Functional Independence Measure Motor Research Articles

Impact of energy intake on the activities of daily living in patients with cervical spinal cord injury undergoing post-acute rehabilitation

Objective To investigate the association between sufficient energy intake and improvement in activities of daily living (ADL) after hospitalization in patients with cervical spinal cord injury (CSCI) undergoing post-acute rehabilitation. Design Retrospective cohort study. Setting Post-acute care hospital from September 2013 to December 2020. Participants Patients with CSCI admitted to a post-acute care hospital for rehabilitation. Intervention Not applicable. Outcome measure(s) Multiple regression analysis was performed to investigate the relationship of sufficient energy intake to Motor Functional Independence Measure (mFIM) gain, mFIM score at discharge, and body weight change during hospitalization. Results In total, 116 patients (104 men and 12 women), median age: 55 (interquartile range [IQR] 41−65) years were included in the analysis. Then, 68 (58.6%) were in the energy-sufficient group, and 48 (41.4%) patients were classified under the energy-deficient group. The two groups did not significantly differ in terms of mFIM gain and mFIM score at discharge. The energy-sufficient group maintained body weight change during hospitalization than the energy-deficient group (0.6 [−2.0−2.0] vs. −1.9 [−4.0−−0.3], P < 0.001). Multiple regression analysis showed no association between sufficient energy intake and outcomes. Conclusion Sufficient energy intake within the first 3 days of admission did not affect ADL improvement during hospitalization in patients with a post-cute CSCI undergoing rehabilitation.

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

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

Potentially Preventable Readmissions After Acute Inpatient Rehabilitation.

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

Effects of Motor Rehabilitation on Balance and Functional Activities in Elderly Patients with Peripheral Neuropathy and Recurrent Falls.

To date, little is known about the effects of motor rehabilitation in peripheral neuropathy (PN) patients with a history of recurrent falls (RFH). This study aimed to assess balance and the activities of daily living (ADLs) in elderly lower limb PN patients with and without RFH and to verify the effects of motor rehabilitation on balance and ADLs in these patients. We collected data from 64 lower limb PN patients, who underwent a conventional motor rehabilitation program: 35 patients had a history of recurrent falls, and 29 did not. The Berg Balance Scale (BBS) and motor FIM, before and after rehabilitation, were the outcome measures. After rehabilitation, lower limb PN patients with RFH had significantly higher scores in BBS and motor FIM (p < 0.001, for both) than at entry. The final BBS score and effectiveness in the BBS score of lower limb PN patients with RFH were lower than those of patients without RFH (p < 0.05 and p = 0.009, respectively). The study shows that conventional motor rehabilitation improves both balance and ADLs in patients, but balance improvement is lower in those with RFH. Thus, motor rehabilitation can be a therapeutic option for the management of these patients.

The impact of dementia on rehabilitation outcomes following hip fracture.

To compare clinical outcomes between patients for whom their participation in inpatient rehabilitation was and was not impacted by dementia through matching patients reporting dementia (dementia group) with those not reporting dementia (non-dementia group). Prospectively collected data held by the Australasian Rehabilitation Outcome Centre (AROC) were analyzed for patients aged 65 years or older receiving inpatient rehabilitation in public hospitals in Australia following a hip fracture and discharged between July 1, 2014, and June 30, 2019. Patients reported as having dementia impacting their rehabilitation program were matched to patients not reporting dementia based on age, admission motor Functional Independence Measure (FIM) score, and accommodation prior to rehabilitation. The matched cohorts were compared in relation to clinical outcomes (motor and cognitive FIM improvement, FIM efficiency, length of stay, and discharge destination) following participation in hospital-based rehabilitation using univariate analysis. Patients with dementia had significantly lower cognitive FIM scores on commencing rehabilitation (17.6 and 26.9, respectively, P < 0.001) and their median length of stay was 2 days shorter than those without dementia (21 and 23 days, respectively, P < 0.001). Relative change in FIM score and FIM efficiency (per week) were lower in the dementia group [relative FIM score change of dementia vs non-dementia, respectively, 26.2% vs. 44.0% (P < 0.001) and FIM efficiency, 6.5 vs. 8.9 (P < 0.001)]. Discharge destination between the two groups was statistically different, with 35.7% of patients with dementia being discharged to residential aged care facilities (RACFs) compared to 21.7% of those without dementia (P < 0.001). More patients with dementia had carers in their private residence in the post-rehabilitation phase, 82.2% vs. 57.6% (P < 0.001). Patients with dementia who sustain a fractured hip benefit from inpatient rehabilitation, although their clinical outcomes are not as good as those without dementia. FIM change and FIM efficiency were lower in the dementia group. Length of stay in the hospital for patients with dementia was shorter due to earlier recognition for the need for placement in either an RACF or at home with carer support. Theneed for placement in an RACF or carer support in a private residence was significantly greater in the dementia group.

Exploring racial/ethnic disparities in rehabilitation outcomes after TBI: A Veterans Affairs Model Systems study.

Almost one-third of the U.S. military population is comprised of service members and veterans (SMVs) of color. Research suggests poorer functional and psychosocial outcomes among Black and Hispanic/Latine vs. White civilians following traumatic brain injury (TBI). This study examined racial/ethnic differences in 5-year functional independence and life satisfaction trajectories among SMVs who had undergone acute rehabilitation at one of five Veterans Affairs (VA) TBI Model Systems (TBIMS) Polytrauma Rehabilitation Centers (PRCs). Differences in demographic and injury-related factors were assessed during acute rehabilitation among White (n = 663), Black (n = 89), and Hispanic/Latine (n = 124) groups. Functional Independence Measure (FIM) Motor, FIM Cognitive, and Satisfaction with Life Scale (SWLS) scores were collected at 1, 2, and 5 years after injury. Racial/ethnic comparisons in these outcome trajectories were made using hierarchical linear modeling. Black SMVs were less likely than White and Hispanic/Latine SMVs to have been deployed to a combat zone; there were no other racial/ethnic differences in any demographic or injury-related variable assessed. In terms of outcomes, no racial/ethnic differences emerged in FIM Motor, FIM cognitive, or SWLS trajectories. The absence of observable racial/ethnic differences in 5-year outcome trajectories after TBI among SMVs from VA TBIMS PRCs contrasts sharply with previous research identifying disparities in these same outcomes and throughout the larger VA health care system. Individuals enrolled in VA PRCs are likely homogenized on key social determinants of health that would otherwise contribute to racial/ethnic disparities in outcome trajectories.

Prism Adaptation Treatment for Right-Sided and Left-Sided Spatial Neglect: A Retrospective Case-Matched Study

ObjectiveTo compare the effectiveness of prism adaptation treatment (PAT) between patients with right- and left-sided spatial neglect (SN). DesignRetrospective case-matched design. SettingInpatient rehabilitation hospitals and facilities. ParticipantsA total of 118 participants were selected from a clinical dataset of 4256 patients from multiple facilities across the United States. Patients with right-sided SN (median age: 71.0 [63.5-78.5] years; 47.5% female; 84.8% stroke, 10.1% traumatic/nontraumatic brain injury) were matched 1:1 with patients with left-sided SN (median age: 70.0 [63.0-78.0] years; 49.2% female; 86.4% stroke, 11.8% traumatic/nontraumatic brain injury) based on age, neglect severity, overall functional ability at admission, and number of PAT sessions completed during their hospital stay. InterventionPrism adaptation treatment. Main Outcome MeasuresPrimary outcomes were pre–post change on the Kessler Foundation Neglect Assessment Process (KF-NAP) and the Functional Independence Measure (FIM). Secondary outcomes were whether the minimal clinically important difference was achieved for pre–post change on the FIM. ResultsWe found greater KF-NAP gain for patients with right-sided SN than those with left-sided SN (Z = 2.38, P=.018). We found no differences between patients with right-sided and left-sided SN for Total FIM gain (Z=–0.204, P=.838), Motor FIM gain (Z=–0.331, P=.741), or Cognitive FIM gain (Z=–0.191, P=.849). ConclusionsOur findings suggest PAT is a viable treatment for patients with right-sided SN just as it is for patients with left-sided SN. Therefore, we suggest prioritizing PAT within the inpatient rehabilitation setting as a treatment to improve SN symptoms regardless of brain lesion side.

Factors Influencing the Use of Walking Aids by Frail Elderly People in Senior Day Care Centers.

Senior day care centers in Japan are the most commonly used insurance service for frail elderly people, and it is important to examine the factors that influence the use of walking aids at these centers. We aimed to investigate the factors affecting the use of walking aids by frail elderly patients in senior daycare centers. A total of 131 frail elderly people (mean age 82.7 ± 6.4 years) formed our study population. They were divided into two groups: solo walking (n = 87) and walking aid (n = 44). Individuals with cognitive decline were excluded. All participants were assessed using Functional Independence Measure Motor (FIM-M) sub-scores. Grip strength, knee extension strength, the 10 s Chair Stand test for Frail elderly (Frail CS-10), Single Leg Standing (SLS), and Timed Up and Go (TUG) tests were measured and compared between the two groups. The walking aid group scored significantly lower than the solo walking group for five items: FIM-M, knee extension muscle strength, Frail CS-10, SLS, and TUG (p < 0.05). Logistic regression analysis revealed that knee extension muscle strength was the only factor that affected the use or disuse of walking aids (p < 0.05). The cut-off value of the knee extensor muscle strength-to-weight ratio for walking alone was 28.5%. Knee extensor muscle strength was the most important factor in determining the use of a walking aid.

Long-term prediction of functional independence using adjusted and unadjusted single items of the functional independence measure (FIM) at discharge from rehabilitation

Context Being able to survive in the long-term independently is of concern to patients with spinal cord injury (SCI), their relatives, and to those providing or planning health care, especially at rehabilitation discharge. Most previous studies have attempted to predict functional dependency in activities of daily living within one year after injury. Objectives (1) build 18 different predictive models, each model using one FIM (Functional Independence Measure) item, assessed at discharge, as independent predictor of total FIM score at chronic phase (3–6 years post-injury) (2) build three different predictive models, using in each model an item from a different FIM domain with the highest predictive power obtained in objective (1) to predict “good” functional independence at chronic phase and (3) adjust the 3 models from objective (2) with known confounding factors. Methods This observational study included 461 patients admitted to rehabilitation between 2009 and 2019. We applied regression models to predict total FIM score and “good” functional independence (FIM motor score ≥ 65) reporting adjusted R 2, odds ratios, ROC-AUC (95% CI) tested using 10-fold cross-validation. Results The top three predictors, each from a different FIM domain, were Toilet (adjusted R 2 = 0.53, Transfers domain), Toileting (adjusted R 2 = 0.46, Self-care domain), and Bowel (adjusted R 2 = 0.35, Sphincter control domain). These three items were also predictors of “good” functional independence (AUC: 0.84–0.87) and their predictive power increased (AUC: 0.88–0.93) when adjusted by age, paraplegia, time since injury, and length of stay. Conclusions Discharge FIM items accurately predict long-term functional independence.

Construct validity and reliability of the participation scale (P-scale) in individuals with spinal cord injury

Objectives To investigate the reliability and the construct validity of the Participation Scale (P-scale) in adults with Spinal Cord Injury (SCI). Design A cross-sectional study. Setting : SARAH Network of Rehabilitation Hospitals, Brazil. Participants : One hundred individuals with SCI. Interventions : Not applicable. Outcome Measures : Sociodemographic and clinical characteristics were investigated. To assess reliability the P-scale was applied twice with a one-week interval. To assess construct validity the Functional Independence Measure, the Beck Depression Inventory, and the Accessibility Perception Questionnaire were administered. Results The mean age of the participants was 38.9 ± 12.80 years. The majority were male (70%) and had traumatic injuries (74%). The P-scale showed significant correlations with the Functional Independence Measure motor domain (rs = −0.280) and cognitive domain (rs = −0.520); with the Beck Depression Inventory score (rs = 0.610); with the Accessibility Perception Questionnaire displacement domain (rs = −0.620) and psycho-affective domain (rs = 0.530). Mean scores obtained on the P-scale differed significantly between the groups with and without depressive symptoms (P = 0.001), neuropathic pain (P = 0.033), and functional dependence (P = 0.001). There was no difference between the paraplegic and quadriplegic groups. The P-scale had adequate internal consistency (Cronbach’s alpha = 0.873), excellent test-retest reliability (ICC2,1 = 0.992; 95% CI = 0.987–0.994), and in the Bland–Altman plot analysis, only six values fell outside the limits of agreement. Conclusion Our results support the use of the P-scale to assess the participation of individuals with SCI in research and clinical practice.

Long-Term Lower Limb Motor Function Correlates with Middle Cerebellar Peduncle Structural Integrity in Sub-Acute Stroke: A ROI-Based MRI Cohort Study

Crossed cerebellar diaschisis (CCD) has been widely investigated in patients with supratentorial stroke. However, the role of CCD in lower limb recovery after stroke is still unknown. In this study, using a region-of-interest-based analysis of diffusion tensor imaging (DTI), a total of 44 cases of stroke within 3 months onset were enrolled for assessment of the cerebral peduncle (CP) and middle cerebellar peduncles (MCP) in CCD. Compared with the control group, the fractional anisotropy ratio (rFA) and laterality index (LI) of the CP and MCP in the stroke group significantly decreased. The rFA of the MCP (unaffected side/affected side) showed a more significant correlation with 1-year paresis grading (PG), lower extremity PG, upper extremity PG, National Institutes of Health Stroke Scale (NIHSS), and functional independence measure (FIM) motor item score, in comparison to the rFA of the CP (affected side/unaffected side) (r = -0.698 vs. r = -0.541, r = -0.651 vs. r = -0.386, r = -0.642 vs. r = -0.565, r = -0.519 vs. r = -0.403, and r = 0.487 vs. r = 0.435, respectively). Furthermore, the LI of the CP had a more significant association with 1-year Brunel Balance Assessment (BBA), upper extremity PG, and Modified Rankin Scale (mRS) as compared to the LI of the MCP (r = 0.573 vs. r = 0.452; r = -0.554 vs. r = -0.528; and r = -0.494 vs. r = -0.344, respectively). We set the cutoff point for the MCP rFA at 0.925 (sensitivity: 79% and specificity: 100%) for predicting lower extremity motor function prognosis and found the receiver operating characteristic (ROC) curve of MCP rFA was larger than that of CP rFA (0.893 vs. 0.737). These results reveal that the MCP may play a significant role in the recovery of walking ability after stroke.

Predictors of 10-year functional independence trajectories in older adults with traumatic brain injury: A Model Systems study.

Older adults have the highest traumatic brain injury (TBI)-related morbidity and mortality, and rates in older adults are increasing, chiefly due to falls. This study used hierarchical linear modeling (HLM) to examine baseline predictors of functional independence trajectories across 1, 2, 5, and 10 years after TBI in older adults. Participants comprised 2,459 individuals aged 60 or older at the time of TBI, enrolled in the longitudinal TBI Model Systems database, and had Functional Independence Measure Motor and Cognitive subscale scores and Glasgow Outcome Scale-Extended scores during at least 1 time point. Functional independence trajectories generally declined over the 10 years after TBI. Individuals who were older, male, underrepresented minorities, had lower education, were unemployed at time of injury, had no history of substance use disorder, or had difficulties with learning, dressing, and going out of the home prior to the TBI, or longer time in posttraumatic amnesia had lower functional independence trajectories across at least one of the functional independence outcomes. These predictors of functional independence in older adults with TBI may heighten awareness of these factors in treatment planning and long-term health monitoring and ultimately as a way to decrease morbidity and mortality.

Association between the Cognitive-Related Behavioral Assessment Severity Stage and Activities of Daily Living Required for Discharge to Home in Patients with Stroke: A Cross-Sectional Study.

This study aimed to characterize cognitive function examined using Cognitive-related Behavioral Assessment (CBA) in activities of daily living (ADLs). According to CBA severity at discharge, 791 patients were assigned to five groups (most severe, severe, moderate, mild, and normal). The total scores for Functional Independence Measure (FIM) motor items were compared for each group. Multiple logistic regression analysis was performed to clarify the association between CBA severity and independence in ADL items. Independence in each ADL according to CBA severity was 0-4.8%, 26.8-45.0%, 84.3-91.0%, and 97.2-100% for all ADLs in the most severe to severe, moderate, mild, and normal groups, respectively. Significant differences were found in the FIM motor score according to CBA severity between the groups (p < 0.01). A mild or normal CBA was associated with a higher odds ratio (OR) for dressing the upper body (OR = 21.90; 95% confidence interval (CI), 13.50-35.70), bladder management (OR = 11.60; 95% CI, 7.21-18.60), transfers to the bed/chair/wheelchair (OR = 18.30; 95% CI, 11.40-29.40), transfers to the toilet (OR = 18.30; 95% CI, 11.40-29.30), and walking (OR = 6.60; 95% CI, 10.60-26.10). A CBA severity greater than mild (23 points) was associated with independence in ADLs that are important for discharge to home.

Minimal clinically important difference of the functional independence measure in older adults with hip fracture

Purpose To investigate the responsiveness and minimal clinically important difference (MCID) of the Functional Independence Measure (FIM) from a clinician’s perspective in hip-fractured elderly undergoing inpatient rehabilitation. Materials and methods Data of 701 hip-fractured elderly admitted to our rehabilitation institute were retrospectively collected. Ten a priori hypotheses were formulated. Results The effect size of the FIM scores after treatment were large (total = 1.38, motor = 1.78). Moderate correlations were found between the change total score of FIM and Barthel Index (BI, rs = 0.51), Functional Ambulation Categories (FAC, rs = 0.52) and a checklist regarding participants’ independence in transfers (rs = 0.59). The area under the receiving operating characteristics were 0.82, 0.81, and 0.85 when BI, FAC and checklist were used as anchors, respectively. Based on these findings, the FIM showed high responsiveness (9/10 hypotheses met). Triangulation of findings showed that MCIDs of 22 and 21 points were the most appropriate for the FIM total and motor score, respectively. Conclusions The FIM scale is appropriate for assessing independence and functional recovery in hip-fractured elderly. Improvements of 22 and 21 points at the total and motor FIM were identified as indicators of minimal clinical change in those admitted to a rehabilitation facility with an FIM total score between 40 and 80.

The Contribution of Genetic Risk for Alzheimer’s &amp; Cardiovascular Disease to Recovery from Traumatic Brain Injuries

Polygenic risk scores (PRS) represent the genetic likelihood of developing a phenotype and represent an exciting opportunity for the development of personalized medicine. This study used PRS to determine if individuals at high-risk for Alzheimer’s (AD) or cardiovascular disease (CVD) would recover differently after TBI compared to low-risk individuals.&#x0D; GWAS with the Illumina Global Screening Array was performed on DNA available for a subset of the BI-Model Systems cohort (N=189). PRS were chosen from the PGS Catalog (https://www.pgscatalog.org) and calculated using the Michigan Imputation Server. 1-year follow-up data (1Y) for the Functional Independence Measure (FIM) was used to evaluate TBI recovery. FIM represents the subject’s self-care ability after TBI and includes a cognitive and motor component.&#x0D; ANCOVA models were used to elucidate the relationship between PRS risk groups (score in top 20% vs. 80%) and 1Y FIM scores. Covariates included age, education, FIM scores at discharge, injury severity, and genetic ancestry. Post-hoc analysis was conducted using 1Y FIM scores of subjects stratified by AD risk and APOE e4 carrier status, a major risk factor for AD onset. Additional post-hoc analysis evaluated hypertension at 1Y by CVD PRS groups using a cox survival model.&#x0D; Individuals with high AD PRS had lower 1Y FIM scores than those with low risk (p= 0.041). Post-hoc analysis showed a trend for APOE e4 carriers with high AD PRS performing worse on FIM motor testing (p=0.145). There was not significant association between the CVD high-risk group and FIM scores (p=0.389). The cox survival model of hypertension trended towards earlier age of onset in the high-risk subjects (p=0.155).&#x0D; This pilot study shows the potential for PRS to identify individuals at risk for worse TBI recovery, allowing for future research on early interventions and their effects on TBI recovery.

Correlations between disease severity and rehabilitation outcomes in patients recovering from covid-19 infection.

Based on long-term follow-up of patients with COVID-19, to evaluate whether the severity of acute COVID-19 infection affects rehabilitation outcomes. Observational cohort study. A total of 61 post-acute COVID-19 patients underwent inpatient and outpatient customized rehabilitation treatment. The severity of acute COVID-19 infection was measured with the World Health Organization Clinical Progression Scale (WHO-CPS). Motor, cognitive, and functional variables were measured using standard and specified scales 6 months or more after acute illness. Of the 61 subjects, 65.6% had severe disease according to WHO-CPS. Significant improvement was found in activities of daily living functions (Functional Independence Measure (FIM) at admission 103.7 ± 18.9 vs FIM at discharge 118.7 ± 6.8) (p < 0.00). Of participants, 88% were able to wean off oxygen completely. A significant correlation was found between higher WHO-CPS, prolonged acute hospitalization, and days of ventilation on the one hand, and lower total and motor FIM at admission, but not with cognitive FIM or Montreal Cognitive Assessment (MoCA). No correlation was found between these parameters and functional level at discharge. The severity of acute COVID-19 infection affects the functional status of survivors at admission to rehabilitation, but, contrary to expectations, not the functional outcomes at discharge. These findings emphasize the importance of customized multidisciplinary rehabilitation programmes for improving the daily functioning and wellbeing of patients with severe COVID-19.

Predicting length of stay with assessment of motor and process skills in subjects with acquired brain injury

ABSTRACT Background The Functional Independence Measure (FIM) is a well-established predictor of length of stay (LOS) for rehabilitation. The Assessment of Motor and Process Skills (AMPS) is a more in-depth construct for measuring activities of daily living (ADL) and may therefore be a valuable adjunct when predicting LOS. This paper aimed to investigate AMPS as a candidate predictor of LOS in a statistical model including FIM. Methods A cohort study of 647 patients with acquired brain injuries admitted for rehabilitation. LOS was analyzed in a multiple regression model with the motor and process/cognitive domains of AMPS and FIM. Results Independence in ADL process ability and FIM cognition were associated with 31% (p < 0.001) and 38% (p < 0.001) shorter LOS, respectively, relative to patients needing total assistance. Independence in ADL motor ability was associated with a 26% (p = 0.002) shorter LOS, whereas FIM motor was not a predictor. Conclusions The AMPS predicts LOS for rehabilitation at a level that is at least as good as that of FIM. Conducting the AMPS early in the course of inpatient rehabilitation provides clinicians and managers with valuable information for planning LOS.

回復期リハビリテーション病棟における大腿骨転子部骨折患者の実績指数に影響を与える要因について

[Purpose] To identify factors affecting the performance index of trochanteric femoral fracture patients. [Participants and Methods] The participants were 117 patients with a trochanteric femoral fracture who underwent convalescent rehabilitation treatment. The relationships between the motor Functional Independence Measure (FIM) gain, length of a stay in the convalescent rehabilitation ward, and nine variables available at the time of admission to the convalescent rehabilitation ward were examined using Spearman’s rank correlation coefficient and multiple regression analysis using the stepwise method. [Results] The motor FIM score, the cognitive FIM score at the time of admission to the convalescent rehabilitation ward and pre-injury walking ability influenced motor FIM gain. No significant correlation was found for length of a stay in the convalescent rehabilitation ward. [Conclusion] The higher the three variables described above as influencing motor FIM gains were, the higher the FIM gains were, especially those of bathtub transfers and movement on stairs.

Hemodialysis Treatment Influences Postoperative Activities of Daily Living Improvement for Patients with Hip Fractures.

The aim of this study was to investigate the influences of hemodialysis (HD) on activities of daily living (ADL) in patients with hip fracture. This study included 28 patients (14 HD and 14 non-HD patients) with acute hip fracture. The effects of variables such as age, sex, surgical procedure, length of hospital stay, serum albumin, C-reactive protein (CRP), number of physical therapy units, and functional independence measure (FIM) were assessed. For each factor, a two-group comparison was conducted between the HD and non-HD groups. Multiple regression analysis was used to examine the factors affecting FIM efficacy (E-FIM). For HD patients, total and motor FIM at discharge, E-FIM, and albumin level were significantly lower than in non-HD patients. Length of hospital stay was significantly longer for HD patients. Multiple regression analysis showed that HD had a negative effect on E-FIM. The results suggest that rehabilitation for HD patients with hip fractures require intervention that not only provides standard rehabilitation but also addresses aspects of renal rehabilitation.

Brain regions associated with Brunnstrom and functional independence measure scores in patients after a stroke: a tract-based spatial statistics study.

[Purpose] We aimed to assess diffusion tensor fractional anisotropy to outline the brain regions associated with the long-term motor and cognitive functional outcomes of patients with stroke. [Participants and Methods] Eighty patients from our previous study were enrolled. Fractional anisotropy maps were acquired on days 14-21 after stroke onset, and tract-based spatial statistics were applied. Outcomes were scored using the Brunnstrom recovery stage and Functional Independence Measure motor and cognition components. Fractional anisotropy images were assessed in relation to outcome scores using the general linear model. [Results] For both the right (n=37) and left (n=43) hemisphere lesion groups, the corticospinal tract and the anterior thalamic radiation were most strongly associated with the Brunnstrom recovery stage. In contrast, the cognition component involved large regions encompassing the anterior thalamic radiation, superior longitudinal fasciculus, inferior longitudinal fasciculus, uncinate fasciculus, cingulum bundle, forceps major, and forceps minor. The results for the motor component were intermediate between those for the Brunnstrom recovery stage and those for the cognition component. [Conclusion] Motor-related outcomes were associated with fractional anisotropy decreases in the corticospinal tract, whereas cognitive outcomes were related to broad regions of association and commissural fibers. This knowledge will help scheduling appropriate rehabilitative treatments.