Admission Functional Independence Measure Scores Research Articles

Effectiveness and efficiency of telerehabilitation on functionality after spinal cord injury: A matched case-control study.

Telerehabilitation in spinal cord injury (teleSCI) is a growing field that can improve access to care and health outcomes in patients with spinal cord injury (SCI). The clinical effectiveness of teleSCI is not known. To compare independence in activities of daily living and mobility capacity in patients following teleSCI and matched controls undergoing traditional rehabilitation. Matched case-control study. TeleSCI occurring in home setting (cases) versus traditional rehabilitation on inpatient unit (controls). Forty-two consecutive patients with SCI followed with teleSCI were compared to 42 historical rehabilitation inpatients (controls) matched for age, time since injury to rehabilitation admission, level of injury (paraplegia/tetraplegia), complete or incomplete injury, and etiology (traumatic/nontraumatic). The teleSCI group (n = 42) was also compared to the complete cohort of historical controls (n = 613). The teleSCI group followed home-based telerehabilitation (3.5 h/day, 5 days/week, 67 days average duration) and historical controls followed in-person rehabilitation. The Functional Independence Measure (FIM), the Spinal Cord Independence Measure (SCIM) and the Walking Index for Spinal Cord Injury (WISCI). We formally compared gains, efficiency and effectiveness. International Standards for Neurological Classification of Spinal Cord Injury and the American Spinal Injury Association Impairment Scale (AIS) were used. The teleSCI group (57.1% nontraumatic, 71.4% paraplegia, 73.8% incomplete, 52.4% AIS grade D) showed no significant differences compared with historical controls in AIS grades, neurological levels, duration, gains, efficiency and effectiveness in FIM, SCIM, or WISCI, although the teleSCI cohort had significantly higher admission FIM scores compared with the complete cohort of historical controls. TeleSCI may provide similar improvements in mobility and functional outcomes as traditional rehabilitation in medically stable patients (predominantly with paraplegia and motor incomplete SCI) when provided with appropriate support and equipment.

Predictors of patient length of stay post stroke rehabilitation.

There is little research on length of hospital stay (LOS) in patients post stroke in South African rehabilitation facilities. As LOS is an important indicator of cost-of-care, this information may be useful to all stakeholders. To determine the predictors of hospital LOS in patients post stroke rehabilitation. A retrospective file review of 243 patients. Patient functional ability was measured using the Functional Independence Measure (FIM). Predictors of LOS were determined with multiple regression analysis. The median admission and discharge FIM scores were 43 (range: 16-119) and 75 (range: 16-120) points respectively. The median LOS was 43 (range: 3-112) days. Predictors of LOS were premorbid psychiatric conditions, impaired speech, requiring oxygen support, the development of pneumonia and admission FIM motor score, with admission FIM motor score being the strongest individual predictor of LOS (41%). Admission FIM score had an influence on patient outcomes and LOS. Patients with higher admission FIM motor scores may be able to participate in rehabilitation better and thus have shorter LOS. Being able to predict LOS on admission allows facility administrators to manage bed occupancy, human and clinical resources in post stroke rehabilitation.

The Impact of Stroke Subtype on Recovery and Functional Outcome after Inpatient Rehabilitation: A Retrospective Analysis of Factors.

The aims of this study were to compare inpatient rehabilitation outcomes between acute stroke subtypes of Cerebral Infarction (CI) and Intracerebral Hemorrhage (ICH), and to determine the predictors of discharge outcomes. A retrospective study of stroke inpatients was carried out using the discharge Functional Independence Measure (FIM) as the primary outcome measure. Relationships between stroke subtype, rehabilitation impairments, and medical complications on FIM -gain were analyzed. Altogether, 280 datasets including 211 (75.4%) CI and 69 (24.6%) ICH were analyzed. ICH patients were significantly younger than CI patients (55 years ICH vs. 64.0 years CI years, p < 0.001), had a 10-fold higher proportion needing ICU admission (ICH 82.6% vs. CI 7.6%, p < 0.001), and had significantly lower total admission FIM scores (67 points ICH vs. 74 CI points, p = 0.006), with lower motor-FIM scores in particular (38 points ICH vs. 48 points CI, p = 0.003). Significant functional improvements after inpatient rehabilitation, i.e., FIM gain, occurred regardless of stroke subtype (FIM-ICH Δ 27 vs. FIM-CI Δ 21, p = 0.05). Despite significantly worse initial stroke severity, ICH patients achieved similar functional gains, independence levels, and return-home rates compared with their CI counterparts after inpatient rehabilitation.

Additional saturday occupational therapy for adults receiving inpatient physiotherapy rehabilitation: a prospective cohort study

BackgroundThe first aim of this study was to investigate the impact of providing an additional four hours of Saturday occupational therapy to patients receiving Saturday physiotherapy in an inpatient setting on length of stay, functional independence, gait and balance. The second aim was to conduct an economic evaluation to determine if the introduction of a Saturday occupational therapy service in addition to physiotherapy resulted in a net cost savings for the rehabilitation facility.MethodsA prospective cohort study with a historical control was conducted in an Australian private mixed rehabilitation unit from 2015–2017. Clinical outcomes included the Functional Independence Measure (Motor, Cognitive, Total), gait speed (10 Meter Walk test) and five balance measures (Timed Up and Go test, Step test, Functional Reach, Feet Together Eyes Closed and the Balance Outcome Measure of Elder Rehabilitation). Economic outcomes were rehabilitation unit length of stay and additional treatment costs.ResultsA total of 366 patients were admitted to the rehabilitation unit over two 20-week periods. The prospective cohort (receiving Saturday occupational therapy and physiotherapy) had 192 participants and the historical control group (receiving Saturday physiotherapy only) had 174 participants. On admission, intervention group participants had higher cognitive (p < 0.01) and total (p < 0.01) Functional Independence Measure scores. Participation in weekend therapy by the intervention group was 11% higher, attending more sessions (p < 0.01) for a greater length of time (p < 0.01) compared to the historical control group.After controlling for differences in admission Functional Independence Measure scores, rehabilitation length of stay was estimated to be reduced by 1.39 (p = 0.08) days. The economic evaluation identified potential cost savings of AUD1,536 per patient. The largest potential savings were attributed to neurological patients AUD4,854. Traumatic and elective orthopaedic patients realised potential patient related cost savings per admission of AUD2,668 and AUD2,180, respectively.ConclusionsImplementation of four hours of Saturday occupational therapy in addition to physiotherapy results in a more efficient service, enabling a greater amount of therapy to be provided on a Saturday over a shorter length of stay. Provision of multidisciplinary Saturday rehabilitation is potentially cost reducing for the treating hospital.

The Association Between Sarcopenia and Functional Improvement in Older and Younger Patients Who Completed Inpatient Rehabilitation: A Prospective Cohort Study.

Objective: To investigate the association between sarcopenia and functional improvement in patients older and younger than 65 years upon completion of an inpatient rehabilitation program.Design: Prospective cohort study.Participants: Adult consecutive patients who completed the inpatient rehabilitation program at a metropolitan tertiary referral hospital general inpatient rehabilitation unit.Methods: Sarcopenia status was determined using the European Working Group on Sarcopenia in Older People 2 algorithm, using muscle mass measured by BioImpedance Analysis and grip strength. Progress in rehabilitation was measured using change in the Functional Independence Measure and Goal Attainment Scaling score. To investigate the age group by sarcopenia status interaction we used quantile regression models with bootstrapped standard error estimation for functional improvement and linear regression model with robust standard error estimation for GAS score.Results: 257 participants [128 (50%) male, median age 63 years (IQR: 52–72)], 33(13%) with sarcopenia, completed inpatient rehabilitation [median length of stay 16 days (IQR: 11–27.5)]. Participants' median Functional Independence Measure change was 24 (IQR 15–33.5) and mean total Goal Attainment Scaling score was 57.6 (SD 10.2). Adjusting for admission Functional Independence Measure score, the median difference in Functional Independence Measure change between participants with and without sarcopenia was: −4.3 (95% CI: −10.6, 1.9); p = 0.17 in participants 65 years and younger, and 4.6 (95% CI: 1.0, 8.2); p = 0.01 in participants older than 65; age-by-sarcopenia interaction p = 0.02.Conclusions: Unlike younger people, older people with sarcopenia have greater functional improvement in inpatient rehabilitation than those without sarcopenia.

Predictors of Functional Outcome in a Cohort of Hispanic Patients Using Exoskeleton Rehabilitation for Cerebrovascular Accidents and Traumatic Brain Injury.

Traumatic brain injury (TBI) and cerebrovascular accidents (CVA) are two of the leading causes of disability in the United States. Robotic exoskeletons (RE) have been approved for rehabilitation by the Federal Drug Administration (FDA) for use after a CVA, and recently received approval for use in patients with TBI. The aim of the study was to determine which factors predict the improvement in functional independence measure (FIM) score after using RE rehabilitation in a population of patients with CVA or TBI. We carried out a retrospective chart-review analysis of the use of the RE (Ekso® GT) in the rehabilitation of patients with TBI and CVA using data from a single, private rehabilitation hospital for patients admitted and discharged between 01/01/2017 and 04/30/2020. From the medical records, we collected presentation date, Glasgow Coma Scale score (GCS) on the date of injury, rehabilitation start date, age, diabetes status on presentation (Yes or No), injury category (TBI or CVA), and both admission and discharge FIM scores. Matching algorithms resulted in one TBI patient matched to three CVA patients resulting in a sample size of 36. The diabetic and non-diabetic populations showed significant differences between age and days from injury to the start of rehabilitation. A multivariate linear regression assessed predictors for discharge motor FIM and found admission motor FIM score and total RE steps to be statistically significant predictors. For each point scored higher on the admission motor FIM the discharge FIM was increased by 1.19 FIM points, and for each 1,000 steps taken in the RE, the discharge motor FIM increased by three points. The type of acquired brain injury (CVA or TBI) was not found to affect functional outcome. The presented results show that key clinic-biologic factors including diabetic status, together with start to rehabilitation play key roles in discharge FIM scores for patients using RE.Clinical Trial Registration: ClinicalTrials.gov, NCT04465019

Abstract P446: African American Women Have Lower Functional Performance During Acute Inpatient Rehabilitation After Intracerebral Hemorrhagic Strokes

Introduction: Intracerebral hemorrhage (ICH), a subtype of stroke, leads to significant long-term disability. Research in stroke recovery and rehabilitation has focused on ischemic strokes. Identifying factors that impact the recovery of function for patients at an inpatient rehabilitation facility (IRF) following an ICH is necessary. Our purpose is to identify factors, including racial and gender disparities, associated with inpatient rehabilitation after ICH. Methods: We performed a retrospective analysis of a tertiary care academic hospital in the Stroke Belt of the US, the University of Alabama at Birmingham, and subsequently, admitted to an IRF from December 2016 through December 2019. Functional performance was measured using the Functional Independence Measure (FIM), an 18-item scale measuring the level of disability in terms of burden of care. Baseline clinical characteristics, demographics, admission and discharge FIM scores, and ICH characteristics including ICH scores and volumes were collected. FIM efficiency was calculated for all patients by dividing the difference in FIM scores at admission and discharge from the total number of days spent at rehab. The differences in FIM efficiency by gender and race were measured using multiple linear regression. Results: We evaluated 65 patients (54.4 ± 14.1 years, 61% males, 46% African American) with a median (interquartile range) ICH score of 1.0 (0.0, 2.0), median ICH volume of 13.4 (4.2, 33.0), and FIM efficiency of 1.6 (1.1, 2.4). In multiple regression, being male was positively associated with FIM efficiency (β=1.02, p = 0.0063) when adjusting for race and ICH score. The FIM efficiency was lower in African Americans (β =-0.95, p = 0.0092) when adjusting for gender and ICH volume. No significant differences were noted in ICH volumes and scores with respect to discharge FIM scores. Conclusions: FIM efficiency, is a good measure of improvement in motor function and ADLs over the rehab period. Our results indicate that African American women could potentially benefit from longer periods of rehabilitation intervention.

How We Assess Spatial Neglect Matters: Prevalence of Spatial Neglect as Measured by the Catherine Bergego Scale and Impact on Rehabilitation Outcomes.

The aim of this study was to determine the prevalence and functional impact of unilateral spatial neglect on right hemisphere stroke patients in an inpatient rehabilitation facility using a multidimensional, functionally based behavioral measure (Catherine Bergego Scale [CBS]). This was a retrospective cohort study of 742 consecutive admissions of patients with right hemispheric stroke to an inpatient rehabilitation facility. Spatial neglect was assessed using the CBS. Functional impact of neglect was measured by hospital length of stay, Functional Independence Measure change per day, discharge destination, and number of falls. As measured by the CBS, 86% of the right hemisphere stroke patients had symptoms of spatial neglect. Moderate and severe neglect was associated with less Functional Independence Measure change per day and lower rates of community discharge. The presence of neglect was not significantly associated with fall rate or length of hospital stay after controlling for admission Functional Independence Measure scores and age. The "difficulty looking left" CBS item had the strongest relationship with total CBS scores and effectively predicted Functional Independence Measure change per day and discharge destination. Using a sensitive measure, the CBS, rates of spatial neglect are extremely high in right hemisphere stroke patients entering inpatient rehabilitation. Both identification and determination of neglect severity are extremely important given their significant relationship to rehabilitation outcomes and discharge destinations. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. Upon completion of this article, the reader should be able to (1) describe why carefully assessing spatial neglect in right hemisphere stroke patients is important; (2) identify multiple dimensions of spatial neglect assessed by the Catherine Bergego Scale and how this approach differs from traditional paper and pencil assessment methods; and (3) describe the relationship between spatial neglect as measured by the Catherine Bergego Scale and functional outcomes of right hemisphere stroke patients in inpatient rehabilitation settings. Advanced. The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Factors affecting functional outcomes of traumatic brain injury rehabilitation at a rehabilitation facility in Saudi Arabia.

Objectives:To identify the factors that affect disability after inpatient rehabilitation (IPR) in persons with traumatic brain injury (TBI).Methods:This retrospective study identified 140 patients aged ≥16 years who were admitted to the TBI rehabilitation unit at King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia between 2015 and 2017. The collected data included demographic variables, TBI cause, coma duration, time from injury to IPR, LOS, and Functional Independence Measure (FIM) scores at IPR admission and discharge.Results:Majority of the patients were young males. The TBI was caused by motor vehicle accidents (MVA) in 95% of patients. The mean coma duration, time from injury to IPR admission, and LOS were 47±38, 264±357, and 75±52 days, respectively. The factors that were found to have an association with FIM change were time from injury to IPR admission (p=0.003, r=-0.250), admission FIM score (p=0.003, r=-0.253), and discharge FIM score (p<0.001, r=0.390). Employed patients had high FIM scores at admission (p=0.029, r=0.184) and discharge (p=0.003, r=0.252).Conclusion:Reduction in disability at discharge was positively associated with the severity of disability at admission and negatively with the time duration from injury to IPR admission, indicating a need to reduce time before admittance to an IPR setup. The high incidence of MVA causing TBI in a young male population strongly points to a need for appropriate measures of prevention.

Sleep Disruption After Brain Injury Is Associated With Worse Motor Outcomes and Slower Functional Recovery

Background. Sleep is important for consolidation of motor learning, but brain injury may affect sleep continuity and therefore rehabilitation outcomes. Objective. This study aims to assess the relationship between sleep quality and motor recovery in brain injury patients receiving inpatient rehabilitation. Methods. Fifty-nine patients with brain injury were recruited from 2 specialist inpatient rehabilitation units. Sleep quality was assessed (up to 3 times) objectively using actigraphy (7 nights) and subjectively using the Sleep Condition Indicator. Motor outcome assessments included Action Research Arm test (upper limb function), Fugl-Meyer Assessment (motor impairment), and the Rivermead Mobility Index. The Functional Independence Measure (FIM) was assessed at admission and discharge by the clinical team. Fifty-five age- and gender-matched healthy controls completed one assessment. Results. Inpatients demonstrated lower self-reported sleep quality (P < .001) and more fragmented sleep (P < .001) than controls. For inpatients, sleep fragmentation explained significant additional variance in motor outcomes, over and above that explained by admission FIM score (P < .017), such that more disrupted sleep was associated with poorer motor outcomes. Using stepwise linear regression, sleep fragmentation was the only variable found to explain variance in rate of change in FIM (R2adj = 0.12, P = .027), whereby more disrupted sleep was associated with slower recovery. Conclusions. Inpatients with brain injury demonstrate impaired sleep quality, and this is associated with poorer motor outcomes and slower functional recovery. Further investigation is needed to determine how sleep quality can be improved and whether this affects outcome.

Examining Fall Risk Assessment in Geriatric Rehabilitation Settings Using Translational Research.

The objective of this study was to identify gaps in and to improve the falls prevention strategy (FPS) of an inpatient rehabilitation facility (IRF) in Toronto, Canada. A modified version of the Stanford Biodesign Methodology was used. Chart reviews, a focus group (n = 8), and semistructured interviews (n = 8) were conducted to evaluate the FPS. Admission Functional Independence Measure score, age, and gender significantly correlated with risk for a fall. The tool used at this IRF was not effectively capturing patients who were at high risk for falls. All healthcare providers interviewed were knowledgeable of fall risks; however, a patient's fall risk status was rarely discussed as a team. The findings informed recommendations to improve the overall FPS at this IRF. Staff may require more coaching for implementing preventative measures/ensuring accountability and evaluating whether current strategies work. These insights can guide improvement initiatives at similar facilities elsewhere.

Abstract WP202: Race/ethnicity Matters: Differences in Stroke Inpatient Medical Rehabilitation Outcomes for Communities of Color

Introduction: Stroke is a leading cause of disability and death in the United States. Racial/ethnic people with stroke demonstrate lower functional independence measure (FIM) scores before and after inpatient medical rehabilitation compared to non-Hispanic Whites. Racial/ethnic differences in FIM scores have implications for discharge. Method: This is a cross-sectional and retrospective analysis of data extracted and pooled across years 2002-2018. Inclusion criteria were: 1) stroke as a primary diagnosis and 2) non-Hispanic White (NHW), Hispanic, non-Hispanic Black (NHB), and non-Hispanic Asian (NHA) patients. Per systematic review evidence, ICD codes 430-438/I60-I69 were used to identify stroke diagnoses. Dependent variables were: length of stay (LOS), admission FIM Cognitive and Motor Total, FIM efficiency, FIM change per day, discharge FIM Cognitive and Motor Total, and discharge to home. NHWs were used as the reference group. Results: There were 3,911 patients across the study period. Age, gender, and admission year were used as covariates. There were racial/ethnic differences in LOS, F (3, 3853) = 2.658, p = .047, partial η2 = .002, with NHAs having longer LOS. Racial/ethnic differences in admission FIM scores were found, F (6, 7750) = 6.727, p &lt; .001, Wilks' λ = .989, partial η2 = .006, with NHAs and Hispanics showing lower cognitive and motor scores. There were no racial/ethnic differences in cognitive or motor efficiency. Racial/ethnic differences in FIM change per day emerged, F (3, 3854) = 4240, p = .005, partial η2 = .003, with Hispanics and NHBs having lower change per day. Racial/ethnic differences in discharge FIM scores were noted, F (6, 7704) = 4.865, p &lt; .001, Wilks' λ = .992, partial η2 = .004, with NHAs and Hispanics having lower total cognitive scores but only Hispanics had lower motor scores. Lastly, Hispanics had higher odds of being discharged home compared to other racial/ethnic groups ( OR = 1.246, 95% CI = 1.046-1.485, p = .014). Discussion: Controlling for covariates, there were significant racial/ethnic differences in stroke inpatient medical rehabilitation outcomes, particularly for Hispanics. Factors involved in creating/maintaining post-stroke rehabilitation disparities for Hispanics (and others) are discussed.

Rehabilitation Outcomes in Patients with Guillain–Barré Syndrome Caused by Zika Virus

Introduction: Zika virus (ZIKV) is transmitted by the bite of the Aedes species mosquito. Infected patients may present flu-like symptoms or even neurological deficits. In Puerto Rico (PR), an increased number of cases of ZIKV were noted in 2016 and a surveillance system was established for monitoring. As of August 2018, a total of 36,097 symptomatic cases of ZIKV had been reported in PR by the Centers for Disease Control and Prevention of the United States. One of the neurological complications secondary to ZIKV was Guillain–Barre syndrome (GBS). The surveillance system reported that 66% of patients with GBS who were tested were positive for ZIKV. This study aims to identify the functional outcomes of GBS patients related to ZIKV as compared to patients with GBS nonrelated to ZIKV during inpatient rehabilitation using functional independence measure (FIM) score. Materials and Methods: A retrospective case–control study design was used. Patients with a diagnosis of GBS admitted to an inpatient rehabilitation unit between January 1, 2016, and August 15, 2017, were deemed eligible. Patients were divided in two groups: (1) GBS-positive ZIKV (experimental) group and (2) GBS-negative ZIKV (control) group. A total of 21 patients were identified; 16 qualified for the study. The primary outcome was the admission and discharge FIM score. Results: A total of 11 (69%) patients were ZIKV positive or presumptive positive and 5 (31%) were ZIKV negative. One hundred (100%) of the patients had significantly improved FIM scores upon discharge. No significant differences between the ZIKV groups were noted on admission or discharge FIM scores. Conclusion: This study demonstrated that all GBS patients benefit from inpatient rehabilitation facility admission and therapy regardless of ZIKV status. Rehabilitation outcome is not determined by ZIKV status.

Perbedaan Skor Functional Independence Measure (FIM) pada Pasien Rawat Inap dengan Stroke Iskemik dan Stroke Hemoragik di Rumah Sakit di Kota Bengkulu Tahun 2018

Stroke is one of the most common causes of disability in the world. Patients with ischemic stroke have different functional improvements from patients with hemorrhagic stroke. The tool is the Functional Independence Measure (FIM) questionnaire. This study aims to determine the difference in FIM scores in hospitalized patients with ischemic stroke and hemorrhagic stroke at hospitals in Bengkulu City. This research is an observational analytic research with cross-sectional design. The study involved stroke patients who hospitalized at RS Bhayangkara Bengkulu City, RSUD Bengkulu City, and RSUD dr. M. Yunus Bengkulu City from January-April 2018 with total sample 22 ischemic stroke patients and 22 hemorrhagic stroke patients who met the inclusion criteria. FIM scores as independent variables, while the type of stroke as dependent variables. The difference between the two variables was analyzed by unpaired t test and Mann-Whitney test. Patients with ischemic stroke had admission FIM score higher than patients with hemorrhagic stroke (26 vs 13,5; p=0.006). There were no differences in discharge FIM score in patients in both types of stroke (1,67 vs 1,58; p=0,081). There was no difference in FIM score gain between patients with ischemic stroke and patients with hemorrhagic stroke (4,12 vs 4,36; p=0,444). Patients with ischemic stroke had higher admission FIM score compared to patients with hemorrhagic stroke, but there was no significant difference in FIM score gain during hospitalization between ischemic stroke and hemorrhagic stroke patients at hospitals in Bengkulu City.

Alanine aminotransferase blood levels and rehabilitation outcome in older adults following hip fracture surgery.

Low alanine aminotransferase (ALT) blood levels are associated with frailty and poor outcome in older adults. Therefore, we studied the association between ALT blood levels before rehabilitation and rehabilitation outcome in older adults following hip fracture surgery. A total of 490 older adults (age>60 years, mean age: 82.9±6.7 years, 82.0% women) admitted to rehabilitation following hip fracture surgery were included. The rehabilitation outcome was assessed by Functional Independence Measure (FIM) scores. ALT blood levels were documented between 1 and 6 months before rehabilitation. Patients with ALT blood levels over 40 IU/l possibly consistent with liver injury were excluded. The cohort was divided into two groups: patients with ALT more than 10 IU/l and patients with ALT less than or equal to 10 IU/l. Upon rehabilitation discharge, the FIM outcome measures (motor, cognitive, gain, efficiency) were significantly higher in patients with ALT more than 10 IU/l relative to patients with ALT less than or equal to 10 IU/l (P<0.05). A logistic regression analysis adjusted for age and sex showed that patients with ALT more than 10 IU/l were more likely to have higher (second to fourth upper quartiles) total FIM scores (>50), cognitive FIM scores (>16), and FIM efficiency (>0.228) upon rehabilitation discharge (odds ratio=1.56-1.78). However, this association was no longer significant following adjustment also for admission total FIM score, cognitive impairment, cancer, and albumin serum levels. High-normal ALT blood levels before rehabilitation are associated with a better rehabilitation outcome in older adults following hip fracture surgery. It may be used when data on admission FIM score, cognitive impairment, cancer, and albumin serum levels are not available.

Abstract WP154: Early Functional Independence Measure Scores Are Associated With 3-Month Quality of Life

Introduction: Limited data exists for inpatient rehabilitation outcomes predicting health-related quality of life (HRQOL) in stroke patients. We evaluated the association between Functional Independence Measure (FIM) scores during inpatient rehabilitation and HRQOL scores at 3 months. Methods: Between 2012 and 2014, consecutive patients admitted to an inpatient rehabilitation hospital with ischemic stroke were consented in a prospective registry with 3-month follow-up. The admission FIM score were recorded. The Neuro-QOL questionnaire was used to assess 3-month HRQOL in 4 domains: upper extremity (UE), lower extremity (LE), executive functions (EF), and general concerns (GC). Impaired HRQOL was defined as T-scores &lt;45 for each domain. We analyzed the unadjusted and adjusted association between FIM scores and impaired HRQOL. Results: One-hundred thirteen patients (mean age 67.3±15.8 years; 50% male; 56.6% white) were included in final analysis. The median time from stroke onset to admission FIM score was 7 days (IQR 4.6-12.4). Median FIM score was 51 points (IQR 35-62). On unadjusted analysis, a 1-point increase in admission FIM scores resulted in less likelihood of impaired 3-month HRQOL domains: 6% for GC (OR 0.94, 95% CI 0.91-0.98, p&lt;0.001), 7% for EF (OR 0.93, 95% CI 0.90-0.96 p&lt;0.001), 4% for LE function (OR 0.96, 95% CI 0.93-0.98, p=0.001), and 3% for UE function (OR 0.97, 95% CI 0.95-0.99, p=0.01). In analyses adjusting for age, sex, time from stroke to FIM evaluation, race, baseline mRS, initial NIHSS, insurance, past medical history (atrial fibrillation, hypertension, renal disease, diabetes mellitus, cardiac disease, and prior stroke), a 1-point increase in admission FIM scores had similar effects on HRQOL domains: 6% for GC (OR 0.94, 95% CI 0.91-0.99, p=0.01), 7% for EF (OR 0.93, 95% CI 0.89-0.97 p=0.001), 5% for LE function (OR 0.95, 95% CI 0.92-0.99, p=0.004), and 3% for UE function (OR 0.97, 95% CI 0.94-0.99, p=0.01). Conclusions: There is a strong association between FIM scores at admission to inpatient rehabilitation and 3-month HRQOL across multiple HRQOL domains. These findings indicate that long-term HRQOL can be predicted earlier in a patient’s course during inpatient rehabilitation.

Impact of Critical Illness Polyneuromyopathy in Rehabilitation: A Prospective Observational Study

BackgroundCritical illness polyneuromyopathy (CIPNM) increasingly is recognized as a source of disability in patients requiring intensive care unit (ICU) admission. The prevalence and impact of CIPNM on patients in the rehabilitation setting has not been established. ObjectivesTo determine the proportion of at-risk rehabilitation inpatients with evidence of CIPNM and the functional sequelae of this disorder. DesignProspective observational study. SettingTertiary academic rehabilitation hospital. PatientsRehabilitation inpatients with a history of ICU admission for at least 72 hours. MethodsElectrodiagnostic studies were performed to evaluate for axonal neuropathy and/or myopathy in at least one upper and one lower limb. Main Outcome MeasurementsThe primary outcome was prevalence of CIPNM. Secondary outcomes included Functional Independence Measure (FIM) scores, rehabilitation length of stay (RLOS), and discharge disposition. ResultsA total of 33 participants were enrolled; 70% had evidence of CIPNM. Admission FIM score, discharge FIM, FIM gain, and FIM efficiency were 64.1, 89.9, 25.5, and 0.31 in those with CIPNM versus 78.4, 94.6, 16.1, and 0.33 in those without CIPNM, respectively. Average RLOS was 123 days versus 76 days and discharge to home was 57% versus 90% in the CIPNM and non-CIPNM groups, respectively. ConclusionsCIPNM is very common in rehabilitation inpatients with a history of ICU admission. It was associated with a lower functional status at rehabilitation admission, but functional improvement was at a similar rate to those without CIPNM. Longer RLOS stay may be required to achieve the same functional level. Level of EvidenceIII

Venous Thromboembolism as Predictor of Acute Care Hospital Transfer and Inpatient Rehabilitation Length of Stay.

The aim of this study was to investigate the impact of venous thromboembolism (VTE) on rate of acute care hospital transfer, inpatient rehabilitation (IPR) length of stay (LOS), and functional outcomes. This was a retrospective cohort study of 2312 consecutive patient discharges from a single IPR facility over an 18-month period. When age, sex, reason for admission, and admission Functional Independence Measure (FIM) scores were controlled for, those with VTE had nearly 2 times greater odds for transfer to acute care hospital than did those without a diagnosis of VTE. Inpatient rehabilitation LOS was 4.700 days (95% confidence interval [CI], 2.956-6.445 days) longer for those with a diagnosis of VTE prior to IPR admission and 2.287 days (95% CI, 1.026-3.547 days) longer for those with a diagnosis of VTE during IPR admission compared with those without a diagnosis of VTE. There was no difference in FIM change based on VTE diagnosis. Venous thromboembolism diagnosis during IPR was associated with a significant decrease in FIM efficiency (-0.358; 95% CI, -0.654 to -0.062) if diagnosed during IPR admission, but there was no difference in FIM efficiency if VTE was diagnosed prior to IPR. Patients with a diagnosis of VTE were more likely to be transferred to the acute care hospital and have longer IPR LOS independent of admission FIM scores. It is important to prevent development of VTE. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) understand the association of venous thromboembolism (VTE) diagnosis with acute hospital transfer and inpatient rehabilitation length of stay; (2) identify reasons for acute hospital transfer in patients diagnosed with VTE; and (3) understand the relationship between VTE diagnosis and functional outcomes during inpatient rehabilitation. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Comparative Inpatient Rehabilitation Outcomes of Total Hip Arthroplasty Patients with and without Restrictive Hip Precautions

Objective: To compare rehabilitation outcomes based on anterior hip arthroplasty for patients with and without post-operative surgical precautions. Methods: Sixty-eight consecutive patients’ medical records were retrospectively reviewed. Main outcome measures included total admission and total discharge functional independence measure (FIM) scores, FIM gain, FIM gain per day, and length of stay (LOS). Results: Group 1, n=31, included patients admitted to inpatient rehabilitation without post-operative surgical precautions. Group 2=37, included patients admitted to inpatient rehabilitation with post-operative surgical precautions. No statistically significant differences were observed between the groups at admission for age (Group 1 mean age=66.74 years; Group 2=67.30 years; F=0.014, p=811) and admission FIM scores (p=.866), suggesting groups were similar at admission. At discharge, both groups made similar progress related to overall FIM gain (p=. 679) and discharge FIM scores (p=.864). There was a statistically significant difference between the groups for LOS with the no-precaution group demonstrating approximately a 3-day shorter stay (Group 1=8.97 days; Group 2=11.73 days; F=0.195, p=0.012). This finding translated into improve FIM efficiency for Group 1 with statistically significant differences observed for Motor FIM gain per day for Group 1=2.83 and for Group 2=2.0 (F=17.275, p=0.007) and Total FIM gain per day with Group 1=2.90 and Group 2=2.07 (F=15.318, p=.006). Conclusion: Both groups made similar progress during inpatient rehabilitation with respect to overall FIM gain and discharge FIM scores. The no-precaution group made gains within a shorter timeframe reflecting improve efficiency with rehabilitation outcomes for the no-precaution group.

Predictors of Acute, Rehabilitation and Total Length of Stay in Acute Stroke: A Prospective Cohort Study

The poststroke acute and rehabilitation length of stay (LOS) are key markers of stroke care efficiency. This study aimed to describe the characteristics and identify the predictors of poststroke acute, rehabilitation and total LOS. This study also defined a subgroup of patients as "short" LOS and compared its complication rates and functional outcomes in rehabilitation with a "long" acute LOS group. A prospective cohort study (n = 1277) was conducted in a dedicated rehabilitation unit within a tertiary academic acute hospital over a 5-year period between 2004 and 2009. The functional independence measure (FIM) was the primary functional outcome measure in the rehabilitation phase. A group with an acute LOS of less than 7 days was defined as "short" acute LOS. Ischaemic strokes comprised 1019 (80%) of the cohort while the rest were haemorrhagic strokes. The mean acute and rehabilitation LOS were 9 ± 7 days and 18 ± 10 days, respectively. Haemorrhagic strokes and anterior circulation infarcts had significantly longer acute, rehabilitation and total LOS compared to posterior circulation and lacunar infarcts. The acute, rehabilitation and total LOS were significantly shorter for stroke admissions after 2007. There was poor correlation (r = 0.12) between the acute and rehabilitation LOS. In multivariate analyses, stroke type was strongly associated with acute LOS, while rehabilitation admission FIM scores were significantly associated with rehabilitation LOS. Patients in the short acute LOS group had fewer medical complications and similar FIM efficacies compared to the longer acute LOS group. Consideration for stroke type and initial functional status will facilitate programme planning that has a better estimation of the LOS duration, allowing for more equitable resource distribution across the inpatient stroke continuum. We advocate earlier transfers of appropriate patients to rehabilitation units as this ensures rehabilitation efficacy is maintained while the development of medical complications is potentially minimised.