Appropriateness/inappropriateness of access to an in-hospital rehabilitation program for patients with respiratory disease

There are no descriptions of the "ideal candidate" or validated indices to justify admitting respiratory patients to hospital-based rehabilitation. This study aimed to quantify appropriate/inappropriate admissions to in-hospital rehabilitation programs among respiratory patients. We analyzed hospitalization records from the ICS Maugeri repository (01 January 2015 - 31 December 2024) across seven Italian ICS Maugeri centers. Patients were categorized as chronic respiratory failure (CRF; 45.70%), chronic obstructive pulmonary disease (COPD; 22.76%), asthma (0.07%), obstructive sleep apnea (OSAS; 10.89%), and miscellaneous dyspnea not related to COPD (19.84%).

Anthropometric, Cumulative Illness Rating Scale, Medical Research Council (MRC) scale, Barthel dyspnea, COPD Assessment Test (CAT), 6-minute walk test (6MWT), and Short Physical Performance Battery (SPPB) were collected. Appropriateness of hospital admission was defined according to literature-based severity cut-offs for all disability items, while inappropriateness was computed on four contemporary items (excluding MRC). The cohort was predominantly male, aged 60-70 years, with CRF (46%) and multiple comorbidities; most (84%) were admitted from home, while >95% of patients returned home. High overall appropriateness in the whole group was 73-87% across items, with the highest % for 6MWT predicted across all TPs (74% OSAS-94% CRF) and lower for SPPB (60% OSAS-78% CRF) and for the MRC dyspnea score (75% OSAS-89% CRF).

The CRF group demonstrated very high appropriateness (>78% in all items), COPD presented strong appropriateness for deconditioning (6MWT: 83%) dyspnea (MRC: 84%), asthma patients showed a lower CAT appropriateness (64%). The OSAS subgroup had the lowest entry appropriateness (55-74%). The dyspnea group exhibited high appropriateness for deconditioning (6MWT: 83%) and for dyspnea (MRC: 81%, Barthel dyspnea: 81%). Among 6086 complete cases, only 2.8% were deemed to be inappropriate admissions. The highest inappropriateness was in the dyspnea subgroup (6%), while the lowest was for CRF (0.7%).  Entry appropriateness was high or very high for overall items, showing 6MWT the best rate and CAT and SPPB the worst. CRF patients showed the highest appropriateness, while the rate of inappropriateness was overall low, with dyspnea and OSAS subgroups the worst and CRF the best. Future strategies must focus on developing standardized, multifaceted evaluation tools to objectively guide inpatient rehabilitation referrals.

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