Average Functional Independence Measure Scores Research Articles

Blind Spots in Hospital Fall Prevention: Falls in Stroke Patients Occurred Not Only in Those at a High Risk of Falling

ObjectivesAlthough the standard falls prevention strategy is to identify and respond to patients with high-risk conditions, it remains unclear whether falls in patients with high fall risk account for most observed falls. In this study, fall risk and number of falls were calculated based on patients' motor and cognitive abilities, and the relationship between the two was examined. DesignWe conducted a retrospective cohort study. Setting and ParticipantsWe included 2518 consecutive patients with stroke who were admitted to a rehabilitation hospital. MethodsData on falls during hospitalization and biweekly assessed Functional Independence Measure scores were retrieved from the medical records. The average Functional Independence Measure scores for the motor and cognitive items were obtained and categorized as complete dependence, modified dependence, and independence. The fall rate (falls/1000 person-days) and number of observed falls in each combined condition were investigated. ResultsModified dependence on motor ability and complete dependence on cognitive ability had the highest risk of falls, with a fall rate of 10.8/1000 person-days and 51 fall observations, which accounted for 4.3% of all falls. Independent motor and cognitive ability had the lowest risk of falls, a fall rate of 2.6/1000 person-days and 146 observed falls, accounting for 12.4% of all falls, which was 2.8 times higher than the number of falls observed in the highest risk of falls condition. Conclusions and ImplicationsThe combined motor-cognitive ability with the highest risk of falls in stroke inpatients did not have the highest number of observed falls. Rather, the combined motor-cognitive ability with the lowest risk of falls tended to have a high number of observed falls. A different strategy is needed to reduce the total number of falls.

225 OLDER PERSONS REHAB AT HOME (OPRAH) INDICATES AN EFFECTIVE ALTERNATIVE PATHWAY TO INPATIENT REHABILITATION

Abstract Background Older adults have longer hospital stays, higher incidence of nosocomial complications and higher readmissions rates. Older persons rehabilitation at home (OPRaH) is a novel service developed to provide patients with intensive domiciliary based therapy to regain function, mobility and social care goals. OPRaH offers a comprehensive geriatric and interdisciplinary approach. The model enables a safe and accelerated discharge from acute care to home. Methods Patients are identified and screened by a team coordinator. On Discharge to OPRaH the following measures were collected; basic demographics, referral source, clinical frailty score and Functional Independence Measures (FIM). Outcomes evaluated are the FIM change, readmission rates, length of inpatient stay savings and time on the service. Data from the first year of operation was analysed using descriptive statistics. Results 109 patients have undergone rehabilitation with the service with a median age of 82 years (63-103 range). Over two thirds (68%) were classified as frail, with 44% living alone. An injurious fall was the most common reason for index hospitalisation (50%). Referral source was inpatient acute medical team in 50% of cases, with 21% from acute geriatrics , 13 % ortho geriatrics, 13% surgical. Average functional independence measure scores improved from 89 to 102 (p = 0.007). There was no difference in the magnitude of improvement by frailty status (13 vs 14, p = 0.85). The average length of stay saving was 7 days per case, with a total of 757 days saved in one year. Readmission rate within 30 days was 9.3 %. Participants highly rated the service through structured evaluation. Conclusion This novel service provides a valuable intervention to a wide case-mix of older adults with evidence of improvements in formal markers of functional impairment after intervention. Referral was based on definable rehabilitation goals and not just on frailty status, age, or gender.

Evaluating Effectiveness of an Acute Rehabilitation Program in Hospital-Associated Deconditioning.

Acute hospitalization can result in significant decline in functional ability, known as hospital-associated deconditioning. Older adults are most vulnerable, with resultant functional difficulties and increased risk of institutionalization. This study evaluates the effectiveness of a multidisciplinary acute rehabilitation program in hospital-associated deconditioning on routinely collected outcome data to examine its impact to determine whether a controlled trial is warranted. We conducted a retrospective review of the hospital database for the national rehabilitation clinical registry for 2013 and 2014. We analyzed responses from patient feedback questionnaires over a 2-year period to assess patient experience of the rehabilitation program. The analysis included 289 patients referred to our acute rehabilitation program. Most patients were aged 81-90 years, representing 47% (n = 137) of all admissions. The main impairment group was deconditioning (54%). The median entry time to the acute rehabilitation program for this impairment group was 5 days from admission and length of stay in the rehabilitation program was 9 days. Many of these patients (57%) were directly discharged home, with only 21% needing transfer for inpatient rehabilitation. The average Functional Independence Measure score gain was 22 for the patients directly discharged home, with an average discharge Functional Independence Measure score of 94/126. Of the patient feedback responses received (response rate: 24%), 96% rated the program as very good or good. We observed improved functional outcomes among program participants, with the majority directly discharged home, reduced transfer to rehabilitation hospitals, and patient acceptance of this acute rehabilitation program. These promising results suggest that a more rigorous evaluation of this acute rehabilitation program in the management of hospital-associated deconditioning is warranted.

The effectiveness of virtual reality therapy in relieving upper limb hemiparesis after stroke: A meta-analysis of randomized and controlled trials

Objective To analyze the clinical efficacy of using virtual reality (VR) to improve the upper limb function of hemiplegic persons. Methods A search was conducted in the PubMed, Cochrane Library, EMBASE, CNKI and Wanfang Data as well as VIP for reports of randomized and controlled studies of using VR in training upper limb function after stroke. A meta-analysis was then performed using version 5.3 of the Review Manager software. Results Ninety studies involving 879 patients were found and analyzed. The data showed that VR was significantly more effective than conventional training in improving Fugl-Meyer assessment scores. It was not superior, however, in improving average Functional Independence Measure scores or performance in the box and blocks test. Conclusion VR is superior to conventional training in promoting the recovery of upper limb function after a stroke. Key words: Stroke; Hemiplegia; Virtual reality; Upper extremities; Meta-analyses

Robot-assisted training can improve the bladder and intestinal functions of paraplegic patients

Objective To explore the clinical effect of training assisted by a lower limb rehabilitation robot on the bladder and intestinal function of paraplegic spinal cord injury survivors. Methods Thirty-eight paraplegic patients with spinal cord injury were divided according to their admission order into an experimental group (n=19) and a control group (n=19). Both groups were given conventional rehabilitation training, while the experimental group was additionally provided with robot-assisted lower limb training in three stages: adaptation, training and consolidation. It lasted 30 minutes daily, 5 days per week for 12 weeks. Before and after the training, an urodynamics examination system was used to evaluate the maximum urine flow, bladder capacity, residual urine volume, bladder pressure and detrusor pressure. Colon transit time, mean rectal pressure and intestinal function were measured using the colon transit test, a mean rectal pressure test, and the Functional Independence Measure (FIM) scale respectively. Results The average bladder volume, maximum urine flow rate, average urine flow rate, detrusor pressure, bladder compliance, average rectal pressure and intestinal FIM score of the robot training group after training were all significantly better than before the training, as were the average residual urine volume and colon transit time. After the training, the average bladder volume, maximum urine flow rate, average urine flow rate, detrusor pressure, bladder compliance and average rectal pressure of the robot training group were all significantly higher than those of the control group, while the average residual urine volume and colon transit time were significantly smaller. Then, 32% of the patients in the experimental group achieved no less than 6 points for their average FIM score, significantly higher than in the control group. Conclusion Robot-assisted lower limb training combined with comprehensive rehabilitation training can effectively improve the bladder and intestinal function of paraplegic patients after a spinal cord injury. Key words: Spinal cord injury; Paraplegia; Rehabilitation robots; Bladder function; Intestinal function

Effect of inpatient rehabilitation on activities of daily living in pediatric cancer patients in Japan.

Most pediatric cancer patients decline physical performance therapy, resulting in limitations in the activities of daily living. The objective of this study was to investigate the effects of rehabilitation in pediatric patients with cancer using the functional independence measure (FIM) score. This retrospective study included 25 inpatient children diagnosed with cancer at a single university hospital from January 2016 to December 2016. All patients underwent rehabilitative intervention during their hospital stay. We investigated the contents of the rehabilitation program and the FIM scores before and after the rehabilitative intervention. The average FIM scores improved in all patients; however, only the total-FIM scores (+4.96 points, P=0.009) and motor-FIM scores (+4.04 points, P=0.005) improved significantly. Conversely, cognitive-FIM score did not significantly improve (+0.92 points, P=0.159). In addition, motor-FIM subgroup scores for locomotion (walk/wheelchair and stairs) were significantly higher (+0.36 points, P=0.039 and +0.64 points, P=0.046, respectively) after rehabilitative intervention, regardless of the length of hospital stay. This study showed that FIM score, particularly motor-FIM score and locomotion subgroup scores, significantly improved owing to participation in inpatient rehabilitation. In conclusion, we found that rehabilitative intervention improved physical activity, especially locomotion.

Lack of repercussions of sleep apnea syndrome on recovery and attention disorders at the subacute stage after stroke: A study of 45 patients

IntroductionSleep apnea syndrome (SAS) frequently occurs after a stroke. Its association with a poor prognosis is open to discussion. ObjectiveTo study, in a physical and rehabilitation medicine (PRM) unit, the possible repercussions of SAS on neurological and functional recovery as well as attentional abilities following a stroke. Patients and methodsForty-five patients, all of whom had recently had a stroke without previously documented SAS, were screened using the ApneaLink® system. An apnea-hypopnea index (AHI) score ≥10 was considered as indicative of SAS. The NIHSS, Fugl-Meyer (FM) and Functional Independence Measure (FIM) Scales were applied on admission and at two months as means of assessing neurological and functional recovery, which was expressed by the difference between the first and the second scores (delta FM, delta NIHSS, delta FIM). The Battery Attention William Lennox (BAWL) Test was given once in order to evaluate attention disorders. SAS severity was categorized according to the AHI. We compared the groups formed (mild, moderate and severe) using the same method. ResultsTwenty-eight patients (62.2%) presented AHI ≥ 10. Stroke characteristics were comparable in the SAS+ and the SAS– groups, with average post-stroke time lapse of 26 days, initial average FIM score of 71.2 points ± 26.3 and initial average NIHSS score of 8.9 ± 4.9. The demographic characteristics of the two groups were likewise comparable with the exception of age, as the SAS+ group was pronouncedly older (65.4 vs. 53.5 years). As for delta FIM, which evaluated functional recovery, it averaged 31.8 ± 20.6. Cases of SAS were found to be mild (37.1%), moderate (28.6%) or severe (34.3%). No significant difference was observed on admission or at 2 months as regards the clinical scales or the BAWL test between the two groups or according to severity, except for the NIHSS score at 2 months in the severe sub-group. Discussion and conclusionThis study did not demonstrate the supposed repercussions of SAS on the recovery or attentional abilities of post-stroke patients. The tests were maybe given too early; they should take place at a lengthier time interval after the stroke, and also to be more complete.

Functioning and disability in stroke

Purpose. To describe functioning and disability in patients with stroke according to the model endorsed by the International Classification of Functioning Disability and Health (ICF) in a rehabilitation hospital.Methods. Adult patients with stroke were consecutively enrolled. The Functional Independence Measure (FIM) and the WHO Disability Assessment Schedule II (WHO-DAS II) were administered in individual sessions. ICF checklist was applied on the basis of medical documentation and rehabilitation team meetings. Descriptive analyses were performed to report on FIM and WHO-DAS II scores. ICF categories reported as a problem by more than 20% of patients were described in detail.Results. Patients (197 in total) were mainly men, aged about 60, with average FIM score of 75. Within ICF Body Functions component 32 categories were applied in at least 20% of the patients, 5 within Body Structures, 27 within Activities and Participation and 7 within Environmental Factors.Conclusions. ICF represents a new integrative tool to help professionals dealing with stroke. The checklist captures the various sequels of stroke in terms of impairments, activity limitations and participation restrictions. It shows the extensive need for rehabilitation, whereby it facilitates consideration of the patient' needs.

An Inpatient Rehabilitation Service for Deconditioned Older Adults

Objective: To determine whether deconditioned older adults referred from internal medicine units in an acute hospital setting benefited from inpatient rehabilitation services. Design: The design of this study was a retrospective review of consecutive admissions to a rehabilitation hospital. Setting: The rehabilitation setting was an 80-bed HealthSouth acute medical rehabilitation center adjacent to the Washington University Medical Center in mid-town St Louis, Mo, and affiliated with Barnes-Jewish Hospital. Patients: Participants were 88 patients aged 55 years and older, having a primary diagnosis of deconditioning or weakness admitted to an inpatient rehabilitation unit from February 2004 to February 2005. Main Outcome Measures: Medical diagnoses, laboratory data, medications prescribed, nutritional status, physical, occupational, and speech therapy interventions, and documentation of geriatric syndromes were obtained from the rehabilitation medical records. Outcomes measured were discharge disposition, the change in functional status as assessed by the Functional Independence Measure (FIM), and the FIM efficiency rating. Results: The majority of patients were referred from the hospital after an average length of stay of 9 days and stayed for an average of 12 days in the acute inpatient rehabilitation unit. The average FIM scores dramatically improved during inpatient rehabilitation (29.4 ± 16.2), the FIM efficiency rating was 3.0 ± 1.9, and 71% of patients were discharged home. Common geriatric syndromes in this sample included depression, cognitive impairment, pain, falls, and polypharmacy. When assessed, vitamin D deficiency/insufficiency was also common in this sample. Conclusions: An inpatient rehabilitation service, focused on the deconditioned older adult, was able to demonstrate significant improvement in FIM scores during an inpatient rehabilitation stay and the majority of these patients were discharged home. These outcomes occurred despite the presence of geriatric syndromes, comorbid illnesses, and a recent hospitalization for an acute medical illness. Further pilot studies on deconditioned patients who are admitted to inpatient rehabilitation service may confirm the need for trials that compare outcomes across other settings such as home and long-term care. Key words: deconditioned, older adults, rehabilitation

Glasgow Coma Scale score, mortality, and functional outcome in head-injured patients.

Preresuscitation Glasgow Coma Scale (P-GCS) score is frequently obtained in injured patients and incorporated into mortality prediction. Data on functional outcome in head injury is sparse. A large group of patients with head injuries was analyzed to assess relationships between P-GCS score, mortality, and functional outcome as measured by the Functional Independence Measure (FIM). Records for patients with International Classification of Diseases, Ninth Revision diagnosis codes indicating head injury in a statewide trauma registry between 1994 and 2002 were selected. P-GCS score, mortality, and FIM score at hospital discharge were integrated and analyzed. Of 138,750 patients, 22,924 patients were used for the mortality study and 7,150 patients for the FIM study. A good correlation exists between P-GCS score and FIM, as determined by rank correlation coefficients, whereas mortality falls steeply between a P-GCS score of 3 and a P-GCS score of 7 followed by a shallow fall. Although P-GCS score is related to mortality in head-injured patients, its relationship is nonlinear, which casts doubt on its use as a continuous measure or an equivalent set of categorical measures incorporated into outcome prediction models. The average FIM scores indicate substantial likelihood of good outcomes in survivors with low P-GCS scores, further complicating the use of the P-GCS score in the prediction of poor outcome at the time of initial patient evaluation. Although the P-GCS score is related to functional outcome as measured by the FIM score and mortality in head injury, current mortality prediction models may need to be modified to account for the nonlinear relationship between P-GCS score and mortality. The P-GCS score is not a good clinical tool for outcome prediction in individual head-injured patients, given the variability in mortality rates and functional outcomes at all scores.