Rehabilitation Improves Both the Prognosis and Activities of Daily Living Scores in Hemodialysis Patients / The Japanese Journal of Rehabilitation Medicine

ABSTRACT

Background: The effects of rehabilitation on hemodialysis patients are unknown. We assessed the effects and investigated the association between rehabilitation treatment effects and all-cause mortality. Methods: This prospective cohort study included 120 patients on maintenance hemodialysis. ADL was assessed using the Functional Independence Measure (FIM) score (total points, 126), which comprises 13 motor items (total points, 91) and five cognitive items (total points, 35). A survival curve was constructed using the Kaplan-Meier analysis and stratified into an increase or no-increase of the FIM score. Multivariable logistic regression analysis was used to determine factors associated with the effects of rehabilitation. Discriminative sensitivity of FIM cognitive items for an increase in total FIM was estimated using the area under the receiver operating characteristic (AuROC) curve. Results: The average total FIM score increased from 64.2±3.6 to 75.8±3.0, and the increase in FIM motor and cognitive items was 11.0±1.3 and 0.5±0.6, respectively. The cumulative survival rate within 2.5 years was significantly higher in the FIM increase group than that in the FIM no-increase group. FIM cognitive items and anemia were significantly associated with rehabilitation effects, and AuROC showed that a cutoff of 34 points in cognitive FIM had moderate discriminative sensitivity for a total FIM increase (AuC, 0.719 ; <i>p</i><0.0008). Conclusions: Rehabilitating hemodialysis patients improved their FIM score (particularly the motor items), and a higher FIM score resulted in a better prognosis. The effectiveness of rehabilitation depends on maintaining a perfect FIM cognitive score.