Functional Independence Measure Gain Research Articles

Weight gain is associated with improvement in activities of daily living in underweight rehabilitation inpatients: a nationwide survey

We retrospectively analysed large-scale, nationwide data from the Kaifukuki (convalescent) Rehabilitation Ward (KRW) survey of 2015. Patients were classified into two groups based on changes in body mass index (BMI) during their KRW stay: increased BMI and non-increased BMI. The primary outcome was motor functional independence measure (FIM) score at discharge, and the secondary outcomes were motor FIM gain and full oral intake at discharge. We analysed 4605 patients (64% women; mean age, 79.3 years). Of these patients, 1128 and 3477 were classified into the increased and non-increased groups, respectively. Multivariate analysis showed that BMI increases were independently associated with motor FIM scores at discharge (partial regression coefficient = 1.165; 95% confidence interval, 0.671-1.659) and motor FIM gains, although BMI increase was not associated with full oral intake. Thus, increasing body weight might lead to activities of daily life improvement in underweight patients undergoing post-acute rehabilitation.

Effectiveness of Intensive Rehabilitation Therapy on Functional Outcomes After Stroke: A Propensity Score Analysis Based on Japan Rehabilitation Database

Aim: To examine the association of the amount of rehabilitation with functional gains of elderly stroke patients at a convalescent rehabilitation ward using propensity score analysis methods and the Japan Rehabilitation Database.Methods: This study was a retrospective cohort study. From the database, 6875 patients who were admitted to the convalescent rehabilitation wards with stroke were identified. After excluding 4586 patients, 2325 were eligible for the study. Intensive rehabilitation therapy (IRT) was defined as rehabilitation therapy of more than 15 hours per week by a physical therapist, an occupational therapist, and/or a speech therapist. Functional Independence Measure (FIM) gain, discharge rate to home, and FIM efficiency were examined using student's t test and the χ2 test after inverse probability weighting (IPW).Results: IRT was provided to 862 patients (37.1%). The unadjusted data showed that patients in the IRT group had a longer hospital stay, more physical therapy, occupational therapy, and speech and language therapy. After adjustment for IPW, the baseline characteristics were found to be closely matched between the 2 groups. The IRT group showed significantly higher motor FIM gain, cognitive FIM gain, FIM gain, and discharge rate to home.Conclusions: The present study demonstrated that a longer rehabilitation time per week was associated with increased functional gain in elderly stroke patients at convalescent rehabilitation wards.

Outcomes of Acute Inpatient Rehabilitation of Patients With Left Ventricular Assist Devices and Subsequent Stroke.

The aim of the study was to examine the functional outcomes and medical complications of patients with left ventricular assist device implantation and subsequent stroke during comprehensive inpatient rehabilitation. Retrospective cohort study of 21 patients admitted to an inpatient rehabilitation facility between 2009 and 2015. Main outcome measurements include admission and discharge Functional Independence Measure, length of stay, and Functional Independence Measure efficiency. The study included 17 male and 4 female patients aged 32-75 yrs. Eleven patients (52%) required transfer to an acute care hospital for evaluation. Fifteen patients completed inpatient rehabilitation with median [interquartile range] length of stay 26 [13.5-34] days (range = 7-59 days), median [interquartile range] Functional Independence Measure gain of 18 [12.5-32], and median [interquartile range] Functional Independence Measure efficiency of 1.0 [0.6-1.44]. Patients who required transfer to acute care during their course but ultimately completed inpatient rehabilitation (n = 5) demonstrated larger median [interquartile range] Functional Independence Measure gain (40 [23-42]) and longer median [interquartile range] length of stay (35 [35-42]) compared with patients who completed inpatient rehabilitation without transfer (Functional Independence Measure gain = 15 [9.25-26.5]; length of stay = 14.5 [11.5-26.25]). Patients with left ventricular assist device implantation and subsequent stroke demonstrate functional gains during acute inpatient rehabilitation programs. A large percent of patients required transfer to acute care.

Factors affecting functional outcome in patients with traumatic brain injury sequelae: Our single-center experiences on brain injury rehabilitation.

This study aims to investigate the effect of rehabilitation on functional level of traumatic brain injury (TBI) patients and to examine the associated factors on functional gain in this patient population. Between October 2010 and November 2015, a total of 71 patients (63 males, 8 females; mean age 26.6±8.1 years; range, 18 to 56 years) who were admitted to our rehabilitation clinic with moderate-to-severe TBI were retrospectively analyzed. Functional recovery was assessed using the Functional Independence Measure (FIM) and Functional Ambulation Classification (FAC) scales. The patients were divided into two groups according to time from TBI to the initiation of rehabilitation: early (<6 months) and late (≥6 months). Possible predictive factors associated with FIM gain were evaluated. There was a significant improvement in the FIM scores from admission to discharge (p<0.001). There was a statistically significant difference in the FIM gain and FIM efficiency between the patient groups according to the initiation of rehabilitation (p<0.001). The FAC scores increased from admission to discharge, showing statistical significance (p<0.001). Duration of rehabilitation, early rehabilitation, heterotopic ossification, and deep venous thrombosis were found to be significant factors associated with FIM gain (p<0.001). Our study results suggest that rehabilitation is effective for functional gain, particularly in the early period in patients with moderate- to-severe TBI and duration of rehabilitation, early rehabilitation, heterotopic ossification, and deep venous thrombosis are also predictors of functional improvement.

A comparison of patients managed in specialist versus non-specialist inpatient rehabilitation units in Australia

Aim: To compare the rehabilitation of patients with brain and spinal cord injury in specialist rehabilitation units and non-specialist rehabilitation units in Australia over a 10-year period.Method: A retrospective cohort study design was used. Epidemiological descriptive analysis was used to examine inpatient rehabilitation data held in the Australasian Rehabilitation Outcomes Centre Registry Database at four discrete time points: 2007, 2010, 2013 and 2016. Data sets included patient demographics, length of stay and the Functional Independence Measure. Data sets were examined for differences between specialist and non-specialist rehabilitation units.Results: Over the 10-year study period, compared to patients admitted to non-specialist rehabilitation units patients admitted to specialist rehabilitation units: (1) were younger and more likely to be male; (2) had a longer time between onset of illness/injury and rehabilitation admission; (3) had a longer median rehabilitation length of stay; (4) had a higher burden of care on admission to rehabilitation; however (5) had a greater functional gain. Patients in specialist rehabilitation units had a lower relative functional efficiency per day of rehabilitation, but higher percentage of Functional Independence Measure gain. In 2016, 66% of brain injury and 51% of spinal cord injury patients were not rehabilitated in specialist rehabilitation units.Conclusion: There are differences in the characteristics of patients admitted to specialist versus non-specialist rehabilitation units. Patients admitted to specialist rehabilitation units have greater functional gain. A noteworthy proportion of brain and spinal cord injury patients are not being rehabilitated in specialist rehabilitation units, particularly patients with non-traumatic injuries.Implications for rehabilitationPatients with a brain or spinal cord injury rehabilitated in specialist rehabilitation units achieve a greater functional gain than those in non-specialist units.Development of best practice admission guidelines would better enable the right care for the right patient in the right setting at the right time.There is a need for longitudinal examination of patient outcomes to better understand the long-term benefits of being rehabilitated in specialist rehabilitation units compared to non-specialist rehabilitation units.

Abstract WP183: Clinical Outcome in Cardioembolic Stroke Patients Receiving DOACs versus Warfarin: K-PLUS Registry

Introduction: Relationship between the selection of oral anticoagulants after acute stroke as secondary prevention and clinical outcome is not elucidated. Our aim is to compare clinical outcome in patients receiving direct oral anticoagulants (DOACs) versus warfarin after their stroke. Methods: In the regional stroke registry, K-PLUS, 1,019 consecutive patients with cardioembolic stroke who were prescribed anticoagulants were retrospectively enrolled from April 2011 to May 2016. Patients with premorbid modified Rankin Scale score of 3 or more and those with incomplete clinical data were excluded. The residual 323 patients were divided into 2 groups by their receiving anticoagulants after their stroke: the warfarin group and the DOACs group. Clinical characteristics, length of hospital stay, Functional Independence Measure (FIM) scores on admission and at discharge of rehabilitation hospital, and mean daily FIM gain were compared between the 2 groups. Results: In the 323 patients, median age was 79 (interquartile range: 73-85) years and 176 (54.5%) were men. A total of 146 patients (46.2%) was prescribed DOACs (dabigatran in 15, rivaroxaban in 46, apixaban in 72, and edoxaban in 13). Median age (81 vs. 79 in median, p = .03) and NIHSS score on acute hospital admission (10 in DOACs vs. 17 in warfarin, p &lt; .01) were lower, and length of acute hospital stay was shorter (13 vs. 17 days, p &lt; .01) in the DOACs group than the warfarin group. In rehabilitation hospitals, both FIM score on admission (86 vs. 32, p &lt; .01) and daily FIM gain (0.22 vs. 0.10, p &lt; .01) was significantly higher in the DOACs group. On multivariate analysis, DOACs prescription (odds ratio 1.79; 95% CI, 1.10-2.93) and NIHSS on acute hospital admission (1.04 per 1 point; 1.01-1.08) were correlated with daily FIM gain ≥ 0.15, independent of other factors including age, length of acute hospital stay, and FIM on admission of rehabilitation hospital. Conclusion: Patients receiving DOACs after their cardioembolic stroke might achieve better clinical outcome than those with warfarin.

The items and level contributing to improve in less than 50 motor functional independence measure upon admission in the stroke recovery rehabilitation ward.

[Purpose] To determine the motor Functional Independence Measure item and level that contribute to improvement in Functional Independence Measure gain in the recovery rehabilitation ward. [Participants and Methods] This study analyzed the data of 1,866 participants who were selected based on four criteria: age, number of days from onset to admission, length of hospital stay, and motor Functional Independence Measure upon admission. Moreover, all items examined were recorded. The participants were divided into two groups, the non-improving and improving group, based on a motor Functional Independence Measure gain of 22 points. The degree of contribution of each item was analyzed based on the median motor Functional Independence Measure. Logistic regression analysis was performed, with the two groups as dependent variables and the item with high contribution as independent variable; receiver operating characteristic analysis was performed. [Results] The items that highly contributed to motor Functional Independence Measure gain were bathing (level 3), dressing (lower body) (level 4), bladder management (level 5), and stair climbing (level 3). [Conclusion] The results of this study were suggested that the items that contribute to the improvement in motor Functional Independence Measure gain in stroke patients with a motor Functional Independence Measure of less than 50 were related to self-care and at least over moderate assistance.

Prospective evaluation of frailty and functional independence in older adult trauma patients

BackgroundThe aim of our study was to assess the association between frailty and functional status in geriatric trauma patients. Methods3-year(2013–2015) prospective analysis and included all geriatric trauma patients(≥65y) discharged to a single rehabilitation center from our level-I trauma center. Frailty was measured using Trauma-Specific-Frailty-Index(TSFI) while Functional status was assessed using functional-independence-measure(FIM) at admission and discharge from rehabilitation center. Multivariate linear regression analysis was performed. Results267 patients were enrolled. Mean age was 76.9 ± 7.1y, 63.6% were males. Overall, 22.8% were frail, and 37.4% were pre-frail. On linear regression, higher motor-FIM, higher cognitive-FIM scores at admission, and longer length-of-stay at rehab were independently associated with increased discharge FIM score. While, ISS(injury-severity-score), pre-frail and frail status were negatively correlated with FIM gain. ConclusionFrail patients were less likely to recover to their baseline functional status compared with non-frail patients. Early focused intervention in frail elderly patients is warranted to improve functional status in this population.

Virtual Reality in Upper Extremity Rehabilitation of Stroke Patients: A Randomized Controlled Trial

ObjectiveVirtual reality game system is one of novel approaches, which can improve hemiplegic extremity functions of stroke patients. We aimed to evaluate the effect of the Microsoft Xbox 360 Kinect video game system on upper limb motor functions for subacute stroke patients. MethodsThe study included 42 stroke patients of which 35 (19 Virtual reality group, 16 control group) completed the study. All patients received 60 minutes of conventional therapy for upper extremity, 5 times per-week for 4 weeks. Virtual reality group additionally received Xbox Kinect game system 30 minutes per-day. Patients were evaluated prior to the rehabilitation and at the end of 4 weeks. Box&Block Test, Functional independence measure self-care score, Brunnstorm stage and Fugl-Meyer upper extremity motor function scale were used as outcome measures. ResultsThe Brunnstrom stages and the scores on the Fugl-Meyer upper extremity, Box&Block Test and Functional independence measure improved significantly from baseline to post-treatment in both the experimental and the control groups. The Brunnstrom stage-upper extremity and Box&Block Test gain for the experimental group were significantly higher compared to the control group, while the Brunnstrom stage-hand, the Functional independence measure gain and Fugl-Meyer gain were similar between the groups. ConclusionsWe found evidence that kinect-based game system in addition to conventional therapy may have supplemental benefit for stroke patients. However, for virtual reality game systems to enter the routine practice of stroke rehabilitation, randomized controlled clinical trials with longer follow-up periods and larger sample sizes are needed especially to determine an optimal duration and intensity of the treatment.

Psychotropic drug use and cognitive rehabilitation practice for elderly patients.

Background Psychotropic drugs were associated with greater risks of adverse drug reactions, including lower the level of consciousness, cause cognitive dysfunction, relax muscles, cause hypotension and others. However, the effect of psychotropic drug use on rehabilitation outcomes is poorly documented in Japan. Objective To assess the association of increased psychotropic drugs during hospitalization with activities of daily living among elderly patients. Setting This study was conducted at the convalescent rehabilitation ward in the Hitachinaka General Hospital in Japan. Method This retrospective longitudinal cohort study included consecutive patients aged ≥ 65years between 2010 and 2016. Participants were divided based on presence or absence of increased psychotropic drugs including benzodiazepines, antidepressants, antipsychotics, and antiepileptic drugs during hospitalization. Functional recovery was assessed by the Functional Independence Measure (FIM). Multivariate analyses were performed, adjusting for confounding factors. Main outcome measures Cognitive gain in the Functional Independence Measure. Results We included 631 participants (227 males, 404 females) with a median age of 78years (interquartile range 73-84years). Multiple regression analysis revealed that change in psychotropic drug use, cognitive FIM at admission, and age were independently and negatively correlated with cognitive FIM gain. Multiple logistic regression analysis indicated that the "Comprehension" and "Memory" items of the cognitive FIM gain were independently and negatively associated with increased psychotropic drug use. Conclusion Increased psychotropic drug use during hospitalization may predict limited the improvement of cognitive activities of daily living in geriatric patients.

Nutritional intake is associated with activities of daily living and complications in older inpatients with stroke

There is no consensus on energy intake in the acute stage and how it relates to improvement in activities of daily living (ADL) in geriatric stroke patients. We examined whether energy intake after admission is related to improvement in ADL and complications. This retrospective cohort study evaluated the data from stroke inpatients at five acute care hospitals, including the mean daily energy intake during the first week after admission. Patients were categorized into two groups based on their daily energy intake; cases where the energy intake per day reached the basal energy expenditure calculated by the Harris-Benedict equation were designated as the intake energy sufficiency group. Patient characteristics were compared between groups. We assessed ADL using the Functional Independence Measure; a secondary outcome was the presence of complications. Of the 192 participants (mean age 79.6 ± 7.6 years) included in the study, 131 patients were admitted for cerebral infarction, 58 for intracerebral hemorrhage and three for subarachnoid hemorrhage. Of the two groups, that with an energy sufficiency had a greater gain in total Functional Independence Measure (median 27 and 9, respectively; P = 0.001) and a lower complication rate (6.7% and 26.5%, respectively; P ≤ 0.001). Multivariate analyses showed that energy sufficiency was independently associated with the total Functional Independence Measure gain and complication rate. Energy intake during the first week after admission affected improvement of ADL and onset of complications during hospitalization in geriatric stroke inpatients. Geriatr Gerontol Int 2018; 18: 1334-1339.

Rehabilitation strategy for hip fracture, focused on behavioral psychological symptoms of dementia for older people with cognitive impairment: A nationwide Japan rehabilitation database.

The aim is to investigate the relationship between a positive outcome on rehabilitation after hip fracture and behavioral psychological symptoms of dementia (BPSD) transition during rehabilitation. This study is a retrospective cohort study based on the Japan Rehabilitation Database. We recruited 756 subjects 65 years of age or older from 31 hospitals in the database. All subjects were in the hospital as patients undergoing rehabilitation for hip fracture. Functional independence measure (FIM), walking ability, Mini-Mental State Examination (MMSE), and BPSD were measured both at the beginning and at the end of rehabilitation. MMSE for 23 or under was defined as the cognitive-impaired group. MMSE for 24 or over was used as the cognitively intact group. Cognitive impaired participants were divided into four groups: participants presented no BPSD both at the beginning of rehabilitation and at the end of rehabilitation (Group (-/-)), participants presented BPSD at the beginning of rehabilitation but resolved at the end of rehabilitation (Group (+/-)), participants had no BPSD at the beginning of rehabilitation but appeared at the end of rehabilitation (Group (-/+)) and participants had sign of BPSD both at the beginning of rehabilitation and at the end of rehabilitation (Group (+/+)). The endpoints were waking ability, FIM gain. As results, one hundred thirty-seven cognitive-impaired older people patients out of 471 (29.1%) suffered from BPSD at the beginning of rehabilitation. FIM gains in cognitively intact group, Group (-/-), Group (+/-), Group (-/+) and Group (+/+) were 24.8 ± 18.7, 17.5 ± 16.9, 27.3 ± 19.7, 17.8 ± 12.2 and 12.2 ± 17.2, respectively. The Group (+/-) was significantly connected to a positive outcome for rehabilitation. The present study suggested that the management of BPSD can lead to better functional recovery during rehabilitation.

Clinical effects of low body mass index on geriatric status in elderly patients.

There is limited information on the relationship of low body mass index (BMI) to the geriatric conditions in elderly patients. The objective of this study is to investigate whether low BMI associates with geriatric status in elderly patients by calculating suitable cut-off point of BMI for assessment of geriatric conditions. A total of 1223 elderly patients was enrolled (male/female: N = 472/751), and cut-off point of the BMI values to assess the geriatric status such as aspiration pneumonia, cognitive impairment was determined by receiver operating characteristic (ROC) analyses. Logistic regression analyses were performed to examine the association between several geriatric status and low BMI. Of these patients, 262 patients (male/female: 101/161) had received standard rehabilitation treatment. Functional Independence Measure (FIM) scores were measured both at admission and discharge to calculate FIM gain and efficiency, and retrospective cohort study was performed. Cut-off point of BMI value to assess the geriatric status was determined (19.0 kg/m2). Significant associations of low BMI to several geriatric factors such as loss of posterior occlusion, cognitive impairment were observed in both male and female. FIM scores in above cut-off point group were significantly higher than in below cut-off point group in female (FIM gain, P = 0.0005; FIM efficiency, P = 0.0025, Mann-Whitney U test). On the other hand, there were no significant differences between low and above BMI cut-off point in FIM scores of male patients. Low BMI might be a useful parameter to evaluate the geriatric status, and the viewpoint would contribute to decide the care plan for the good end-of-life of elderly.

Anticholinergic load negatively correlates with recovery of cognitive activities of daily living for geriatric patients after stroke in the convalescent stage.

Anticholinergic drugs are associated with risks of falls, confusion and cognitive dysfunction. However, the effect of anticholinergic drug use on rehabilitation outcomes after a stroke is poorly documented. We therefore aimed to establish whether the anticholinergic load was associated with functional recovery among geriatric patients convalescing after stroke. Consecutive geriatric stroke patients admitted and discharged from a convalescence rehabilitation ward between 2010 and 2016 were included in this retrospective cohort study. Anticholinergic load was assessed by the Anticholinergic Risk Scale (ARS), and functional recovery was assessed by the Functional Independence Measure (FIM). The primary outcome was cognitive FIM (FIM-C) gain, but we also assessed the interaction of other putative factors identified from univariate analysis. Multivariate analyses were performed, adjusting for confounding factors. We included 418 participants (171 males, 247 females) with a median age of 78years (interquartile range, 72-84years). Multiple regression analysis revealed that ARS change, length of stay, and epilepsy were independently and negatively correlated with cognitive FIM gain. Multiple logistic regression analysis indicated that the "Comprehension" and "Memory" items of the cognitive FIM gain were independently and negatively associated with anticholinergic load. A causal relationship cannot be established, but increased ARS scores during hospitalization may predict limited cognitive functional improvement in geriatric patients after stroke. Alternatively, cognitive impairment may lead to increased use of anticholinergic drugs.

Evaluation of functional outcomes in traumatic spinal cord injury with rehabilitation-acquired urinary tract infections: A retrospective study

ObjectiveThe objective of this study was to evaluate the impact of urinary tract infections (UTIs) acquired during acute inpatient traumatic Spinal Cord Injury (tSCI) rehabilitation on Functional Independence Measure (FIM) gains.DesignRetrospective chart review of consecutive patients with tSCI admitted to an acute rehabilitation facility from 2007–2012. The primary outcome was FIM scores and the association with UTI.ResultsThe sample included 110 patients and 70 acquired UTIs. No demographic differences were observed between groups with and without UTI. Those with UTIs had significantly lower FIM motor scores, on admission, discharge, and gain, as well as lower FIM efficiency and longer lengths of stay compared to those without a UTI. Recurrence of UTI was associated with increased length of stay, but did not impact FIM motor gains.ConclusionsThere was a statistically significant correlation between acquired UTIs and lower FIM motor scores on admission, gain, and discharge in tSCI rehabilitation. The correlation of UTI and decreased FIM gains are similar to other neurorehabilitation populations with UTI occurrence. UTIs are an important negative variable when measuring functional outcomes in rehabilitation. Further prospective studies should be performed to investigate this correlation.

Outcomes of patients with multiple sclerosis at a neurorehabilitation unit in Saudi Arabia.

Objectives:To assess the impact of inpatient multidisciplinary rehabilitation on a Saudi Arabian population of patients with multiple sclerosis (MS).Methods:We retrospectively analyzed the data of patients with MS who underwent inpatient rehabilitation between 2009 and 2015 at King Fahad Medical City (KFMC). Differences in Functional Independence Measure (FIM) scores (used in rehabilitation settings to assess the functional independence of patients) and length of stay (LOS) were measured between patients of different ages, sexes, and types of MS and analyzed using the independent t-test. The Pearson correlation coefficient was used to investigate the correlation between FIM, LOS, and other variables.Results:In total, 24 patients were identified, with an average age of 36 years. The average age at disease onset was 31 years. Disease duration ranged from 1-20 years, with a mean of 7 years. The most common type of MS was relapsing-remitting (45.8%). The mean FIM score at admission was 77.5 and at discharge 97.25. Functional independence measure gain ranged from 2-51, with a mean of 18.58. Functional independence measure efficiency (FIM gain divided by LOS) ranged between 0.09-0.95. The length of stay ranged between 21-95 days, with a mean of 37.79 days. There was a significant association between age and FIM efficiency (p=0.043).Conclusions:Inpatient rehabilitation is an important intervention that improves the functional independence of patients with chronic MS.

The association of increased drugs use with activities of daily living and discharge outcome among elderly stroke patients.

The main outcome measures were Functional Independence Measure (FIM) gain and home discharge. Results In total, 417 participants (165 males and 252 females; mean age, 78.8years) were assessed and classified into home discharge (n=226) and non-home discharge (n=191) groups. The median FIM score was 77 (interquartile range 57-96). Multiple linear regression analysis revealed that increased use of drugs during hospitalization negatively correlated with FIM gain. Multiple logistic regression analysis showed that increased use of drugs was independently associated with a low possibility of home discharge. Conclusion The increased use of drugs during hospitalization was negatively associated with both functional recovery and possibility of home discharge among geriatric stroke patients in a convalescent rehabilitation ward.

Effectiveness of preoperative physical therapy for older patients with hip fracture.

To clarify the effectiveness of preoperative physical therapy for older patients after hip fracture in an acute care hospital. In the present retrospective observational study, data from the Japan Rehabilitation Database were analyzed for patients admitted to an acute care hospital with hip fracture between 2005 and 2015. In this study, all eligible patients received surgery within 10 days of admission. Propensity score analysis was used to compare outcomes between patients who underwent preoperative rehabilitation and those who did not. The primary outcome was motor Functional Independence Measure (FIM) gain. Of the 681 patients eligible after applying exclusion criteria, 50% underwent preoperative rehabilitation after hip fracture. Both before and after adjustment by inverse probability weighting, motor FIM gain was significantly higher in patients who underwent preoperative rehabilitation (motor FIM gain 31.1 ± 18.2 before weighting, 31.1 ± 18.2 after weighting) than in those who did not (motor FIM gain 24.6 ± 18.1 before weighting, P < 0.01; 26.2 ± 17.6 after weighting, P < 0.02). In addition, motor FIM effectiveness and motor FIM at discharge were significantly higher among patients who underwent preoperative rehabilitation. Our data suggest that preoperative rehabilitation after hip fracture is associated with better rehabilitation outcomes than no preoperative rehabilitation. Geriatr Gerontol Int 2018; 18: 1003-1008.

Rehabilitation outcomes of stroke patients with low left ventricular ejection fraction in the subacute rehabilitation phase

To examine the left ventricular ejection fraction in patients with subacute stroke and compare rehabilitation outcomes between those with decreased left ventricular ejection fraction and those without. Retrospective chart review. A total of 482 consecutive patients with stroke admitted to a convalescent rehabilitation hospital. Patients were assessed using transthoracic echocardiography within 7 days of admission. The patients were divided into a group with low left ventricular ejection fraction and a group with preserved left ventricular ejection fraction. Functional Independence Measure (FIM) scores at admission and discharge, FIM gain, FIM efficiency, and discharge disposition were compared between groups. The low left ventricular ejection fraction group had significantly lower cognitive and total FIM scores on admission than the preserved left ventricular ejection fraction group. The patients in the low left ventricular ejection fraction group tended to be transferred to acute hospitals more frequently. How-ever, the total score of discharge FIM, FIM gain, and FIM efficiency did not differ significantly between the groups when rehabilitation was continued until discharge. Stroke patients with low left ventricular ejection fraction in the subacute phase could achieve almost the same functional outcomes as those of patients with preserved left ventricular ejection fraction. Although the general medical condition should be considered, the finding of low left ventricular ejection fraction did not pose a barrier to successful rehabilitation after stroke.

Difference in independent mobility improvement from admission to discharge between subacute stroke patients using knee-ankle-foot and those using ankle-foot orthoses.

[Purpose] To verify differences in independent mobility improvements between people with subacute stroke with knee-ankle-foot orthoses (KAFOs) and those with ankle-foot orthoses (AFOs) from admission to discharge, and to identify the relationship between mobility improvements and their characteristics. [Participants and Methods] This study included 381 hospitalized patients with subacute stroke who required complete mobility assistance at admission and for whom KAFOs (KAFO group) or AFOs (AFO group) were prescribed after admission. The functional independence measure (FIM) score at admission and discharge, FIM gain, age, Brunnstrom stage (BS) of the paretic lower limb at admission, and the period from admission to prescription for lower limb orthoses were investigated. [Results] Repeated-measures two-way analysis of variance revealed a significant group × time interaction in the walk/wheelchair and stair-climbing items of the FIM. Improvements in the scores in the KAFO group were significantly lower than those in the AFO group. Age, BS, FIM at admission, and period from admission to lower limb orthosis prescription significantly correlated with FIM gain in the walk/wheelchair and stair-climbing items. [Conclusion] A more effective intervention using lower limb orthoses with consideration of the influence of age, motor paralysis, and activities of daily living at admission is required to promote the improvements of people with subacute stroke prescribed KAFOs or AFOs.