Level Of Functional Independence Research Articles

Predictive Factors of First-Pass Effect in Patients Who Underwent Successful Endovascular Thrombectomy for Emergent Large Vessel Occlusion.

The primary treatment goal of current endovascular thrombectomy (EVT) for emergent large-vessel occlusion (ELVO) is complete recanalization after a single maneuver, referred to as the 'first-pass effect' (FPE). Hence, we aimed to identify the predictive factors of FPE and assess its effect on clinical outcomes in patients with ELVO of the anterior circulation. Among the 129 patients who participated, 110 eligible patients with proximal ELVO (intracranial internal carotid artery and proximal middle cerebral artery) who achieved successful recanalization after EVT were retrospectively reviewed. A comparative analysis between patients who achieved FPE and all others (defined as a non-FPE group) was performed regarding baseline characteristics, clinical variables, and clinical outcomes. Multivariate logistic regression analyses were subsequently conducted for potential predictive factors with p<0.10 in the univariate analysis to determine the independent predictive factors of FPE. FPE was achieved in 31 of the 110 patients (28.2%). The FPE group had a significantly higher level of functional independence at 90 days than did the non-FPE group (80.6% vs. 50.6%, p=0.002). Pretreatment intravenous thrombolysis (IVT) (odds ratio [OR], 3.179; 95% confidence interval [CI], 1.025-9.861; p=0.045), door-to-puncture (DTP) interval (OR, 0.959; 95% CI, 0.932-0.987; p=0.004), and the use of balloon guiding catheter (BGC) (OR, 3.591; 95% CI, 1.231-10.469; p=0.019) were independent predictive factors of FPE. In conclusion, pretreatment IVT, use of BGC, and a shorter DTP interval were positively associated with FPE, increasing the chance of acquiring better clinical outcomes.

FUNCTIONAL STATUS AMONG PATIENTS WITH STAGE III PARKINSON’S DISEASE

Aims Of Study: The purpose of the study was to assess the functional capabilities of patients with Stage III Parkinson's disease (PD). Functional status of PD patients declines due to impaired postural reflexes and characteristic loss of balance which became evident at Stage III thus activities of daily living (ADLs) are compromised as the severity of the disease increases. Methodology: Descriptive case series was conducted on stage III PD patients (n=64). Patients with age ranges from 45 to 75 years were recruited and patients with other neurological issues were excluded. They were assessed using a Functional independence measure scale having reliability 0.95. Results: Out of 64 patients, 75% required minimal assistance and 9.4% required supervision while performing the ADLs. Whereas, 81% of patients need 2 hours of personal care assistance according to burden of care. Limitations &amp; Future Implications: Only functional status of PD patient is determined no exercise regime or intervention were incorporated to assess their impact on the PD patient functional activities. Thus, future studies should be carried out to find the correlation between aerobic exercises and their impact on PD patient level of functional independence. Originality: Information added was all taken from databases and reduced to similarity index and was not submitted to any other journal. Conclusion: Stage III Parkinson’s disease patient required minimal level of assistance while performing tasks of daily living. However, majority of these patients required 2 hours of personal care assistance on average per day to compete with daily living.

An investigation of the effects of dual-task balance exercises on balance, functional status and dual-task performance in children with Down syndrome

ABSTRACT Purpose To investigate the effects of dual task (DT) balance exercises on functional status, balance, and DT performance in children with Down Syndrome (DS). Methods Participants were divided into two groups: intervention group (IG; n = 13) and control group (CG;n = 14). WeeFIM was used to measure the functional independence level and balance was evaluated using the Pediatric Balance Scale. DT performance was assessed using Timed Up and Go, Single Leg Stance, Tandem-Stance and 30 s Sit to Stand tests without concomitant task, with motor task or cognitive task. The IG received 16 sessions of DT training twice a week for 8 weeks. Results Functional level, balance, and DT performance improved significantly in the IG, whereas only balance improved in the CG. Significantly better results were achieved in the IG, as demonstrated by greater pre/post-treatment changes. Conclusion DT balance exercises improved functional level, balance and DT performance of children with DS.

Changing Epidemiology and Functional Outcomes of Inpatient Rehabilitation in Asian Traumatic Brain Injury Cases before and during the COVID-19 Pandemic: A Retrospective Cohort Study.

This study aimed to compare acute injury and rehabilitation characteristics for traumatic brain injury (TBI) inpatients during the pre and post COVID-19 pandemic periods. A retrospective study of TBI inpatients between 1 April 2018 and 31 December 2019 (pre COVID-19 period), and 1 July 2020 and 31 March 2022 (post COVID-19 period) was performed to compare demographics, premorbid comorbidity, TBI characteristics, rehabilitation complications, admission and discharge functional independence measure (FIM®), length of stay and discharge status. A total of 187 data sets were analyzed (82 pre COVID-19 and 105 post COVID-19). Post COVID-19 TBI inpatients were older by 11 years (pre COVID-19 mean 55 years vs. post COVID-19 mean 66 years, and p < 0.001), with 23% higher female inpatients (pre COVID-19 13.4% vs. post COVID-19 36.2%, and p < 0.001) and 25% higher presence of comorbidities (pre COVID-19 52.4% vs. post COVID-19 77.1%, and p < 0.001). In the post COVID-19 group, total discharge FIM (Td-FIM) was significantly lower by ~12 points (pre COVID-19 94.5 vs. post COVID-19 82, and p = 0.011), Td-FIM ≥ 91 was lower by ~18% (pre COVID-19 53.7% vs. post COVID-19 36.2%, and p = 0.017), and the need for caregivers increased by ~17% (pre COVID-19 68% vs. post COVID-19 85.4%, and p = 0.006) Conclusions: Our findings signal a demographic shift towards older, frailer TBI with lower functional independence levels post COVID-19.

Does Function Level of Individuals With Autism Spectrum Disorder Affect The Family Impact?

The aim of our study is to examine the effect of differences in the levels of functionality of individuals with autism spectrum disorder (ASD) on level of family involvement.Our study has been carried out with the relatives of ASD individuals attending Aydın Efeler Municipality Autism Sports and Life Center. The Pediatric Functional Independence Criterion (WeeFIM) has been used to determine the functional independence levels of children, and The Family Impact Scale (FIS) has been used to measure the impact on the families of children with chronic disabilities. Our study was completed with the assessment of 98 individuals diagnosed with ASD (age=10.17±5.11, gender=15 female/83 male) and 98 pairs of their parents. The total WeeFim score was determined as 94.73 ±20.26 (independent) and the family impact scale scores were determined as 63.03 ± 12. The correlation analysis showed the sub WeeFIM impact the financial burden my family, self-care, communication, social status were statistically significant and weak correlation score between the total score (p&amp;lt;0.05; respectively, r=-0.025, r=-0.027, r=-0.310, r=-0.273). There was also a statistically significant, negative and moderate correlation between the total impact score of the FIS and the social status of the WeeFIM (p&amp;lt;0.00; r=-0.402).This study shows that family influence on individuals with ASD affects their social status. In addition, self-care, communication skills, and social status negatively affect individuals with more financial problems. In families with individuals with ASD, the independence of children affects the quality of life of families.

42 Utilizing FAB Scores to Determine Next Level of Care for Patients with Burn Injury

Abstract Introduction Determining next level of care for burn patients is a difficult task for the entire medical team. Secondary to the nature of the injury, patients often do not have the social or economic support required to return to their prior level of function. The Functional Assessment for Burns (FAB) score has been shown an objective measure to determine functional independence and a predictor of discharge outcomes in adults. However, it is undetermined whether this assessment can be utilized to guide next level of care and time which it takes to return to prior level of function. We hypothesized the number of therapy sessions to be positively associated with patients’ return to baseline FAB. Methods This single center, retrospective study of patients admitted to a single ABA-verified burn center was completed by collecting FAB assessment scores within 48 hours of admission and within 48 hours of discharge over the last year. Demographics, injury characteristics, surgical procedures, and number of treatment sessions were collected. Shapiro-wilk test was utilized to test for normality. Regression analysis was utilized to analyze variable associations with changes in FAB scores. A paired t test was used to compare paired FAB scores between admission and discharge. Results One-hundred patients were included with a median age of 53 (38.5, 64) years and 7 (3.5, 14) percent total body surface area burned (TBSA). The median FAB for preadmission (preadm.), admission (adm.), and discharge (DC) were 35 (35, 35), 17 (14, 24), and 24 (19, 32), respectively. The paired difference between adm. and DC scores (&amp;lt; 0.001) indicated significant improvement. TBSA and age, together, were significant predictors of change in preadm. to adm. FAB (r2=0.202, p&amp;lt; 0.001). Adm. FAB and TBSA were both associated with number of therapy sessions. Only 16% of patients returned to preadm. level of functional independence by discharge with only 20% qualifying for / entering a post-acute inpatient rehabilitation facility. Number of combined therapy sessions was not associated with return to preadm. FAB. Of note, only 28% returned within 90% of preadmission FAB by discharge. In fact, 13% actually saw their FAB regress from adm. to DC. None of the collected variables were associated with the negative change in FAB scores through admission. Conclusions In this sample, number of sessions was not predictive of return to preadmission FAB; however, this may be due to the low numbers that achieved the milestone at all. Despite this fact, there was an alarmingly small number admitted to a subsequent inpatient rehabilitation facility. There was a significant improvement in paired scores from admission to discharge. Taken together, there may be value in reassessing inpatient rehabilitation facility adm. criteria. Applicability of Research to Practice FAB scores may be a useful indicator of further rehabilitation needs.

An Australian aged care home for people subject to homelessness: health, wellbeing and cost–benefit

BackgroundOlder people subject to homelessness face many challenges including poor health status, geriatric syndromes, and depression, coupled with barriers in accessing health and aged care services. Many are in need of formal aged care at a younger age than the general population, yet, in Australia, specialised aged-care services to support this vulnerable cohort are limited.MethodsThis study was an evaluation of a new purpose-built aged care home for people with high care needs and who are homeless or at risk of homelessness. Over the first 12 months post-admission, the study examined: (1) changes in residents’ physical, mental, psychological and social health, and (2) the costs incurred by the study cohort, including any cost benefit derived.ResultsThirty-five residents enrolled in the study between March 2020 – April 2021. At admission, almost half of residents were within the range for dementia, the majority were frail, at high risk for falls, and had scores indicative of depression. Over time, linear mixed-effect models showed significant improvement in personal wellbeing scores, with clinically significant improvements in overall health related quality of life. Levels of physical functional independence, frailty, and global cognition were stable, but cognitive functional ability declined over time. Comparison of 12 month pre- and post- admission cost utility data for a smaller cohort (n = 13) for whom complete data were available, suggested an average per resident saving of approximately AU$32,000, while the QALY indicators remained stable post-admission.ConclusionWhile this was a small study with no control group, these preliminary positive outcomes add to the growing body of evidence that supports the need for dedicated services to support older people subject to homelessness.

The effect of strengthening and aerobic exercises on balance and functional independence levels in students with intellectual disabilities

Purpose This study was planned to examine the effects of strengthening and aerobic exercise training applied to students with intellectual disabilities on balance and functional independence. Methods A total of 107 intellectually disabled students, 36 girls, and 71 boys, aged between 11 and 18 years, studying at Denizli Çamlık Special Education Practice Center School were included in the study. In the study, a training program consisting of twice-a-week aerobic exercises was applied for one year and home strengthening exercises three days a week was applied for three months. Participants were assessed before and after the training program. Balance was assessed with the 10-meter walk test and Pediatric Balance Scale (PDS). Functional independence was assessed with the Children’s Functional Independence Measure (WeeFim). Results Participants demonstrated significant improvements in 10-meter walking test, PDS and WeeFim scores (p < 0.05). Conclusion The results obtained from the study showed that strengthening and aerobic exercise training applied to students with intellectual disabilities positively affected walking, balance, and functional independence.

Functional status and quality of life in young adults with cerebral palsy

Objective: To identify the sociodemographic characteristics, pain level, quality of life, functional state, mobility, and depression level in adults with cerebral palsy (CP). Material and methods. Our study included 78 adults with CP (mean age 24.75±7.66 years, 40.5% males) and 79 control subjects (mean age 26.74±6.72 years, 38.5% males). The quality of life, depression, and mobility of all participants were evaluated. In addition, functional status, functional independence and activity level were evaluated in the adult CP group. The depression level was determined by the Beck Depression Inventory (BDI), the mobility level was identified via Rivermead Mobility Index (RMI), and the quality of life was evaluated by the Short Form-36 (SF-36). The functional level of adults with CP was assessed with Gross Motor Function Classification System. Functional independence and activity level were evaluated using the Functional Independence Measure scale (FIM). Pain level was assessed with Visual Analogue Scale (VAS). Results. The patient and control groups were statistically different in terms of their educational status, marital status, duration of marriage, employment status, and monthly income (p&lt;0.05). SF-36 summary scale scores and subgroup scores, as well as RMI and FIM scores of CP patients, were lower than in the control group. In addition, we revealed a statistically significant positive correlation of FIM scores with SF-36 physical and mental components, along with a statistically significant negative correlation of VAS with FIM, and of FIM with GMFCS: p&lt;0.001, r= 0.450; p=0.013, ^0.279; p=0.022, r= -0.257; p&lt;0.001, r= -0.741, respectively. Conclusion. We established that the quality of life, along with the mobility and functional levels, were lower in young adults with CP than in the control group, while the depression and pain levels were higher vs. control group. Hence, pain, depression, mobility, functional level, and quality of life should be assessed during the follow-up of adult patients with CP

Improvements and Residual Limitations Experienced by Patients With Guillain-Barré Syndrome Undergoing Inpatient Rehabilitation.

The purposes of this study were to (1) describe the level of functional independence of patients with Guillain-Barré syndrome before and after inpatient rehabilitation, (2) determine whether the level of functional independence increased in each functional domain during inpatient rehabilitation, and (3) determine whether independence at the end of inpatient rehabilitation differed significantly between domains. Data from patients with Guillain-Barré syndrome discharged from inpatient rehabilitation settings in 2019 were obtained from the Uniform Data System for Medical Rehabilitation database. The primary variables analyzed were paired, dichotomous variables of the number of patients who achieved full independence in the admission and discharge scores for the activities that comprise the domains, subscales, and total of the Functional Independence Measure. All patients admitted to inpatient rehabilitation required assistance with at least one if not several domains of function, motor, as well as cognitive. By the end of the inpatient rehabilitation stay, for each domain of function, significantly more patients were independent ( P < 0.0001). Independence at the end of inpatient rehabilitation differed significantly between domains ( P < 0.0001); more patients achieved independence in the communication (87.5%) and social cognition (74.8%) domains while fewer patients achieved independence in the self-care (35.9%), transfers (34.2%), and locomotion domains (24.7%).

Gait, balance and functional independence level in stroke patients

Gait, balance and functional independence level in stroke patients

A Study to Assess the Functional Independance and Disability Evaluvation Among Stroke Patients

Introduction: Stroke is medically called cerebrovascular accident (CVA) that's described as a surprising lack of feature due to harm to the brain (hemorrhagic stroke) and absence of blood deliver to the brain (ischemic stroke) reasons weak spot of muscle specifically on one aspect of the body, confusion, trouble in speaking, visible disturbances, trouble in walking, surprising intense headache which ends up in long time disability. The World Health Organization has currently proposed a brand new International Classification of Functioning, Disability and Health that defines additives of functioning and disability, in addition to sports and participation. The latter thing describes nine domain names of interest and participation: getting to know and making use of knowledge; widespread responsibilities and demands; communication; mobility; self-care; home lifestyles; interpersonal interplay and relationships; main lifestyles areas; and community, social, and civic lifestyles. Although scientific trials of stroke interventions robotically use mortality as an outcome, different results are each essential for scientific investigations and applicable to patients.Methods:A descriptive research design was adopted for the study. (n=60 )Samples patients with stroke whowere met the inclusion criteria is selected by using convenience sampling technique. After selecting the sample, the investigator introduced him-self and explained the purpose of the study to the participants’. Informed consent was obtained from the patients relatives after assured confidentiality. The Demographic and clinical variables were collected by using multiple choice questionnaires. The functional independence and disability assessing by using Barthel Index and Modified Ranking Scale. The score is monitored on the day of data collection. Each score evaluation will take 10 minutes. The data were tabulated and analyzed by descriptive and inferential statistics. Results: The level of functional independence among stroke patients study finding shows that out of 60 samples in level of functional independence by using Barthel index, 22(36.7%) were severely dependent, 20(33.3%) were moderately dependent, 11918.3%) were slightly dependent and 7(11.7%) were totally dependent and level of disability among stroke patients study finding despite that out of 60 samples, 22(36.7%) had moderately severe disability, 14(23.3%) had moderate disability, 11(18.3%) had slight disability, 10(16.7%) had severe disability and 3(5%) had no significant disability. Conclusion:A Barthel index and Modified Ranking Scale was effective scale to assessing the functional independence and disability among stroke patients.

Immediate Weight-Bearing Following Biplanar Plating of Periprosthetic Femoral Fractures

Purpose: Femoral fractures in geriatric patients have a high 1-year mortality rate. Early mobilization without restrictions and full weight-bearing in elderly periprosthetic femoral fractures may improve mortality, morbidity, and accelerate functional recovery. The purpose of this study was to evaluate periprosthetic femoral fractures treated with biplanar plating and early ambulation. Materials and Methods: We conducted a retrospective study of periprosthetic femoral fractures treated with biplanar plating and immediate weight-bearing over a 4-year period. All patients were treated with anatomic reduction and primary bone healing, with biplanar fixation through a single, lateral-based incision. The primary outcome was radiographic union. Secondary outcomes were preinjury level and postinjury level of functional independence and need for revision surgery. Results: Seven patients met the inclusion criteria. The average age was 79.7 (range, 63 to 88) years. The average follow-up period was 18 months. Bony union occurred in all patients after the index procedure, with no revision surgeries documented. Five patients (71%) returned to preoperative ambulatory status, and all patients returned to their preoperative living environment. Conclusion: Our study supports the possibility of immediate weight-bearing in geriatric periprosthetic femur fractures treated with anatomic reduction and biplanar plating through a single lateral-based incision, although additional studies are needed.

Thrombectomy-Capable Stroke Centre-A Key to Acute Stroke Care System Improvement? Retrospective Analysis of Safety and Efficacy of Endovascular Treatment in Cardiac Cathlab.

The optimal structure of the acute ischaemic stroke treatment network is unknown and eagerly sought. To make it most effective, different treatment and transportation strategies have been developed and investigated worldwide. Since only a fraction of acute stroke patients with large vessel occlusion are treated, a new entity-thrombectomy-capable stroke centre (TCSC)-was introduced to respond to the growing demand for timely endovascular treatment. The purpose of this study was to present the early experience of the first 70 patients treated by mechanical means in a newly developed cardiac Cathlab-based TCSC. The essential safety and efficacy measures were recorded and compared with those reported in the invasive arm of the HERMES meta-analysis-the largest published dataset on the subject. We found no significant differences in terms of clinical and safety outcomes, such as early neurological recovery, level of functional independence at 90 days, symptomatic intracranial haemorrhage, parenchymal haematoma type 2, and mortality. These encouraging results obtained in the small endovascular centre may be an argument for the introduction of the TCSC into operating stroke networks to increase patient access to timely treatment and to improve clinical outcomes.

Associação entre nível de independência funcional e percepção subjetiva da dor em idosos no pós-operatório de artroplastia de quadril

ABSTRACT Hip replacement (HR) is a surgery that replaces the injured joint with a prosthesis. The postoperative period can reduce functional independence and affect the subjective experience of pain in older adults. This study evaluated the association between the level of functional independence and the subjective experience of pain in older adults who underwent HR. This cross-sectional descriptive quantitative association study used the functional independence measure (FIM) to assess the level of functional independence and the visual analogue scale (VAS) to analyze the subjective experience of pain. Spearman’s correlation test was used to evaluate the association between FIM and VAS and simple linear regression to analyze the influence of one variable on another (p≤0.05). This study evaluated 48 older adults, with a mean age of 71.5±9 years, of which 37.5% (n=18) were men and 62.5% (n=30) were women. The mean VAS and FIM values were 3.5 (±1.6) and 107 (±17.82), respectively, and they had a significant and inverse association (p=0.006; r=−0.389; R2=0.142). This study showed an inversely proportional relationship between the subjective experience of pain and the level of functional independence in older patients who underwent HR. Therefore, health professionals should pay more attention to pain in these patients in order to optimize their functional recovery and increase their functional independence.

Association between the level of functional independence and the subjective experience of pain in older adults after hip replacement

RESUMO A artroplastia de quadril (AQ) é um procedimento cirúrgico que consiste na substituição da articulação lesionada por uma prótese. O pós-operatório pode reduzir a independência funcional e repercutir na percepção subjetiva da dor em idosos. O estudo avaliou a associação entre o nível de independência funcional e a percepção subjetiva da dor em idosos submetidos à AQ. Trata-se de um estudo transversal, descritivo, quantitativo e de associação. A medida de independência funcional (MIF) foi utilizada para avaliar o nível de independência funcional, e a escala visual analógica (EVA) foi empregada para avaliar a percepção subjetiva da dor. O teste de correlação de Spearman foi utilizado para verificar a associação entre a MIF e a EVA, e uma regressão linear simples, para analisar a influência de uma variável sobre a outra (p≤0,05). Um total de 48 idosos foram avaliados, com média de idade de 71,5±9 anos, em que 37,5% (n=18) pertenciam ao sexo masculino e 62,5% (n=30) ao feminino. A avaliação da EVA mostrou uma média de 3,5 (±1,6), enquanto a MIF, 107 (±17,82). Observamos uma associação significante e inversa com p=0,006 e com r de −0,389, com R2 de 0,142. Este estudo mostrou que há uma relação inversamente proporcional entre a sensação subjetiva da dor e o nível de independência funcional de idosos no pós-operatório de AQ. A partir disso, é necessário que os profissionais da saúde deem mais atenção ao quadro álgico desses idosos, visando otimizar sua recuperação funcional a fim de aumentar sua independência funcional.

Assessment of Level of Functional Independence among Elderly Population in an Urban Community

Introduction: Aging is the process of becoming older. Activities of daily living (ADLs) are basic tasks that must be accomplished every day for an individual to thrive. Independence in performing ADLs is a central aspect of functioning. Older adults with or without musculoskeletal complaints frequently experience impairments and limitations in functioning in various life areas. Objectives of the current study are to assess the functional independence among the elderly population and to identify the factors affecting the activity of daily living (ADL) of elderly population. Methodology: The study was a community-based descriptive study. It was carried out to assess the functional independence and factors affecting on ADL among the elderly population of urban community. The sample size was estimated to be 60 and random sampling was used to choose the study subjects. Result: The common finding of the study was 43.35%. Majority of elderly population were slightly dependent. 40% were moderately dependent. 16.66% were severely dependent. Moreover, the common factor affecting on the ADL was (13.91%) shivering of hands and (13.04%) general weakness. Conclusion: From the study, researcher came to understand that after having adequate data on ADL, it is found that maximum elderly population is moderately dependent and the common factors affecting ADL were muscle weakness and shivering of hands.

The effect of functional independence levels on sleep and constipation in children with cerebral palsy.

The study aimed to examine the effect of functional independence levels on sleep behavior and constipation in children with cerebral palsy. This cross-sectional observational single-center study was carried out in a special rehabilitation center in Istanbul. Inclusion criteria were those aged between 4 and 18 years with Gross Motor Function Classification System III-IV-V functional independence levels. Those who had surgery concerning intestinal health, had a chronic infectious bowel disease, had congenital intestinal anomalies, had received botox treatment in the last 6 months, had uncontrolled epileptic seizures, had complained of constipation in the last 6 months, and had cardiopulmonary disease were excluded from the study. The sociodemographic characteristics of the participants and the Gross Motor Function Classification System were recorded. Pediatric Functional Independence Scale (Functional Independence Measure for Children) was used to measure the functional independence level, Pediatric Sleep Questionnaire was used to measure the level of sleep problems, and Constipation Severity Scale was used to measure constipation severity. A total of 60 children who were diagnosed with cerebral palsy were included. According to Gross Motor Function Classification System, 46.7% of the cases were Level III, 35% were Level IV, and 18.3% were Level V. There was a negative moderate significant correlation between Functional Independence Measure for Children and Pediatric Sleep Questionnaire (r=-0.303; p=0.019) and between Functional Independence Measure for Children and Constipation Severity Scale (r=-0.342; p=0.007). We described that lower functional independence levels were related to worse sleep and constipation symptoms. The results suggest that effective strategies for developing functional independence levels may be beneficial for both sleep and constipation symptoms in the concept of cerebral palsy management.

Cluster analysis of functional independence in community-dwelling older people

BackgroundThe concept of Functional Independence (FI), defined as ‘functioning physically safe and independent from other persons, within one’s context”, plays an important role in maintaining the functional ability to enable well-being in older age. FI is a dynamic and complex concept covering four clinical outcomes: physical capacity, empowerment, coping flexibility, and health literacy. As the level of FI differs widely between older adults, healthcare professionals must gain insight into how to best support older people in maintaining their level of FI in a personalized manner. Insight into subgroups of FI could be a first step in providing personalized support This study aims to identify clinically relevant, distinct subgroups of FI in Dutch community-dwelling older people and subsequently describe them according to individual characteristics.ResultsOne hundred fifty-three community-dwelling older persons were included for participation. Cluster analysis identified four distinctive clusters: (1) Performers – Well-informed; this subgroup is physically strong, well-informed and educated, independent, non-falling, with limited reflective coping style. (2) Performers – Achievers: physically strong people with a limited coping style and health literacy level. (3) The reliant- Good Coper representing physically somewhat limited people with sufficient coping styles who receive professional help. (4) The reliant – Receivers: physically limited people with insufficient coping styles who receive professional help. These subgroups showed significant differences in demographic characteristics and clinical FI outcomes.ConclusionsCommunity-dwelling older persons can be allocated to four distinct and clinically relevant subgroups based on their level of FI. This subgrouping provides insight into the complex holistic concept of FI by pointing out for each subgroup which FI domain is affected. This way, it helps to better target interventions to prevent the decline of FI in the community-dwelling older population.

Relationship of Psychological and Cognitive Factors to Pain During Hip Fracture Rehabilitation: A Retrospective Analysis

<h3>Research Objectives</h3> To determine if impairments in cognition, expressive language, or pre-existing anxiety and/or depression were associated with pain perception, opioid use, and progress during inpatient rehabilitation following hip fracture. <h3>Design</h3> Retrospective Cohort. <h3>Setting</h3> Inpatient rehabilitation facility. <h3>Participants</h3> One hundred patients admitted for rehabilitation following petrochanteric hip fracture between January 1, 2018 and December 30, 2020. Patients with intact, mild, or moderate/severe cognitive impairments were randomly selected for inclusion at a 1:1:1 ratio. Patients with dementia were excluded. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Prior diagnosis of depression of anxiety, self-reported pain levels (rated 1-10) and opioid use during first week of admission, rehabilitation efficiency (change in functional independence [GG] per day), length of stay. <h3>Results</h3> Expressive language was assessed using language domains on the Montreal Cognitive Assessment (MoCA) and therapist assessments of patients' abilities to express their needs and wants (Section BB of CMS IRF-PAI 3.0). A positive correlation between the Expression of Ideas and Wants and the average maximum pain levels (ρ = 0.243, P=0.015) was observed, using Spearman's correlation. Language assessments on the MoCA were not related to pain (ρ=-0.078, P=0.46). Higher average pain scores were associated with a diagnosis of anxiety and/or depression (ρ = 0.252, P=0.012), lower MoCA scores (ρ = -0.225, P=0.031) and younger age (-0.243, P=0.015). These three factors were all independently associated with pain in a multivariable model (P< 0.05). Anxiety and/or depression was also associated with higher opioid frequency (ρ = 0.308, P=0.002). There was a significant relationship between maximal pain scores and level of functional independence on admission and rehabilitation efficiency (ρ = -0.259, P=0.009). <h3>Conclusions</h3> Higher self-reported pain is associated with less efficient progress in rehabilitation. Patient cognition and ability to express oneself may affect pain reporting. Patients with anxiety and/or depression reported higher pain and used opioids more frequently than those without a diagnosis. Additional pain-management strategies should be considered in these populations. <h3>Author(s) Disclosures</h3> None.