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Upper-extremity function prospectively predicts adverse discharge and all-cause COPD readmissions: a pilot study

Authors Ehsani H, Mohler MJ, Golden T, Toosizadeh N

Received 6 August 2018

Accepted for publication 18 November 2018

Published 18 December 2018 Volume 2019:14 Pages 39—49

DOI https://doi.org/10.2147/COPD.S182802

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Dr Richard Russell


Hossein Ehsani,1,2 Martha Jane Mohler,1–3 Todd Golden,2 Nima Toosizadeh1–3

1Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA; 2Arizona Center on Aging, Department of Medicine, University of Arizona, Tucson, AZ, USA; 3Division of Geriatrics, General Internal Medicine and Palliative Medicine, Department of Medicine, University of Arizona, Tucson, AZ, USA

Background: Frailty can inform management approaches for individuals with COPD. However, inpatient measures of frailty are seldom employed because they are time-consuming or inapplicable for bed-bound patients. We investigated the feasibility and potential of an innovative sensor-based upper-extremity function (UEF) test for frailty assessment in predicting adverse outcomes.
Methods: Hospitalized patients with COPD-related exacerbations (aged ≥55 years) were recruited and performed the UEF test within 24 hours of admission. UEF parameters were obtained and fed into our previously developed frailty model to calculate frailty status (non-frail, pre-frail, and frail) and frailty score (0: extreme resilience to 1: extreme frailty). In-hospital (length of stay) and post-discharge (discharge disposition, 30-day exacerbation with treatment, and all-cause 30-day readmission) outcomes were collected. Associations between UEF frailty and outcomes were investigated using ANOVA and logistic models adjusted for demographic data.
Results: In total, 42 patients were recruited. All participants were able to perform the UEF test. Based on UEF, participants were stratified into three groups of non-frail (n=6, frailty score =0.18±0.09), pre-frail (n=14, frailty score =0.45±0.09), and frail (n=22, frailty score =0.78±0.11). Both frailty status and frailty score were significantly associated with unfavorable discharge disposition (P<0.005) and all-cause 30-day readmission (P<0.05). On the other hand, UEF frailty measures were associated with neither hospital length of stay (P>0.5) nor 30-day exacerbation with treatment (P>0.70). Age was only significantly associated with unfavorable discharge disposition (P=0.048).
Conclusion: In agreement with previous work, the current findings underline the importance of measuring frailty for risk-stratification of COPD patients. The UEF was feasible and easily performed among all hospitalized COPD patients. In this study, we have shown that, using our quick and objective frailty measures, COPD patients can be prospectively risk-stratified in terms of unfavorable discharge disposition and all-cause 30-day readmissions.

Keywords: COPD, frailty, adverse health outcomes, early readmission, biomechanics, gait, wearable sensors

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