In de eerste drie artikelen van het proefschrift wordt ingegaan op het meten van comorbiditeit. Uit deze review bleek dat het meewegen van de ernst van comorbiditeit - namelijk de impact op het... Show moreIn de eerste drie artikelen van het proefschrift wordt ingegaan op het meten van comorbiditeit. Uit deze review bleek dat het meewegen van de ernst van comorbiditeit - namelijk de impact op het functioneren - een sterkere relatie heeft met de uitkomstmaat functioneren na revalidatie. Hierop hebben wij de FCI aangevuld met een ernst beoordelingsschaal op basis van impact op functioneren. Na interviews met specialisten ouderengeneeskunde en een beoordeling van de betrouwbaarheid hebben we een uiteindelijke gewogen FCI samengesteld. Ten slotte bleek dat deze gewogen FCI een betere voorspellende waarde had op functioneren na geriatrische revalidatie, in vergelijking met de originele FCI en de Charlson index.In de twee laatste artikelen van het proefschrift wordt de rol van comorbiditeit verder onderzocht: in relatie tot het krijgen van intercurrente aandoeningen tijdens de geriatrische revalidatie en de vorming van comorbiditeit clusters. Comorbiditeit is een risicofactor voor het krijgen van intercurrente aandoeningen tijdens de revalidatie: hoe meer comorbiditeiten, hoe groter de kans op meerdere intercurrente aandoeningen. Met name diabetes vergrootte dit risico. Ten slotte werden verschillende comorbiditeitsclusters gevonden, waarna bleek dat vooral het cardiovasculaire comorbiditeitsprofiel een verhoogd risico op onsuccesvolle revalidatie heeft. Show less
Kabboord, A.D.; Godfrey, D.; Gordon, A.L.; Gladman, J.R.F.; Eijk, M. van; Balen, R. van; Achterberg, W.P. 2020
Background In the inpatient rehabilitation of older patients, estimating to what extent the patient may functionally recover (functional prognosis), is important to plan the rehabilitation... Show moreBackground In the inpatient rehabilitation of older patients, estimating to what extent the patient may functionally recover (functional prognosis), is important to plan the rehabilitation programme and aid discharge planning. Comorbidity is very common in older patients. However, the role of comorbidity in making a functional prognosis is not clearly defined. The aim of this study was to investigate a modified and weighted Functional Comorbidity Index (w-FCI) in relation to functional recovery and compare its predictive performance with that of the Charlson comorbidity index (CCI) and the original Functional Comorbidity Index (FCI). Methods The COOPERATION study (Comorbidity and Outcomes of Older Patients Evaluated in RehabilitATION) is a prospective observational cohort study. Data of patients that were admitted in an inpatient geriatric rehabilitation facility in the UK between January and September 2017, were collected. The outcome measures were: the Elderly Mobility Scale (EMS) and Barthel index (BI) at discharge, EMS gain/day and BI gain/day. Baseline comorbidity was assessed using the CCI, the FCI and the w-FCI. Correlations, receiver operating curves (ROC), and multiple linear regression analyses were performed. The models were adjusted for age, gender and EMS or BI on admission. Results In total, 98 patients (mean age 82 years; 37% male) were included. The areas under the ROC curves of the w-FCI (EMS at discharge: 0.72, EMS gain/day: 0.72, BI at discharge: 0.66 and BI gain/day: 0.60) were higher than for the CCI (0.50, 0.53, 0.49, 0.44 respectively) and FCI (0.65, 0.55, 0.60, 0.49 respectively). The w-FCI was independently associated with EMS at discharge (20.7% of variance explained (PVE), p < 0.001), EMS gain/day (11.2PVE, p < 0.001), and BI at discharge (18.3 PVE, p < 0.001). The FCI was only associated with EMS gain/day (3.9 PVE, p < 0.05). None of the comorbidity indices contributed significantly to BI gain/day (w-FCI: 2.4 PVE, p > 0.05). Conclusions The w-FCI was predictive of mobility & function at discharge and mobility gain per day, and outperformed the original FCI and the CCI. The w-FCI could be useful in assessing comorbidity in a personalised way and aid functional prognosis at the start of rehabilitation. Show less
Kabboord, A.D.; Eijk, M. van; Dingenen, L. van; Wouters, M.; Koet, M.; Balen, R. van; Achterberg, W.P. 2019
AimsTo investigate the reliability of a weighted version of the Functional Comorbidity Index (w-FCI) compared with that of the original Functional Comorbidity Index (FCI) and to test its usability....Show moreAimsTo investigate the reliability of a weighted version of the Functional Comorbidity Index (w-FCI) compared with that of the original Functional Comorbidity Index (FCI) and to test its usability.Patients and methods Sixteen physicians collected data from 102 residents who lived in 16 different nursing homes in the Netherlands. A multicentre, prospective observational study was carried out in combination with a qualitative part using the three-step test interview, in which participants completed the w-FCI while thinking aloud and being observed, and were then interviewed afterward. To analyse inter-rater reliability, a subset of 41 residents participated. The qualitative part of the study was completed by eleven elderly care physicians and one advanced nurse practitioner.Measurements The w-FCI was composed of the original FCI supplemented with a severity rating per comorbidity, ranging from 0 (disease absent) to 3 (severe impact on daily function). The w-FCI was filled out at baseline by 16 physicians and again 2 months later to establish intra-rater reliability (intraclass correlations; ICCs). For inter-rater reliability, four pairs of raters completed the w-FCI independently from each other.Results The ICCs were 0.90 (FCI) and 0.94 (w-FCI) for intra-rater reliability, and 0.61 (FCI) and 0.55 (w-FCI) for inter-rater reliability. Regarding usability of the w-FCI, five meaningful themes emerged from the qualitative data: 1) sources of information; 2) deciding on the presence or absence of disease; 3) severity of comorbidities; 4) usefulness; and 5) content.Conclusion The intra-rater reliability of the FCI and the w-FCI was excellent, whereas the inter-rater reliability was moderate for both indices. Based on the present results, a modified w-FCI is proposed that is acceptable and feasible for use in older patients and requires further investigation to study its (predictive) validity. Show less
Kabboord, A.D.; Eijk, M. van; Buijck, B.I.; Koopmans, R.T.C.M.; Balen, R. van; Achterberg, W.P. 2018
BackgroundOlder patients often have multiple comorbidities and are susceptible to develop intercurrent diseases during rehabilitation. This study investigates intercurrent diseases and associated... Show moreBackgroundOlder patients often have multiple comorbidities and are susceptible to develop intercurrent diseases during rehabilitation. This study investigates intercurrent diseases and associated factors in patients undergoing geriatric stroke rehabilitation, focussing on pre-existing comorbid conditions, overall comorbidity and baseline functional status.Materials and MethodsThis multicentre prospective cohort study included 15 skilled nursing facilities. Data were collected at baseline and at discharge. The primary outcome measures were presence and number of intercurrent diseases, and secondary their impact on change in rehabilitation goals or length of stay was examined. Comorbidity was assessed with the Charlson index, and functional status with the Barthel index (BI).ResultsOf the 175 included patients, 51% developed an intercurrent disease. A lower baseline BI, a higher Charlson index, presence of diabetes mellitus (DM) and kidney disease were related to the occurrence of an intercurrent disease (p<0.05). Moreover, a lower BI, a higher Charlson index, and particularly the presence of DM were independently associated. If both comorbidity and a lower baseline functional status were present, the odds ratio (95%CI) of developing intercurrent diseases was 6.70 [2.33-19.2], compared to 1.73 [0.52-5.72] (comorbidity only) and 1.62 [0.53-4.94] (only BI ≤14).ConclusionsOn admission, functional impairments and comorbidity (particularly diabetes) independently contribute to developing intercurrent diseases during geriatric stroke rehabilitation. Therefore, routine evaluation of comorbidity and functional status at the start of rehabilitation helps to identify patients at risk. Particular attention should be paid to patients with DM to prevent the occurrence of intercurrent diseases and support optimal functional recovery. Show less
Kabboord, A.D.; Eijk, M. van; Fiocco, M.; Balen, R. van; Achterberg, W.P. 2016
