Long-Term Change and Predictors of Change in Physical and Mental Function after Rehabilitation: A Multi-Centre Study
DOI:
https://doi.org/10.2340/jrm.v55.2809Keywords:
Rehabilitation, Function, Sense of Coherence, Coping resourcesAbstract
Objective: To investigate changes and predictors of change in physical and mental function over a 3-year period after rehabilitation.
Design: Prospective cohort.
Participants: Patients, across diseases, living in western Norway, accepted for somatic specialized interprofessional rehabilitation (n = 984).
Methods: Physical and mental function were assessed at admittance (baseline), and after 1 and 3 years using the Medical Outcome Study Short Form 36 (SF-36). Associations between changes in SF-36 component summary scores and sense of coherence, pain, disease group (musculoskeletal, neoplasm, cardiovascular, neurological, other), exercise habits and demographic variables were analysed using linear mixed modelling.
Results: In the total group, mean (standard deviation) physical component summary scores improved by 2.9 (8.4) and 3.4 (9.3) points at 1 and 3 years, respectively. Mental component summary scores improved by 2.1 (9.7) and 1.6 (10.8) points. Improvement in physical component summary was significantly greater for patients with higher sense of coherence (b = 0.09, p = 0.001) and for the neoplasm disease group (b = 2.13, p = 0.046). Improvement in mental component summary was significantly greater for patients with low sense of coherence (b = –0.13, p = < 0.001) and higher level of education (b = 3.02, p = 0.0302). Interaction with age (physical component summary: b = 0.22, p = 0.039/mental component summary b = 0.51, p = 0.006) indicated larger effect at 1 year than at 3 years.
Conclusion: Physical and mental function improved in the total study group over the 3-year period. Sense of coherence at baseline was associated with improved physical and mental function, suggesting that coping resources are important in rehabilitation.
LAY ABSTRACT
Rehabilitation aims to improve function among people with disabilities. This study investigated how physical and mental function change in a 3-year period after rehabilitation, and the factors related to these changes. In a cohort of 984 rehabilitation patients, physical and mental function were measured before rehabilitation (baseline) and at 1 and 3 years after rehabilitation. Both physical and mental function improved over a period of 3 years, with the greatest improvement from baseline to 1 year. Improved function at 1 year remained relatively stable over time. Participants with higher coping resources at baseline, measured by sense of coherence, had the greatest improvement in physical function, and less improvement in mental function. Participants’ disease group influenced change in physical function. Participants with a higher level of education demonstrated greater improvement in mental function. These results imply that coping resources should be addressed as an important part of rehabilitation.
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Stucki G, Bickenbach J. 1.1 Basic concepts, definitions and models. J Int Soc Phys Rehabil Med 2019; 2: S1 8-12.
https://doi.org/10.4103/jisprm.jisprm_5_19 DOI: https://doi.org/10.4103/jisprm.jisprm_5_19
Wade DT. What is rehabilitation? An empirical investigation leading to an evidence-based description. Clin Rehabil 2020; 34: 571-583.
https://doi.org/10.1177/0269215520905112 DOI: https://doi.org/10.1177/0269215520905112
Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2021; 396: 2006-2017.
https://doi.org/10.1016/S0140-6736(20)32340-0 DOI: https://doi.org/10.1016/S0140-6736(20)32340-0
Stucki G. Advancing the rehabilitation sciences. Front Rehabil Sci 2021; 1: 1-4.
https://doi.org/10.3389/fresc.2020.617749 DOI: https://doi.org/10.3389/fresc.2020.617749
Bickenbach J, Sabariego C, Stucki G. Beneficiaries of rehabilitation. Arch Phys Med Rehabil 2021; 102: 543-548.
https://doi.org/10.1016/j.apmr.2020.09.392 DOI: https://doi.org/10.1016/j.apmr.2020.09.392
World Health Organization. Towards a common language for functioning, disability and health ICF. 2002; Geneva: World Health Organization; 2002.
Stenholm S, Westerlund H, Head J, Hyde M, Kawachi I, Pentti J, et al. Comorbidity and functional trajectories from midlife to old age: the Health and Retirement Study. J Gerontol A Biol Sci Med Sci 2015; 70: 332-338.
https://doi.org/10.1093/gerona/glu113 DOI: https://doi.org/10.1093/gerona/glu113
Rooth V, van Oostrom SH, Deeg DJ, Verschuren WM, Picavet HS. Common trajectories of physical functioning in the Doetinchem Cohort Study. Age Ageing 2016; 45: 382-388.
https://doi.org/10.1093/ageing/afw018 DOI: https://doi.org/10.1093/ageing/afw018
Soberg HL, Finset A, Roise O, Bautz-Holter E. The trajectory of physical and mental health from injury to 5 years after multiple trauma: a prospective, longitudinal cohort study. Arch Phys Med Rehabil 2012; 93: 765-774.
https://doi.org/10.1016/j.apmr.2011.08.050 DOI: https://doi.org/10.1016/j.apmr.2011.08.050
Howrey BT, Graham JE, Pappadis MR, Granger CV, Ottenbacher KJ. Trajectories of functional change after inpatient rehabilitation for traumatic brain injury. Arch Phys Med Rehabil 2017; 98: 1606-1613.
https://doi.org/10.1016/j.apmr.2017.03.009 DOI: https://doi.org/10.1016/j.apmr.2017.03.009
Puthucheary ZA, Gensichen JS, Cakiroglu AS, Cashmore R, Edbrooke L, Heintze C, et al. Implications for post critical illness trial design: sub-phenotyping trajectories of functional recovery among sepsis survivors. Crit Care 2020; 24: 577.
https://doi.org/10.1186/s13054-020-03275-w DOI: https://doi.org/10.1186/s13054-020-03275-w
Aasdahl L, Granviken F, Meisingset I, Woodhouse A, Evensen KAI, Vasseljen O. Recovery trajectories in common musculoskeletal complaints by diagnosis contra prognostic phenotypes. BMC Musculoskelet Disord 2021; 22: 455.
https://doi.org/10.1186/s12891-021-04332-3 DOI: https://doi.org/10.1186/s12891-021-04332-3
Forslund MV, Perrin PB, Sigurdardottir S, Howe EI, van Walsem MR, Arango-Lasprilla JC, et al. Health-related quality of life trajectories across 10 years after moderate to severe traumatic brain injury in Norway. J Clin Med 2021; 10: 157.
https://doi.org/10.3390/jcm10010157 DOI: https://doi.org/10.3390/jcm10010157
Schindel D, Schneider A, Grittner U, Jobges M, Schenk L. Quality of life after stroke rehabilitation discharge: a 12-month longitudinal study. Disabil Rehabil 2021; 43: 2332-2341.
https://doi.org/10.1080/09638288.2019.1699173 DOI: https://doi.org/10.1080/09638288.2019.1699173
Preede L, Saebu M, Perrin PB, Nyquist A, Dalen H, Bautz-Holter E, et al. One-year trajectories of mental and physical functioning during and after rehabilitation among individuals with disabilities. Health Qual Life Outcomes 2015; 13: 135.
https://doi.org/10.1186/s12955-015-0328-z DOI: https://doi.org/10.1186/s12955-015-0328-z
Seves BL, Hoekstra F, Hettinga FJ, Dekker R, van der Woude LHV, Hoekstra T. Trajectories of health-related quality of life among people with a physical disability and/or chronic disease during and after rehabilitation: a longitudinal cohort study. Qual Life Res 2021; 30: 67-80.
https://doi.org/10.1007/s11136-020-02647-7 DOI: https://doi.org/10.1007/s11136-020-02647-7
Antonovsky A. Unraveling the mystery of health: how people manage stress and stay well. San Fransisco, CA: Jossey-Bass, 1987.
Eriksson M, Lindstrom B. Antonovsky's sense of coherence scale and the relation with health: a systematic review. J Epidemiol Community Health 2006; 60: 376-381.
https://doi.org/10.1136/jech.2005.041616 DOI: https://doi.org/10.1136/jech.2005.041616
Moen VP, Eide GE, Drageset J, Gjesdal S. Sense of Coherence, disability, and health-related quality of life: a cross-sectional study of rehabilitation patients in Norway. Arch Phys Med Rehabil 2019; 100: 448-457.
https://doi.org/10.1016/j.apmr.2018.06.009 DOI: https://doi.org/10.1016/j.apmr.2018.06.009
Garratt AM, Schmidt L, Mackintosh A, Fitzpatrick R. Quality of life measurement: bibliographic study of patient assessed health outcome measures. BMJ 2002; 324: 1417.
https://doi.org/10.1136/bmj.324.7351.1417 DOI: https://doi.org/10.1136/bmj.324.7351.1417
Garratt AM, Ruta DA, Abdalla MI, Buckingham JK, Russell IT. The SF36 health survey questionnaire: an outcome measure suitable for routine use within the NHS? BMJ 1993; 306: 1440-1444.
https://doi.org/10.1136/bmj.306.6890.1440 DOI: https://doi.org/10.1136/bmj.306.6890.1440
Garratt AM, Stavem K. Measurement properties and normative data for the Norwegian SF-36: results from a general population survey. Health Qual Life Outcomes 2017; 15: 51.
https://doi.org/10.1186/s12955-017-0625-9 DOI: https://doi.org/10.1186/s12955-017-0625-9
Ware JE, Jr., Kosinski M, Keller SD. SF-36 Physical and Mental Health Summary Scales: a user's manual. Boston, MA: Health Assessment Lab, 1994.
Ware JE, Jr., Kosinski M, Dewey JE. SF-36 health survey: manual and interpretation guide. Lincoln, RI: Quality Metric Inc, 2000.
Eriksson M, Lindstrom B. Validity of Antonovsky's sense of coherence scale: a systematic review. J Epidemiol Community Health 2005; 59: 460-466.
https://doi.org/10.1136/jech.2003.018085 DOI: https://doi.org/10.1136/jech.2003.018085
Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain 1986; 27: 117-126.
https://doi.org/10.1016/0304-3959(86)90228-9 DOI: https://doi.org/10.1016/0304-3959(86)90228-9
Kurtze N, Rangul V, Hustvedt BE, Flanders WD. Reliability and validity of self-reported physical activity in the Nord-Trondelag Health Study: HUNT 1. Scand J Public Health 2008; 36: 52-61.
https://doi.org/10.1177/1403494807085373 DOI: https://doi.org/10.1177/1403494807085373
Moen VP, Drageset J, Eide GE, Gjesdal S. Dimensions and predictors of disability - a baseline study of patients entering somatic rehabilitation in secondary care. PLoS One 2018; 13: e0193761.
https://doi.org/10.1371/journal.pone.0193761 DOI: https://doi.org/10.1371/journal.pone.0193761
World Health Organization (WHO). ICD-10: international statistical classification of diseases and related health problems: tenth revision. 2nd edn. Geneva: World Health Organization, 2004.
Pallant J. Part 4: Statistical techniques to explore relationships among variables. SPSS Survival Manual A step by step guide to data analysis using IBM SPSS. Berkshire, England Open University Press, 2016: p. 137.
Lydersen S. Statistical review: frequently given comments. Ann Rheum Dis 2015; 74: 323-325.
https://doi.org/10.1136/annrheumdis-2014-206186 DOI: https://doi.org/10.1136/annrheumdis-2014-206186
Ogura K, Yakoub MA, Christ AB, Fujiwara T, Nikolic Z, Boland PJ, et al. What are the minimum clinically important differences in SF-36 scores in patients with orthopaedic oncologic conditions? Clin Orthop Relat Res 2020; 478: 2148-2158.
https://doi.org/10.1097/CORR.0000000000001341 DOI: https://doi.org/10.1097/CORR.0000000000001341
Badhiwala JH, Witiw CD, Nassiri F, Akbar MA, Jaja B, Wilson JR, et al. Minimum clinically important difference in SF-36 scores for use in degenerative cervical myelopathy. Spine (Phila Pa 1976) 2018; 43: E1260-E1266.
https://doi.org/10.1097/BRS.0000000000002684 DOI: https://doi.org/10.1097/BRS.0000000000002684
Swigris JJ, Brown KK, Behr J, du Bois RM, King TE, Raghu G, et al. The SF-36 and SGRQ: validity and first look at minimum important differences in IPF. Respir Med 2010; 104: 296-304.
https://doi.org/10.1016/j.rmed.2009.09.006 DOI: https://doi.org/10.1016/j.rmed.2009.09.006
Simning A, Caprio TV, Seplaki CL, Temkin-Greener H, Szanton SL, Conwell Y. Patient-reported outcomes in functioning following nursing home or inpatient rehabilitation. J Am Med Dir Assoc 2018; 19: 864-870.
https://doi.org/10.1016/j.jamda.2018.06.014 DOI: https://doi.org/10.1016/j.jamda.2018.06.014
Benz T, Angst F, Lehmann S, Aeschlimann A. Association of the sense of coherence with physical and psychosocial health in the rehabilitation of osteoarthritis of the hip and knee: a prospective cohort study. BMC Musculoskelet Disord 2013; 14: 159.
https://doi.org/10.1186/1471-2474-14-159 DOI: https://doi.org/10.1186/1471-2474-14-159
Hochwälder J, Forsell Y. Is sense of coherence lowered by negative life events? J Happiness Stud 2011; 12: 475-492.
https://doi.org/10.1007/s10902-010-9211-0 DOI: https://doi.org/10.1007/s10902-010-9211-0
Tseli E, Vixner L, LoMartire R, Grooten WJA, Gerdle B, Ang BO. Prognostic factors for improved physical and emotional functioning one year after interdisciplinary rehabilitation in patients with chronic pain: results from a national quality registry in Sweden. J Rehabil Med 2020; 52: jrm00019.
https://doi.org/10.2340/16501977-2648 DOI: https://doi.org/10.2340/16501977-2648
Tanaka A, Shipley MJ, Welch CA, Groce NE, Marmot MG, Kivimaki M, et al. Socioeconomic inequality in recovery from poor physical and mental health in mid-life and early old age: prospective Whitehall II cohort study. J Epidemiol Community Health 2018; 72: 309-313.
https://doi.org/10.1136/jech-2017-209584 DOI: https://doi.org/10.1136/jech-2017-209584
Gell NM, Mroz TM, Patel KV. Rehabilitation services use and patient-reported outcomes among older adults in the United States. Arch Phys Med Rehabil 2017; 98: 2221-2227 e2223.
https://doi.org/10.1016/j.apmr.2017.02.027 DOI: https://doi.org/10.1016/j.apmr.2017.02.027
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