Change In Functional Independence Measure Score Research Articles

469 Recovery Rate of Motor Function During Rehabilitation After Traumatic Cervical Spinal Cord Injury Predicts Functional Status at Years 1 and 5 After Surgery: A Multicenter, Longitudinal Cohort Study

INTRODUCTION: Traumatic spinal cord injury (SCI) is a devastating condition. Early surgical decompression and rehabilitative efforts in cervical SCI patients has been shown to improve neurological outcomes. METHODS: A longitudinal, retrospective cohort study was conducted from the multicenter Spinal Cord Injury Model Systems (SCIMS) database on patients with motor Functional Independence Measure (FIM) scores at admission to and discharge from rehabilitation, year 1, and year 5. Patients who underwent surgical decompression with neurological levels of injury limited to the cervical region and those with American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades of A and B were included. The FIM score was utilized to calculate changes in motor FIM scores over each respective time period. Multivariate logistical regression was performed to identify longitudinal predictors associated with functional independence. RESULTS: A total of 351 patients met the inclusion criteria. The change in motor FIM score during the inpatient rehab period was a significant predictor of achieving FI at 1 and 5 years (year 1: aOR = 15.6, 95% CI 3.94-77.6, p < 0.0001; year 5: aOR = 28.0, 95% CI 6.13-173.6, p < 0.0001). For patients not achieving FI at year 1, the change in motor FIM score during inpatient rehab was a greater predictor of FI at year 5 (aOR = 64.7, 95% CI 5.15-1717.3, p = 0.0004). CONCLUSIONS: Inpatient rehabilitation efforts may lead to greater long-term functional status and carry emphasized importance for patients who do not attain functional independence by year 1.

Transcranial Doppler ultrasonography can predict inpatient rehabilitation functional outcome in patients with stroke.

Despite advances in imaging techniques and treatment modalities, tools to predict recovery after stroke remain limited. To determine if transcranial Doppler (TCD) mean flow velocities were predictive of functional recovery following ischemic stroke. Data were collected from patients with stroke admitted to an academic tertiary care facility in the southeastern region of the United States between 2012 and 2019 who had a middle cerebral artery distribution ischemic stroke, TCD, and were discharged to our inpatient rehabilitation facility. Mean flow velocities were categorized as low (<40 cm/s), normal (40-80 cm/s), or high (>80 cm/s). Functional Independence Measure (FIM) scores were collected on admission to and discharge from inpatient rehabilitation. Multiple linear regression models were used to assess the differences in mean FIM score changes by categories of mean flow velocities. We enrolled 57 patients, mean age 60 years, 73.7% male. Compared to the normal velocity group, those with abnormally low velocities had a significantly smaller change in their FIM score (adjusted β = -8.42; p = .01). Compared to the normal velocity group, those with abnormally high velocities experienced a greater change in FIM score, but this association was not statistically significant (beta = 1.12; p = .77). In this limited population, we found that low mean flow velocity as measured by TCD ultrasonography after a middle cerebral artery stroke is associated with poorer functional recovery following inpatient rehabilitation. Our results suggest that the value of TCD ultrasonography as a tool to predict motor recovery after stroke warrants further investigation.

Identifying Racial and Ethnic Disparities in Acute Inpatient Rehabilitation

ObjectiveTo investigate whether racial, ethnic, and linguistic disparities exist at discharge from an acute inpatient rehabilitation facility (IRF) by examining change in Functional Independence Measure (FIM) scores and discharge destination. DesignThis is a retrospective study using our IRF's data from the Uniform Data System for Medical Rehabilitation from 2013-2019. FIM scores and discharge destination were compared between race, language, and ethnic groups, with adjustment for patient characteristics. SettingAn urban hospital with a level 1 trauma center, comprehensive stroke center, and IRF with Commission on Accreditation of Rehabilitation Facilities (CARF) certification. Participants2518 patients admitted to the IRF from 2013-2019 (N=2518). InterventionsNot applicable. Main Outcome MeasuresChange in FIM score and discharge destination. ResultsAfter adjusting for covariates, non-White patients and patients with limited English proficiency had significantly lower functional recovery, as measured by smaller changes in FIM scores from IRF admission to discharge. Additionally, both groups were more likely to be discharged home with home health care than to a skilled nursing facility, compared with White and English-speaking patients. Disparities in discharge destination persisted within patients with noncommercial insurance (Medicaid or Medicare) and a stroke diagnosis but not within those who had commercial insurance or a nonstroke diagnosis. ConclusionsRacial and linguistic disparities were identified within our CARF certified IRF; however, the organization is committed to reducing health care disparities. Next steps will include investigating interventions to reduce disparities.

The impact of dementia on rehabilitation outcomes following hip fracture.

To compare clinical outcomes between patients for whom their participation in inpatient rehabilitation was and was not impacted by dementia through matching patients reporting dementia (dementia group) with those not reporting dementia (non-dementia group). Prospectively collected data held by the Australasian Rehabilitation Outcome Centre (AROC) were analyzed for patients aged 65 years or older receiving inpatient rehabilitation in public hospitals in Australia following a hip fracture and discharged between July 1, 2014, and June 30, 2019. Patients reported as having dementia impacting their rehabilitation program were matched to patients not reporting dementia based on age, admission motor Functional Independence Measure (FIM) score, and accommodation prior to rehabilitation. The matched cohorts were compared in relation to clinical outcomes (motor and cognitive FIM improvement, FIM efficiency, length of stay, and discharge destination) following participation in hospital-based rehabilitation using univariate analysis. Patients with dementia had significantly lower cognitive FIM scores on commencing rehabilitation (17.6 and 26.9, respectively, P < 0.001) and their median length of stay was 2 days shorter than those without dementia (21 and 23 days, respectively, P < 0.001). Relative change in FIM score and FIM efficiency (per week) were lower in the dementia group [relative FIM score change of dementia vs non-dementia, respectively, 26.2% vs. 44.0% (P < 0.001) and FIM efficiency, 6.5 vs. 8.9 (P < 0.001)]. Discharge destination between the two groups was statistically different, with 35.7% of patients with dementia being discharged to residential aged care facilities (RACFs) compared to 21.7% of those without dementia (P < 0.001). More patients with dementia had carers in their private residence in the post-rehabilitation phase, 82.2% vs. 57.6% (P < 0.001). Patients with dementia who sustain a fractured hip benefit from inpatient rehabilitation, although their clinical outcomes are not as good as those without dementia. FIM change and FIM efficiency were lower in the dementia group. Length of stay in the hospital for patients with dementia was shorter due to earlier recognition for the need for placement in either an RACF or at home with carer support. Theneed for placement in an RACF or carer support in a private residence was significantly greater in the dementia group.

Medication regimen complexity index and rehabilitation outcomes in post-acute hip fracture patients study: a retrospective study

Polypharmacy is a common problem amongst the elderly population. The complexity of the drug regimen refers not only to a simple medication count, but also to the number of daily doses, frequency, and special instructions given for their use. Medication regimen complexity may affect health outcomes, including an increase in hospitalization rates, drug non-adherence, and mortality rates. To assess whether the admission medication regimen complexity index score is associated with rehabilitation outcomes in hip fracture patients; secondary- to assess whether changes in the medication regimen complexity index scores during rehabilitation are associated with rehabilitation outcomes. A retrospective study of 336 hip fracture patients admitted to a post-acute rehabilitation hospital. Primary rehabilitation outcome was assessed via the discharge functional independence measure score. Secondary outcomes included functional independence measure score changes, length of stay and discharge destination. Patients with low admission medication regimen complexity index scores attained significantly higher admission and discharge motor functional independence measure scores (40.1 vs. 37.1, p = 0.044; 57.1 vs. 52.9, p = 0.014, respectively), a higher motor functional independence measure score effectiveness (36.1 vs. 31.3, p = 0.030) and a higher rate of favorable motor functional independence measure effectiveness score (58.1% vs. 42.0%, p = 0.004). A multiple linear regression analysis revealed that the admission medication regimen complexity index score was not associated with the discharge functional independence measure score (standardized coefficient = -0.058; p = 0.079). A high medication regimen complexity which usually implies severe comorbidity should not be considered a barrier for the rehabilitation of older patients.

Abstract WP68: Clinical Characteristics And Inpatient Rehabilitation Outcomes In Patients With Posterior Circulation Strokes

Introduction: Posterior circulation strokes (PCS) are considered to have poor outcomes with high mortality and morbidity, but comparisons of functional outcome with anterior circulation strokes (ACS) have yielded conflicting results. Differences in demographics, cardiovascular risk factors and stroke etiology have been proposed, with ischemic PCS patients tending to be younger, more often male, and more frequently diabetic. Objectives: Describe the clinicodemographic profile and functional outcomes in PCS patients admitted to inpatient rehabilitation (IPR), and identify factors associated with functional change. Methods: A retrospective review of a database maintained on consecutive stroke patients admitted to IPR at Memorial Hermann-TIRR between 2017 and 2019 was conducted. Demographics, Functional Independence Measure (FIM) scores, and discharge disposition of 806 patients were assessed. Table 1 displays significance testing by univariate analysis. Baseline characteristics, pre-stroke mRS, NIHSS, admit FIM, and length of stay (LOS) in IPR were adjusted in regression models. Results and Conclusions: Results are summarized in Table 1. Diabetes and prior stroke or TIA occurred in higher percentages of patients with PCS, or concurrent ACS/PCS. NIHSS was higher in ACS patients with a mean of 9.6 (SD 7.1, p&lt;0.001) and median of 6 with IQR of 11. Total FIM score on admission to IPR was 53.3 (SD 16.5) for PCS compared to 46.6 (SD 16.9, p&lt;0.001) in ACS patients. Motor FIM score change was 28.6 (SD 12.2) in PCS compared to 27.2 (SD 12.8) in ACS. Adjusting for baseline variables of admit FIM, NIHSS and LOS, we found no significant differences in total or motor FIM change between the groups from admission to discharge. There was no greater odds for improvement on total or motor FIM for ACS compared to PCS. In summary, patients with PCS and ACS respond similarly to rehab therapy as captured on the FIM score, with a higher amount of therapy associated with better improvement.

Quality improvement outcomes from the introduction of a geriatrician into a rehabilitation setting.

Geriatrician impact on patient and system outcomes in formal rehabilitation settings has not been well described to date. We studied the effect of adding a geriatric medicine consultation service to a geriatric focused rehabilitation setting providing care to dialysis and non-dialysis patients. A pre- and post-retrospective observational cohort study from January 1, 2009 to June 30, 2019 on all consecutively admitted adults aged 65 and older to general rehabilitation program, and adults aged 60 and older to specialized dialysis rehabilitation program, within a 25 bed general rehabilitation unit in a large urban academic rehabilitation center in Toronto, Ontario. Data were analyzed with quality improvement methodology including Statistical Process Control charts (XmR and U charts). Addition of a geriatric medicine service providing automatic comprehensive geriatric assessment and co-management consultative services for all admitted patients from admission onwards who met criteria for the intervention. The intervention commenced on August 1, 2013. Outcome measures were length of stay (days), service interruption frequency, and average functional independence measure (FIM) change (discharge FIM minus admission FIM) which uses the validated FIM score, a marker of functional ability. A 22 point change in FIM score is clinically relevant. Patient characteristics: general rehabilitation patients (n=1395, mean age=79.7, 50.1% female) and dialysis rehabilitation patients (n=838, mean age=72.8, 41.8% female). The average FIM change following intervention improved from 20.8 to 29.3 in the general rehabilitation cohort (40.6% improvement, SD=5.51) and from 22.1 to 30.6 in the dialysis rehabilitation cohort (38.6% improvement, SD=5.88). Changes in length of stay (24.9%-28.1% reduction) and service interruption frequency (34.3%-49.7% reduction) were also observed. Introduction of a geriatric medicine service for rehabilitation inpatients was associated with significant FIM score improvements. Our results suggest this intervention contributes to important gains in functional independence in reduced time for older adults receiving inpatient rehabilitative care.

Recovery in glioblastoma multiforme during inpatient rehabilitation is equivalent in first versus repeat resection: A 10-year retrospective analysis.

Inpatient rehabilitation improves function in people with brain tumors, including glioblastoma multiforme (GBM) but there are limited data on the impact of multiple resections on outcomes. We hypothesize that outcomes will be more favorable for those patients with a single resection when compared to those with more than one resection. To examine functional outcomes in inpatient rehabilitation for people with GBM who underwent one or more resections prior to admission. Retrospective analysis. Inpatient rehabilitation unit within a large, urban, academic medical center. Patients who were admitted to our institution for the treatment of initial GBM or GBM recurrence necessitating surgical resection or repeat resection. Not applicable. Total FIM Change, Total Functional Independence Measure (FIM) Efficiency, Motor and Cognitive FIM efficiency, and proportion discharged home. From 2006 to 2016, 94 persons with GBM were admitted. Eight were readmissions classified as "repeat" and another seven transferred to the medical floor and excluded. Of the 79 patients included, 56 were first and 23 second resections, with a group mean age of 62.7 + 12.2 years and were 51% male. On analysis of covariance, change in FIM score from admission to discharge was insignificant between groups, adjusted for age and acute care length of stay (17.1 vs. 17.4, F[1, 75]=0.027, P=.871). Likewise, the proportion of home discharge was not significant between groups (chi-square, 75.0% vs. 78.3%, P=.758). Patients who have undergone second resections for GBM are reasonable candidates for admission to the inpatient rehabilitation units despite carrying a poor prognosis and having multiple exposures to surgical morbidity. Factors to take into account are that candidates considered for a second resection may be relatively younger or healthier and therefore may perform better from a functional standpoint. In addition, postoperative steroid administration may play a role in the similarities the authors noted. A larger, multicenter study should validate our findings (limited by sample size and a single location) and identify factors predicting a successful outcome.

Rehabilitation under Social Isolation: Outcomes of Older Individuals with Hip Fractures, Admitted to a Postacute Geriatric Rehabilitation Center, during the COVID-19 Pandemic

Background/Aims: The novel coronavirus SARS-CoV-2 is the cause of an ongoing pandemic. The highest mortality rate is observed among the older adult population. During the first wave of the pandemic (March–June 2020), following a national health decree demanding that no visitors or family members be allowed in health institutions, our geriatric rehabilitation center closed gates to all visitors from the outside. We aimed to assess the rehabilitation outcomes of older patients with hip fractures in the first pandemic wave, who underwent rehabilitation under complete social isolation from primary care givers and family members. Methods: This was a retrospective cohort study. It took place at a university-affiliated, major postacute geriatric rehabilitation center. Rehabilitation outcomes measured were discharge functional independence measure (FIM) score and motor FIM score, FIM score change, motor FIM score change, favorable motor FIM effectiveness, length of stay, discharge destination, and home aid at discharge. Results: The study group included 36 patients who were admitted during the first wave of the COVID-19 pandemic (March 1, 2020, to June 30, 2020). The control group comprises 106 individuals with hip fractures who were admitted in the respective time periods during the previous 2 years, that is, March 1, 2018, to June 30, 2018, and March 1, 2019, to June 30, 2019. The facility’s occupancy rates were much lower during the first wave of the pandemic in comparison with previous years (78 and 99%, respectively). Patients showed similar demographics and comorbidities, but the social isolation group was more severely deconditioned upon admission. All rehabilitation outcomes were similar between groups. Conclusion: According to the findings of this retrospective study, social isolation from family and caregivers did not have a detrimental effect on the rehabilitation outcomes of these patients. More evidence must be gathered and presented on the matter.

Abstract P69: Clinical and Demographic Characteristics Associated With Cognitive Recovery During Stroke Inpatient Rehabilitation

Introduction: We examined patient characteristics associated with cognitive improvement during inpatient rehabilitation. Methods: This was a retrospective review of clinical data from inpatient stroke rehabilitation units collected from 9/2017- 8/2019. Multiple and logistic regressions were used to examine the relationship between demographics, vascular risk factors and cognitive Functional Independence Measure (FIM) change scores on comprehension, expression, social interaction, problem solving, and memory in stroke patients, adjusted for cognitive FIM scores on admission. Results: The study cohort consisted of 680 patients with a mean age of 68 ± 14 years and median hospital LOS of 15 days. The percentage of patients that improved on comprehension, expression, social interaction, problem solving, and memory FIM scores was 61%, 65%, 62%, 64%, and 64%, respectively. Multiple regression analysis indicated that predictors of cognitive recovery included hypertension, stroke type, age, and NIHSS score. Specifically, hypertension predicted significantly less improvement on problem solving FIM scores (p=.033). Intracerebral hemorrhage (ICH) predicted significantly greater improvement on comprehension and problem solving FIM scores as compared to ischemic stroke (p=.047, p=.032, respectively). Compared to age &lt; 65, age ≥ 65 predicted less improvement on comprehension, expression, and memory FIM scores (p&lt;.001, p=.003, p&lt;.001, respectively). NIHSS scores ≥ 21 predicted less improvement on comprehension, expression and problem solving FIM scores than NIHSS scores &lt; 20 (p=.013, p=.017, p=.005, respectively). Logistic regression analysis suggested that the odds of cognitive improvement (defined as at least three FIM score changes ≥2) for ICH was 1.7 times greater than ischemic stroke (95% CI 1.07-2.72; Table 1). Conclusion: Hypertension, stroke type, age, and NIHSS score have profound impacts on cognitive recovery in during inpatient rehabilitation.

Robotic Exoskeleton Gait Training During Acute Stroke Inpatient Rehabilitation.

Stroke is the leading cause of severe disability in adults resulting in mobility, balance, and coordination deficits. Robotic exoskeletons (REs) for stroke rehabilitation can provide the user with consistent, high dose repetition of movement, as well as balance and stability. The goal of this intervention study is to evaluate the ability of a RE to provide high dose gait therapy and the resulting effect on functional recovery for individuals with acute stroke. The investigation included a total of 44 participants. Twenty-two participants received RE gait training during inpatient rehabilitation (RE+SOC Group), and a matched sample of 22 individuals admitted to the same inpatient rehabilitation facility-receiving conventional standard of care treatment (SOC group). The effect of RE training was quantified using total distance walked during inpatient rehabilitation and functional independence measure (FIM). The total distance walked during inpatient rehabilitation showed a significant difference between the SOC and RE+SOC groups. RE+SOC walked twice the distance as SOC during the same duration (time spent in inpatient rehabilitation) of training. In addition, the average change in motor FIM showed a significant difference between the SOC and RE+SOC groups, where the average difference in motor FIM was higher in RE+SOC compared to the SOC group. The results suggest that RE provided increased dosing of gait training without increasing the duration of training during acute stroke rehabilitation. The RE+SOC group increased their motor FIM score (change from admission to discharge) compared to SOC group, both groups were matched for admission motor FIM scores suggesting that increased dosing may have improved motor function.

Red Cell Distribution Width as a Predictor of Functional Outcome in Rehabilitation of Older Stroke Patients.

BackgroundRed cell distribution width (RDW) is a prognostic marker in vascular diseases. While increased RDW predicts mortality and outcomes after ischemic stroke, evidence regarding its prognostic significance in stroke rehabilitation is lacking. Thus, the present study investigated the relationship of RDW with stroke, orthopedic, and deconditioning rehabilitation outcomes.MethodsThis prospective comparative study included three groups (stroke, orthopedic, and deconditioning) of older adult patients hospitalized for rehabilitation. The patients in each group were divided into two subgroups according to whether they had high (>14.5%) or normal (≤14.5%) RDW levels on admission. Functional outcome was assessed by total and motor FIM (Functional Independence Measure) score changes and efficiency at admission and on discharge.ResultsOf the 234 eligible patients, 108 (46.2%) had high RDW. Of the 50 stroke rehabilitation patients, 13 (26%) had high RDW. FIM change and efficiency scores were significantly lower in patients with high RDW only in the stroke rehabilitation group. However, multiple linear regression analysis showed that high RDW was not independently associated with total and motor FIM gain or total and motor FIM efficiency.ConclusionHigh RDW levels on admission to rehabilitation were associated with poor rehabilitation outcome in stroke patients but were not an independent risk factor for rehabilitation outcomes.

Introducing a clinically effective allied health rapid discharge team within a complex aged subacute in-patient cohort on a cost recovery basis: the Supported Patient centred Early Discharge (SPeED) initiative.

This case study reports the outcomes of an early supported discharge program. This model of care was trialled after Victoria introduced subacute weighted inlier equivalent separations funding to subacute in-patients in 2016. An allied health team (Supported Patient centred Early Discharge (SPeED)) managed patients suitable for assessment, intervention and early supported discharge (ESD). The SPeED cohort was compared to a matched historical control. Data included no advantage financially (NAF) days, length of stay (LOS), functional independence measure (FIM) scores and 30-day readmission rates. Staff and patient experiences were collected through surveys and call-back data. Regression analysis compared quantitative data, whereas a broad thematic approach compared qualitative data. There were no differences between the study cohort and historical control in age or sex (P>0.05). The SPeED cohort had lower median NAF days (F=-21.38; 95% confidence interval (CI) -37.70, -15.00; P<0.001), shorter LOS (F)=4.65; 95% CI -0.41, -0.02; P=0.034), fewer readmissions within 30 days (odds ratio 0.14; 95% CI -0.03, 0.68; P=0.014) and greater change in FIM scores during admission (F=4.20; 95% CI 0.16, 10.74; P=0.044). Staff morale was high in recognition of improved patient care. Patient satisfaction remained positive across the SPeED cohort and historical control group. The introduction of a dedicated allied health ESD team within a geriatric evaluation and management population is effective and enhances patient outcomes.

The Effect of Body Mass Index on Pulmonary Related Debility Rehabilitation.

Obesity is a known factor for the development of abnormal respiratory physiology. However, several studies have found that obesity does not hinder functional recovery in patients hospitalized for postacute care following a stroke or cardiovascular event. This study was designed to determine the effect of overweight and obesity on patients with acute pulmonary disease, hospitalized in an inpatient rehabilitation facility (IRF). To investigate the impact of body mass index (BMI) on indices of function, specifically, the functional independence measure (FIM) among patients with pulmonary related debility admitted to a rehabilitation hospital. Retrospective cohort study. Pulmonary unit in an acute freestanding rehabilitation hospital. All patients admitted to an IRF with a diagnosis of pulmonary related debility over a 6-year period. The data used in the study included the patient height and weight (measured on admission) and FIM (scored on admission and discharge). The primary study outcome measure was the change in FIM per day by the patients' BMI category. For the 381 patients admitted during the observation period, BMI was compared with FIM score changes per day (FIM efficiency). After adjusting for age and sex, the FIM efficiency only slightly differed by BMI, failing to reach statistical significance. However, age did significantly influence the outcome (P = .05). This study demonstrates that among a large group of patients with a pulmonary related debility, there was no statistically significant correlation between BMI and FIM efficiency. The overweight patients were similar in progression to those who were underweight, normal weight, and obese. However, this study found that increased age adversely affected the outcome of rehabilitation. III.

Evaluation of an OSA risk stratifying and treatment protocol during inpatient rehabilitation of post-stroke patients

To evaluate outcomes, outside of a clinical trial setting, of a protocol utilizing overnight oximetry (NOx) to risk stratify post-stroke patients for obstructive sleep apnea (OSA) followed by autoadjusting continuous positive airway pressure (APAP) treatment in patients considered high risk for OSA. Retrospective observational study of post-stroke patients at an academic inpatient stroke rehabilitation facility. Patients underwent NOx, and those at high risk for OSA (oxygen desaturation index 3%>10 per hour) were attempted on a trial of APAP, and further stratified into high risk adherent with treatment (HRAT) or high-risk failed treatment (HRFT). Change in functional independence measure (FIM) was used to assess recovery. Two hundred twenty-four post-stroke patients underwent NOx, with 120 (53%) considered high risk for OSA. Twelve (10%) were compliant with APAP treatment (>4h/night on > 70% of nights). No difference in change in FIM scores was observed for HRAT versus HRFT [total FIM change - 5.8, 95% CI (- 13.9, 2.2); motor FIM change - 4.5, 95% CI (- 11.5, 2.4); cognitive FIM change - 1.3, 95% CI (-3.8, 1.2)]. A subgroup analysis matched 14 HRAT patients (using adherence criterion of APAP usage > 50% of nights) to 35 HRFT patients. A statistically significant, but clinically irrelevant, difference in total FIM change was observed (HRAT vs HRFT, difference between means - 5.2, p = 0.03). The use of APAP in high-risk patients was poorly tolerated and did not improve post-stroke recovery. Further studies with larger sample sizes are needed to determine the effect of APAP treatment on short-term recovery.

Association between anticholinergic drug prescription changes and rehabilitation outcome in post-acute hip fractured patients

Purpose: To follow changes in anticholinergic drug prescriptions throughout hip fractured patients’ rehabilitation; to assess whether a change in anticholinergic burden affects rehabilitation outcome.Methods: Retrospective study of 869 hip fractured patients admitted between January 2011 to October 2015, performed in a post-acute geriatric rehabilitation center. The Anticholinergic Cognitive Burden Scale quantified the anticholinergic burden. Main outcome measures: Functional Independence Measure, motor Functional Independence Measure, Montebello Rehabilitation Factor Score on motor Functional Independence Measure and length of stay. Multiple linear regression analysis tested for independent association between admission anticholinergic burden and anticholinergic burden change during rehabilitation, and rehabilitation outcomes.Results: One hundred and sixty two (18.7%) patients were prescribed additional anticholinergic medications upon discharge; 76 (8.7%) were prescribed fewer. Patients with high admission anticholinergic burden presented with a significantly higher rate of higher education, less likely to reside at home, less independent pre-fracture, exhibited a significantly lower admission and discharge Functional Independence Measure score, a lower Functional Independence Measure score change and a lower Montebello Rehabilitation Factor Score. Admission anticholinergic burden, but not changes in anticholinergic burden during rehabilitation, was found to be independently associated with rehabilitation outcome (discharge FIM score).Conclusions: High admission anticholinergic burden is associated with lower functional ability in hip fractured patients. Changes in anticholinergic drug prescription during rehabilitation were not associated with rehabilitation outcomes.Implications for rehabilitationClinicians should make an effort to reduce AC drug use in hip fractured patients on admission to post-acute rehabilitation.AC burden should be carefully monitored throughout the rehabilitation period and reduced whenever possible.When functional ability does not improve as expected, AC burden should be considered as an intervening factor.

Discharge Destination from a Rehabilitation Unit After Acute Ischemic Stroke.

We reviewed numerous variables for ischemic stroke patients admitted to a rehabilitation unit to determine those that were statistically associated with discharge destination. A retrospective chart review of patients with ischemic stroke discharged from the rehabilitation unit between January 1, 2005 and December 31, 2015. Variables were examined for their association with discharge destination (home versus long-term care (LTC)). Univariable relationships with discharge destination were assessed, and a multivariable logistic regression model was built. Univariate predictors of discharge to LTC: advanced age, decreasing admission and discharge functional independence measure (FIM) scores, increasing change in FIM score from admission to discharge, dependency, residence outside of home before the stroke, absence of a caregiver, urinary and bowel incontinence, low Berg balance score at admission and discharge, low Montreal Cognitive Assessment scores, smoking, chronic heart failure, and an inability to transfer. Multivariable logistic regression: five factors remained significant predictors with LTC disposition: advanced age, bowel incontinence, residence outside of the home prior to stroke, right hemisphere site of the stroke, and absence of a caregiver. Several easily measured variables were significantly associated with discharge to LTC versus home following stroke rehabilitation.

Use of Oral Hydration Protocols for Dysphagic Patients Following Stroke

The aim of the study was to describe the use of oral hydration protocols for dysphagic patients following stroke. We reviewed inpatient records for patients able to take food and liquids orally within 30 days of an ischemic stroke. Orders were hierarchically defined with three levels of liquid consistency modification (LCM) and six levels of augmented hydration orders (AHOs). Change from admission to discharge in hydration and functional independence measure (FIM) scores across LCM and AHO groups was assessed. Length of stay, admission FIM, discharge FIM, and change in FIM scores were all significantly related to LCM and AHO group assignment. Need for supplemental intravenous hydration was low (6.9%) over the 2-year study period and was significantly related to both LCM and AHO group assignment. The association of LCM and AHO interventions with functional outcomes and need for intravenous fluids helps to validate their clinical utility.

Association of BDNF VAL66MET with post-stroke functional recovery

The Val66Met single nucleotide polymorphism (SNP rs6265) of the Brain-Derived Neurotrophic Factor ( BDNF ) gene decreases BDNF secretion. Previous studies in patients with stroke have shown that the Val66Met polymorphism is associated with poorer outcome. The aim of this study was to determine whether or not the BDNF Val66Met genotype is associated with functional outcome after stroke in our inpatient rehabilitation sample. One hundred and five individuals admitted for inpatient rehabilitation following a stroke and who were also enrolled in the Partners HealthCare Biobank. The genotypes for BDNF SNP rs6265 for individuals with stroke were obtained from the Partners HealthCare Biobank Portal. Main outcome measures were the Functional Independence Measure (FIM) on admission and discharge. Stroke outcome was defined as the change in FIM scores between discharge and admission. The prediction of motor and cognitive outcome at discharge was modeled using BDNF Val66Met genotype. Regression analyses were performed to identify the significant associations of the genetic factor with functional outcome. Individuals with stroke who were homozygous for the GG genotype had significantly lower FIM cognition subscale ( P = 0.023) and memory subscores ( P = 0.011) as compared to those with either the heterozygous AG or homozygouse AA genotypes. In addition, the GG genotype was a significant predictor for poor memory outcome ( P = 0.021, OR = −0.036 [B = −0.067 to −0.005]) when controlling for age and gender. This association may be due to the association with memory since the memory score is contained within the cognition subscale. The preliminary data suggests that BDNF Val66Met polymorphsim may impede stroke recovery, especially cognitive function. Further studies with larger samples are warranted to elucidate the role and mechanism of BDNF genetic variants in stroke recovery.

The effect of body mass index on functional outcome of patients on cardiac rehabilitation

Background: While data suggests that obesity increases the risk for cardiovascular disease, some have demonstrated that after a cardiovascular event those with obesity tend to recover more quickly than do those whose weight is normal; a phenomenon termed the “obesity paradox”. This study was designed to determine whether this obesity paradox is also reflected in the recovery of patients with debility secondary to a cardiovascular event undergoing care in a rehabilitation hospital.Objective: Investigate the association between body mass index (BMI) and the functional progress among patients with a recent cardiovascular decline, admitted to an acute rehabilitation hospital.Design and methods: Retrospective cohort study which included all patients admitted to a rehabilitation hospital, with a recent diagnosis of acute cardiac decline from January 2000–April 2006. Main Outcome Measures: Functional Independence Measure (FIM) score gain per day by BMI category.Results: Of the 678 patients admitted during the observation period, BMI was compared with FIM score changes per day (FIM efficiency). After adjusting for age, and sex, the FIM efficiency differed by BMI, though the difference was not statistically significant (p=0.069). While not statistically significant, the normal weight group showed the best results, followed, in order by the obese group, the overweight group, and the underweight group.Conclusion: This study of patients on a cardiac rehabilitation unit failed to demonstrate that obesity significantly impairs functional progress during the rehabilitation process.