Abstract

The ability of neuropsychological tests to predict rehabilitation outcome is unclear, particularly when other ratings of cognition are available. Neuropsychological test scores and functional ratings of cognition (Functional Independence Measure (FIM) Cognition score) were used to predict improvement in patient mobility and self-care skill, as measured by the FIM Motor score. Regression models used both raw neuropsychology test scores and age-adjusted scores. Retrospective chart review was performed for patients on an inpatient rehabilitation unit and referred for neuropsychological assessment. The group included 126 subjects (average age 64.2 ± 17.1 years) and a variety of medical diagnoses. Neuropsychological tests included the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). After forcing the Admission FIM Cognition score into the model, RBANS scores and duration of rehabilitation predicted FIM Motor improvements (F = 11.42, p < 0.0001). Raw neuropsychological test scores performed better than the model with age-adjusted test scores. FIM Cognition alone did not predict FIM Motor improvements. Neuropsychological tests, combined with duration of rehabilitation, predicted mobility gains for patients undergoing inpatient rehabilitation beyond what was predicted by another, readily available, assessment of cognition. Neuropsychology raw scores performed better than age-adjusted scores, raising questions about the standard use of demographic adjustments for predicting real-world function.

Highlights

  • For patients receiving inpatient rehabilitation, cognitive impairment has been demonstrated to have a negative effect on self-care skills [1,2,3,4,5]

  • The t-tests comparing groups that did (n = 126) and did not (n = 1409) undergo neuropsychological exam found no differences in the Admission Motor Functional Independence Measure (FIM) scores (p = 0.44)

  • The group that was referred for neuropsychological exam had, significantly lower Admission Cognitive FIM scores (p = 0.0002)

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Summary

Introduction

For patients receiving inpatient rehabilitation, cognitive impairment has been demonstrated to have a negative effect on self-care skills [1,2,3,4,5]. Information about a patient’s cognitive skills can aid in the prediction of rehabilitation outcome [6,7,8,9,10,11,12] and greater knowledge of this predictive relationship would be useful in anticipating patient assistance needs at discharge. Information about cognition is routinely obtained during the rehabilitation admission through ratings by rehabilitation therapists. These ratings relate to cognition in a functional, applied setting. Some patients are referred for neuropsychological exam during the rehabilitation admission but it is unclear whether this additional exam provides unique information in predicting selfcare and mobility skills. We examined whether mobility gains for patients with cognitive deficit could be predicted from neuropsychological test scores beyond what is predicted by readily available, functional ratings of cognition

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