Discharge Motor Functional Independence Measure Research Articles

Improvement of predictive accuracies of functional outcomes after subacute stroke inpatient rehabilitation by machine learning models.

Stepwise linear regression (SLR) is the most common approach to predicting activities of daily living at discharge with the Functional Independence Measure (FIM) in stroke patients, but noisy nonlinear clinical data decrease the predictive accuracies of SLR. Machine learning is gaining attention in the medical field for such nonlinear data. Previous studies reported that machine learning models, regression tree (RT), ensemble learning (EL), artificial neural networks (ANNs), support vector regression (SVR), and Gaussian process regression (GPR), are robust to such data and increase predictive accuracies. This study aimed to compare the predictive accuracies of SLR and these machine learning models for FIM scores in stroke patients. Subacute stroke patients (N = 1,046) who underwent inpatient rehabilitation participated in this study. Only patients' background characteristics and FIM scores at admission were used to build each predictive model of SLR, RT, EL, ANN, SVR, and GPR with 10-fold cross-validation. The coefficient of determination (R2) and root mean square error (RMSE) values were compared between the actual and predicted discharge FIM scores and FIM gain. Machine learning models (R2 of RT = 0.75, EL = 0.78, ANN = 0.81, SVR = 0.80, GPR = 0.81) outperformed SLR (0.70) to predict discharge FIM motor scores. The predictive accuracies of machine learning methods for FIM total gain (R2 of RT = 0.48, EL = 0.51, ANN = 0.50, SVR = 0.51, GPR = 0.54) were also better than of SLR (0.22). This study suggested that the machine learning models outperformed SLR for predicting FIM prognosis. The machine learning models used only patients' background characteristics and FIM scores at admission and more accurately predicted FIM gain than previous studies. ANN, SVR, and GPR outperformed RT and EL. GPR could have the best predictive accuracy for FIM prognosis.

Predictors Of Outcome In ICH Patients Initially Admitted To The ICU Who Are Transferred To Inpatient Rehab (P5-7.002)

<h3>Objective:</h3> Assess factors associated with good functional outcomes after ICH requiring ICU admission. <h3>Background:</h3> Intracerebral hemorrhage (ICH) is associated with high mortality, with patients requiring intensive care unit (ICU) admission having worse outcomes. However, current scores are limited in their ability to predict functional outcomes. <h3>Design/Methods:</h3> We collected data using a prospectively maintained registry of stroke patients admitted to 5 inpatient rehabs (IR)s in our hospital system between 1/2018 to 6/2019. We performed predictive modeling with RIDGE regression analysis to predict the rehab discharge motor functional independence measure (FIM). Variables used to perform predictive modeling included age, ICU length of stay (LOS), concurrent IVH, ICH expansion, decompressive surgery, laterality of ICH, symptom onset to rehab admission, rehab admission motor FIM score, initial NIHSS, and total therapy days. <h3>Results:</h3> We identified 166 patients with ICH admitted to IR, of which a significant number (51%) were initially admitted to the ICU. After excluding patients with incomplete variables, 61 patients were included in the model. The median age was 59[47–71] years, and 44% were female. The median initial NIHSS was 12 [5–18], and the length of stay in the ICU was 6 [3–10] days. 34 (55.7%) of the patient had IVH, and 7 (11.5%) had hematoma expansion. 7 (11.5%) needed decompressive surgery. The median admit motor FIM score was 24 [17–36], and after a median of 14 [14–14] days in IR, the median discharge motor FIM score more than doubled to 58 [46–69]. Our predictive model had an r-squared of 0.65. Decompressive surgery patients had better scores by 4 points than patients without decompressive surgery. As therapy days increase by one day, discharge motor FIM scores increase by approximately 2 points. <h3>Conclusions:</h3> Our model can satisfactorily predict rehab discharge motor FIM. However, additional factors involved in the process will be explored to improve the model. <b>Disclosure:</b> Dr. Ahmad has nothing to disclose. Dr. Tariq has nothing to disclose. Christin Silos has nothing to disclose. Ms. Hernandez has nothing to disclose. Ms. Contreras has nothing to disclose. Dr. Savitz has nothing to disclose.

Potentially Preventable Readmissions After Acute Inpatient Rehabilitation.

The aim of the study is to identify causes and risk factors for potentially preventable readmissions of patients discharged from an inpatient rehabilitation facility. Our hospital billing database was used to identify patients discharged from our inpatient rehabilitation facility between 2013 and 2018 and experienced a potentially preventable readmission within 90 days ( n = 75). Retrospective chart review was completed to obtain clinical data. Of the patients discharged from the inpatient rehabilitation facility who did not experience a potentially preventable readmission, a group of age- and sex-matched controls ( n = 75) was randomly selected. The two study groups were compared using univariate and multivariate analyses. Our study found that individuals who discharged from acute inpatient rehabilitation were more likely to be readmitted with a potentially preventable readmission if they have a greater number of comorbidities, were admitted initially with a spinal cord injury, or have lower admission or discharge Functional Independence Measure motor scores. The most common potentially preventable readmission diagnoses were sepsis, renal failure, respiratory problems, and urinary tract infection. Identifying patients with the common causes for potentially preventable readmissions, in addition to the noted risk factors, is an important consideration for inpatient rehabilitation discharge planning.

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.

Long-Term Outcomes of Patients with Primary Brain Tumors after Acute Rehabilitation: A Retrospective Analyses of Factors.

Although primary brain tumors are relatively rare, they cause significant morbidity and mortality due to the high rates of neurological impairment. The purpose of this study was to examine the physical and functional outcomes of patients with primary brain tumors who had undergone inpatient rehabilitation. This was a retrospective study which recruited 163 patients who had been admitted for inpatient rehabilitation. Rehabilitation outcomes, including the Functional Independence Measure (FIM) and Glasgow Outcome Scale (GOS), were recorded up to 1 year post-discharge. The majority of patients (79.1%) had low-grade (WHO Class I-II) tumors, 35 (21.5%) were diagnosed with GBM and 52 (31.9%) had recurrent brain tumors. Rehabilitation outcomes were sustained, with 125 (76.7%) and 113 (69.3%) patients having a GOS of ≥4 at 6 months and 1 year after discharge, respectively. A GOS of ≥4 at 1 year was negatively associated with high-grade tumors (p < 0.001) and radiotherapy (p = 0.028), and positively associated with a higher discharge FIM motor score (p < 0.001) and the presence of a caregiver after discharge (p = 0.034). Our study demonstrates significant positive functional benefits from 4 weeks of inpatient neuro-oncological rehabilitation for patients with primary brain tumors, as well as the importance of supportive care from caregivers.

Use of the Frailty Tools Fi Mds and Fi Rockwood to Predict Outcomes of Inpatient Rehabilitation after Proximal Hip Fracture

Background Among factors which affect the outcome of rehabilitation after hip fracture, the role of pre-fracture frailty has not been defined. Objective To assess the impact of frailty on rehabilitation outcome in elderly persons with proximal hip fracture. Setting Geriatric rehabilitation center. Design Retrospective observational study. Subjects Forty consecutive patients with proximal hip fracture. Methods The following parameters were calculated: FI-MDS frailty index, Rockwood Clinical Frailty Scale (FI Rockwood), Functional Independence Measure (FIM) on discharge, absolute functional gain (ΔFIM), length of stay (LOS), and FIM gain per day (ΔFIM/LOS). FIM discharge ≥90 and motor FIM discharge &gt;58 indicated success in rehabilitation. Results There were 31 women and 9 men, mean age 80 years. The mean pre-fracture FI MDS was 10 points (SD 5.8) out of 58 possible, the mean FI Rockwood score was 3 (SD 1.7) out of 7 possible. The mean admission FIM was 76.6 (SD 16), the mean discharge FIM was 92.7 (SD 19.3), mean LOS 22.5 days (SD 9.7), mean ΔFIM/LOS 0.8 (SD 0.6). Pre-fracture frailty was associated with worse outcome of rehabilitation: FI MDS predicted discharge FIM ≥90 with OR 0.86, p 0.012; FI Rockwood predicted discharge FIM ≥90 with OR 0.68, p 0.027; FI MDS predicted discharge motor FIM &gt;58 with OR 0.91, p 0.07; FI Rockwood predicted discharge motor FIM &gt;58 with OR 0.71, p 0.027. Conclusions Though pre-fracture frailty correlated with FIM on discharge, neither frailty tool was specific enough to predict success in rehabilitation and the necessary length of rehabilitation. Translating frailty scores in tools adequate for clinical decision making remains an aim for future studies.

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

Characteristics of Acute Stroke Patients Readmitted to Inpatient Rehabilitation Facilities: A Cohort Study.

Reducing acute care readmissions from inpatient rehabilitation facilities (IRFs) is a healthcare reform goal. Stroke patients have higher acute readmission rates and persistent impairments, warranting second IRF hospitalization consideration. To provide evidence-based information to justify IRF readmission for patients with post-stroke impairments. Variables that increase the likelihood of a second IRF hospitalization. Retrospective cohort study. Seven-center rehabilitation network. Stroke patients, readmitted to acute care, who returned or did not return to an in-network IRF between 1 October 2014-31 December 2017(n = 380). Univariable analyses (Returned/Did Not Return to IRF) described demographics, stroke type and risk factors. Between group differences in readmission causes, motor impairments and functional independence measure (FIM) scores were examined. Return to IRF logistic regression model included variables with P< .1. Odds ratio and 95% CI were calculated; Relative risk was calculated for categorical variables. P< .05 equaled statistical significance. One hundred ninety-two stroke patients returned to IRF, 188 did not. Returned to IRF patients were younger (60.6 vs. 66 years; P< .001), sustained hemorrhagic strokes (22.4 vs. 14.2%; P= .01), had lower cardiac disease prevalence (41.7 vs. 55.3%; P= .008) or non-Medicare insurance (59.9 vs. 39.4%; P< .001). Did Not Return to IRF patients had higher admission and discharge motor and total FIM scores. Per point decrease in discharge FIM, second IRF hospitalization odds increased 4% (OR 1.04; 95% CI 1.01-1.07; P= .02). Hemorrhagic stroke patients had 33% increased odds or a 15% higher relative risk of second IRF hospitalization than patients with ischemic stroke [OR 1.33; 95% CI 1.21-1.47; RR 1.15; 95% CI 1.1-1.2; P< .001]. Non-Medicare insurance was associated with 39% increased odds or a 20% higher relative risk of second IRF hospitalization than Medicare [OR 1.39; 95% CI 1.01-1.92; RR 1.2, 95% CI 1.006-1.404; P= .04). Hemorrhagic stroke, non-Medicare insurance or lower discharge FIM score during the first IRF hospitalization predict a second IRF stay. Further work is needed to establish the validity of within IRF stay readmission measures.

The association between hand grip strength and rehabilitation outcome in post-acute hip fractured patients.

Various factors have been shown to affect the rehabilitation outcome of hip fractured patients. Considering the decrease in muscle mass with aging and its impact on mobility, we hypothesized that a relationship exists between hand grip strength and rehabilitation outcome. We retrospectively studied 373 post-hip fracture patients, admitted for rehabilitation. Muscle strength was measured by hand grip dynamometer. functional independence measure motor functional independence measure, motor functional independence measure effectiveness and length of stay). A favorable functional gain was defined as a motor Functional Independence Measure effectiveness score > 0.5. The Spearman correlation assessed the associations between hand grip strength and outcome measures. A multiple linear regression model tested whether hand grip strength was an independent predictor of discharge motor Functional Independence Measure scores and length of stay RESULTS: Significant correlations were found between hand grip strength and functional outcomes. A significant independent association was found between hand grip strength and discharge motor Functional Independence Measure score after adjustment for confounding demographic and clinical variables. High hand grip strength on admission was significantly associated with a greater chance of achieving a favorable functional gain (OR 1.064, 95% CI, 1.01-1.13; p = 0.032). Hand grip strength was not found to be associated with length of stay. Hand grip strength is independently associated with rehabilitation outcome in post-acute frail hip fractured patients. Initial screening for hand grip strength on admission may help identify patients who require an intensive resistance exercise program.

Posterior cord syndrome: Demographics and rehabilitation outcomes

Context/Objectives: To describe demographics, clinical characteristics, and functional outcomes of patients with incomplete spinal cord injuries and posterior cord syndrome (PCS). Design: Five-year retrospective case series. Setting: Spinal cord injury (SCI) rehabilitation unit at a Level 1 tertiary university medical center. Participants: 9 patients with incomplete cord injuries diagnosed with PCS admitted to rehabilitation within the past 5 years. Outcome measures: Functional Independence Measure (FIM) motor scores, length of stay (LOS), discharge disposition. Results: Incidence of PCS was 2% with an average age of 62.0 years. The most common etiology for PCS was spinal cord compression from localized tumors (78%). Seven (78%) patients had paraparesis. All patients had an American Spinal Injury Association impairment scale (AIS) classification of AIS D. SCI-related complications most commonly included: neuropathic pain (78%), spasticity (44%), and neurogenic bladder (78%). Average LOS on the rehabilitation unit was 28 days. Average admission and discharge FIM motor scores were significantly improved (P = 0.001) from 41 to 65, respectively. Two-thirds (67%) of patients were able to walk at least 150 feet with a rolling walker prior to discharge. Most (78%) patients were discharged to home. Continence improved from admission to discharge from 22% vs 56% (bladder) and 67% vs 78% (bowel). Conclusions: We can conclude that PCS most often results in paraparesis due to tumor compression. Typical SCI-related medical complications are encountered. These patients often experience significant functional improvements during SCI rehabilitation with the majority also having bladder and bowel continence allowing them to return home at discharge.

Hypogonadism is associated with lower functional performance during inpatient rehabilitation following hypoxic ischemic encephalopathy

Neuroendocrine dysfunction, including hypogonadism, is a frequent complication after traumatic brain injury (TBI). Hypogonadism has been associated with worse functional performance after TBI. The prevalence of hypogonadism and its relationship to functional status after hypoxic ischemic encephalopathy (HIE) has not been previously reported. This study aimed to determine if hypogonadism is also negatively associated with functional performance during inpatient rehabilitation following HIE. Records were reviewed from male patients sequentially admitted for inpatient rehabilitation following HIE over a three-year period at an academic inpatient rehabilitation facility in the United States. Demographic, diagnostic, Functional Independence Measure (FIM) data, and serum endocrine results were collected. Linear regression analysis was performed to investigate the association between hormone values and functional status with a focus on Testosterone (T) function. Twenty-nine male subjects were admitted with HIE during the target time frame. Subjects had a mean age of 37.6 years. Twenty subjects had T levels drawn on admission to rehabilitation; of these, five (25%) had levels below the normal range (2.0–8.0 ng/mL). Lower T levels were associated with worse admission total FIM ( P = 0.001), motor FIM ( P = 0.004) and cognitive FIM scores ( P = 0.003). Low T levels were also associated with worse discharge total FIM ( P = 0.04) and cognitive FIM scores ( P = 0.05) and a trend towards lower discharge motor FIM scores ( P = 0.06). The prevalence of hypogonadism in this population of HIE subjects was 25%, similar to that seen in studies of subjects with TBI. Hypogonadism was negatively associated with a lower functional status across domains. This relationship is similar to that seen in the traumatic brain injury population. Impaired hormone function should be considered clinically following HIE and warrants further investigation.

Methylprednisolone Therapy in Acute Traumatic Spinal Cord Injury: Analysis of a Regional Spinal Cord Model Systems Database.

The objective of this study was to assess the relationship between exposure to methylprednisolone (MP) and improvements in motor function among patients with acute traumatic spinal cord injury (TSCI). MP therapy for patients with TSCI is controversial because of the current conflicting evidence documenting its benefits and risks. We conducted a retrospective cohort study from September 2007 to November 2014 of 311 patients with acute TSCI who were enrolled into a model systems database of a regional, level I trauma center. We linked outcomes and covariate data from the model systems database with MP exposure data from the electronic medical record. The primary outcomes were rehabilitation discharge in American Spinal Injury Association (ASIA) motor scores (sum of 10 key muscles bilaterally as per International Standards for Neurological Classification of Spinal Cord Injury, range, 0-100) and Functional Independence Measure (FIM) motor scores (range, 13-91). Secondary outcomes measured infection risk and gastrointestinal (GI) complications among MP recipients. For the primary outcomes, multivariable linear regression was used. There were 160 MP recipients and 151 nonrecipients. Adjusting for age, sex, weight, race, respective baseline motor score, surgical intervention, injury level, ASIA Impairment Scale (AIS) grade, education, and insurance status, there was no association with improvement in discharge ASIA motor function or FIM motor score among MP recipients: -0.34 (95% CI, -2.8, 2.1) and 0.75 (95% CI, -2.8, 4.3), respectively. Adjusting for age, sex, race, weight, injury level, and receipt of surgery, no association with increased risk of infection or GI complications was observed. This retrospective cohort study involving patients with acute TSCI observed no short-term improvements in motor function among MP recipients compared with nonrecipients. Our findings support current recommendations that MP use in this population should be limited.

Spinal cord injury rehabilitation in Riyadh, Saudi Arabia: time to rehabilitation admission, length of stay and functional independence.

(1) To describe functional status, length of stay (LOS) and time to rehabilitation admission trends. (2) To identify independent predictors of motor function following rehabilitation. Retrospective cohort study. Spinal injury rehabilitation unit at King Fahad Medical City, Riyadh, Saudi Arabia. From chart review of 312 traumatic and 106 nontraumatic adult patients with spinal cord injury (SCI) we extracted information on time from injury to rehabilitation admission, rehabilitation LOS, Functional Independence Measure (FIM) motor score (admission and discharge), American Spinal Injury Association Impairment Scale (AIS) grade and demographics. Hierarchical regression was employed to investigate variables associated with discharge FIM motor score for traumatic and nontraumatic SCI. Mean±s.d., median days from injury to rehabilitation admission were 377±855, 150 days for traumatic SCI and 288±403, 176 days for nontraumatic SCI. For individuals with traumatic SCI, after accounting for admission FIM motor score, tetraplegia and time from injury to rehabilitation admission had a significant but small negative association with discharge FIM motor score. For individuals with nontraumatic SCI, increasing age and higher AIS grade had a significant negative association with discharge FIM motor score. Shorter time from injury to rehabilitation admission may improve outcomes for those with traumatic SCI. As time spent in rehabilitation was shorter than in most other countries, a change in practice in this area may be warranted. Developing strategies to improve outcomes for older patients with nontraumatic SCI would also be beneficial.

Antispasmodic medications may be associated with reduced recovery during inpatient rehabilitation after traumatic spinal cord injury

Objective: To determine whether antispasmodic medications are associated with neurological and functional outcomes during the first year after traumatic spinal cord injury (SCI).Design/Methods: Retrospective analysis of prospectively collected data from six inpatient SCI rehabilitation centers. Baseline-adjusted outcomes at discharge and one-year follow-up were compared using analysis of covariance between patients who received antispasmodic medication on at least 5 days during inpatient rehabilitation and patients who did not.Outcome measures: Rasch-transformed motor subscore of the Functional Independence Measure (FIM); International Standards for Neurological Classification of Spinal Cord Injury motor scores, grade, and level.Results: Of 1,259 patients, 59.8%, 35.4%, and 4.8% were injured at the cervical, thoracic, and lumbosacral levels, respectively. 65.6% had motor complete injury. Rasch-transformed motor FIM score at admission averaged 23.3 (95% confidence interval (CI) 22.4–24.2). Total motor score averaged 39.2 (95% CI 37.8–40.6). 685 patients (54.4%) received one or more antispasmodic medications on at least 5 days. After controlling for demographic and injury variables at admission, Rasch-transformed motor FIM scores at discharge were significantly lower (P = 0.018) in patients receiving antispasmodic medications than in those who did not. This trend persisted in secondary analyses for cervical, thoracic, and lumbosacral subgroups. Multivariate regression showed that receiving antispasmodic medication significantly contributed to discharge motor FIM outcome. At one-year follow-up, no outcomes significantly differed between patients ON or OFF antispasmodics.Conclusions: Antispasmodic medications may be associated with decreased functional recovery at discharge from inpatient traumatic SCI rehabilitation. Randomized prospective studies are needed to directly evaluate the effects of antispasmodic medication on recovery.

Predicting Functional Independence Measure Scores During Rehabilitation with Wearable Inertial Sensors.

Evaluating patient progress and making discharge decisions regarding inpatient medical rehabilitation rely upon standard clinical assessments administered by trained clinicians. Wearable inertial sensors can offer more objective measures of patient movement and progress. We undertook a study to investigate the contribution of wearable sensor data to predict discharge functional independence measure (FIM) scores for 20 patients at an inpatient rehabilitation facility. The FIM utilizes a 7-point ordinal scale to measure patient independence while performing several activities of daily living, such as walking, grooming, and bathing. Wearable inertial sensor data were collected from ecological ambulatory tasks at two time points mid-stay during inpatient rehabilitation. Machine learning algorithms were trained with sensor-derived features and clinical information obtained from medical records at admission to the inpatient facility. While models trained only with clinical features predicted discharge scores well, we were able to achieve an even higher level of prediction accuracy when also including the wearable sensor-derived features. Correlations as high as 0.97 for leave-one-out cross validation predicting discharge FIM motor scores are reported.

Nighttime sleep is correlated with effectiveness of inpatient rehabilitation for hemiplegia patients after stroke

The purpose of the present study was to clarify the relationship between nighttime sleep and effectiveness of inpatient rehabilitation for stroke patients during convalescence. Fifteen patients participated. Nighttime sleep was measured by actigraph recording. Actual sleep time was significantly correlated with discharge motor Functional Independence Measure (FIM) score and FIM efficiency. Wake after sleep onset (WASO) time was significantly correlated with length of stay. Sleep efficiency was significantly correlated with discharge motor FIM score. Our study showed a relationship between nighttime sleep and effectiveness of inpatient rehabilitation during convalescence after stroke.

Perioperative urinary retention, short‐term functional outcome and mortality rates of elderly hip fracture patients

Perioperative urinary retention (POUR) is common among hip fracture patients. The aim of the present study was to compare the prevalence, risk factors, functional outcomes and survival rates of patients with and without POUR. This was a retrospective chart review study that was carried out in an orthogeriatric hip fracture unit. A total of 639 consecutive hip fracture patients who had hip surgery followed by a standard rehabilitation course participated in the study. Post-void residual volume (PVRV), Functional Independence Measure (FIM) scores (total and motor FIM, FIM gain) and mortality rates (90 and 365 days, end of follow up) were measured. A total of 328 patients (51.3%) suffered from POUR. Diabetes (OR 1.55, 95% CI 1.04-2.31), urinary infection (OR 3.25, 95% CI 2.16-4.90) and delirium (OR 1.66. 95% CI 1.09-2.52) emerged as the best predictors for POUR. Functional gains were slightly better in patients without POUR (P = 0.037 and P = 0.023, for discharge motor and total FIM gain, respectively). There were no differences in FIM gains at discharge in male patients, whether with or without POUR. However, female patients without POUR showed significantly better motor and total FIM gains on discharge (P = 0.003 and P = 0.003, respectively), compared with females with POUR. In multiple linear regression analyses, POUR in female (but not male) patients was predictive for adverse motor FIM gain (beta = -0.089, P = 0.046). In Cox regression analysis, urinary retention was not associated with mortality rates. POUR is highly prevalent in elderly hip fracture patients. It adversely affects the functional outcome of female patients, but is not associated with increased mortality rates.

Does Early Functional Outcome Predict 1-year Mortality in Elderly Patients With Hip Fracture?

Hip fractures in the elderly are followed by considerable risk of functional decline and mortality. The purposes of this study were to (1) explore predictive factors of functional level at discharge, (2) evaluate 1-year mortality after hip fracture compared with that of the general population, and (3) evaluate the affect of early functional outcome on 1-year mortality in patients operated on for hip fractures. A total of 228 consecutive patients (average age, 77.6 ± 7.4 years) with hip fractures who met the inclusion criteria were enrolled in an open, prospective, observational cohort study. Functional level at discharge was measured with the motor Functional Independence Measure (FIM) score, which is the most widely accepted functional assessment measure in use in the rehabilitation community. Mortality rates in the study population were calculated in absolute numbers and as the standardized mortality ratio. Multivariate regression analysis was used to explore predictive factors for motor FIM score at discharge and for 1-year mortality adjusted for important baseline variables. Age, health status, cognitive level, preinjury functional level, and pressure sores after hip fracture surgery were independently related to lower discharge motor FIM scores. At 1-year followup, 57 patients (25%; 43 women and 14 men) had died. The 1-year hip fracture mortality rate compared with that of the general population was 31% in our population versus 7% for men and 23% in our population versus 5% for women 65 years or older. The 1-year standardized mortality rate was 341.3 (95% CI, 162.5-520.1) for men and 301.6 (95% CI, 212.4-391.8) for women, respectively. The all-cause mortality rate observed in this group was higher in all age groups and in both sexes when compared with the all-cause age-adjusted mortality of the general population. Motor FIM score at discharge was the only independent predictor of 1-year mortality after hip fracture. Functional level at discharge is the main determinant of long-term mortality in patients with hip fracture. Motor FIM score at discharge is a reliable predictor of mortality and can be recommended for clinical use.

Rehabilitation Outcomes of Persons with Complete Paraplegia at a Private Rehabilitation Hospital

In order to overcome activity limitations, prevent secondarycomplications and early death and achieve community integration comprehensiverehabilitation post spinal cord injury (SCI), is essential. The aim ofthe study was to evaluate outcomes of patients with complete paraplegia whoreceived rehabilitation at a private rehabilitation hospital.A quantitative, descriptive methodology was implemented. All patientswith complete, traumatic, thoracic spinal cord injuries, admitted to the studyhospital in the study period, were consecutively sampled. Thirty five patientswere identified of whom16 adhered to the inclusion criteria. The FunctionalIndependence Measure (FIM ) and Needs Assessment Checklist (NAC) wereused as measuring instruments.The mean length of stay was 95 days. Discharge FIM motor scores ranged from 72 to 83 with a mean of 79.3. Themean gain in FIM motor score was 55 and varied from 45 to 61. Discharge NAC scores ranged from 264 to 340 with amean of 300 out of a possible 347. A correlation between length of stay and discharge FIM scores (p = 0.05) were found.Both NAC and FIM scores indicated high levels of physical independence. According to NAC scores patients wereeducated on the prevention of secondary complications and received psychological counselling. Discharge planningand community integration scored lower with means of 80% and 61% respectively. Community based completionof rehabilitation programmes, the incorporation of the NAC, or another participation outcome measure and implementationof on-going programme monitoring and assessment strategies is recommended.

Factors Associated With Home Discharge After Rehabilitation Among Male Veterans With Lower Extremity Amputation

To determine the patient-, treatment-, and facility-level factors that are associated with home discharge among male veterans with lower extremity amputation who received inpatient rehabilitation after surgery. A retrospective observational study. Veterans Affairs Medical Centers. This study included 1480 male veterans. Generalized estimating equation models were used to model the likelihood of home discharge to account for within-facility clustering. We reported odds ratios (ORs) and 95% confidence intervals (95% CIs). Discharged to home. There were a total of 1163 (78.6%) veterans who were discharged home after the surgical hospitalization, compared with other locations. Patients who were married were more likely to be discharged home compared with patients who were not married (OR = 1.51, 95% CI = 1.14-1.99, P < .01). Compared with being transferred from another hospital or extended care, patients who were admitted from home were far more likely to be discharged home (OR = 8.43, 95% CI = 5.48-12.96, P < .0001). Patients with evidence of local significant infection were less likely to be discharged home (OR = 0.57, 95% CI = 0.39-0.83, P < .01), as were patients with evidence of congestive heart failure (OR = 0.62, 95% CI = 0.45-0.85, P < .01) or depression (OR = 0.63, 95% CI = 0.40-0.98, P = .04). Veterans with greater discharge motor Functional Independence Measure scores were more likely to be discharged home (OR = 1.23, 95% CI = 1.16-1.31 per 10-point increase in discharge Functional Independence Measure motor score, P < .0001). Conversely, patients undergoing procedures for ongoing active cardiac pathology were less likely to be discharged home (OR = 0.55, 95% CI = 0.37-0.81, P < .01). This study showed a strong association between the sociological factors of marital status and living location before hospitalization and home discharge. The significance of discharge functional status highlights the importance of addressing the expected care burden once patients are discharged home.