TY - JOUR
T1 - Executive Function Moderates Functional Outcomes of Engagement Strategies during Rehabilitation in Older Adults
AU - Ercal, Baris
AU - Rodebaugh, Thomas L.
AU - Bland, Marghuretta D.
AU - Barco, Peggy
AU - Lenard, Emily
AU - Lang, Catherine E.
AU - Miller, J. Philip
AU - Yingling, Michael
AU - Lenze, Eric J.
N1 - Funding Information:
This study was supported by grants R01 MH099011 and R25 MH112473 from the NIMH. Additional funding came from U01 UL1TR002345 from the NIH, and the Taylor Family Institute for Innovative Psychiatric Research and the Center for Brain Research in Mood Disorders at Washington University.
Funding Information:
Author Disclosures: Dr Rodebaugh reported grants from the National Institutes of Mental Health (NIMH) during the conduct of the study. Dr Bland reported grants from the National Institutes of Health (NIH) during the conduct of the study. Dr Barco reported grants from the NIMH during the conduct of the study; grants from the Missouri Department of Transportation, NIH, and Craig H. Neilson Foundation outside the submitted work; and personal fees from the University of Missouri and The Rehabilitation Institute of St. Louis outside the submitted work. Dr Lang reported grants from the NIH during the conduct of the study, grants from the NIH outside the submitted work, and royalties from AOTA Press outside the submitted work. Dr Miller reports that he has received research funding from the Patient-Centered Outcomes Research Institute. Dr Lenze reports he received grants from the COVID Early Treatment Fund, the Taylor Family Institute for Innovative Psychiatric Research, and the Center for Brain Research in Mood Disorders for this study. He also reports grant funding in the past 36 mos from the Patient-Centered Outcomes Research Institute, Takeda, Alkermes, Janssen, Acadia, COVID Early Treatment Fund, FastGrants, Skoll Foundation, and Barnes Jewish Foundation. He has received consulting fees in the past 36 mos from Janssen and Jazz Pharmaceuticals. No other disclosures were reported.
Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021
Y1 - 2021
N2 - Objective This study examined cognitive, affective, and medical impairments and their impact on rehabilitation approaches for improving functional outcome after hospitalization in older adults. Design A secondary analysis of a randomized clinical trial in 229 adults 65 yrs or older admitted to two skilled nursing facilities undergoing rehabilitation services was conducted. Patients were randomized to receive physical and occupational therapy by therapists trained in systematic approaches to engage patients, called Enhanced Medical Rehabilitation, or standard of care. The outcome of interest was functional improvement, defined as Barthel Index at discharge (controlling for Barthel Index upon admission). This study analyzed the relationship of measures of cognition, depression, and medical comorbidities as predictors of functional outcome and as moderators interacting with treatment group. Results Clock drawing score moderated treatment effect size; the functional improvement of Enhanced Medical Rehabilitation over standard of care therapy reduced with increasing executive impairment. In contrast, general cognitive abilities, depression, medical comorbidities, and readiness for rehabilitation were neither predictors nor moderators of functional improvement. Conclusions For older adults undergoing rehabilitation, greater functional improvement with the motivational techniques of Enhanced Medical Rehabilitation was contingent on patients having intact executive function. Given that executive function impairments are common in rehabilitation populations, new strategies are needed to improve treatment outcomes in physical/occupational therapy. To Claim CME Credits Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives Upon completion of this article, the reader should be able to (1) Discuss the role of baseline affective, cognitive, and medical impairments in impacting functional outcomes of older adults undergoing rehabilitation; (2) Describe the behavioral change and motivational approaches that are core features of the novel intervention known as Enhanced Medical Rehabilitation (E-MR); and (3) Determine the role of baseline executive function in moderating the effect of rehabilitation intervention on functional outcomes in older adults. Level Advanced Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
AB - Objective This study examined cognitive, affective, and medical impairments and their impact on rehabilitation approaches for improving functional outcome after hospitalization in older adults. Design A secondary analysis of a randomized clinical trial in 229 adults 65 yrs or older admitted to two skilled nursing facilities undergoing rehabilitation services was conducted. Patients were randomized to receive physical and occupational therapy by therapists trained in systematic approaches to engage patients, called Enhanced Medical Rehabilitation, or standard of care. The outcome of interest was functional improvement, defined as Barthel Index at discharge (controlling for Barthel Index upon admission). This study analyzed the relationship of measures of cognition, depression, and medical comorbidities as predictors of functional outcome and as moderators interacting with treatment group. Results Clock drawing score moderated treatment effect size; the functional improvement of Enhanced Medical Rehabilitation over standard of care therapy reduced with increasing executive impairment. In contrast, general cognitive abilities, depression, medical comorbidities, and readiness for rehabilitation were neither predictors nor moderators of functional improvement. Conclusions For older adults undergoing rehabilitation, greater functional improvement with the motivational techniques of Enhanced Medical Rehabilitation was contingent on patients having intact executive function. Given that executive function impairments are common in rehabilitation populations, new strategies are needed to improve treatment outcomes in physical/occupational therapy. To Claim CME Credits Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives Upon completion of this article, the reader should be able to (1) Discuss the role of baseline affective, cognitive, and medical impairments in impacting functional outcomes of older adults undergoing rehabilitation; (2) Describe the behavioral change and motivational approaches that are core features of the novel intervention known as Enhanced Medical Rehabilitation (E-MR); and (3) Determine the role of baseline executive function in moderating the effect of rehabilitation intervention on functional outcomes in older adults. Level Advanced Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
KW - Executive Function
KW - Occupational Therapy
KW - Physical Therapy
KW - Rehabilitation
UR - http://www.scopus.com/inward/record.url?scp=85108245697&partnerID=8YFLogxK
U2 - 10.1097/PHM.0000000000001739
DO - 10.1097/PHM.0000000000001739
M3 - Article
C2 - 34131093
AN - SCOPUS:85108245697
SN - 0894-9115
VL - 100
SP - 635
EP - 642
JO - American Journal of Physical Medicine and Rehabilitation
JF - American Journal of Physical Medicine and Rehabilitation
IS - 7
ER -