Motor FIM Scores Research Articles

Predicting the Trajectory of Participation After Traumatic Brain Injury: A Longitudinal Analysis.

To identify factors that predict trajectories of participation over the first 5 years after moderate to severe traumatic brain injury (TBI). TBI Model System Programs. Community-dwelling individuals with TBI, 16 years of age or older (n = 1947). Secondary analysis of a prospective, nonrandomly sampled, longitudinal data registry. Participation Assessment with Recombined Tools-Objective (PART-O). Age at injury and FIM Motor score predicted trajectory of participation over the first 5 years after moderate to severe TBI. Older age predicted generally worse participation overall as well as progressively worsening participation over time. Higher FIM Motor raised the predicted participation values, although it reduced the rate of improvement in participation scores over time. FIM Cognitive scores, race, depression, years of education, and living setting did not predict trajectory but did significantly influence participation consistently at all time points. The trajectories of participation over the first 5 years after TBI can be predicted by age at injury and FIM Motor scores. These findings may enhance the ability of rehabilitation professionals to identify individuals at risk for poor participation after TBI and develop targeted interventions for optimizing involvement in life activities.

The relationships between diffusion-tensor fractional anisotropy within cerebral peduncles and outcomes among patients with hemiparesis due to cerebral infarction

This study aimed to evaluate the relationships between diffusion-tensor fractional anisotropy (FA) within cerebral peduncles and outcomes among patients with hemiparesis due to cerebral infarction. Diffusion-tensor FA brain images were acquired 14–21 days after cerebral infarction. The ratio of FA values within the cerebral peduncles of the affected and unaffected hemispheres (rFA) was calculated for each patient ( n = 40) and assessed for correlation with Brunnstrom stage (BRS: 1–6), motor component of the functional independence measure (FIM-motor: 13–91), and the total length of stay (LOS) until discharge from rehabilitation ( P < 0.05). The rFA values were 0.582–1.037 (median: 0.881) and BRS scores were 1–6 (median: 5) for shoulder/elbow/forearm, 2–6 (median: 4.5) for hand, and 3–6 (median: 5) for lower extremities. FIM-motor scores were 51–91 (median, 79.5) and LOS ranged from 45 to 195 days (median: 130 days). Correlation coefficients were statistically significant between rFA and shoulder/elbow/forearm BRS (0.646), hand BRS (0.621), lower extremity BRS (0.637), FIM-motor (0.337), and LOS (−0.446). Diffusion-tensor FA values correlated with outcome measurements. This observation suggests that FA values within cerebral peduncles may subserve as an index for outcome prediction of patients after cerebral infarction.

The association of neurostimulant and antidepressant use with functional recovery during stroke rehabilitation

Different therapies may be required to support recovery after stroke. Although the primary method is intensive rehabilitation therapy, medications may augment therapist-led rehabilitation. The purpose of this study was to describe the differences in admission motor and cognitive function for stroke patients who received neurostimulants or antidepressants during acute rehabilitation compared with patients without each of these medications, and determine the association between medication use and functional recovery. We examined data for a patient cohort who received acute rehabilitation at three facilities in the United States from 2009–2014. From the electronic medical record we obtained sociodemographics, clinical characteristics, and whether neurostimulants or antidepressants were prescribed and administered within one week of rehabilitation admission. Functional status as the outcome was measured by the Functional Independence Measure (FIM - higher score is better function). After excluding patients using both medications, we modeled use of each medication for its association with FIM motor, cognitive and total scores at discharge from inpatient rehabilitation. Patients in this cohort were 66 years of age (median), 49% were female, and the acute rehabilitation length of stay was 16 days (median). Neurostimulants or antidepressants were not prescribed for 2159 patients whereas 526 (19.6%) received a neurostimulant and 700 (24.5%) an antidepressant. Motor and cognitive functions were significantly more impaired on admission for patients who received the neurostimulant or the antidepressant ( Fig. 1 ). After adjusting for sociodemographics and clinical characteristics, receipt of neurostimulants or antidepressants was not associated with discharge FIM motor and was associated with a lower discharge FIM-cognitive score ( P < 0.01). In this stroke rehabilitation patient cohort, medication therapy with neurostimulants and antidepressants was associated with more impaired cognitive function at discharge but no longer a difference in motor function. Further research is needed to determine how medications interact to assist in functional recovery.

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

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

Changes in Basic Movement Ability and Activities of Daily Living After Hip Fractures: Correlation Between Basic Movement Scale and Motor-Functional Independence Measure Scores.

The aim of this study was to examine the correlation between basic movement ability and activities of daily living (ADL) in elderly patients after hip fracture surgery and predict ADL outcomes from changes in basic movement ability. Fifty-four patients receiving rehabilitation after hip fracture surgery were collected prospectively. Ambulatory ability was evaluated using a Basic Movement Scale (BMS), and ADL was evaluated using the motor subscale of the Functional Independence Measure (motor-FIM). From the results of evaluating BMS and motor-FIM weekly, the important postoperative period to regain ADL was investigated. There was a close correlation between BMS and motor-FIM scores at each evaluation point (r = 0.971, P < 0.001) and a significant correlation between weekly BMS and motor-FIM gains (r = 0.741, P < 0.001). Cluster analysis of BMS scores from postoperative week (POW) 2 to 12 showed three patterns of change, with BMS scores at POW 2 reflecting the outcome. The very strong correlation between BMS and motor-FIM scores suggests that BMS is a favorable indicator of changes in ADL. Because basic movement ability at POW 2 also reflected the prognosis, constructive interventions should be implemented early to help patients ambulate and regain other basic movements by no later than POW 2.

Impact of orthotic therapy for improving activities of daily living in individuals with spinal cord injury: a retrospective cohort study.

Retrospective cohort study. To determine the impact of leg orthotic therapy for improving activities of daily living after spinal cord injury. Participating acute care and rehabilitation hospitals across Japan. We retrospectively identified individuals with spinal cord injury admitted to eight participating hospitals in 2015-2016 from the Japan Rehabilitation Database. Data for 293 individuals were analyzed. Propensity score analysis by inverse probability weighting (IPW) was applied to adjust for potential bias and create two comparable groups. Outcomes were compared between the leg orthotic group and the non-leg orthotic group, using IPW. The primary outcome was motor Functional Independence Measure® (FIM) effectiveness score and the secondary outcome was motor FIM score at discharge. FIM was measured on hospital admission and discharge. Leg orthoses were prescribed for 26% of the 293 individuals. Those prescribed leg orthoses had significantly higher motor FIM effectiveness scores than those who were not, before and after IPW (motor FIM effectiveness: 0.54 vs. 0.35, p < 0.01 and 0.45 vs. 0.36, p = 0.02). Discharge motor FIM was significantly higher in individuals who were prescribed leg orthoses than in those who were not, before and after IPW (discharge motor FIM: 64.5 vs. 52.2, p < 0.01 and 58.9 vs. 53.5, p = 0.02). Leg orthoses may improve activities of daily living in individuals with spinal cord injury after the acute phase.

Comparing Blunt and Penetrating Trauma in Spinal Cord Injury: Analysis of Long-Term Functional and Neurological Outcomes.

Background: Comparisons between patients with penetrating spinal cord injury (PSCI) and blunt spinal cord injury (BSCI) are scarce. Purpose: To describe baseline characteristics and neurological and functional outcomes for patients with BSCI and PSCI. Methods: Participants with BSCI (n = 5,316) and PSCI (n = 1,062) were extracted from the Spinal Cord Injury Model Systems database from January 1994 to January 2015. Participant injury and demographic characteristics were recorded. Outcomes were measured using the International Standards for Neurological Classification of Spinal Cord Injury and FIM motor scores. Outcomes for patients with American Spinal Injury Association Impairment Scale (AIS) complete injuries were analyzed separately from incomplete injuries at three time points: acute hospitalization, SCI rehabilitation, and 1-year follow-up. Results: Patients with PSCI compared to those with BSCI were more likely to present with complete injuries (56.8% vs 35.9%; p < .001) and were less likely to undergo spine surgery (19.6% vs 80.6%; p < .001). For incomplete injuries, no significant differences were observed between groups in FIM scores or AIS grade improvement at 1 year. For complete injuries, patients with BSCI showed an increased one-grade (15.7% vs 9.1%; p < .001) and three-grade (5.4% vs 1.9%; p = .014) AIS improvement at 1 year. Multivariate regression analysis demonstrated an independent effect for BSCI on AIS improvement at 1 year (odds ratio [OR], 1.74; 95% CI, 1.13-2.70; C-stat = 0.66). Conclusion: Patient with PSCI had more complete injuries and lower surgery rates. Patients with complete BSCI show greater AIS improvement at 1 year, and incomplete injuries show no difference in neurological improvement between groups. Overall, patients with PSCI demonstrated worse functional outcomes at 1 year.

Acute phase nutritional screening tool associated with functional outcomes of hip fracture patients: A longitudinal study to compare MNA-SF, MUST, NRS-2002 and GNRI

Several hip fracture patients are malnourished, but no study has attempted to determine the optimal nutritional screening tool for predicting functional outcomes. We investigated the association between each nutritional status assessed by four nutritional screening tools at admission and functional outcomes during the postoperative acute phase in hip fracture patients. The Mini Nutritional Assessment-Short Form (MNA-SF), the Malnutrition Universal Screening Tool (MUST), the Nutritional Risk Score 2002 (NRS-2002) and the Geriatric Nutritional Risk Index (GNRI) were assessed at admission before surgery. We evaluated the motor domain of the functional independence measure (motor-FIM) score at discharge, efficiency on the motor-FIM (change in the motor-FIM score after postoperative rehabilitation divided by postoperative length of hospital stay), and 10-m walking speed at postoperative 14 days as functional outcomes. Two hundred and five patients (mean patient age, 83.5±7.0 years; range, 65-100 years; 82% female) were included. The MNA-SF evaluation classified 56 patients as well-nourished, 103 as at risk of malnutrition and 46 as malnourished. The MUST evaluation classified 97 patients as low risk, 42 as medium risk and 66 as high risk. The NRS-2002 evaluation classified 89 patients as well-nourished, 69 as medium risk and 47 as nutritionally at risk. The GNRI evaluation classified 44 patients as no risk, 74 as low risk and 87 as a major risk. Multiple linear regression analysis revealed that MNA-SF had a significant association with discharge motor-FIM (well-nourished vs. at risk of malnutrition, standardised β=-0.06, p=0.04; vs. malnourished, standardised β=-0.32, p<0.01), efficiency on the motor-FIM (well-nourished vs. malnourished, standardised β=-0.19, p=0.02) and 10-m walking speed (well-nourished vs. malnourished, standardised β=-0.30, p<0.01). The GNRI was significantly associated with 10-m walking speed (no risk vs. mild risk, standardised β=-0.23, p=0.02; vs. major risk, standardised β=-0.37, p<0.01), but not of motor-FIM and efficiency on the motor-FIM. No significant relationships were found among MUST and NRS-2002 and any functional outcomes. The MNA-SF was found to be an optimal nutritional screening tool to associate with functional outcomes during the postoperative acute phase of elderly hip fracture patients.

Do Performance Measures of Strength, Balance, and Mobility Predict Quality of Life and Community Reintegration After Stroke?

ObjectiveTo investigate the extent to which physical performance measures of strength, balance, and mobility taken at discharge from inpatient stroke rehabilitation can predict health-related quality of life (HRQoL) and community reintegration after 6 months. DesignLongitudinal study. SettingUniversity laboratory. ParticipantsAdults (N=75) recruited within 1 month of discharge home from inpatient stroke rehabilitation. InterventionsNot applicable. Main Outcome Measures36-Item Short Form Health Survey (SF-36) for HRQoL and Subjective Index of Physical and Social Outcome (SIPSO) for community reintegration. Physical performance measures were the 6-minute walk test, timed Up and Go (TUG) test, Berg Balance Scale, Community Balance and Mobility Scale, and isokinetic torque and power of hip, knee, and ankle on the paretic and nonparetic sides. Other prognostic variables included age, sex, stroke type and location, comorbidities, and motor FIM score. ResultsSeparate stepwise linear regressions were performed using the SF-36 and SIPSO as dependent variables. The total paretic lower limb torque and 6-minute walk test predicted the SF-36 Physical Component Summary (adjusted R2=.30). The total paretic lower limb torque and TUG test predicted the SIPSO physical component (adjusted R2=.47). The total paretic lower limb torque significantly predicted the SF-36 Mental Component Summary, but the adjusted R2 was low (.06). Similarly, the TUG test significantly predicted the SIPSO social component, but again the adjusted R2 was low (.09). ConclusionsMeasures of physical performance including muscle strength and mobility at discharge can partially predict HRQoL and community reintegration 6 months later. Further research is necessary for more accurate predictions.

Health Conditions: Effect on Function, Health-Related Quality of Life, and Life Satisfaction After Traumatic Spinal Cord Injury. A Prospective Observational Registry Cohort Study

ObjectiveTo analyze relations among injury, demographic, and environmental factors on function, health-related quality of life (HRQoL), and life satisfaction in individuals with traumatic spinal cord injury (SCI). DesignProspective observational registry cohort study. SettingSpecialized acute and rehabilitation SCI centers. ParticipantsParticipants (N=340) from the Rick Hansen Spinal Cord Injury Registry (RHSCIR) who were prospectively recruited from 2004 to 2014 were included. The model cohort participants were 79.1% men, with a mean age of 41.6±17.3 years. Of the participants, 34.7% were motor/sensory complete (ASIA Impairment Scale [AIS] grade A). InterventionsNone. Main Outcome MeasuresPath analysis was used to determine relations among SCI severity (AIS grade and anatomic level [cervical/thoracolumbar]), age at injury, education, number of health conditions, functional independence (FIM motor score), HRQoL (Medical Outcomes Study 36-Item Short-Form Health Survey [Version 2] Physical Component Score [PCS] and Mental Component Score [MCS]), and life satisfaction (Life Satisfaction-11 [LiSat-11]). Model fit was assessed using recommended published indices. ResultsGoodness of fit of the model was supported by all indices, indicating the model results closely matched the RHSCIR data. Higher age, higher severity injuries, cervical injuries, and more health conditions negatively affected FIM motor score, whereas employment had a positive effect. Higher age, less education, more severe injuries (AIS grades A–C), and more health conditions negatively correlated with PCS (worse physical health). More health conditions were negatively correlated with a lower MCS (worse mental health), however were positively associated with reduced function. Being married and having higher function positively affected Lisat-11, but more health conditions had a negative effect. ConclusionsComplex interactions and enduring effects of health conditions after SCI have a negative effect on function, HRQoL, and life satisfaction. Modeling relations among these types of concepts will inform clinicians how to positively effect outcomes after SCI (eg, development of screening tools and protocols for managing individuals with traumatic SCI who have multiple health conditions).

Cognitive and Functional Outcomes following Inpatient Rehabilitation in Patients with Acquired Brain Injury: A Prospective Follow-up Study.

Objectives:To study the effects of cognitive retraining and inpatient rehabilitation to study the effects of cognitive retraining and inpatient rehabilitation in patients with acquired brain injury (ABI).Design and Setting:This was a prospective follow-up study in a neurological rehabilitation department of quaternary research hospital.Patients and Methods:Thirty patients with ABI, mean age 36.43 years (standard deviation [SD] 12.6, range 18–60), mean duration of illness 77.87 days (SD 91.78, range 21–300 days) with cognitive, physical, and motor-sensory deficits underwent inpatient rehabilitation for minimum of 14 sessions over a period of 3 weeks. Nineteen patients (63%) reported in the follow-up of minimum 3 months after discharge. Type of ABI, cognitive status (using Montreal Cognitive assessment scale [MoCA] and cognitive Functional Independence Measure [Cog FIM]®), and functional status (motor FIM®) were noted at admission, discharge, and follow-up and scores were compared.Results:Patients received inpatient rehabilitation addressing cognitive and functional impairments. Baseline MoCA, motor FIM, and Cog FIM scores were 15.27 (SD = 7.2, range 3–30), 31.57 (SD = 15.6, range 12–63), and 23.47 (SD = 9.7, range 5–35), respectively. All the parameters improved significantly at the time of discharge (MoCA = 19.6 ± 7.4 range 3–30, motor FIM® = 61.33 ± 18.7 range 12–89, Cog FIM® =27.23 ± 8.10 range 9–35). Patients were discharged with home-based programs. Nineteen patients reported in follow-up and observed to have maintained cognition on MoCA (18.8 ± 6.8 range 6–27), significantly improved (P < 0.01) on Cog FIM® (28.0 ± 7.7 range 14–35) and motor FIM® =72.89 ± 16.2 range 40–96) as compare to discharge scores.Conclusions:Cognitive and functional outcomes improve significantly with dedicated and specialized inpatient rehabilitation in ABI patients, which is sustainable over a period.

Employment Stability in Veterans and Service Members With Traumatic Brain Injury: A Veterans Administration Traumatic Brain Injury Model Systems Study

ObjectiveTo examine incidence and predictors of employment stability in veterans and military service members with traumatic brain injury (TBI) who return to work. DesignProspective observational cohort study. SettingFour rehabilitation centers. ParticipantsVeterans and military service members (N=110) with mild (26%), moderate (22%), or severe (52%) TBI enrolled in the Department of Veterans Affairs Polytrauma Rehabilitation Centers TBI Model Systems database within 2 years of injury who were discharged between January 2009 and June 2015. InterventionsNot applicable. Main Outcome MeasureEmployment stability as reflected by competitive employment at 1- and/or 2-year follow-up. ResultsOver half (n=61, 55%) of the participants had stable employment at the time the first competitive employment date was recorded. Individuals with stable employment were more likely to be white (79%) and to have slightly higher cognitive and motor discharge scores on the FIM. Based on univariate analysis, more severe TBI and higher FIM motor scores at discharge were significantly associated with employment stability. At follow-up, compared with veterans and military service members who had unstable employment, those with stable employment had higher scores on motor and cognitive FIM and lower scores of self-report symptoms on the Neurobehavioral Symptom Inventory, the 9-item Patient Health Questionnaire-Depression, the 7-item Generalized Anxiety Disorder Questionnaire, and the PTSD Checklist-Civilian version. ConclusionsA number of unique factors affect employment stability in veterans and military service members with TBI. Study findings identify veterans and military service members who have stable employment and predictors of employment stability.

Usefulness of the prediction method based on a logarithmic model for functional recovery in stroke patients: in case of using the motor-Functional Independence Measure score.

Predicting functional recovery is important for the rehabilitation of stroke patients. This study aimed to examine the predictive validity of motor items of Functional Independence Measure (motor-FIM) using the prediction method based on a logarithmic model. This prospective observational cohort study included 111 patients with subacute stroke (mean age: 67.0±13.8 years). The motor-FIM score was assessed at admission, 1 month after admission, and at discharge. We calculated the predictive value of motor-FIM scores at discharge using a logarithmic model, which used only motor-FIM scores at admission and 1 month after admission. The relationship between the actual motor-FIM score at discharge and the predictive value was assessed with the intraclass correlation coefficient. The motor-FIM score at admission, 1 month after admission, and at discharge, and the predictive value were 41.9±15.0, 52.3±18.4, 66.0±18.8, and 65.1±21.2, respectively. The predictive value was highly correlated with the actual motor-FIM score at discharge (intraclass correlation coefficient=0.89). Our results suggest that we can use the prediction method based on a logarithmic model for predicting the motor-FIM score at discharge. This may be useful for designing rehabilitation programs for patients with subacute stroke.

Linking existing instruments to develop a continuum of care measure: accuracy comparison using function-related group classification.

To compare measurement accuracy of test forms with varied number of items (13, 8, and 4 items) generated from the self-care physical function item bank composed of Functional Independence Measure (FIM™) and the Minimum Data Set (MDS). Retrospective data analysis of 2499 Veterans who completed both FIM and MDS within 6days. We compared measurement accuracy between the converted FIM (FIMc) motor score generated from the MDS and the original FIM (FIMa) motor score (13 items) at: (a) individual-level using point differences, and (b) group-level using function-related group (FRG). The differences of mean FIMa and FIMc scores were between 0.05 and 1.07 points for all test forms. Over 81% of FIMc from MDS_13 were within 15 points of the FIMa. 81-90% of FRGs generated by the FIM short forms was identical to those generated by the FIMa for stroke, lower limb amputation, knee and hip replacement; and 59.9-90.5% by all MDS test forms. All MDS test forms had above 74% agreement with same or adjacent FMGs (ICC 0.65-0.91). The accuracy is dependent on the comparison level (i.e., individual or group), length of the test and which FRG is used. Our results partially support using existing instruments-without decreasing the number of the items-to generate a continuum of care measurement.

Motor recovery in post-stroke patients with aphasia: the role of specific linguistic abilities

Background: Aphasia is a serious consequence of stroke but aphasics patients have been routinely excluded from participation in some areas of stroke research.Objective: To assess the role of specific linguistic and non-verbal cognitive abilities on the short-term motor recovery of patients with aphasia due to first-ever stroke to the left hemisphere after an intensive rehabilitation treatment.Methods: 48 post-acute aphasic patients, who underwent physiotherapy and speech language therapy, were enrolled for this retrospective cohort-study. Four types of possible predictive factors were taken into account: clinical variables, functional status, language and non-verbal cognitive abilities. The motor FIM at discharge was used as the main dependent variable.Results: Patients were classified as follows: 6 amnestic, 9 Broca’s, 7 Wernicke’s, and 26 global aphasics. Motor FIM at admission (p = 0.003) and at discharge (p = 0.042), all linguistic subtests of Aachener AphasieTest (p = 0.001), and non-verbal reasoning abilities (Raven’s CPM, p = 0.006) resulted significantly different across different types of aphasia. Post-hoc analyses showed differences only between global aphasia and the other groups. A Multiple Linear Regression shows that admission motor FIM (p = 0.001) and Token test (p = 0.040), adjusted for clinical, language, and non-verbal reasoning variables, resulted as independent predictors of motor FIM scores at discharge, while Raven’s CPM resulted close to statistical significance.Conclusions: Motor function at admission resulted as the variable that most affects the motor recovery of post-stroke patients with aphasia after rehabilitation. A linguistic test requiring also non-linguistic abilities, including attention and working memory (i.e. Token test) is an independent predictor as well.

Recreational therapy services with individuals recovering from spinal cord injury in inpatient rehabilitation: A cost-effectiveness analysis

The purpose of this study was to examine the cost of delivery of inpatient therapeutic services in relation to their influence on change in functional independence (as measured by the Functional Independence Measure [FIM]) of people with spinal cord injuries (SCIs). Participants included adults with SCI (N = 549) who received treatment during inpatient rehabilitation at the study site during a 7-year span. Results from ordinary least squares multiple regression analysis indicated that recreational therapy (RT) significantly predicted both total and motor FIM scores, while occupational therapy (OT) predicted motor FIM change. When costs of service provision and change in motor FIM scores were compared, RT required fewer units of treatment to predict change in motor FIM scores and was less costly per unit than OT. Although not causal, findings provide evidence of the benefits of RT and lend support to the continued use of RT in inpatient rehabilitation programs.

Relationship between Activities of Daily Living and Readmission within 90 Days in Hospitalized Elderly Patients with Heart Failure.

Aims To examine the relationship between activities of daily living (ADL) and readmission within 90 days and assess the cutoff value of ADL to predict readmission in hospitalized elderly patients with heart failure (HF). Methods This cohort study comprised 589 consecutive patients with HF aged ≥65 years, who underwent cardiac rehabilitation from May 2012 to May 2016 and were discharged home. We investigated patients' characteristics, basic attributes, and ADL (motor and cognitive Functional Independence Measure [FIM]). We analyzed the data using the unpaired t-test, χ2 test, Cox proportional hazard model, receiver operating characteristic (ROC) curve, and Kaplan-Meier method. Results Of 589 patients, 113 met the criteria, and they were divided into the nonreadmission (n = 90) and readmission groups (n = 23). Age, body mass index, New York Heart Association class, hemoglobin level, and motor FIM score were significantly different between the two groups (p < 0.05). The body mass index (hazard ratio [HR]: 0.87; p < 0.05) and motor FIM score (HR: 0.94; p < 0.01) remained statistically significant. The cutoff value for the motor FIM score determined by ROC curve analysis was 74.5 points (area under the curve = 0.78; p < 0.001). Conclusion The motor FIM score in elderly patients with HF was an independent predictor of rehospitalization within 90 days.

Effects of a Self-Exercise Program on Activities of Daily Living in Patients After Acute Stroke: A Propensity Score Analysis Based on the Japan Association of Rehabilitation Database

ObjectiveTo investigate whether self-exercise programs for patients after stroke contribute to improved activities of daily living (ADL) at hospital discharge. DesignRetrospective, observational, propensity score (PS)–matched case-control study. SettingGeneral hospitals. ParticipantsParticipants included patients after stroke (N=1560) hospitalized between January 3, 2006, and December 26, 2012, satisfying the following criteria: (1) data on age, sex, duration from stroke to hospital admission, length of stay, FIM score, modified Rankin Scale (mRS) score, Glasgow Coma Scale score, Japan Stroke Scale score, and self-exercise program participation were available; and (2) admitted within 7 days after stroke onset, length of stay was between 7 and 60 days, prestroke mRS score was ≤2, and not discharged because of FIM or mRS exacerbation. A total of 780 PS-matched pairs were selected for each of the self-exercise program and no–self-exercise program groups. InterventionSelf-exercise program participation. Main Outcome MeasuresAt discharge, FIM motor score, FIM cognitive score, FIM motor score gain (discharge value − admission value), FIM motor score gain rate (gain/length of stay), a binary variable divided by the median FIM motor score gain rate (high efficiency or no–high efficiency), and mRS score. ResultsPatients were classified into a self-exercise program (n=780) or a no–self-exercise program (n=780) group. After matching, there were no significant between-group differences, except motor system variables. The receiver operating characteristic curve for PS had an area under the curve value of .71 with a 95% confidence interval of .68 to .73, and the model was believed to have a relatively favorable fit. A logistic regression analysis of PS-matched pairs suggested that the self-exercise program was effective, with an overall odds ratio for ADL (high efficiency or no–high efficiency) of 2.2 (95% confidence ratio, 1.75–2.70). ConclusionsSEPs may contribute to improving ADL.

Association Between Time to Rehabilitation and Outcomes After Traumatic Spinal Cord Injury

ObjectiveTo examine the relations between time to rehabilitation after spinal cord injury (SCI) and rehabilitation outcomes at discharge and 1-year postinjury. DesignRetrospective cohort study. SettingFacilities designated as Spinal Cord Injury Model Systems. ParticipantsPatients (N=3937) experiencing traumatic SCI between 2000 and 2014, who were 18 years or older, and who were admitted to a model system within 24 hours of injury. InterventionsNot applicable. Main Outcome MeasuresRasch-transformed FIM motor score at discharge and 1-year postinjury, discharge to a private residence, and the Craig Handicap Assessment and Reporting Technique (CHART) Physical Independence and Mobility scores at 1-year postinjury. ResultsAfter accounting for health status, a 10% increase in time to rehabilitation was associated with a 1.50 lower FIM motor score at discharge (95% confidence interval [CI], −2.43 to −0.58; P=.001) and a 3.92 lower CHART Physical Independence score at 1-year postinjury (95% CI, −7.66 to −0.19; P=.04). Compared to the mean FIM motor score (37.5) and mean CHART Physical Independence score (74.7), the above-mentioned values represent relative declines of 4.0% and 5.3%, respectively. There was no association between time to rehabilitation and discharge to a private residence, 1-year FIM motor score, or the CHART mobility score. ConclusionsEarlier rehabilitation after traumatic SCI may improve patients' functional status at discharge.

Abstract TP149: Utilization of a Robotic Exoskeleton to Provide Increased Mass Practice for Gait Training and its Impact on Discharge Destination for Individuals With Acute Stroke

Introduction: Mass practice of task-specific activity, such as repeated stepping for gait retraining, is an integral part of acute stroke rehabilitation. New technologies including the use of a robotic exoskeleton (RE) have recently been introduced to the inpatient rehab facility (IRF). A RE can help skilled physical therapists (PT) provide repetitive stepping practice to patients who have had a stroke. Hypothesis: We hypothesize the use of a RE will enable PTs in an IRF to provide added stepping practice to their therapy program and influence discharge destination as compared to traditional treatment plans. Methods: Fifteen participants with acute stroke (&lt;6 months post, age 58±10; height 66±5in; 176±35lbs; LOS 29±7days) were recruited for RE gait training during inpatient rehabilitation in conjunction with traditional therapy. Participants ambulated in the RE over level surfaces with the assistance of a PT (minimum of 3 sessions in the RE). Participant inclusion requirements: medical clearance, upright standing tolerance (≥15 min), intact skin, and physically fit into the device. A matched sample of participants (n=15) was selected from a hospital database (matching criteria: length of stay, admission motor FIM, age, gender and affected side). The data was analyzed using independent sample and paired sample t-tests. Results: Participants in the RE group walked an average distance of 212 feet in traditional PT where gait training was provided and 551 feet in RE sessions (p=.033). Discharge destination for the RE group: 10 home; 3 subacute; 2 nursing facilty and for the matched sample: 13 home; 2 subacute. Motor FIM scores significantly increased from admission to discharge: RE group (p≤.001) and matched group (p≤.001). Motor FIM gain at discharge in the RE group significantly increased compared to the matched sample, 26.4±6.4 vs. 21.6±5.9, (p=0.044). Conclusions: This exploratory investigation demonstrated the RE provides increased dosing of gait training. Discharge destination was not notably impacted by method of gait training. Improvement of motor FIM scores in the RE group begins to demonstrate the impact of mass practice provided by the RE. Further research is needed to objectively explore the impact of RE on functional mobility and quality of life.