Acute Inpatient Rehabilitation Hospital Research Articles

Acute Inpatient Rehabilitation Functional Outcomes and Disposition After Liver Transplant

ObjectiveTo describe the outcomes (change in functional independence and discharge disposition) of patients who after liver transplantation received acute inpatient rehabilitation in a freestanding rehabilitation hospital. DesignA retrospective chart review was conducted of patients admitted to an acute inpatient rehabilitation hospital within 6 months of undergoing liver transplantation between January 2014 and December 2018. Change in function from rehabilitation admission to discharge was measured using FIM Change and FIM Efficiency. SettingA freestanding rehabilitation hospital. Participants107 patients who underwent acute inpatient rehabilitation at a freestanding rehabilitation hospital within 6 months after liver transplantation who met inclusion criteria (N=107). Most were men (71.96%), and the mean age of the patient population was 62.15 years. InterventionsAcute inpatient rehabilitation consisting of at least 3 hours of therapy 5 days a week split between physical therapy, occupational therapy, and speech language pathology services. Main Outcome MeasureFIM Change, FIM Efficiency, Discharge Disposition. ResultsParticipants were found to have statistically significant positive FIM Change (P<.00001) and FIM Efficiency (P<.00001). The mean FIM Change and Efficiency were 35.7±11.8 and 2.4±1.0, respectively. 83.2% (n = 89) were ultimately discharged to the community. ConclusionAcute inpatient rehabilitation provides patients who have received a liver transplant with the opportunity to measurably improve their function and independence, with most patients being able to return home.

Benefits and barriers to return to education and relationship to quality of life for people living with spinal cord injury: Results of a mixed methods study

Context There is limited research on return to education (RTE) after spinal cord injury (SCI). As a result, few programs exist to help people achieve this goal. Objective The primary objective was to investigate the barriers and facilitators to RTE, and the relationship between RTE and quality of life (QOL). The secondary objective was to examine the role of a Vocational Resource Facilitation (VRF) program on RTE. Methods A mixed methods approach with a semi-structured interview and online survey was used. Participants included 15 people with SCI with RTE goals who received VRF services at an acute inpatient rehabilitation hospital. Qualitative responses on the barriers, facilitators and perceived benefits of RTE were analyzed using a grounded theory strategy. Results Barriers to RTE included physical and mental health, transportation, time, environmental barriers, finances, lack of knowledge about available resources, and discrimination. Facilitators to RTE included the VRF program, social support, financial support, virtual learning, organizational support, and policy constructs. People who RTE after SCI reported better QOL, less depressed mood than those who did not, and were more likely to have returned to work. Conclusions This study highlighted common barriers and facilitators to RTE, and potential areas of intervention. VRF is a potentially efficacious early intervention vocational rehabilitation approach that improves participation in education and employment for people with SCI. People who received VRF and achieved RTE may have better QOL outcomes and improved employability.

A - 99 Older Adult Male with Idiopathic Normal Pressure Hydrocephalus (iNPH): Neuropsychological Case Study.

Idiopathic normal pressure hydrocephalous (iNPH) is a potentially reversible syndrome characterized by ventriculomegaly. Parkinsonism is an often-overlooked clinical feature of iNPH. Mostile et al. (2022) argued that the diagnostic iNPH "triad" should be reconsidered as a "tetrad" including parkinsonism. This case will discuss iNPH presenting with parkinsonism. Patient is an 81-year-old male with a history of iNPH with Hakim's triad. His medical history includes hyperlipidemia, hypertension, deep vein thrombosis, benign prostatic hyperplasia, total knee replacement, and chronic depression. Presenting concerns were continued cognitive and gait impairments. Patient was referred from his physiatrist for evaluation of his cognitive functioning and assistance with discharge planning in an acute inpatient rehabilitation hospital. Patient was neuropsychologically evaluated to clarify the etiology of his cognitive presentation. Patient's cognitive profile was impaired in areas of attention, executive functioning, processing speed, visuoperception, and displayed a subcortical memory profile. Patient had intact functioning in areas of oral reading, naming, and working memory. Motor examination was evident for apraxia, task-specific tremor, and micrographia. This case report provides additive findings for common presentation of iNPH including parkinsonism presenting with comorbid psychiatric and medical confounders, highlighting the need for further research on neuropsychological profile of iNPH post shunt procedure. It also accentuates the need to accept parkinsonism as one of the common presentations of iNPH. Akinesia has been reported in nearly 70% of iNPH cases (Krauss et al, 1997), with bradykinesia and postural instability being the main parkinsonian features. Asymmetry and resting tremor were seen to be uncommon (Molde et al., 2017).

Promoting Restful Sleep in an Acute Inpatient Rehabilitation Hospital For Individuals With Acquired Brain Injury: A Feasibility Project

<h3>Research Objectives</h3> To obtain preliminary data on the usefulness of audiobooks to promote sleep using objective measures <h3>Design</h3> Within-subjects design with two experimental conditions, one with audiobook and the other without. Participants were randomized into one of two groups counterbalanced for order. <h3>Setting</h3> Inpatient rehabilitation hospital. <h3>Participants</h3> 6 adults (3 males,3 females) with acquired brain injury (5 from stroke and 1 from brain tumor). Ages ranged from 33 to 72 (M=58.5, SD=13.9). <h3>Interventions</h3> Participants were monitored for sleep activity for 4 consecutive nights. For 2 consecutive nights, participants listened to an audiobook of their choice prior to bed using headphones. <h3>Main Outcome Measures</h3> Actigraph data (wrist-worn accelerometer) was analyzed to derive total sleep time. <h3>Results</h3> The audiobooks were well-tolerated by the participants. Repeated measures ANOVA taking order into account showed a significant overall effect of condition, F(1,4)=33.7, p=0.004 with a significant condition x order interaction, F(1,4)=21.8, p=0.010. The effect was much more exaggerated among those who were assigned to the audiobook on days 3 and 4 (phase 2), showing an average increase in total sleep time of 45 minutes. <h3>Conclusions</h3> Non-pharmacological sleep interventions are needed for patients with acquired brain injury to avoid the potential detrimental effects of medications. These findings are preliminary with a very small sample. However, examination of the data showed that five out of six participants showed an increase in total sleep time after using the audiobook before bedtime with the remaining participant showing very little change between conditions. Further study is needed to understand how audiobooks may serve as a non-pharmacological tool to help patients achieve better sleep in a hospital setting. <h3>Author(s) Disclosures</h3> Fire Tablet and titles were provided by Audible

Measuring Discharge Outcomes, Length of Stay, and Functional ADL Score During COVID-19 in Inpatient Rehabilitation Hospitals

ObjectiveTo measure discharge disposition, length of stay (LOS), and functional activities of daily living (ADL) scores for patients admitted to acute inpatient rehabilitation hospitals (IRHs) during the coronavirus disease 2019 (COVID-19) pandemic and to compare these parameters with a period prior to the pandemic. DesignRetrospective cohort study via systematic retrospective chart review of consecutive patients admitted to IRHs from January 1-February 19, 2020 (pre–COVID-19T), and COVID-19 time period/patients admitted from April 1, 2020-May 9, 2020 (COVID-19T). SettingSystem of 3 IRHs in the Northeastern United States. ParticipantsPre–COVID-19T, n=739; COVID-19T, n=335, of whom n=139 were positive for COVID-19 (COVID+) and n=196 were negative (COVID−) (N=1074). InterventionsNot applicable. Main Outcome MeasuresDischarge disposition, LOS, and functional ADL scores. ResultsCOVID-19T patients were younger (P=.03) and less likely to be White (P=.03). These patients also had a higher case mix index (CMI; P<.01), longer acute care LOS (P<.01), and longer IRH LOS (P<.01). Patients who were COVID+ (during COVID-19T) were less likely to be White (P<.01), had lower CMI (P<.01), had higher admission and discharge functional ADL scores (P=.02, P<.01), and had longer acute care LOS compared with those who were COVID− (P<.01). There were no differences in discharge outcomes between pre–COVID-19T and COVID-19T cohorts (P=.75), including when stratified for COVID-19 status (P=.74). Functional ADL scores on admission and discharge were lower in COVID-19T than in pre–COVID-19T (P=.01), including when stratified for COVID-19 status though not significant (P=.06). ConclusionsThere were no differences in discharge outcomes for any group. IRH LOS was significantly increased during the pandemic, but there were no statistically significant differences between the COVID+ and COVID− cohorts within COVID-19T. Functional ADL scores were significantly lower during COVID-19T, but COVID status was not a significant predictor. This suggests that COVID+ status was not a barrier to discharge or functional outcomes. This supports the importance of IRHs to restore function and discharge patients to home, even with a more medically complex COVID-19 pandemic population.

Convergent Validity of In-Person Assessment of Inpatients With Traumatic Brain Injury Using the Brief Test of Adult Cognition by Telephone (BTACT).

To examine convergent validity of the Brief Test of Adult Cognition by Telephone (BTACT) by determining correlation with established neuropsychological tests, administered an average of 4.4 days apart, in an inpatient traumatic brain injury (TBI) population. Acute inpatient rehabilitation hospital. Fifty-five patients receiving inpatient rehabilitation for new-onset TBI (69.1% male; mean age = 37 years, SD = 14 years). Cross-sectional, secondary data analysis. BTACT; California Verbal Learning Test-second edition (CVLT-2); Wechsler Adult Intelligence Scale-IV (WAIS-IV) Digit Span; Trail Making Test; semantic fluency; phonemic fluency; Symbol Digit Modalities Test; Wisconsin Card Sorting Test. The BTACT was significantly associated with established neuropsychological tests across composite scores of overall cognition (r = 0.64, P < .001), episodic verbal memory (r = 0.66, P < .001), and executive function (r = 0.56, P < .001). For BTACT subtests, Word List Immediate Recall and Word List Delayed Recall were correlated with CVLT-2 learning trials total score (r = 0.57, P < .01) and long delay free recall (r = 0.60, P < .001), respectively. BTACT Digits Backward correlated with WAIS-IV Digit Span (r = 0.51, P < .01). BTACT Animal Fluency was associated with semantic fluency (r = 0.65, P < .01), phonemic fluency (r = 0.60, P < .01), and Trail Making Test Part B (r = 0.39, P < .01). BTACT composite scores of overall cognition, verbal memory, and executive function demonstrate initial convergent validity in a TBI inpatient population. Future research should examine validity in a larger sample of individuals with TBI.

Inpatient Virtual Vision Clinic Improves Access to Vision Rehabilitation Before and During the COVID-19 Pandemic

ObjectiveTo describe and evaluate a secure video call system combined with a suite of iPad vision testing apps to improve access to vision rehabilitation assessment for inpatients. DesignRetrospective. SettingTwo acute care inpatient rehabilitation hospitals and 1 long-term acute care (LTAC) hospital. ParticipantsRecords of inpatients seen by the vision service. InterventionsRecords from a 1-year telemedicine pilot performed at acute rehabilitation (AR) hospital 1 and then expanded to AR hospital 2 and LTAC hospital during coronavirus disease 2019 (COVID-19) were reviewed. In the virtual visits, an occupational therapist measured the patients’ vision with the iPad applications and forwarded results to the off-site Doctor of Optometry (OD) for review prior to a video visit. The OD provided diagnosis and education, press-on prism application supervision, strategies and modifications, and follow-up recommendations. Providers completed the telehealth usability questionnaire (10-point scale). Main Outcome MeasuresVision examinations per month at AR hospital 1 before and with telemedicine. ResultsWith telemedicine at AR hospital 1, mean visits per month significantly increased from 10.7±5 to 14.9±5 (P=.002). Prism was trialed in 40% of cases of which 83% were successful, similar to previously reported in-person success rates. COVID-19 caused only a marginal decrease in visits per month (P=.08) at AR1, whereas the site without an established program (AR hospital 2) had a 3-4 week gap in care while the program was initiated. Cases at the LTAC hospital tended to be more complex and difficult to manage virtually. The telehealth usability questionnaire median category scores were 7 for Ease of Use, 8 for Interface Quality, 6 for Reliability, and 9 for Satisfaction and Future Use. ConclusionsThe virtual vision clinic process improved inpatient access to eye and visual neurorehabilitation assessment before and during the COVID-19 quarantine and was well accepted by providers and patients.

Free-standing acute inpatient rehabilitation hospital enhanced practices and policies in response to theCOVID-19 outbreak.

This special report was developed to communicate policy and procedures for free-standing acute inpatient rehabilitation hospitals (AIRHs) to protect patients and healthcare personnel and to prevent further spread of severe acute respiratory syndrome coronavirus 2. The recommended policies were developed in conjunction with the New Mexico Department of Health and hospital leadership. As we attain additional knowledge and experience during this pandemic, suggestions of best practice will continue to evolve for AIRHs. The authors encourage readers to work with local regulatory officials to ensure regulatory compliance as well as respect of the availability of local resources.

Glioblastoma Multiforme: Functional Outcomes in a Three Year Retrospective Cohort Study of an Acute Inpatient Rehabilitation Hospital

To analyze the functional outcomes of patients with glioblastoma multiforme (GBM) in an acute inpatient rehabilitation facility (IRF).

Effect of the COVID-19 Pandemic on Postacute Care Decision Making

The response to the coronavirus disease 2019 (COVID-19) pandemic in the United States has resulted in rapid modifications in the delivery of health care. Key among them has been surge preparation to increase both acute care hospital availability and staffing while using state and federal waivers to provide appropriate and efficient delivery of care. As a large health system in New York City, the epicenter of the pandemic in the United States, we were faced with these challenges early on, including the need to rapidly transition patients from acute care beds to provide bed capacity for the acute care hospitals. Rehabilitation medicine has always played an essential role in the continuum of care, establishing functional goals while identifying patients for postacute care planning. During this crisis, this expertise and the overwhelming need to adapt and facilitate patient transitions resulted in a collaborative process to efficiently assess patients for postacute care needs. We worked closely with our skilled nursing facility, home care partners, and an acute inpatient rehabilitation hospital to adapt their admissions processes to the patient population with COVID-19, all the while grappling with varying access to vital supplies, testing, and manpower. As the patient criteria were established, rapid pathways were created to postacute care, and we were able to create much needed bed capacity in our acute care hospitals.

Exploring self-management within hospital-based stroke care: current and future opportunities

Purpose This study explored stroke self-management within a tertiary hospital setting from the perspectives of health professionals working across the continuum of stroke care. Materials and methods A qualitative descriptive design guided five focus groups in the acute stroke service (n = 2), inpatient rehabilitation (n = 2), and outpatient day hospital service (n = 1). Focus groups were transcribed verbatim and analysed using thematic analysis. Results Twenty-eight health professionals participated representing medical, nursing, and allied health services. Two themes emerged from the data: Pieces of the puzzle illustrates the inconsistent understanding about self-management with elements of the puzzle described but rarely within the full concept of self-management; Readiness for self-management highlighted that although self-management should commence in the acute setting, there were many factors influencing why this was not always happening. Conclusions A consistent conceptualisation and approach to stroke self-management in the hospital setting is required. Interprofessional education and shared intentional language can enhance understanding and practice. IMPLICATIONS FOR REHABILITATION Understanding and application of stroke self-management varies among members of hospital-based stroke teams. Health professionals working in hospital-based stroke care should use the term self-management with their patients. Education of healthcare teams is necessary to develop knowledge about self-management and develop consistent practices across the continuum of care.

A-112 Validity of In-Person Assessment of Traumatic Brain Injury Inpatients Using the Brief Test of Adult Cognition by Telephone

Abstract Objective Examine the correlation of the Brief Test of Adult Cognition by Telephone (BTACT) with established neuropsychological tests in an inpatient traumatic brain injury (TBI) population. Method Participants were 55 patients aged 18–76 years (M age = 37 years; 69% male) receiving inpatient rehabilitation for new-onset TBI at a level I trauma center, acute inpatient rehabilitation hospital. The BTACT is a brief cognitive test battery consisting of the following subtests: Word List Immediate and Delayed Recall (episodic verbal memory), Digits Backward (working memory), Number Series (inductive reasoning), Animal Fluency (verbal fluency), and Backward Counting (processing speed). With the intention of mirroring cognitive functions measured by the BTACT, the neuropsychological battery was comprised of the California Verbal Learning Test-2 (CVLT-2), Wechsler Adult Intelligence Scale-IV (WAIS-IV) Digit Span, Trail Making Test (TMT), semantic fluency, phonemic fluency, Symbol Digit Modalities Test, and Wisconsin Card Sorting Test. Results The BTACT was related to established neuropsychological tests across composite scores of overall cognition (r = .64, p &amp;lt; .001), episodic verbal memory (r = .66, p &amp;lt; .001), and executive function (r = .56, p &amp;lt; .001). For BTACT subtests, Word List Immediate Recall and Word List Delayed Recall were correlated with CVLT-2 learning trials total (r = .57, p &amp;lt; .01) and long delay free recall (r = .60, p &amp;lt; .001), respectively. BTACT Digits Backward correlated with WAIS-IV Digit Span (r = .51, p &amp;lt; .01). BTACT Animal Fluency was related to semantic fluency (r = .65, p &amp;lt; .01), phonemic fluency (r = .60, p &amp;lt; .01), and TMT-B (r = .39, p &amp;lt; .01). Conclusion BTACT composite scores of overall cognition, verbal memory, and executive function are valid measures in a TBI inpatient population.

Dimensions of Poststroke Depression and Neuropsychological Deficits in Older Adults

ObjectivePoststroke depression (PSD) has a heterogeneous presentation and is often accompanied by cognitive impairment. This study aimed to identify distinct dimensions of depressive symptoms in older adults with PSD and to evaluate their relationship to cognitive functioning. DesignCross-sectional factor and correlational analyses of patients with poststroke depression. SettingPatients were recruited from the community and from acute inpatient stroke rehabilitation hospitals. ParticipantsParticipants had suffered a stroke and met DSM-IV criteria for major depression (≥18 Montgomery Åsberg Depression Scale; MADRS). InterventionNone. MeasurementsMADRS was used to quantify depression severity at study entry. Neuropsychological assessment at the time of study entry consisted of measures of Global Cognition, Attention, Executive Function, Processing Speed, Immediate Memory, Delayed Memory, and Language. ResultsThere were 135 (age ≥50) older adult participants with PSD and varying degrees of cognitive impairment (MMSE Total ≥20). Factor analysis of the MADRS identified three factors, that is sadness, distress, and apathy. Items comprising each factor were totaled and correlated with neuropsychological domain z-score averages. Symptoms of the apathy factor (lassitude, inability to feel) were significantly associated with greater impairment in executive function, memory, and global cognition. Symptoms of the sadness and distress factors had no relationship to cognitive impairment. ConclusionPSD consists of three correlated dimensions of depressive symptoms. Apathy symptoms are associated with cognitive impairment across several neuropsychological domains. PSD patients with prominent apathy may benefit from careful attention to cognitive functions and by interventions that address both psychopathology and behavioral deficits resulting from cognitive impairment.

Comparison of the Neurobehavioral Symptom Inventory and the Rivermead Postconcussion Symptoms Questionnaire

ABSTRACTObjective: This study sought to determine the similarity of constructs measured by the Neurobehavioral Symptom Inventory (NSI) and Rivermead Postconcussive Symptoms Questionnaire (RPQ) and the potential for interchangeability of scores from the two scales.Setting: Three acute inpatient rehabilitation hospitals in the USA.Participants: 497 community dwelling persons with traumatic brain injury (TBI) who completed the NSI and the RPQ during the same assessment. Inclusion criteria were (a) medical documentation of TBI, (b) age 18 to 64 years, (c) capacity to give informed consent, (d) resides in the community, (e) ability to complete all study measures in English, (f) absence of interfering medical or psychiatric condition.Design: Prospective cohort observational studyMain Measures: NSI; RPQResults: Scores from the NSI and RPQ showed a strong association (Spearman’s r = 0.89). Exploratory factor analysis showed that items from the two measures loaded on similar factors. A crosswalk between the two measures was created by equating scores from the scales based on percentile ranks.Conclusion: Results indicate substantial conceptual and empirical overlap between the NSI and RPQ. The percentile crosswalk developed from this dataset may allow combined analysis of post-concussive symptoms from datasets that include either the NSI or the RPQ.

Rasch Analysis of Postconcussive Symptoms: Development of Crosswalks and the Brain Injury Symptom Scale

ObjectiveThe first aim of this study was to develop a Rasch-based crosswalk between 2 postconcussive symptom measures, the Neurobehavioral Symptom Inventory (NSI) and the Rivermead Postconcussive Symptom Questionnaire (RPQ). The second goal was to utilize Rasch analysis to formulate a new proposed scale containing the best theoretical and psychometric items. DesignProspective cohort observational study. SettingThree acute inpatient rehabilitation hospitals in the United States. ParticipantsCommunity-dwelling persons (N=497) who were previously hospitalized and were diagnosed with mild to severe traumatic brain injury. Participants were (1) 18-64 years old; (2) could give informed consent; (3) able to complete study measures in English; (4) did not have an interfering medical or psychiatric condition. InterventionsNot applicable. Main Outcome MeasuresNSI, RPQ. ResultsRasch analysis revealed 4 subdimensions across the 2 scales: cognitive, affective, physical, and visual. Crosswalk tables were generated for the first 3. Visual items were too few to generate a crosswalk. Iterative Rasch analysis produced a new scale with items rated from none to severe including the best items in each of these dimensions. ConclusionsThe NSI and RPQ have considerable overlap and measure the same overarching constructs. Crosswalk tables may be helpful for clinicians and researchers to convert scores from 1 measure to the other. A more psychometrically sound scale, the Brain Injury Symptom Scale, composed of items from the NSI and RPQ, is proposed and will need further validation.

Intervention for Increasing Vitamin D Supplementation in a Deficient Rehabilitation Population: Outcomes of a Quality Improvement Initiative.

Vitamin D deficiency (VDD) is highly prevalent and increases the risk of osteoporosis, falls, and fractures. Patients in acute inpatient rehabilitation have several risk factors for VDD, the adverse effects of which may hinder long-term functional gain. To evaluate the prevalence of and risk factors for VDD in patients admitted to acute inpatient rehabilitation and to evaluate the efficacy of a standardized vitamin D screening and supplementation protocol. Prospective cohort study as part of a quality improvement initiative. An academic, freestanding acute inpatient rehabilitation hospital. Patients consecutively admitted over a 4-month period between November 2014 and February 2015 (n=128 pre-intervention and n=129 post-intervention). Universal screening of vitamin D level on admission followed by utilization of a standard supplementation protocol. Vitamin D insufficiency (VDI) and VDD prevalence along with screening, and supplementation rates. Preintervention, 10.2% of patients were screened for VDD, with 23.1% VDI and 46.2% VDD. Postintervention, 89.9% were screened, with 31.9% VDI and 47.4% VDD. 6.3% of all patients were supplemented on vitamin D preintervention compared to 53.5% postintervention. In multivariate analyses, the odds of VDD was significantly associated with African American race (OR 7.30, 95% CI, 1.56-34.20, P = .12) and age younger than 65 (OR 13.62 95% CI, 2.51-73.83, P = .002). Diagnoses in the "other neurologic" category were associated with decreased odds of VDD (OR 0.01, 95% CI, 0.001-0.193, P = .002). Given the high prevalence of VDD in an acute inpatient rehabilitation hospital, a routine screening and standardized supplementation protocol may improve quality of care. III.

Simulation-Based Education for Urgent Medical Complications Common to the Rehabilitation Setting: An Educational Program for Physical Medicine and Rehabilitation Residents.

Simulation technology is being increasingly adopted into medical education and is consistently associated with positive effects on knowledge, skills, and patient-related outcomes. There is little evidence on the use of simulation technology for the instruction of urgent medical complications to physical medicine and rehabilitation (PM&R) residents. To examine whether a simulation-based educational program can improve PM&R resident confidence and knowledge in the assessment and management of urgent medical complications. Pretest-posttest design. Academic freestanding acute inpatient rehabilitation hospital. Twelve Post-Graduate Year (PGY)-2 PM&R residents at the start of the academic year. Residents completed an integrated didactic and simulation-based curriculum on the assessment and management of five urgent medical complications: seizures, agitation, ventricular assist device (VAD)-associated complications, sympathetic storming, and autonomic dysreflexia. Simulations were conducted using a high-fidelity manikin. Surveys and knowledge assessments were completed at baseline and immediately following training. Survey responses were recorded on a Likert scale ranging from 1 = strongly disagree to 5 = strongly agree. Multiple-choice knowledge assessments were scored out of 100%. Within-group differences from baseline to postintervention were analyzed. There was a positive correlation between baseline experience and baseline confidence scores (r = 0.877). Improved confidence was demonstrated in the assessment and management of all five topics (P < .05). Knowledge assessment scores significantly improved from 57.8% (95% confidence interval [CI] 50.6% to 65.4%) at baseline to 85.0% (95% CI 81.6% to 88.4%) following the course (P < .001). The education program was rated highly by both learners (mean satisfaction score, Likert score [LS] = 4.6) and instructors (mean satisfaction score, LS = 4.5). Application of a simulation-based educational model to the instruction of urgent medical complications to PM&R residents resulted in increased knowledge with added benefits of confidence building and high levels of enjoyment. II.

The Serum BDNF Level Offers Minimum Predictive Value for Motor Function Recovery After Stroke.

Brain-derived neurotrophic factor (BDNF) plays an important role in neuroplasticity and neurogenesis following ischemic and non-ischemic brain injury. The predictive value of BDNF for short-term outcome after stroke is controversial. The objective of this study was to investigate the relationship among serum BDNF level, fractional anisotropy (FA), and functional outcome during post-acute stroke rehabilitation. Serum BDNF levels were measured on admission to an acute inpatient rehabilitation hospital. The primary functional outcome was functional independence measure (FIM) motor subscore at discharge. The secondary outcome measures were FIM total score at discharge, FIM motor subscore on admission, length of stay in the hospital, and discharge destination. We investigated the relationship among the level of serum BDNF and FA as well as functional outcome measures. Three hundred forty-eight consecutive stroke subjects were included in the analysis. Serum BDNF levels on admission were statistically but not clinically correlated with FIM motor subscore at discharge (r = 0.173, P = 0.001) and FIM total score at discharge (r = 0.155, P = 0.004). Receiver operating characteristic (ROC) analysis of BDNF as a predictor for FIM motor subscore improvement showed low accuracy of prediction with an area under the curve (AUC) of 0.581 (P = 0.026). Serum BDNF significantly correlated with FA in the high FIM motor group (n = 10, r = 0.609, P = 0.031) but not in the low FIM motor group (n = 11, r = - 0.132, P = 0.349). The serum BDNF level alone offers minimum predictive value for recovery of motor function during post-acute rehabilitation. Our findings suggest that serum BDNF level may be correlated with FA.

Translating evidence into action: An intervention for increasing vitamin D supplementation in a deficient rehabilitation population

Introduction/Background Inadequate vitamin D is highly prevalent, affecting approximately 42-77% of the general United States population. Vitamin D deficiency (VDD) increases the risk of osteoporosis, falls, and fractures. Acute inpatient rehabilitation patients have several risk factors for VDD, and the adverse effects of VDD may hinder long-term functional gain. Material and method Prospective cohort study, evaluating patients admitted before and after a screening intervention as part of a quality improvement initiative at an academic, freestanding acute inpatient rehabilitation hospital. This study included a convenience sample of patients admitted two months pre-intervention (n = 128), and patients admitted two months post-intervention (n = 129). Providers obtained a routine serum vitamin D level on admission (universal screening), then utilized a standard supplementation protocol. Vitamin D insufficiency (VDI) was defined as a 25-hydroxyvitamin D (25(OH)D) level of 20–29.9 ng/mL, and VDD as  Results Pre-intervention, 10.2% of patients were screened for VDD, with 23.1% found to be VDI and 46.2% VDD. Post-intervention, 89.9% of patients were screened, with 31.9% found to be VDI and 47.4% VDD. Pre-intervention, 88.9% of all screened patients were on vitamin D supplementation at discharge versus 75.0% post-intervention. In both uni- and multivariate analyses, we found increased risk of VDD was significantly associated with African American race (OR 7.3, 95% CI, 1.56–34.2, P = 0.12) and age younger than 65 (OR 13.6, 95% CI, 2.5–73.8, P = 0.002). Diagnoses in the “other neurologic” category were associated with decreased risk of VDD (OR 0.01, 95% CI, 0.001–0.193, P = 0.002). Conclusion Given the high prevalence of VDD in an acute inpatient rehabilitation hospital, a routine screening and standardized supplementation protocol may be a good practice to improve quality of care.

Development of an Arabic inpatient satisfaction survey: application in acute medical rehabilitation setting in Saudi Arabia

BackgroundIn the management of chronic disease, evidence suggests that satisfied patients exhibit more loyalty to treatment providers and greater adherence to treatment regimens. This is particularly so in the rehabilitation setting. We aimed to develop a reliable and valid Arabic-language survey to objectively measure inpatient satisfaction in medical rehabilitation settings in Saudi Arabia.MethodsThe King Fahad Medical City Rehabilitation Hospital Patient Satisfaction Survey (RH PSS) is a self-administered survey that addresses four domains of rehabilitation care: access, structure, process, and outcomes. The RH PSS was developed through four steps. Step 1: An item-generation process utilizing input from patients, rehabilitation professionals, and the relevant literature. Step 2: Individual interviews and focus groups, conducted for cognitive testing of the survey and to examine content validity. Step 3: Assessment of internal consistency and construct validity. Step 4: Survey implementation wherein factor analysis and reliability and validity testing were conducted. The survey was conducted at an acute inpatient medical rehabilitation hospital in Saudi Arabia. A total of 709 rehabilitation inpatients participated.ResultsThe RH PSS demonstrated reasonable reliability and validity. Cronbach’s alpha for all the RH PSS subscales ranged from 0.81 to 0.89, and 0.96 for the entire survey. Factor analysis showed good correlation of the 33 survey items and the subscales. The RH PSS demonstrated a good level of predictive validity through the high correlation between the global item “intent to recommend” and overall satisfaction (R2 = 0.786, adjusted R2 = 0.783, p = 0.01).ConclusionsThe RH PSS is the first satisfaction survey with reported validity and reliability testing to address inpatient rehabilitation settings in Saudi Arabia. Further research involving multiple sites is recommended for nationwide validation.