Total Functional Independence Measure Research Articles

The Impact of Stroke Subtype on Recovery and Functional Outcome after Inpatient Rehabilitation: A Retrospective Analysis of Factors.

The aims of this study were to compare inpatient rehabilitation outcomes between acute stroke subtypes of Cerebral Infarction (CI) and Intracerebral Hemorrhage (ICH), and to determine the predictors of discharge outcomes. A retrospective study of stroke inpatients was carried out using the discharge Functional Independence Measure (FIM) as the primary outcome measure. Relationships between stroke subtype, rehabilitation impairments, and medical complications on FIM -gain were analyzed. Altogether, 280 datasets including 211 (75.4%) CI and 69 (24.6%) ICH were analyzed. ICH patients were significantly younger than CI patients (55 years ICH vs. 64.0 years CI years, p < 0.001), had a 10-fold higher proportion needing ICU admission (ICH 82.6% vs. CI 7.6%, p < 0.001), and had significantly lower total admission FIM scores (67 points ICH vs. 74 CI points, p = 0.006), with lower motor-FIM scores in particular (38 points ICH vs. 48 points CI, p = 0.003). Significant functional improvements after inpatient rehabilitation, i.e., FIM gain, occurred regardless of stroke subtype (FIM-ICH Δ 27 vs. FIM-CI Δ 21, p = 0.05). Despite significantly worse initial stroke severity, ICH patients achieved similar functional gains, independence levels, and return-home rates compared with their CI counterparts after inpatient rehabilitation.

Impacts of Prism Adaptation Treatment on Spatial Neglect and Rehabilitation Outcome: Dosage Matters

We examined whether number of prism adaptation treatment (PAT) sessions in regular clinical practice would predict spatial neglect (SN) improvement and rehabilitation outcomes. We reviewed clinical records from 16 U.S. rehabilitation hospitals where neurological patients were assessed for SN using the Catherine Bergego Scale (CBS) and if SN was detected, and may have received PAT. Multiple linear regression was used to predict CBS Change (indicating SN improvement) in 520 patients who received PAT while considering age, sex, diagnosis, time post diagnosis, CBS at baseline, neglected side of space, and length of stay. Another set of regression models including the same variables and adding Function Independent Measure (FIM®) at admission was used to predict FIM Gains (indicating rehabilitation outcomes) in 1720 patients receiving PAT or not. We found that greater number of PAT sessions predicted greater CBS Change, especially in patients with moderate-to-severe neglect. Number of PAT sessions also positively correlated with Total FIM, Motor FIM, and Cognitive FIM Gains regardless of SN severity classification at baseline. Furthermore, number of PAT sessions predicted CBS Change and FIM Gains among patients completing ≤8 PAT sessions but not among patients with ≥8 sessions, who however, showed greater CBS Change with increased PAT frequency (i.e., fewer days between two consecutive sessions). Receiving more once-daily PAT sessions predicted greater improvement in SN and rehabilitation outcomes. Receiving PAT at a higher frequency for 8 or more sessions predicted better SN improvement. Thus, dosage matters. The study provides practice-based evidence that PAT is appropriate for inpatient rehabilitation.

Additional saturday occupational therapy for adults receiving inpatient physiotherapy rehabilitation: a prospective cohort study

BackgroundThe first aim of this study was to investigate the impact of providing an additional four hours of Saturday occupational therapy to patients receiving Saturday physiotherapy in an inpatient setting on length of stay, functional independence, gait and balance. The second aim was to conduct an economic evaluation to determine if the introduction of a Saturday occupational therapy service in addition to physiotherapy resulted in a net cost savings for the rehabilitation facility.MethodsA prospective cohort study with a historical control was conducted in an Australian private mixed rehabilitation unit from 2015–2017. Clinical outcomes included the Functional Independence Measure (Motor, Cognitive, Total), gait speed (10 Meter Walk test) and five balance measures (Timed Up and Go test, Step test, Functional Reach, Feet Together Eyes Closed and the Balance Outcome Measure of Elder Rehabilitation). Economic outcomes were rehabilitation unit length of stay and additional treatment costs.ResultsA total of 366 patients were admitted to the rehabilitation unit over two 20-week periods. The prospective cohort (receiving Saturday occupational therapy and physiotherapy) had 192 participants and the historical control group (receiving Saturday physiotherapy only) had 174 participants. On admission, intervention group participants had higher cognitive (p < 0.01) and total (p < 0.01) Functional Independence Measure scores. Participation in weekend therapy by the intervention group was 11% higher, attending more sessions (p < 0.01) for a greater length of time (p < 0.01) compared to the historical control group.After controlling for differences in admission Functional Independence Measure scores, rehabilitation length of stay was estimated to be reduced by 1.39 (p = 0.08) days. The economic evaluation identified potential cost savings of AUD1,536 per patient. The largest potential savings were attributed to neurological patients AUD4,854. Traumatic and elective orthopaedic patients realised potential patient related cost savings per admission of AUD2,668 and AUD2,180, respectively.ConclusionsImplementation of four hours of Saturday occupational therapy in addition to physiotherapy results in a more efficient service, enabling a greater amount of therapy to be provided on a Saturday over a shorter length of stay. Provision of multidisciplinary Saturday rehabilitation is potentially cost reducing for the treating hospital.

The effectiveness of a physiatrist-led acute hospital based postoperative hip fracture inpatient rehabilitation program: A single-center retrospective study

Background Postoperative hip fracture rehabilitation in Singapore has historically been carried out in both acute and community hospitals (CH). An increasing majority of patients with hip fractures now receive inpatient rehabilitation in CH, and it is often believed that Acute hospital (AH) - based rehabilitation may be less cost-effective than their CH counterparts. Objective: This retrospective study aims to review the effectiveness of an AH-based hip fracture postoperative rehabilitation program. Methods This study retrospectively reviewed the database of postoperative hip fracture patients who underwent a physiatrist-led AH-based inpatient rehabilitation from Jan 2010 to Dec 2016. The primary outcomes were the functional improvement assessed by functional independence measure (FIM) and FIM efficiency. The secondary outcome included the length of stay (LOS), successful discharge to home rate, mortality rate, and complication rate. Results A total of 293 cases were included in the study. After participation in the inpatient rehabilitation program, the mean total FIM increased from 83.9 ± 12.7 (mean ± SD) to 93.9 ± 16.2 ( p &lt; .001). The motor FIM increased from 47.1 ± 10.9 to 56.1 ± 10.1 ( p &lt; .001). 269 (91.8%) patients were successfully discharged home. Inpatient mortality was 0.3% (1/293). The complications rate during inpatient rehabilitation was 16.0% with urinary tract infection being the most frequent complication (10.2%). The median LOS for inpatient rehabilitation was 19 days (15, 28). Conclusions After completing a physiatrist-led postoperative hip fracture inpatient rehabilitation program in an acute hospital, patients demonstrated significant functional improvement ( p &lt; .0001). The inpatient rehabilitation program has a high discharge home rate and low in-hospital mortality.

Effect of a weekly functional independence measure scale on the recovery of patient with acute stroke: A retrospective study.

Excessive assistance may decrease stroke patients' physical activity and make them more dependent on assistance. We have structured a system that provides an ADL (activities of daily living) educational program that focuses on stroke patients' toileting in our daily clinical practice. Here, we investigated the effect of a functional independence measure (FIM) scale on the recovery of patients with acute stroke.We retrospectively collected the data of 407 stroke patients from the medical record system of our emergency hospital in Tsukuba, Japan. The enrolled stroke patients (n = 373) were divided into FIM and control groups. Both groups received the standard treatment, but for the FIM group, ward and rehabilitation staff calculated the toilet FIM score for patients 1 ×/wk. The FIM scale measures the amount of assistance a patient needs to perform activities of daily living and is often used in rehabilitation settings. The rehabilitation staff then instructed the ward staff about better assistance methods based on each patient's physical function and executive dysfunction. We evaluated the usefulness of the FIM scale was based on the patients' FIM scores at discharge and improvements in their scores.The recoveries of the total, motor, and cognitive FIM scores recovery at discharge were significantly greater in the FIM group compared with the control group (68.0 vs 45.0, P = .004; 41.0 vs 24.0, P = .005; and 24.0 vs 20.0, P = .007, respectively). The use of the FIM scale contributes to the patients' recovery of physical function and cognitive function.The FIM scale can contribute to stroke patients' recovery of activities of daily living.

Prolonged disorders of consciousness: identification using the UK FIM + FAM and cohort analysis of outcomes from a UK national clinical database

Purpose 1: To determine whether Total UK FIM + FAM scores can identify patients in VS/MCS. 2: Using the identified cut-off points, to examine outcomes from specialist rehabilitation. Methods Part 1: Retrospective analysis of a consecutive clinical cohort (n = 388) presenting to a single specialist PDOC evaluation programme 2007–2021. FIM + FAM scores were analysed by PDOC diagnosis to define cut-off points for vegetative (VS) and minimally conscious states (MCS). Part 2: Multicentre cohort analysis of prospectively-collected clinical outcomes data from the UK Rehabilitation Outcomes Collaborative database of adults in PDOC registered 2011–2020 (n = 2384 in 68 centres). Results Cut-off points of ≤31 and 32–35 in FIM + FAM total scores respectively identified patients in VS/MCS-Minus and MCS-Plus. Approximately 365 PDOC patients are admitted to specialist rehabilitation units in England each year. By discharge, 43% have emerged into consciousness and demonstrate a wide range of disability. A few reached full independence, but the majority remained severely dependent. Nevertheless, those who emerged generated mean net life-time savings of over £436,000 (£400 million for this cohort). Conclusion In absence of a dedicated PDOC registry, FIM + FAM scores can identify patients in VS/MCS at population level. Identifying those who emerge and providing timely rehabilitation generates cost-savings well-exceeding the cost of the evaluation/rehabilitation programme. Implications for rehabilitation The UK National Health Service currently collects no systematic data to identify patients in PDOC, so we have no accurate information on how many patients there are, where they are managed or what their outcomes are. In the absence of more direct data, total FIM + FAM scores of < =31 and 32–35 respectively can be used to identify patients in vegetative and minimally conscious states. Of the 365 or so patients admitted to specialist rehabilitation units per year, 43% emerge into consciousness leaving about 150 patients per year in PDOC states that are likely to be permanent. Identifying those who emerge and providing timely rehabilitation generates cost-savings that pay for the entire PDOC evaluation/rehabilitation programme many times over.

Inpatient rehabilitation of working-age adults with ischemic stroke: comparing men and women clinical and functional characteristics at admission and predicting functionality.

The role of gender in functional independence for activities of daily living after ischemic stroke is still controversial. We aim to a) compare clinical characteristics of men and women at inpatient rehabilitation admission b) compare their functional independence at admission and discharge c) identify predictors of functional independence. Retrospective observational cohort study. State-of-the-art variables were used for admission and discharge comparisons and to predict total FIM (Functional Independence Measure) at discharge, FIM gain, FIM efficiency and FIM effectiveness using multivariate linear regressions. 144 patients (33% women) admitted to inpatient rehabilitation in a Spanish specialized center, with less than 3 weeks since ischemic stroke onset were included. Men were older (p = 0.039), 19.6% of men had diabetes mellitus (6.4% of women) (p = 0.038), with 52.6% of men being non-smokers (72.3% of women) (p = 0.022). No significant differences were observed in FIM at admission, discharge, FIM gain, efficiency or effectiveness (total, motor either cognitive FIM). Regression analysis identified sex (ß = -0.13), stroke severity (ß = -0.25) and admission total FIM (ß = -0.69) as significant predictors of total FIM gain (R2 = 0.42). The same variables predicted discharge total FIM: sex (ß = -0.12), severity (ß = -0.23) and admission total FIM (ß = 0.59) (R2 = 0.51). FIM efficiency was predicted by admission total FIM (ß = -0.64), severity (ß = -0.24), age (ß = -0.17) and length of stay (ß = -0.45) (R2 = 39.9%). FIM effectiveness model explained only 13.5% of the variance. No functional differences between men and women in any independence measure were found. Sex was a significant predictor but leaving half of the variance unexplained.

Abstract WP68: Clinical Characteristics And Inpatient Rehabilitation Outcomes In Patients With Posterior Circulation Strokes

Introduction: Posterior circulation strokes (PCS) are considered to have poor outcomes with high mortality and morbidity, but comparisons of functional outcome with anterior circulation strokes (ACS) have yielded conflicting results. Differences in demographics, cardiovascular risk factors and stroke etiology have been proposed, with ischemic PCS patients tending to be younger, more often male, and more frequently diabetic. Objectives: Describe the clinicodemographic profile and functional outcomes in PCS patients admitted to inpatient rehabilitation (IPR), and identify factors associated with functional change. Methods: A retrospective review of a database maintained on consecutive stroke patients admitted to IPR at Memorial Hermann-TIRR between 2017 and 2019 was conducted. Demographics, Functional Independence Measure (FIM) scores, and discharge disposition of 806 patients were assessed. Table 1 displays significance testing by univariate analysis. Baseline characteristics, pre-stroke mRS, NIHSS, admit FIM, and length of stay (LOS) in IPR were adjusted in regression models. Results and Conclusions: Results are summarized in Table 1. Diabetes and prior stroke or TIA occurred in higher percentages of patients with PCS, or concurrent ACS/PCS. NIHSS was higher in ACS patients with a mean of 9.6 (SD 7.1, p&lt;0.001) and median of 6 with IQR of 11. Total FIM score on admission to IPR was 53.3 (SD 16.5) for PCS compared to 46.6 (SD 16.9, p&lt;0.001) in ACS patients. Motor FIM score change was 28.6 (SD 12.2) in PCS compared to 27.2 (SD 12.8) in ACS. Adjusting for baseline variables of admit FIM, NIHSS and LOS, we found no significant differences in total or motor FIM change between the groups from admission to discharge. There was no greater odds for improvement on total or motor FIM for ACS compared to PCS. In summary, patients with PCS and ACS respond similarly to rehab therapy as captured on the FIM score, with a higher amount of therapy associated with better improvement.

Acute Inpatient Rehabilitation Improves Function Independent of Comorbidities in Medically Complex Patients

Objectives(1) To evaluate the benefits of acute inpatient rehabilitation for a medically complex patient population and (2) to assess the effect of comorbid conditions on rehabilitation outcomes. DesignRetrospective cohort study. SettingFreestanding inpatient rehabilitation facility. ParticipantsA total of 270 medically complex adult patients including those with cardiac, pulmonary, and orthopedic conditions, with mean age of 73.6 years; 52.6% were female and 47.4% were male (N=270). InterventionsNot applicable. Main Outcome MeasuresFunctional Independence Measure (FIM) gain, FIM efficiency, rehabilitation length of stay (RLOS), home discharge rate, and readmission to acute care (RTAC). ResultsAmong 270 medically complex patients, mean total FIM gain, mean RLOS, and mean FIM efficiency with SD were 26.0±13.6 points, 12.6±5.9 days, and 2.3±1.6, respectively. A total of 71.9% of patients were discharged to home, 12.2% for RTAC, and 15.9% to a skilled nursing facility (SNF). Hypertension (HTN) was the only comorbidity significantly associated with FIM gain (53.7% [total FIM gain ≥27] vs 67.2% [total FIM gain <27]; P=.024) and FIM efficiency (53.3% [FIM efficiency ≥2.12] vs 67.4% [FIM efficiency <2.12]; P=.025), independent of age, body mass index, sex, race, ethnicity, insurance type, and Charlson Comorbidity Index. The 5 most common reasons for RTAC were cardiac, pulmonary, acute blood loss anemia, infection, and neurologic conditions. ConclusionsAmong 270 medically complex patients, 71.9% were discharged to home, 15.9% to an SNF, and 12.2% for RTAC with a mean RLOS 12.6 days, mean total FIM gain of 26 points, and mean FIM efficiency of 2.3, which were all better than those of all admissions at our facility in 2018. Furthermore, RLOS, total FIM gain and FIM efficiency in this study were all better than their corresponding eRehabData weighted national benchmarks (RLOS, 15.82 days; FIM gain, 25.57; FIM efficiency, 2.13) for a total of 202,520 discharges in 2018. These findings support acute inpatient rehabilitation for this patient population. With the exception of HTN, no medical comorbidities or demographic variables were associated with rehabilitation outcomes.

Centering race/ethnicity: Differences in traumatic brain injury inpatient rehabilitation outcomes.

Persons of color have a higher incidence of traumatic brain injury (TBI) and experience disparities in the quality and quantity of interventions received, discharge disposition, functional outcomes, and mortality rate post TBI. To examine racial/ethnic differences in rehabilitation outcomes for patients with TBI. Multiyear (2005-2016) and retrospective cohort using secondary data analysis from inpatient rehabilitation facilities (IRFs) across the United States. eRehabData participating IRFs throughout the United States. Forty-one thousand eight hundred forty-seven adults with a diagnosis of TBI, admitted to U.S. eRehabData participating IRFs. Not applicable. Inpatient rehabilitation functional outcomes and discharge disposition. Participants were 41,847 non-Hispanic Whites (NHWs), Hispanics, non-Hispanic Asians (NHAs), and non-Hispanic Blacks (NHBs) aged 18-107 years. NHWs were used as the reference group. NHBs had the longest length of stay (17.65 ± 14.96). At admission, NHB, Hispanic, and NHA races/ethnicities were significantly associated with 1-3 point lower motor, cognitive, and total Functional Independence Measure (FIM) scores. NHB race was significantly associated with less than 1-point lower cognitive, motor, and total efficiency FIM scores. At discharge, NHB race was significantly associated with 1-2 point lower motor, cognitive, and total FIM scores; Hispanics and NHA race were associated with less than 1-point lower cognitive FIM scores. Compared to NHWs, Hispanic ethnicity was associated with greater odds of a discharge to home (odds ratio=1.16, 95% confidence interval=1.06-1.27). Contrary to established literature on functionality differences 1 year post TBI, the current study found racial/ethnic differences in functional outcomes during inpatient rehabilitation. These findings suggest a need for cultural competence/sensitivity in the care of racial/ethnic persons and centering potential contributing factors for racial/ethnic differences in TBI rehabilitation outcomes.

The Relationship Between Urinary Symptom Severity And Functional Status İn Patients With Stroke.

Lower Urinary Tract Dysfunction (LUTD) is a condition that is common in stroke patients and affects their quality of life and psychological state. To determine the factors affecting LUTD severity in stroke patients and to evaluate its relationship with functional status. 77 stroke patients were included in our study. Demographic and stroke characteristics of all patients were recorded. Functional Ambulation Scale (FAS), Functional Independence Measure (FIM), the Core Lower Urinary Tract Symptom Score (CLSS) Questionnaire, Beck Depression Scale were administered to the patient. 33 of 77 patients had urodynamic study and these patients constituted the subgroup of the study. Patients were grouped according to type of disorder, type of detrusor and detrusor sphincter dyssynergia (DSD) using urodynamic study findings. The mean CLSS of men was significantly higher than women (P = 0.017). A significant positive correlation was found between age and CLSS (P = 0.035 r = 0.24) and negative correlation was found between total FIM and all sub-parameter scores and mean of CLSS (P = 0.001 r = -0.467). LUTD is common in stroke patients and the presence of urinary symptoms is associated with poor functional status. No significant relationship was observed between urodynamic data except maximum flow rate and CLSS.

Relationship between oral hygiene and function and activities of daily living at discharge in convalescent patients with stroke.

This study was designed to examine the relationship between improvement in oral hygiene and function and activities of daily living (ADLs) at discharge in patients admitted to convalescent rehabilitation wards. Eligible criteria were patients with stroke with a score of 13 or higher (i.e., severe oral problems) on the Revised Oral Assessment Guide (ROAG) at admission. Age, gender, primary diseases, rehabilitation dose, dentist visits and denture status, Eichner classification, eating status at admission and discharge, and body mass index at admission were collected. The patients were classified into two groups: those with ROAG scores of less than 9 points at discharge (good ROAG group) and those with scores of 9 points or more (poor ROAG group), and Functional Independence Measure (FIM) gain and total FIM discharge scores were compared using univariate and multivariate analyses. The good and poor ROAG groups comprised 126 and 366 patients, respectively. The good ROAG group had significantly higher total FIM score, FIM efficiency, and FIM gain at discharge than the poor ROAG group (112 vs. 82; P < 0.001). The ROAG scores at discharge were independently associated with FIM gain (partial regression coefficient = -9.889, 95% confidence interval = -13.499 to -6.279) and total FIM score at discharge. Improvement in oral hygiene and function in convalescent patients with stroke was associated with ADLs at hospital discharge.

Evaluation of Functional Independence and Pain in Covid-19 Patients with Mild Neurological Impairments during the Hospital Stay

Background: Novel COVID 19 is a infectious disease caused by a recently discovered corona virus. It is characterized as an acute respiratory syndrome followed by neurological diseases like acute necrotizing encephalopathy/disseminated encephalomyelitis, Guillain – barre syndrome, stroke inflammatory neuropathy. Common clinical symptoms include headache, insomnia, dizziness, delirium, myopathy, ataxia, seizures, complete/partial anosmia, ageusia, hypoxia, muscle and nerve pain and peripheral nervous system manifestation. The purpose of this survey was to evaluate the functional independence and pain in Covid-19 patients with mild neurological impairments during the hospital stay. Method: 85 covid–19 diagnosed patients with mild neurological impairments such as non-specific headache, anosmia, aguesia, myalgia, fatigue etc. of age group 25 to 60 years admitted in hospital were recruited. Patient function is assessed using the FIM instrument at the time of admission and at the time of discharge. The severity of the patient’s pain and the impact of this pain on the patient’s daily functioning was evaluated using the brief pain inventory scale. Patients with comorbidity diseases like surgery and cancer, infants, children, ventilated ICU patients were excluded from the study. Results: The study found that among the 85 respondent participants majority of 53(62.4%) had severe pain and 82 of them(96.5%) had high pain interference. According to the interpretation the total FIM score shows a significant improvement from admission to discharge with the p-value of 0.000. Conclusion: The study concluded that there was a significant difference on functional independence and pain in Covid-19 patients with mild neurological impairments during the hospital stay.

Outcomes of Early Rehabilitation in Traumatic Brain Injury

<h3>Research Objectives</h3> To determine the functional outcomes and the associated clinical predictors of early rehabilitation of patients with all TBI severity. <h3>Design</h3> Retrospective analysis. <h3>Setting</h3> Acute inpatient rehabilitation (AIR) unit. <h3>Participants</h3> A total of 491 patients with head trauma were screened and reviewed between 1 November 2010 and 30 October 2012 within 72 hours of admission to the neurosurgical ward in an acute tertiary hospital. Patients who fulfilled the following criteria were then recommended and transferred to AIR: (1) presence of impairments or disabilities which could benefit from a comprehensive inpatient rehabilitation programme, (2) potential to participate in a goal-oriented rehabilitation programme and (3) medical stability to participate in a rehabilitation setting. One hundred and sixteen patients were directly transferred to AIR. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Rehabilitation Length of Stay (RLOS); Functional Independence Measure (FIM); FIM gain and FIM efficiency. <h3>Results</h3> The median age of the patients transferred to AIR was 72.0 (IQR 58.3-79.8). Most sustained a mild injury (75.9%). The total functional and motor gains after AIR were significant (p< 0.001). The median total FIM gain was 12.00 (IQR 2.00-41.00) points. The median FIM efficiency was 0.55 (IQR 0.67-1.58) points/day. The median RLOS (days) was 20.50 (IQR 12.25-30.50). Increased age, complications, high motor admission FIM (AFIM) and long RLOS were associated with lower FIM gain and lower FIM efficiency. <h3>Conclusions</h3> Our study showed majority of the patients selected for AIR were mild TBI and older patients. There was functional improvement in patients with TBI receiving early rehabilitation. Increased age, presence of complications, high motor AFIM and increased RLOS were associated with lower FIM gain and lower FIM efficiency. <h3>Author(s) Disclosures</h3> Nil.

Rehabilitation outcomes of survivors of cardiac arrest admitted to ICUs in Australia and New Zealand (ROSC ANZ): A data linkage study

IntroductionRehabilitation outcomes in cardiac arrest survivors are largely unknown, with no data comparing out-of-hospital cardiac arrests (OHCA) and in-hospital cardiac arrests (IHCA). This study aimed to describe and compare inpatient rehabilitation outcomes in these patients who were admitted from intensive care units (ICU). MethodsA retrospective linkage and analysis of cardiac arrest patients in the Australian and New Zealand Intensive Care Society Adult Patient Database and the Australasian Rehabilitation Outcomes Centre inpatient dataset discharged to inpatient rehabilitation between January 2017 and June 2018. Primary outcome was the functional improvement during rehabilitation (difference between the Functional Independence Measurement (FIM) score on admission and discharge). Multivariate regression analyses were performed to determine factors associated with functional improvement. ResultsIn the 240 (84 OHCA and 156 IHCA) patients included, the median length of inpatient rehabilitation was 15 days [1st–3rd quartile (Q1-Q3): 9–24]. OHCA patients were more likely to be admitted to rehabilitation for neurological issues (41.7%) and IHCA for medical reasons (51.9%). Median (Q1-Q3) change in total FIM scores was similar between the two groups (24.5[10–37]) vs 21[11–31], adjusted p = 0.20), with most of the FIM change seen in the motor items, and this was only associated with a lower admission FIM score. The majority of OHCA and IHCA patients were discharged home (91.5% and 89.7%, respectively), although with an increased need for a carer at home compared to baseline (27.2% to 55.6%). ConclusionPatients discharged from ICU following OHCA and IHCA achieved reasonable and similar functional improvement during inpatient rehabilitation.

Monitoring of Rehabilitative Nursing Practices in relation to Functional Ability for Patients with Spinal Cord Injury

Background: Spinal cord injuries (SCI) is a serious medical status that influences the patients’ life as well as that of their family, patients with SCI need to perform daily tasks and optimize their physical and cognitive functioning. This can be achieved through rehabilitation. Rehabilitative nurses should be knowledgeable and have an experience to care for patients with SCI and prevent possible complications. Aim of the study: to monitor the rehabilitative nursing practices in relation to functional ability for patients with spinal cord injury. Setting: Medical Rehabilitation hospital in Madinah city in the Kingdom of Saudi Arabia. Design: a cross sectional descriptive and correlational design. Sample: A convenient sample of 46 nurses caring for patients with SCIs and a purposive sample of 36 patients who have SCIs based on the inclusion criteria. Tools: 1-Observational checklist assessment of rehabilitative nursing practices for patient with SCI. 2- Functional Independence Measure (FIM) instrument was used in this study. Results: nearly three quarters (71.7%) of nurses had inadequate practices regarding total rehabilitative nursing practices for patients with SCI, while only around quarter (28.3%) of nurses had adequate of practice, the mean score of total functional independent measure were (85.58±20.92). Conclusion: the present study concluded that nearly three quarter of nurses had inadequate practices regarding total rehabilitative nursing practices for patients with SCI. Concerning total motor functional independence measure; it was found that more than half of patients needed helper with modified dependence. Additionally, the highest majority of patients did not needed helper regarding cognitive functional. There was a positive correlation between types of injury with motor functional independence measure. Finally, there were no significant correlation between total rehabilitative nurses’ practices for patients with spinal cord injury, motor, cognitive and total FIM of the patients. Recommendations: The study recommended future research is required in replicating the study at different settings with large sample size in Saudi Arabia with the aim of generalizing the results.

Predictive factors of functional abilities in older patients with peripheral neuropathy.

Little is known about the outcome predictors in peripheral neuropathy (PN). This prospective observational study aimed to identify possible factors predicting the functional abilities in older patients with PN undergoing motor rehabilitation. Data were collected in 80 PN patients, aged over 65years, performing a standard inpatient motor rehabilitation program. The total Functional Independence Measure (FIM) score after rehabilitation, as well as efficiency and effectiveness in total-FIM, were the outcome measures. Backward multiple regression analyses identified the predictors of functional status. At the end of rehabilitation, total-FIM score was 102.66 ± 10.75, efficiency in total-FIM 0.64 ± 0.29 and effectiveness in total-FIM 48.81 ± 15.35%. Katz index at admission was a predictor of the final total-FIM score (beta 0.46, p < 0.001) and efficiency in total-FIM (beta -0.38, p = 0.001). Conversely, age was a predictor of the final total-FIM score (beta -0.31, p = 0.002) and effectiveness in total-FIM (beta -0.49, p < 0.001). The R2 values of the models were, respectively, 0.39, 0.15, and 0.24. In PN patients, functional impairment at admission and age are important predictors of functional abilities at the end of rehabilitation. These findings suggest the need for more intensive rehabilitation in older, more disabled PN patients because they risk achieving lower functional levels with standard rehabilitation programs.

Effect of acceptance and commitment therapy on rehabilitation patients with spinal cord injury

This study aimed to explore the differences between the effectiveness of using a combination of rehabilitation and acceptance commitment therapy (ACT), and rehabilitation therapy alone for the treatment of spinal cord injury (SCI). The newly admitted patients with spinal cord injury whose post-traumatic stress disorder (PTSD) score was higher than 38 points were randomly categorized into the treatment group and control group, with 30 patients in each group. One group underwent ACT and rehabilitation treatment, while the other underwent rehabilitation treatment only. PTSD and functional independence measure (FIM) scores were evaluated. Changes in scores were compared between the two groups before, one month, two months, and three months after treatment. The total PTSD score in SCI patients who were treated with ACT was significantly different before and after treatment (P < 0.05). Total FIM scores were also significantly different before and after treatment (P < 0.05). The FIM score in the treatment group was significantly higher than that in the control group after 2 and 3 months of treatment (P < 0.05). The combination of rehabilitation therapy and ACT could immediately reduce stress levels and significantly improve impaired function, lifelong self-care ability, and the impact of rehabilitation therapy.

Factors Related to Greater Functional Recovery after Suffering a Stroke.

Background: In a stroke, the importance of initial functional status is fundamental for prognosis. The aim of the current study was to investigate functional status, assessed by the Functional Independence Measure (FIM) scale, and possible predictors of functional outcome at discharge from inpatient rehabilitation. Methods: This is a retrospective study that was carried out at the Physical Medicine and Rehabilitation Service in A Coruña (Spain). A total of 365 consecutive patients with primary diagnosis of stroke were enrolled. The functional assessments of all patients were performed through the FIM. A descriptive and a bivariate analysis of the variables included in the study was made and a succession of linear regression models was used to determine which variables were associated with the total FIM at discharge. Results: Prior to having the stroke, 76.7% were totally independent in activities of daily living. The FIM scale score was 52.5 ± 25.5 points at admission and 83.4 ± 26.3 at hospital discharge. The multivariate analysis showed that FIM scores on admission were the most important predictors of FIM outcomes. Conclusions: Our study indicates that the degree of independence prior to admission after suffering a stroke is the factor that will determine the functionality of patients at hospital discharge.

Effects of High-Intensity Interval Training After Stroke (The HIIT Stroke Study) on Physical and Cognitive Function: A Multicenter Randomized Controlled Trial

ObjectiveTo assess the effects of high-intensity interval training (HIIT) on physical, mental, and cognitive functioning after stroke. DesignThe HIIT Stroke Study was a single-blind, multicenter, parallel-group randomized controlled trial. SettingSpecialized rehabilitation units at 3 Norwegian hospitals. ParticipantsAdult stroke survivors (N=70) 3 months to 5 years after a first-ever stroke. Mean age was 57.6±9.2 years and 58.7±9.2 years in the intervention and control groups, respectively. InterventionsParticipants were randomized to standard care in combination with 4×4 minutes of treadmill HIIT at 85%-95% of peak heart rate or standard care only. OutcomesOutcomes were measured using physical, mental, and cognitive tests and the FIM and Stroke Impact Scale. Linear mixed models were used to analyze differences between groups at posttest and 12-month follow-up. ResultsThe intervention group showed a significant treatment effect (95% confidence interval [CI]) from baseline to posttest on a 6-minute walk test of 28.3 (CI, 2.80-53.77) meters (P=.030); Berg Balance Scale 1.27 (CI, 0.17-2.28) points (P=.025); and Trail Making Test Part B (TMT-B; −24.16 [CI, −46.35 to −1.98] s, P=.033). The intervention group showed significantly greater improvement on TMT-B at the 12-month follow-up (25.44 [CI, −49.01 to −1.87] s, P=.035). The control group showed significantly greater improvement in total Functional Independence Measure score with a treatment effect of −2.37 (CI, −4.30 to −0.44) points (P=.016) at 12-month follow-up. No significant differences were identified between groups on other outcomes at any time point. ConclusionsHIIT combined with standard care improved walking distance, balance, and executive function immediately after the intervention compared with standard care only. However, only TMT-B remained significant at the 12-month follow-up.