Discharge Functional Independence Measure Research Articles

Predicting Participation Level Six Month Following Inpatient Stroke Rehabilitation

Objective(s): To explore how well discharge Functional Independence Measures motor (FIM-M) and cognitive (FIM-C) and Activity MeasureePost Acute Care Basic Mobility (AMPAC-BM), Daily Activities (AMPAC-DA) and Applied Cognition (AMPAC-AC) sub-scores predict outcome 6 months following inpatient stroke rehabilitation (ISR). Design: Retrospective analyses of clinical database. Setting: Rehabilitation unit within an academic medical center. Participants: Sixty-two of 165 (38%) ISR patients with follow-up (no differences based on follow-up) having a mean ageZ68.1(14.3) y, NIHSSZ8.1(6.4) and rehabilitation length of stayZ15.8(7.9) d. Seventy four percent had an ischemic stroke and it was a recurrent stroke ion 23%. Interventions: ISR. Main Outcome Measure(s): Stroke Impact Scale-Participation (SIS-P) and recovery scale (SIS-RS) scores 6m post-discharge, controlling for age and NIHSS. Results: Mean discharge AMPAC-BM, AMPAC-DA and AMPAC-AC subscores were 51.9(12.2), 44.6(9.0) and 41.4(10.3), respectively. Mean FIM-M and FIM-C subscores were 55.8(16.0) and 28.7(6.4) and mean SIS-P and SIS-RS scores were 56.0(25.1) and 62.9(24.9), respectively. Spearman’s rho between FIM subscores and 6m SIS scores ranged from 0.327 to 0.565 (all p<.01). Correlation coefficients for AMPAC-BM and AMPAC-DA subscores ranged from 0.435 to 0.606 (all p<.001) while coefficients between AMPAC-AC and SIS-P and SIS-RS were 0.239 (pZ.06) and 0.301 (p<.02), respectively. Separate ordinal regressions were performed for FIM and AMPAC predicting 6m SIS-P. Both were significant (p<.001) with a Nagelkerke pseudo R of 0.33 and 0.34, respectively. Similarly, regressions for FIM and AMPAC predicting 6m SIS-RS were significant (p<.001), both R Z 0.36. Conclusions: FIM and AMPAC subscales assessed at discharge from ISR hold weak to moderate univariate correlations with participation 6m after ISR. Even though much faster and easier to administer, the AMPAC appears identical with the FIM in its ability to predict participation levels 6m outcomes after ISR.

Poster 118 Prolonged Treatment of Paroxysmal Sympathetic Hyperactivity Limits Functional Gains: A Case Report

PM&RVolume 7, Issue 9S p. S130-S130 Friday Poster Presentation Poster 118 Prolonged Treatment of Paroxysmal Sympathetic Hyperactivity Limits Functional Gains: A Case Report Tomasz Chec BS, Tomasz Chec BS Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United StatesSearch for more papers by this authorZiva Petrin MD, Ziva Petrin MD Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United StatesSearch for more papers by this authorMatthew B. Sonagere DO, Matthew B. Sonagere DO Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United StatesSearch for more papers by this authorKristofer J. Feeko DO, Kristofer J. Feeko DO Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United StatesSearch for more papers by this author Tomasz Chec BS, Tomasz Chec BS Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United StatesSearch for more papers by this authorZiva Petrin MD, Ziva Petrin MD Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United StatesSearch for more papers by this authorMatthew B. Sonagere DO, Matthew B. Sonagere DO Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United StatesSearch for more papers by this authorKristofer J. Feeko DO, Kristofer J. Feeko DO Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United StatesSearch for more papers by this author First published: 08 September 2015 https://doi.org/10.1016/j.pmrj.2015.06.157Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume7, Issue9SSeptember 2015Pages S130-S130 RelatedInformation

Prevalence of delirium in geriatric rehabilitation in Israel and its influence on rehabilitation outcomes in patients with hip fractures.

The aim of this study was to assess the prevalence of delirium among geriatric patients with hip fractures and to examine the influence of delirium on rehabilitation outcomes. A prospective study was carried out among 95 hip fracture patients admitted to an orthopedic geriatric rehabilitation ward. At admission, the following data were gathered: sociodemographic data, prefracture Activities of Daily Living (ADL), Functional Independence Measure (FIM), Mini-Mental State Examination, comorbidities, and medication. Delirium was assessed using the Confusion Assessment Method. The severity of delirium among patients with a positive score on the Confusion Assessment Method was assessed using the Delirium Rating Scale-Revised-98 (DRS-R-98). Rehabilitation outcomes were evaluated by comparing FIM and ADL at admission and at discharge. The research findings showed that the prevalence of delirium among patients was 30%. In addition, a significant difference was found between patients who developed delirium and those who did not. Patients who developed delirium were mostly Jewish, with lower ADL levels at admission, more significant renal failure, lower levels of FIM, and lower Mini-Mental State Examination scores. Furthermore, FIM at discharge and delta FIM were lower among patients who developed delirium than among those who did not. The research conclusions indicated that the functional recovery of patients with delirium is slower. Therefore, it is important to adjust the therapeutic approach to these patients.

Early Predictors of Functional Outcome After Trauma

BackgroundDespite the availability of routinely collected trauma data, researchers who investigate rehabilitation outcomes, functional evaluation, and comparative effectiveness have not incorporated this potentially clinically meaningful information in their modeling as predictors or adjustors. ObjectiveThe purpose of this study was to identify variables from the scene of a traumatic accident and from the emergency department that can be used in assessing functional outcomes of persons who survive trauma. DesignProspective study. SettingLevel I academic trauma center. PatientsPersons who sustained and survived a spinal cord injury, a traumatic brain injury, or polytrauma. MethodsTrauma and rehabilitation registries were merged by matching the 2 data files for each patient by medical record number, and the files were verified by gender and date of birth. Analysis consisted of standard descriptive statistics (frequencies and averages). A 2-staged linear regression was used to investigate the relationship between the demographic, scene, and ED data elements and discharge functional outcome. Main Outcome MeasureDischarge Functional Independence Measure (FIM). ResultsOlder patients with government insurance had poorer discharge FIM scores compared with patients who had commercial insurance. The Injury Severity Score (ISS) and Glasgow Coma Scale score from the scene of the accident were significantly associated with the discharge FIM. Persons with a lower ISS had significantly higher discharge FIM scores than did persons with a higher ISS (P < .001). For every unit change in Glasgow Coma Scale score, FIM scores increased by 0.488 points (P = .030). ConclusionThe use of routinely collected trauma data elements can be useful in assessing the continuum of patient care. Incorporating trauma data into research has the potential to improve our models of functional outcomes and provide meaningful risk adjustors when comparing and evaluating rehabilitation care systems and treatments.

Acute rehospitalisation during the first 3 months of in-patient rehabilitation for traumatic brain injury.

Unplanned re-admission to acute care hospitals during in-patient rehabilitation causes disruption to the rehabilitation program and increases the cost of health care. The aims of the present study were to identify the frequency, reasons and duration of disruption to rehabilitation because of acute re-admissions during the first 3 months of in-patient rehabilitation for traumatic brain injury (TBI) and to investigate the correlation between the duration of acute rehospitalisation and the discharge functional independence measure (FIM) score. A retrospective study was conducted on patients admitted for in-patient rehabilitation following TBI to a rehabilitation hospital in Auckland, New Zealand, between January 2009 and August 2013. Data on duration and reasons for acute rehospitalisation, as well as admission and discharge FIM scores, were obtained from electronic patient records. Pearson correlation was used to evaluate the relationship between the duration of acute rehospitalisation and the discharge FIM score. Of the 628 patients admitted for brain injury rehabilitation, 71 (11.3%) required acute rehospitalisation within the first 3 months. The main reasons for acute rehospitalisation were preventable medical causes (43.8%), including urinary tract infections, respiratory tract infections and coronary artery disease. Of the acute re-admissions, 76.6% were within the first month of admission to the rehabilitation centre and 46.6% needed in-patient treatment in the acute care hospital for > 5 days. There was a moderately strong negative correlation between the duration of stay in the acute care hospital and the discharge FIM score (r = - 0.412; P = 0.0005). A significant number of patients admitted for in-patient rehabilitation following TBI require acute rehospitalisation due to preventable medical causes. Because the duration of acute rehospitalisation has a negative impact on rehabilitation functional gain, preventive measures and surveillance need to be further investigated and optimised.

Cancer Rehabilitation: Do Functional Gains Relate to 60 Percent Rule Classification or to the Presence of Metastasis?

BackgroundLiterature supporting the benefits of inpatient rehabilitation for cancer patients is increasing. Many cancer patients, however, do not qualify for inclusion in the Centers for Medicare and Medicaid 60% rule and consequently may not receive services. The benefit of inpatient rehabilitation in this specific cancer group has not been investigated and is the focus of this study. ObjectiveTo investigate functional gains made during inpatient rehabilitation by patients impaired by cancer, and to compare the functional gains made during inpatient rehabilitation for patients impaired by cancer in relation to the presence or absence of metastatic disease and compliance or noncompliance with the Medicare 60% rule. SettingFreestanding university-affiliated rehabilitation hospital. ParticipantsA total of 176 adult patients admitted for inpatient rehabilitation due to cancer. MethodsRetrospective chart review of patients admitted for inpatient rehabilitation with deficits identified related to cancer. Main Outcome MeasuresDemographic data including cancer type, presence of metastasis, age, gender, marital status, ethnicity, length of stay (LOS), discharge destination, and transfer to acute care. Functional status including admission and discharge Functional Independence Measure Score (FIM), total, motor, and cognitive FIM gains, total, motor, and cognitive FIM efficiency for the study sample, for patients with and without a diagnosis compliant with the 60% rule and for patients with and without metastatic disease. ResultsIn all, 176 cases met inclusion criteria. An admission coded diagnosis that was compliant with the 60% rule was present in 97 cases (55.1%). In 153 cases, the presence or absence of metastatic disease was known. Metastatic disease was present in 69 cases (45%). All groups (total sample, metastatic versus nonmetastatic, compliant versus noncompliant) made significant functional gains. Patients with a diagnosis noncompliant with the 60% rule had higher admission total FIM (P = .001), discharge total FIM (P = .014), admission motor FIM (P = .005), admission cognitive FIM (P = .008), and discharge cognitive FIM (P < .001) scores than those with a compliant diagnosis. Patients with metastatic disease had higher admission total FIM (P = .026) and admission (P = .001) and discharge (P = .02) cognitive FIM scores than patients with nonmetastatic disease. There were no significant differences between groups regarding total, motor, or cognitive FIM gains or total motor or cognitive FIM efficiencies. Differences in age, length of stay, and admission motor and discharge FIM scores between groups were related to cancer types and source of impairment. ConclusionPatients with functional limitations resulting from cancer or its treatment made significant functional gains in inpatient rehabilitation. There were no significant differences in functional gains made by those with or without metastatic disease or those compliant versus noncompliant with the 60% rule. The presence of metastatic disease or a diagnosis not compliant with the 60% rule does not preclude cancer patients from making significant functional gains.

Effect of Body Mass Index on Inpatient Rehabilitation Outcomes After Single-level Discectomy

Objectives: Disk herniation is a common health problem leading to work disability. Discectomy is the generally used treatment method for cases not responding to conservative care. Rehabilitation improves functional outcomes, but there is little data on outcomes of patients undergoing inpatient rehabilitation after discectomy in Iran. We examined the influence of obesity on inpatient rehabilitation outcomes following single-level discectomy. Methods: This was a prospective study evaluating 143 patients admitted to rehabilitation facility after discectomy between January 2009 and September 2011. Patients were divided into 3 groups based on body mass index: nonobese (<25 kg/m2), overweight (25 to 29.9 kg/m2), and moderately obese (30 to 40 kg/m2). Functional independence measure (FIM) scores, length of stay (LOS), FIM efficiency, as well as standing and walking days for each patient were assessed. FIM was also assessed after 1 month follow-up. Results: FIM at follow-up increased significantly in comparison with admission values in all patients (P<0.001). There was no difference between groups in admission FIM, discharge FIM, FIM change, FIM efficiency, and FIM at follow-up. There was no difference between groups considering the outcomes of standing and walking. Conclusions: Body mass index did not affect FIM after single-level discectomy and does not influence the inpatient rehabilitation outcomes.

Effects of ankle-foot orthoses on functional recovery after stroke: a propensity score analysis based on Japan rehabilitation database.

ObjectivesThe purpose of the present study was to investigate potential effects of ankle–foot orthoses (AFOs) on the functional recovery of post-acute stroke patients following rehabilitation.Subjects and MethodsThis study is a retrospective cohort study. Participants were in-hospital stroke patients registered in the Japan Rehabilitation Database between 2005 and 2012. A total of 1862 patients were eligible after applying exclusion criteria. Propensity score analysis was applied to adjust for potential bias and to create two comparable groups. An additional subset analysis focused on Functional Independence Measure (FIM) scores on admission.ResultsIn this sample, 30.7% of 1863 eligible patients were prescribed AFOs. Propensity score matched analysis showed that patients with AFOs had significantly higher scores than those without them for discharge FIM (mean: 91.3 vs 85.8; p=0.02), FIM gain (mean: 28.9 vs 23.5; p<0.001), and FIM efficiency (mean: 0.27 vs 0.22; p<0.001). Inverse probability weighting analysis showed similar results. In the subset analysis, patients with AFOs had significantly higher discharge FIM compared with those without them in the low admission FIM subgroup only. In addition, patients with AFOs performed independent exercise more than those without them (p<0.001).ConclusionsThese data suggest that stroke survivors may have better functional recovery if they are prescribed an AFO than if they are not prescribed an AFO. The use of AFOs is considered to be a feasible option to improve functional recovery of stroke rehabilitation patients.

Abstract T P127: Look Past the NIHSS! Rehabilitation Metrics that Predict Home Discharge in Ischemic Stroke Patients

Introduction: The goals of stroke rehabilitation are to restore functional ability and to return patients' home with a good quality of life. There is a paucity of data on stroke rehabilitation tools that both track improvements and help predict the likelihood of home discharge. Hypothesis: Improvement in functional independence measure (FIM) score increases home discharge rates, decreases acute care readmissions and decreases placement in skilled nursing facilities (SNF). Advanced age and infections such as symptomatic UTI (SUTI) negate FIM score improvement. Methods: We merged the prospectively collected Stroke and Neurorehabilitation Registries at our comprehensive stroke center, identifying ischemic stroke patients admitted between January 2011 and November 2013 (n=367). Demographics, rehabilitation metrics and NIHSS were collected. Age, SUTI, discharge FIM and rehabilitation length of stay (LOS Rehab) were included in the multivariate regression. Results: Of 367 ischemic stroke patients, 273 went home, 47 to a SNF, 25 to acute care and 22 to another facility (i.e.,assisted living, board and care). All patients tolerated 3 hours of daily therapy (PT, OT, SLP). Despite median NIHSS values of 9 in both groups (P=0.356), patients with SUTI had lower FIM scores on admission (49.2 ± 13.9 vs. 56.8±15.2; P&lt;0.0001) and discharge (68.5 ± 16.9 vs. 76.3 ± 17.0; P&lt;0.0001). For a one year age increase, there was a 5% increase in SNF admit (OR 1.05, 95%CI 1.02-1.08; P&lt;0.001) compared to home. For a one unit increase in FIM, there was a 4% decrease in another facility admit (OR 0.96, 95% CI 0.93 to 0.99; P&lt;0.01), a 6% decrease in SNF admit (OR 0.94, 95%CI 0.92-0.96; P&lt;0.001) and a 10% decrease in acute care readmit (OR 0.90, 95% CI 0.88-0.94; P&lt;0.0001) compared to home. For a one day increase in LOS Rehab, there was a 19% decrease in acute care readmit (OR 0.81, 95% CI 0.73-0.89; P&lt;0.0001) compared to home, and a 7% increase in home discharge compared to another facility (OR 1.07, 95% CI 1.02 to 1.12; P&lt;0.001). Conclusions: Improved FIM score and increased LOS Rehab were the primary criteria for home discharge after stroke rehabilitation. Advanced age increased the likelihood of SNF placement. SUTI impacted rehabilitation progress, but did not affect discharge to home.

Inpatient rehabilitation outcomes in patients with malignant spinal cord compression compared to other non-traumatic spinal cord injury: A population based study

ObjectiveTo compare and describe demographic characteristics, clinical, and survival outcomes in patients admitted for inpatient rehabilitation following malignant spinal cord compression (MSCC) or other causes of non-traumatic spinal cord injury (NT-SCI).DesignA retrospective cohort design was employed, using data retrieved from administrative databases.SettingRehabilitation facilities or designated rehabilitation beds in Ontario, Canada, from April 2007 to March 2011.ParticipantsPatients with incident diagnoses of MSCC (N = 143) or NT-SCI (N = 1,274) admitted for inpatient rehabilitation.Outcome measuresDemographic, impairment, functional outcome (as defined by the Functional Independence Measure (FIM)), discharge, healthcare utilization, survival, and tumor characteristics.ResultsThere was a significant improvement in the FIM from admission to discharge (mean change 20.1 ± 14.3, <0.001) in the MSCC cohort. NT-SCI patients demonstrated a higher FIM efficiency (1.2 ± 1.7 vs. 0.8 ± 0.8, <0.001) and higher total (24.0 ± 14.4 vs. 20.1 ± 14.3, <0.001) FIM gains relative to MSCC cases. However, there were no differences between the MSCC and NT-SCI cohorts in length of stay (34.6 ± 30.3 vs. 37.5 ± 35.2, P = 0.8) or discharge FIM (100.7 ± 19.6 vs. 103.3 ± 18.1, P = 0.1). Three-month, 1-year, and 3-year survival rates in the MSCC and NT-SCI cohorts were 76.2% vs. 97.6%, 46.2% vs. 93.7%, and 27.3% vs. 86.7%, respectively. The majority (65.0%) of patients with MSCC was discharged home and met their rehabilitation goals (75.5%) at comparable rates to patients with NT-SCI (69.7 and 81.3%).ConclusionDespite compromised survival, patients with MSCC make clinically significant functional gains and exhibit favorable discharge outcomes following inpatient rehabilitation. Current administrative data suggests the design and scope of inpatient rehabilitation services should reflect the unique survival-related prognostic factors in patients with MSCC.

Acute Intravenous Tissue Plasminogen Activator Therapy does not Impact Community Discharge after Inpatient Rehabilitation

Discharge status and acute re-hospitalization are used as indicators of stroke severity and recovery. Intravenous t-PA (tissue plasminogen activator) is one of two treatments shown to have a positive impact. Stroke rehabilitation patients are an important population who will end up integrated back into the community, institutionalized or hospitalized due to late stroke complications. We sought to determine factors contributing to post rehabilitation discharge and acute re-hospitalization, in particular, the impact of t-PA therapy. Retrospective analysis of census data from ischemic stroke patients on the UTHealth Stroke/Neurorehabilitation Services at Memorial Hermann Hospital - Texas Medical Center between Jan 2011 and Nov 2013, discharged to the Community, SNF (Skilled Nursing Facility) or AC (Acute Care). Demographics and NIHSS (National Institutes of Health Stroke Scale) were collected. Discharge FIM (Functional Independence Measure) was the reference standard. Genitourinary infections were a negative mediator in the multivariate regression. Of 346 patients, 274 returned to the community, 47 to SNF, and 25 to AC. Median NIHSS values were 8 in the community group, 11 in SNF and 9.5 in AC. 31.8% of patients received IV t-PA in the community group, 23.4% in SNF and 24% in AC. There were no statistically differences in community discharge rates. One day increase in rehabilitation hospitalization correlated with 19% decreased odds of AC readmission (OR 0.81; P=0.001). One unit discharge FIM increase correlated with 13% decreased odds of AC readmission (OR 0.87; P=0.003). One year age increase correlated with 4% increased odds of SNF admission (OR 1.04; P=0.02). Intense rehabilitation evidenced by FIM improvement and length of stay, impacts community discharge in mild to moderate stroke patients. t-PA had no effect. This study is limited by sample size, retrospective design and undetermined psychosocial factors.

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.

Specificity of Early Impairment Assessment in Predicting Post-Stroke Functional Independence Measure Discharge Factor Scores

Specificity of Early Impairment Assessment in Predicting Post-Stroke Functional Independence Measure Discharge Factor Scores

The Effect of Age on Rehabilitation Outcome After Traumatic Brain Injury Assessed by the Functional Independence Measure (FIM)

Background. The impact of age on rehabilitation outcome after traumatic brain injury (TBI) as measured by changes in the Functional Independence Measure (FIM) has been addressed in several seemingly conflicting reports. Differences may be explained by different study populations and different ways of analyzing data. Objective. To investigate the role of data analysis in the interpretation of the age effect on rehabilitation outcome after TBI by comparing classical analyses of the total FIM score with a new item-wise analysis that unfolds the comprehensive amount of information contained in the FIM measurement otherwise concealed by the total score. Methods. We analyzed admission and discharge FIM data from 411 consecutive TBI patients admitted to inpatient rehabilitation during 1998-2011 by both methods. Results. The classical analysis indicated similar rehabilitation outcome in the 18 to 39, 40 to 64, and 65+ years age groups, which could be explained by selection of strong elderly patients and/or methodological problems with classical data analyses, whereas the item-wise analysis demonstrated profound age effect on most FIM items throughout the age interval covered. Conclusions. The item-wise analysis meets requirements of proper data analysis, avoids concealing diversity in rehabilitation outcome behind the total FIM score, and provides a flexible, informative, and clinically relevant data analysis.

Impact of Contact Isolation on FIM Score Change, FIM Efficiency Score, and Length of Stay in Patients in Acute Inpatient Rehabilitation Facility

To explore the impact of contact isolation on the change in functional independence measure (FIM) score, FIM efficiency score, and length of stay. Retrospective matched case control study. Tertiary care hospital (academic medical center). Persons admitted to an acute inpatient rehabilitation facility at a tertiary care hospital from July 2009 through December 2010. Retrospective chart review by obtaining patient data regarding contact isolation status, patient demographics, and rehabilitation diagnosis. Two hundred charts were reviewed, which resulted in identification of 20 patients in contact isolation. These patients subsequently were matched to patients not in contact isolation based on age, rehabilitation diagnosis, and type of insurance. Admission and discharge FIM scores were obtained for these 40 study subjects (20 cases and 20 matched controls). The primary study outcome measurements were change in FIM score (discharge FIM score minus admission FIM score), FIM efficiency score (change in FIM score divided by length of stay), and length of stay. Compared with patients not in contact isolation, patients in contact isolation showed no statistically significant difference in FIM score change, a lower FIM efficiency score (P= .010), and a 39% longer length of stay (P= .017) when adjusting for confounders. This study identifies contact isolation as a likely variable that is associated with increased length of stay and decreased FIM efficiency score in patients in an acute inpatient rehabilitation facility. Further study is needed to identify the role or mechanisms by which contact isolation is involved in these adverse effects so that interventions may be developed to counteract them.

Outcomes of Acute Inpatient Rehabilitation of Patients With Left Ventricular Assist Devices

To investigate the benefits of comprehensive inpatient rehabilitation for patients after left ventricular assist device (LVAD) implantation. A retrospective cohort study. An urban academic inpatient rehabilitation hospital. This study included 58 patients admitted to inpatient rehabilitation after LVAD implantation between 2009 and 2012. Chart review of demographic, clinical, and functional data for patients admitted to inpatient rehabilitation after LVAD implantation was performed. Length of stay, admission and discharge Functional Independence Measure (FIM), and FIM efficiency. The study included 47 male and 11 female patients ages 21.8-84.1 years (mean [standard deviation {SD}], 64.2 ± 11.2 years). The mean (SD) length of time between LVAD implantation and admission to rehabilitation was 27.0 ± 15.3 days. Twenty-one patients (36%) required transfer to an acute care hospital. Ten patients returned after transfer and completed inpatient rehabilitation. For the 47 total patients who completed inpatient rehabilitation, the mean (SD) length of stay was 20.3 ± 10.8 days (range, 7-50 days). Mean (SD) admission and discharge FIM scores were 68.4 ± 13.6 and 91.7 ± 11.8, respectively, with a mean (SD) difference between admission and discharge FIM scores of 23.4 ± 11.2. The mean (SD) FIM efficiency was 1.33 ± 0.65. Complications during rehabilitation included anemia that required transfusion, respiratory distress, epistaxis, gout flare, automated implantable cardioverter defibrillator firing, and gastrointestinal bleeding. Patients with LVADs demonstrate functional gains in inpatient rehabilitation. However, there is a high incidence of complications in this population, which often requires transfer to an acute care setting.

Mood after Moderate and Severe Traumatic Brain Injury: A Prospective Cohort Study

ObjectiveTo evaluate the course of mood and identify its determinants up to 3 years after moderate to severe traumatic brain injury (TBI).DesignProspective cohort study.PatientsPatients hospitalised with moderate to severe TBI, who survived until hospital discharge.MethodsAt 3, 6, 12, 18, 24, and 36 months post-injury, mood was assessed with the Wimbledon Self-Report Scale (WSRS) in the home environment. Motor and cognitive outcome were assessed with the Functional Independence Measure (FIM), and the Functional Assessment Measure (FAM), respectively. Repeated measurements analysis was performed to determine the course of mood over time and its determinants.ResultsA total of 98 patients (72% men), aged 33 (SD 12.9) years, 78% with severe TBI, was included. Mood did not change until 18 months post TBI, after which it significantly improved (p = 0.016). The FIM score significantly improved up to 18 months post-TBI (p = 0.012) and the FAM score up to 12 months post-TBI (p = 0.000), after which both remained stable. In univariable analyses, time post TBI (β = −0.04, p = 0.008), initial discharge destination (β = 2.13, p = 0.010), FIM (β = −0.22, p<0.001) and FAM (β = −0.29, p<0.001) were significant predictors of mood. In a multivariable mixed model, time post TBI, FAM score, and discharge destination were the strongest predictors of mood. Higher FAM scores were related to better mood scores (β = −0.28, p<0.001). Patients initially discharged home tended to have better mood scores over time than patients first treated in inpatient rehabilitation centers or nursing homes (β = 1.27; p = 0.071).ConclusionMood starts to improve 18 months after TBI when motor and cognitive outcome have stabilized. Time post TBI, cognitive outcome and initial discharge destination are the strongest predictors of mood up to 3 years after TBI. These data suggest that mood scores of patients with moderate and severe TBI should be frequently monitored, especially in rehabilitation centers and nursing homes.

Effects of testosterone levels on functional recovery with rehabilitation in stroke patients.

The effects of testosterone on functional recovery in stroke patients have not previously been studied. The purpose of the study was to determine the effects of pre-rehabilitation serum testosterone levels on functional recovery in male stroke patients. In total, 111 male stroke patients admitted to our department were enrolled in the study (age: 74 ± 10 years, days from stroke onset: 36 ± 14 days). Serum concentration of free testosterone (Free-T) was measured upon admission. Patients were also evaluated using the Functional Independence Measure (FIM) at admission and discharge. The main outcome variable was FIM at discharge. Correlations between Free-T and FIM were evaluated using Spearman's rank-order correlation coefficients. We performed multivariate linear regression analysis to assess the effects of testosterone on functional outcome with adjustment for patient background variables. In addition, we added a subgroup analysis based on age. The average Free-T serum concentration was 4.7 ± 1.7 pg/ml. There was a significant positive correlation between Free-T and discharge FIM. The multivariate linear regression model showed that Free-T concentration was significantly associated with FIM at discharge (β = 0.09; P = 0.01). In the subgroup analysis, Free-T had significant association with discharge FIM only in patients under 76 years old (β = 0.24; P < 0.001). Our data suggest that serum Free-T levels have a positive effect for discharge FIM in male stroke patients.

Formula for predicting FIM for stroke patients at discharge from an acute ward or convalescent rehabilitation ward

Jeong S, Inoue Y, Kondo K, Matsumoto D, Shiraishi N. Formula for predicting FIM for stroke patients at discharge from an acute ward or convalescent rehabilitation ward. Jpn J Compr Rehabil Sci 2014; 5: 19-25. Objective: To develop formulas for predicting Functional Independence Measure (FIM) at the time of discharge from an acute or convalescent hospital ward using multicenter data. Methods: Data from 4,311 acute patients (22 hospitals) and 1,941 convalescent patients (24 hospitals) were divided into two groups (calculation group and verification group). Multiple regression analysis was performed to develop formulas for predicting discharge FIM and test their validity with data from the verification group. Results: The formula derived for predicting discharge FIM for acute patients was 85.04 + (-0.53 × age) + (12.06 × subarachnoid hemorrhage) + (-7.90 × complication present) + (-0.70 × number of days from onset of stroke until admission) + (1.24 × admission GCS) + (-1.08 × admission NIHSS) + (-4.15 × modified Rankin Scale score before stroke) + (0.30 × admission motor FIM) + (1.03 × admission cognitive FIM), with R2 = 0.78. The formula derived for predicting discharge FIM for convalescent patients was 33.04 + (-0.34 × age) + (-3.88 × complication present) + (-0.11 × number of days from onset of stroke until admission) + (2.44 × admission GCS) + (-1.68 × modified Rankin Scale score before stroke) + (0.53 × admission motor FIM) + (1.25 × admission cognitive FIM) (R2 = 0.66). Conclusion: Using a large multicenter database, we developed separate formulas for predicting FIM at discharge from an acute ward and from a convalescent ward with proven external validity.

Gender differences in functional outcome of elderly hip fracture patients

The purpose of the present study was to investigate whether gender might affect functional outcome of hip fractured patients undergoing in-hospital rehabilitation. This was a retrospective chart review study comprising of 759 consecutive elderly patients suffering traumatic hip fracture. All patients underwent a standard orthogeriatric care of surgical hip repair and post-acute rehabilitation care. Functional outcome (female vs male gender) was assessed by motor and total Functional Independence Measurement (FIM) scores on discharge. Data was analyzed by t-tests χ(2) -test and multiple linear regression analyses. A total of 574 (75.6%) out of all patients were females. There were no differences in admission FIM scores; however, male patients had a higher prevalence of comorbidities. FIM scores on discharge were higher in female patients (motor FIM, P=0.007; motor FIM gain, P=0.001; compared with males). A multiple linear regression analysis showed that female gender was independently associated with higher total FIM at discharge (β coefficient=0.056, P=0.008), higher motor FIM at discharge (β coefficient=0.071, P=0.007) and higher total FIM gain at discharge (β coefficient=0.11, P=0.008). The findings suggest that absolute discharge FIM scores of females are higher, compared with male patients. After adjusting for possible covariates, female gender still emerged as an independent predictor for higher FIM at discharge, suggesting that male gender should be considered as adversely affecting rehabilitation outcome of hip fracture male patients.