Background: Cognitive status has been reported to be an important predictor of rehabilitation outcome. The Montreal Cognitive Assessment (MoCA) was designed to overcome some of the limitations of established cognitive screening tools such as the Mini-Mental State Examination (MMSE). The purpose of this study is to evaluate the psychometric characteristics of the MoCA as a screening tool in a geriatric rehabilitation program and its ability to predict rehabilitation outcome.

Methods: Forty-seven geriatric rehabilitation program patients participated in the study. Assessments of each patient's functional (Functional Independence Measure) and cognitive status (MMSE and MoCA) were performed. Information on discharge destinations were obtained and rehabilitation efficacy and efficiency scores were calculated.

Results: Significant correlations were found between the MoCA and other cognitive status measures. Cognitive status at admission and successful rehabilitation were also associated. Defining rehabilitation success on the basis of relative functional efficacy (an indicator that includes the patient's potential for improvement), the sensitivity and specificity of the MoCA were 80% and 30% respectively. The attention subscale of the MoCA was also uniquely predictive of rehabilitation success. The attention subscale (cutoff 5/6) of the MoCA had a sensitivity of 40% and specificity of 90%, as did the MMSE.

Conclusions: As a cognitive screening tool, the MoCA appears to have acceptable psychometric properties. Results suggest that the MoCA can have a considerable advantage over the MMSE in sensitivity and equivalence in specificity using both total and attention scale scores. The MoCA may be a more useful measure for detecting cognitive impairment and predicting rehabilitation outcome in this population.

Assessing the burden linked to caring for the frail elderly is becoming an important issue in rehabilitation. The purpose of this study was to translate/validate the Montgomery Borgatta Caregiver Burden Scale into French for use in Canada. This easy-to-use questionnaire evaluates aspects of burden such as objective, subjective stress and subjective demand burden. The instrument underwent: 1) parallel translation/back-translation; 2) expert's committee review leading to an experimental version; 3) pre-test to ensure wording clarity; and 4) study of psychometric properties with bilingual subjects (n = 27) and French-speaking subjects (n = 18). Results suggest that convergence between the original and the French versions is satisfactory for two of the three sub-scales of the MBCBS (ICC 0.83 et 0.96). The test-retest stability coefficients are also very good (ICC of 0.92 et 0.91), as is internal consistency (0.90, 0.66). The objective burden sub-scale correlates moderately with a measure of functional autonomy (SMAF). Results for the subjective burden scale linked to demand are, however, inadequate. All in all, two of the three sub-scales of the French-Canadian version of the Montgomery Borgatta Caregiver Burden Scale demonstrate adequate psychometric properties, thereby favouring its use in geriatric rehabilitation.

Warfarin dosing for thromboprophylaxis in post-operative patients is time-consuming. Warfarin-dosing nomograms can be used in post-operative arthroplasty patients, but warfarin requirements are lower in frail older people. We modified an existing post-arthroplasty nomogram to a frail-friendly version and evaluated its performance in a frail elderly post-orthopaedic surgery on a geriatric rehabilitation ward to determine if it would improve quality indicators for oral anticoagulation. On a geriatric rehabilitation unit, post-operative orthopaedic patients were assigned to either physician-adjusted warfarin dosing or the nursing-administered nomogram. The proportion of days within target INR values was significantly higher in the nomogram group (77%, 95% CI 74% to 81%) compared to the physician-adjusted group (53%, 95% CI 46% to 60%), with no major bleeding or thromboembolic complications. The number of warfarin-related telephone calls to physicians was significantly reduced by tenfold. Use of a frail-friendly nomogram improved quality and efficiency of patient care on a geriatric rehabilitation unit.