabucchi
  • Giuseppe Bellelli
Original Article



To evaluate patients’ participation during physical therapy sessions as assessed with the Pittsburgh rehabilitation participation scale (PRPS) as a possible predictor of functional gain after rehabilitation training.


All patients aged 65 years or older consecutively admitted to a Department of Rehabilitation and Aged Care (DRAC) were evaluated on admission regarding their health, nutritional, functional and cognitive status. Functional status was assessed with the functional independence measure (FIM) on admission and at discharge. Participation during rehabilitation sessions was measured with the PRPS. Functional gain was evaluated using the Montebello rehabilitation factor score (MRFS efficacy), and patients stratified in two groups according to their level of functional gain and their sociodemographic, clinical and functional characteristics were compared. Predictors of poor functional gain were evaluated using a multivariable logistic regression model adjusted for confounding factors.


A total of 556 subjects were included in this study. Patients with poor functional gain at discharge demonstrated lower participation during physical therapy sessions were significantly older, more cognitively and functionally impaired on admission, more depressed, more comorbid, and more frequently admitted for cardiac disease or immobility syndrome than their counterparts. There was a significant linear association between PRPS scores and MRFS efficacy. In a multivariable logistic regression model, participation was independently associated with functional gain at discharge (odds ratio 1.51, 95 % confidence interval 1.19–1.91).


This study showed that participation during physical therapy affects the extent of functional gain at discharge in a large population of older patients with multiple diseases receiving in-hospital rehabilitation.


Participation Rehabilitation Physical therapy Functional gain 


Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Statement of human and animal rights

All procedures performed were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The local ethics committee approved the study and the waiver of informed consent given the retrospective nature of the study.


  1. 1.
    Tallis R (1992) Rehabilitation of the elderly in the 21st century. The F. E. Williams Lecture 1992. J R Coll Physicians Lond 26:413–422PubMedGoogle Scholar
  2. 2.
    Bachmann S, Finger C, Huss A et al (2010) Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials. BMJ 340:c1718CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Ashworth PD, Longmate MA, Morrison P (1992) Patient participation: its meaning and significance in the context of caring. J Adv Nurs 17:1430–1439CrossRefPubMedGoogle Scholar
  4. 4.
    Wade DT, de Jong BA (2000) Recent advances in rehabilitation. BMJ 320:1385–1388CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Wressle E (2002) Client participation in the rehabilitation process. In: Division of occupational therapy, DoNaL. Faculty of Health Sciences, Linköpings Universitet, pp 1–67Google Scholar
  6. 6.
    Maclean N, Pound P (2000) A critical review of the concept of patient motivation in the literature on physical rehabilitation. Soc Sci Med 50:495–506CrossRefPubMedGoogle Scholar
  7. 7.
    Lenze EJ, Munin MC, Quear T et al (2004) The Pittsburgh rehabilitation participation scale: reliability and validity of a clinician-rated measure of participation in acute rehabilitation. Arch Phys Med Rehabil 85:380–384CrossRefPubMedGoogle Scholar
  8. 8.
    Lenze EJ, Munin MC, Dew MA et al (2004) Adverse effects of depression and cognitive impairment on rehabilitation participation and recovery from hip fracture. Int J Geriatr Psychiatry 19:472–478CrossRefPubMedGoogle Scholar
  9. 9.
    Lenze EJ, Munin MC, Quear T et al (2004) Significance of poor patient participation in physical and occupational therapy for functional outcome and length of stay. Arch Phys Med Rehabil 85:1599–1601CrossRefPubMedGoogle Scholar
  10. 10.
    Paolucci S, Di Vita A, Massicci R et al (2012) Impact of participation on rehabilitation results: a multivariate study. Eur J Phys Rehabil Med 48:455–466PubMedGoogle Scholar
  11. 11.
    Cameron ID, Schaafsma FG, Wilson S et al (2012) Outcomes of rehabilitation in older people-functioning and cognition are the most important predictors: an inception cohort study. J Rehabil Med 44:24–30CrossRefPubMedGoogle Scholar
  12. 12.
    Fusco D, Bochicchio GB, Onder G et al (2009) Predictors of rehabilitation outcome among frail elderly patients living in the community. J Am Med Dir Assoc 10:335–341CrossRefPubMedGoogle Scholar
  13. 13.
    Morghen S, Bellelli G, Manuele S et al (2011) Moderate to severe depressive symptoms and rehabilitation outcome in older adults with hip fracture. Int J Geriatr Psychiatry 26:1136–1143PubMedGoogle Scholar
  14. 14.
    Hershkovitz A, Kalandariov Z, Hermush V et al (2007) Factors affecting short-term rehabilitation outcomes of disabled elderly patients with proximal hip fracture. Arch Phys Med Rehabil 88:916–921CrossRefPubMedGoogle Scholar
  15. 15.
    Keys A, Fidanza F, Karvonen MJ et al (1972) Indices of relative weight and obesity. J Chronic Dis 25:329–343CrossRefPubMedGoogle Scholar
  16. 16.
    Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198CrossRefPubMedGoogle Scholar
  17. 17.
    Yesavage JA, Brink TL, Rose TL et al (1982) Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 17:37–49CrossRefPubMedGoogle Scholar
  18. 18.
    McGivney SA, Mulvihill M, Taylor B (1994) Validating the GDS depression screen in the nursing home. J Am Geriatr Soc 42:490–492CrossRefPubMedGoogle Scholar
  19. 19.
    Parmelee PA, Thuras PD, Katz IR et al (1995) Validation of the cumulative illness rating scale in a geriatric residential population. J Am Geriatr Soc 43:130–137CrossRefPubMedGoogle Scholar
  20. 20.
    Keith RA, Granger CV, Hamilton BB et al (1987) The functional independence measure: a new tool for rehabilitation. Adv Clin Rehabil 1:6–18PubMedGoogle Scholar
  21. 21.
    Granger CV, Hamilton BB, Linacre JM et al (1993) Performance profiles of the functional independence measure. Am J Phys Med Rehabil 72:84–89CrossRefPubMedGoogle Scholar
  22. 22.
    Corrigan JD, Smith-Knapp K, Granger CV (1997) Validity of the functional independence measure for persons with traumatic brain injury. Arch Phys Med Rehabil 78:828–834CrossRefPubMedGoogle Scholar
  23. 23.
    Stineman MG, Shea JA, Jette A et al (1996) The functional independence measure: tests of scaling assumptions, structure, and reliability across 20 diverse impairment categories. Arch Phys Med Rehabil 77:1101–1108CrossRefPubMedGoogle Scholar
  24. 24.
    Kidd D, Stewart G, Baldry J et al (1995) The functional independence measure: a comparative validity and reliability study. Disabil Rehabil 17:10–14CrossRefPubMedGoogle Scholar
  25. 25.
    Talkowski JB, Lenze EJ, Munin MC et al (2009) Patient participation and physical activity during rehabilitation and future functional outcomes in patients after hip fracture. Arch Phys Med Rehabil 90:618–622CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Rolland Y, Pillard F, Lauwers-Cances V et al (2004) Rehabilitation outcome of elderly patients with hip fracture and cognitive impairment. Disabil Rehabil 26:425–431CrossRefPubMedGoogle Scholar
  27. 27.
    Dong Y, Slavin MJ, Chan BP et al (2013) Cognitive screening improves the predictive value of stroke severity scores for functional outcome 3-6 months after mild stroke and transient ischaemic attack: an observational study. BMJ Open 3:e003105CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Andreescu C, Lenze EJ, Dew MA et al (2007) Effect of comorbid anxiety on treatment response and relapse risk in late-life depression: controlled study. Br J Psychiatry 190:344–349CrossRefPubMedGoogle Scholar
  29. 29.
    Peduzzi P, Concato J, Kemper E et al (1996) A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 49:1373–1379CrossRefPubMedGoogle Scholar
  30. 30.
    Skidmore ER, Whyte EM, Holm MB et al (2010) Cognitive and affective predictors of rehabilitation participation after stroke. Arch Phys Med Rehabil 91:203–207CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Wressle E, Eeg-Olofsson AM, Marcusson J et al (2002) Improved client participation in the rehabilitation process using a client-centred goal formulation structure. J Rehabil Med 34:5–11CrossRefPubMedGoogle Scholar
  32. 32.
    Resnick B (2002) Geriatric rehabilitation: the influence of efficacy beliefs and motivation. Rehabil Nurs 27:152–159CrossRefPubMedGoogle Scholar
  33. 33.
    Sluijs EM, Kok GJ, van der Zee J (1993) Correlates of exercise compliance in physical therapy. Phys Ther 73:771–782CrossRefPubMedGoogle Scholar
  34. 34.
    Lequerica AH, Donnell CS, Tate DG (2009) Patient engagement in rehabilitation therapy: physical and occupational therapist impressions. Disabil Rehabil 31:753–760CrossRefPubMedGoogle Scholar
  35. 35.
    Bellelli G, Bernardini B, Trabucchi M (2012) The specificity of geriatric rehabilitation: myth or reality? A debate from an Italian perspective. J Am Med Dir Assoc 13:94–95CrossRefPubMedGoogle Scholar
  36. 36.
    Torpilliesi T, Bellelli G, Morghen S et al (2012) Outcomes of nonagenarian patients after rehabilitation following hip fracture surgery. J Am Med Dir Assoc 13:81-e1–81-e5Google Scholar
  37. 37.
    Bellelli G, Noale M, Guerini F et al (2012) A prognostic model predicting recovery of walking independence of elderly patients after hip-fracture surgery. An experiment in a rehabilitation unit in Northern Italy. Osteoporos Int 23:2189–2200CrossRefPubMedGoogle Scholar
  38. 38.
    Valderrama-Gama E, Damian J, Guallar E et al (1998) Previous disability as a predictor of outcome in a geriatric rehabilitation unit. J Gerontol A Biol Sci Med Sci 53:M405–M409CrossRefPubMedGoogle Scholar
  39. 39.
    Alexander NB, Guire KE, Thelen DG et al (2000) Self-reported walking ability predicts functional mobility performance in frail older adults. J Am Geriatr Soc 48:1408–1413CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Sara Morghen
    • 1
    • 2
  • Alessandro Morandi
    • 1
    • 2
  • Andrew A. Guccione
    • 4
  • Michela Bozzini
    • 1
  • Fabio Guerini
    • 1
    • 2
  • Roberto Gatti
    • 5
  • Francesco Del Santo
    • 1
  • Simona Gentile
    • 1
    • 2
  • Marco Trabucchi
    • 2
    • 3
  • Giuseppe Bellelli
    • 2
    • 6
  1. 1.Department of Rehabilitation and Aged Care “Fondazione Camplani” HospitalCremonaItaly
  2. 2.Geriatric Research GroupBresciaItaly
  3. 3.Tor Vergata UniversityRomeItaly
  4. 4.Department of Rehabilitation ScienceFairfaxUSA
  5. 5.Laboratory of Analysis and Rehabilitation of Motor FunctionSan Raffale InstituteMilanItaly
  6. 6.Department of Health ScienceUniversity of Milano-Bicocca, Milan and Geriatric Clinic, “S Gerardo” HospitalMonzaItaly

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