Ann Rehabil Med.  2020 Feb;44(1):69-76. 10.5535/arm.2020.44.1.69.

Factors Affecting the Discharge Destination of Patients With Spinal Bone Metastases

• Akezaki Y
• Nakata E
• Kikuuchi M
• Sugihara S

• KMID: 2501047
• DOI: http://doi.org/10.5535/arm.2020.44.1.69

Abstract

Objective
To investigate the factors affecting the discharge destination of patients with spinal bone metastases.
Methods
We reviewed the medical records of patients admitted to our institute with a diagnosis of skeletalrelated events secondary to malignant disease. Exclusion criteria comprised decreased cognitive function and hypercalcemia, brain metastasis, peritoneal dissemination, and pleural dissemination. The factors examined included the discharge destination, age, sex, the Barthel Index (BI) at admission and discharge, pain at admission and discharge, number of co-resident household members, length of hospital stay, treatment strategy, spinal instability neoplastic score, vertebral body collapse, spinal level of bone metastases, and motor paralysis. For the discharge destination, patients at discharge were grouped into two categories. The home group included patients discharged to their own homes, and the non-home group included patients discharged to other hospitals.
Results
Of 140 patients, the home group comprised 120 patients and the non-home group comprised 20 patients. Activities of daily living (ADL) and pain at rest and during motion improved significantly in the home group, whereas only pain at rest and during motion improved significantly in the non-home group. The results indicated that discharge BI and motor paralysis were the best predictors of the discharge destination; a BI cut-off value of 72.5 predicted discharge to home.
Conclusion
This study showed that the ADL level on discharge and motor paralysis affected the discharge destination of patients with spinal bone metastases. These results are likely to be helpful in predicting the discharge destination of patients with spinal bone metastases.

Keyword

Cancer; Pain; Activities of daily living; Spine; Motor paralysis

Figure

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  Fig. 1. Receiver operating characteristic curve for prediction of home group. A 72.5 score on the Barthel Index gave a clear cut-off value for the discharges to home.

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  Fig. 2. Kaplan-Meier survival curves for patients with spinal bone metastases by discharge destination.

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