[Outpatient geriatric rehabilitation: an evaluation of two models assessing trends of medical outcomes]

Abstract

In Germany, complex and intensified outpatient geriatric rehabilitation is currently scarcely practised, mainly in model projects. The evaluation of these projects is exclusively conducted in uncontrolled studies. In our project "AMBRA", two different organisational models of geriatric rehabilitation are compared: a mobile rehabilitation team based at a geriatric hospital department and an outpatient rehabilitation centre run by GPs trained in geriatrics. Outcomes were assessed in terms of capability of self-care (Barthel-Index), mobility (Tinetti-Test, Timed "Up & Go"-Test, TUG), and depression (Geriatric Depression Scale, GDS). They were documented at three points in time (start of rehabilitation, end of rehabilitation, 6 months after end of rehabilitation) and analysed by multivariate analyses of variance (repeated measurements). 162 complete patients histories were taken in the first 18 months of the project. They show significant improvements in capability of self-care and mobility (both Tinetti-Test and TUG) between the beginning and the end of rehabilitation (adjusted for age, sex, cognitive function, diagnosis, rehabilitation model). On a medium-term basis, these results remained stable (TUG declined, however). Average GDS values did not change significantly. There were no significant sex- or age-related effects. The patients' cognitive function influenced changes in the results of the Barthel-Index and the Tinetti-Test. Patients with skeletal diseases showed less favourable trends in the Barthel-Index as did patients with cognitive impairments caused by vascular disease in the TUG, but these patients also benefited in the course of the model rehabilitation procedures. Differences in trends between patient groups of the two models were observed in the Barthel-Index. 96 % of patients previously living at home were still living there at the end of rehabilitation, 91 % were still living there 6 months after the end of rehabilitation. At the end of rehabilitation, 67 % of patients described an improvement of their personal situation associated with the rehabilitation procedure. Six months later, 82 % described an improvement or a stabilisation of their personal situation. Our results show positive medium-term rehabilitation trends concerning medical and subjective outcomes. In order to analyse effectiveness, we will have to wait for the results of a regional control group which is being recruited.