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Do Co-Morbidities and Cognition Impact Functional Change and Discharge Needs in Parkinson Disease?

Marciniak, Christina M. MD; Choo, Clara M. BA; Toledo, Santiago D. MD; Semik, Patrick E. BA; Aegesen, Andrea L. DO

American Journal of Physical Medicine & Rehabilitation: April 2011 - Volume 90 - Issue 4 - pp 272-280
doi: 10.1097/PHM.0b013e31820b15a2
Original Research Articles: Cognitive

Objective: The aim of this study was to assess the impact of cognition, baseline motor function, and co-morbid medical conditions on functional change, discharge destination, and discharge needs in patients admitted to acute rehabilitation for Parkinson-related impairments.

Design: This retrospective chart review study evaluated the records of patients admitted to acute rehabilitation over a 5-yr period with a primary impairment category of parkinsonism. Functional status was measured at admission and discharge; 3-mo follow-up function was also collected in a sample of discharged patients.

Results: Eighty-nine patients (mean age, 74.26 yrs) were admitted over the 5-yr time frame. A more complicated Medicare tier diagnosis (tier 2) was associated with lower total and motor score Functional Independence Measure gains compared with tier 3 (P = 0.009 and P = 0.016, respectively). Cognitive scores at admission were not related to need for caregivers upon discharge. Overall Functional Independence Measure gain (adjusted R2 = 0.073, P = 0.006) and Functional Independence Measure gain efficiency (adjusted R2 = 0.142, P < 0.001) inversely correlated with age. At the 3-mo follow-up, a random sample (38%) of patients contacted postdischarge demonstrated continued improvements.

Conclusions: Significant improvement may be seen after acute rehabilitation in patients with Parkinson disease, irrespective of cognitive impairment. More complicated medical tier diagnoses result in less Functional Independence Measure gain, and older individuals with Parkinson disease are more likely to show less functional change. However, functional improvements are still statistically significant.

From the Northwestern University and the Rehabilitation Institute of Chicago, Illinois (CMM, CMC, SDT, PES); and University of Michigan, Ann Arbor, Michigan (ALA).

All correspondence and requests for reprints should be addressed to: Christina M. Marciniak, MD, Rehabilitation Institute of Chicago, 345 E Superior RM 1154, Chicago, IL 60611.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Presented at the Annual Meeting of the Association of Academic Physiatrists in April 2010 (abstract).

© 2011 Lippincott Williams & Wilkins, Inc.