Predictors of basic and instrumental activities of daily living performance in persons receiving rehabilitation services

Objective: To examine the relations among cognitive and emotional function and other patient impairment and demographic variables and the performance of daily activities. Design: Cohort. Setting: Acute inpatient rehabilitation, skilled nursing facilities, home care, and outpatient clinics. Participants: Adults (N=534) receiving services for neurologic (32.3%), lower-extremity orthopedic (42.7%), or complex medical (24.9%) conditions. Mean age was 63.8 years; 55% were women; 88.6% were white; and the time since condition onset ranged from 0.2 to 3.9 years. Interventions: Not applicable. Main Outcome Measures: Activity Measure for Post-Acute Care: applied cognitive, personal care and instrumental, and physical and movement scales; Mental Health Inventory-5 (MHI-5); and patient-identified problems (vision, grasp). Results: Path analyses resulted in good model fit both for the total sample and 3 patient subgroups (chi(2) test, P>.05; comparative fit index >.95). There was a significant (P<.05) direct relation between the applied cognitive, grasp, and personal care and instrumental variables in all patient groups. There were also significant indirect relations between the MHI-5, visual impairment, and grasp problems with the personal care and instrumental scale through an association with the applied cognitive scale. Strength and significance of associations between age, sex, and physical and movement and personal care and instrumental scales varied more across patient groups. The model R-2 for the personal care and instrumental scale for the total sample was .60, with R-2 values of .10,.72, and .62 for the lower-extremity orthopedic, neurologic, and complex medical groups, respectively. Conclusions: Results suggest that variations in cognitive function, along with visual impairment and lower perceived well-being are associated with a patient's ability to complete daily activities. Rehabilitation professionals should consider cognitive and emotional factors as well as physical performance when planning treatment programs to restore daily activity function.