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). 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. 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). 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.

中文翻译：

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改良的功能合并症指数在预测老年康复功能预后方面优于Charlson指数和原始功能合并症指数：一项前瞻性观察研究

在老年患者的住院康复中，估算患者可以在多大程度上恢复功能（功能预后），对于计划康复计划和协助出院计划很重要。合并症在老年患者中很常见。但是，合并症在进行功能性预后中的作用尚不清楚。这项研究的目的是研究与功能恢复有关的经修改和加权的功能性合并症指数（w-FCI），并将其与查尔森合并症指数（CCI）和原始功能性合并症指数（FCI）的预测表现进行比较。合作研究（在康复中评估老年患者的合并症和结局）是一项前瞻性观察性队列研究。收集了2017年1月至9月间在英国的老年医学康复设施中入院的患者数据。结果指标为：出院时的老年人活动量表（EMS）和Barthel指数（BI），每天EMS收益和每天BI收益。使用CCI，FCI和w-FCI评估基线合并症。进行了相关性，接收器工作曲线（ROC）和多重线性回归分析。入院时对模型进行了年龄，性别和EMS或BI调整。总共包括98名患者（平均年龄82岁；男性占37％）。w-FCI的ROC曲线下面积（放电时的EMS：0.72，EMS每天的收益：0.72，放电时的BI：0.66和BI每天的收益：0.60）高于CCI（0.50，0.53，0.49） ，分别为0.44）和FCI（分别为0.65、0.55、0.60、0.49）。w-FCI与出院时的EMS独立相关（20.7％的方差解释（PVE），p <0.001），每天EMS收益（11.2PVE，p <0.001）和出院时的BI（18.3 PVE，p <0.001） ）。FCI仅与每天的EMS收益相关（3.9 PVE，p <0.05）。没有任何合并症指数显着影响每天的BI收益（w-FCI：2.4 PVE，p> 0.05）。w-FCI可预测出院时的活动度和功能以及每天的活动度增加，并且优于原始的FCI和CCI。w-FCI可用于以个性化方式评估合并症，并在康复开始时帮助功能预后。FCI仅与每天的EMS收益相关（3.9 PVE，p <0.05）。没有任何合并症指数显着影响每天的BI收益（w-FCI：2.4 PVE，p> 0.05）。w-FCI可预测出院时的活动度和功能以及每天的活动度增加，并且优于原始的FCI和CCI。w-FCI可用于以个性化方式评估合并症，并在康复开始时帮助功能预后。FCI仅与每天的EMS收益相关（3.9 PVE，p <0.05）。没有任何合并症指数显着影响每天的BI收益（w-FCI：2.4 PVE，p> 0.05）。w-FCI可预测出院时的活动度和功能以及每天的活动度增加，并且优于原始的FCI和CCI。w-FCI可用于以个性化方式评估合并症，并在康复开始时帮助功能预后。