Functional Independence Measure Research Articles

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

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

Functional Outcomes of Patients with Primary Brain Tumors Undergoing Inpatient Rehabilitation at a Tertiary Care Rehabilitation Facility in Saudi Arabia

Rehabilitation services play a crucial role in improving the functionality and quality of life of individuals with a brain tumor; however, outcomes of inpatient rehabilitation based on tumor characteristics are not well known in the literature. This study was carried out to evaluate the effects of tumor characteristics on functional outcomes. A retrospective chart review was conducted for all adults with a diagnosis of primary brain tumor admitted for IPR between January 2014 and December 2019. Information was collected regarding demographics, characteristics of primary brain tumors, length of stay (LOS) and Functional Independence Measurement (FIM) scores. There were 46 patients, with the majority being male. The most common brain tumors were glioblastoma multiforme and meningioma. The mean LOS was 47.93 ± 26.40 days and the mean FIM gain was 78 ± 14. The type, grade and location of primary brain tumors did not show a significant correlation with the length of stay and functional gains during inpatient rehabilitation. There was a positive correlation between the FIM at admission and discharge, and a significant inverse correlation between the FIM score at admission and LOS. In-patient rehabilitation improved the functional outcomes in adult patients with primary brain tumors. Strategies to incorporate IPR in the care continuum of patients with brain tumors need to be adapted to improve regional services.

Gamified Physical Rehabilitation for Older Adults With Musculoskeletal Issues: Pilot Noninferiority Randomized Clinical Trial

Resource-rich countries are facing the challenge of aging societies, a high risk of dependence, and a high cost of care. Researchers attempted to address these issues by using cost-efficient, innovative technology to promote healthy aging and regain functionality. After an injury, efficient rehabilitation is crucial to promote returning home and prevent institutionalization. However, there is often a lack of motivation to carry out physical therapies. Consequently, there is a growing interest in testing new approaches like gamified physical rehabilitation to achieve functional targets and prevent rehospitalization. The purpose of this study is to assess the effectiveness of a personal mobility device compared with standard care in the rehabilitation treatment of patients with musculoskeletal issues. A total of 57 patients aged 67-95 years were randomly assigned to the intervention group (n=35) using the gamified rehabilitation equipment 3 times a week or to the control group (n=22) receiving usual standard care. Due to dropout, only 41 patients were included in the postintervention analysis. Outcome measures included the short physical performance battery (SPPB), isometric hand grip strength (IHGS), functional independence measure (FIM), and the number of steps. A noninferiority related to the primary outcome (SPPB) was identified during the hospital stay, and no significant differences were found between the control and intervention groups for any of the secondary outcomes (IHGS, FIM, or steps), which demonstrates the potential of the serious game-based intervention to be as effective as the standard physical rehabilitation at the hospital. The analysis by mixed-effects regression on SPPB showed a group×time interaction (SPPB_I_t1=-0.77, 95% CI -2.03 to 0.50, P=.23; SPPB_I_t2=0.21, 95% CI -1.07 to 0.48, P=.75). Although not significant, a positive IHGS improvement of more than 2 kg (Right: 2.52 kg, 95% CI -0.72 to 5.37, P=.13; Left: 2.43 kg, 95% CI -0.18 to 4.23, P=.07) for the patient from the intervention group was observed. Serious game-based rehabilitation could potentially be an effective alternative for older patients to regain their functional capacities. ClinicalTrials.gov NCT03847454; https://clinicaltrials.gov/ct2/show/NCT03847454.

Relationship between patient functionality impairment and caregiver burden: is there a cut off point for the severe COPD patient?

ABSTRACT Background Chronic obstructive pulmonary disease (COPD) patients experience a progressive limitation of their functionality accompanying their clinical evolution. Concretely, severe COPD patients usually require the figure of a caregiver. Caregiver burden has yet to be explored in other similar chronic diseases. The objective is to propose a cutoff point in different functional impairment aspects, to predict the presence of caregiver burden. Methods Severe COPD patients were divided into two groups according to the caregiver burden, measured with the Zarit Burden Interview (ZBI). The patients were assessed with the London Chest Activity of Daily Living (LCADL) scale, the Functional Independence Measure (FIM), and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Results 70 COPD patients and their caregivers were included in this cross-sectional study. The ROC curve indicated a cutoff point of 19 in the LCADL scale (AUC = 0.722). Dependence in daily life activities had a cutoff point of 123 in the FIM (AUC = 0.776). Social participation in activities of daily living had a cutoff point of 37 in the WHODAS 2.0 (AUC = 0.739). Conclusion Dyspnea related to functional status, dependence in daily life activities, and social participation in activities of daily living of severe COPD patients can predict caretaker burden.

The effect of body awareness on trunk control, affected upper extremity function, balance, fear of falling, functional level, and level of independence in patients with stroke

ABSTRACT Objectives This study was conducted to examine the effects of body awareness on trunk control, affected upper extremity function, balance, fear of falling, functional level, and level of independence in patients with stroke. Methods 35 individuals between the ages of 21 and 78 who were diagnosed with stroke were included in the study. The body awareness of the individuals participating in the study was determined with the Body Awareness Questionnaire (BAQ), trunk control with Trunk Impairment Scale (TIS), the affected upper extremity functions with Motor Activity Log-28 (MAL,-28), and Fugl-Meyer Upper Extremity Assessment (FMUEA), balance with Berg Balance Scale (BBS), fear of falling with Tinetti Falls Efficacy Scale (TFES), functional level with Barthel Activities of Daily Living Index (BI) and level of independence with Functional Independence Measures (FIM). Results For patients participating in the study, 26% were female, 74% were male and 43% showed left, 57% showed right hemisphere involvement. In simple linear regression analysis, BAQ measurement had a statistically significant effect on TIS (F = 25.439 p = 0.001), MAL-28 (F = 7.852 p = 0.008), FMUEA (F = 12.155 p = 0.001), BBS (F = 13.506 p = 0.001), TFES (F = 13.119 p = 0.001), BI (F = 19.977 p = 0.001) and FIM (F = 22.014 p = 0.001) in patients with stroke. Conclusions In conclusion, body awareness was found to be one of the factors affecting trunk control, affected upper extremity function, balance, fear of falling, functional level, and level of independence in patients with stroke. It was thought that there was a need for assessment of body awareness and include bodyawareness in rehabilitation programs in patients with stroke.

Always Look on the Bright Side: Associations of Optimism With Functional Outcomes After Stroke.

Background Psychological health is as an important contributor to recovery after cardiovascular disease, but the roles of both optimism and depression in stroke recovery are not well characterized. Methods and Results A total of 879 participants in the SRUP (Stroke Recovery in Underserved Populations) 2005 to 2006 Study, aged ≥50 years, with incident stroke admitted to a rehabilitation facility were included. Optimism was assessed by the question: "Are you optimistic about the future?" Depression was defined by Center for Epidemiologic Studies Depression scale score >16. Participants were categorized into 4 groups: optimistic/without depression (n=581), optimistic/with depression (n=197), nonoptimistic/without depression (n=36), and nonoptimistic/with depression (n=65). Functional Independence Measure scores were used to assess stroke outcomes at discharge, 3 months after discharge, and 1 year after discharge with adjusted linear mixed models to estimate score trajectories. Participants were a mean age of 68 years (SD, 13 years), 52% were women, and 74% were White race. The optimistic/without depression group experiencedthe most recovery oftotal Functional Independence Measurescores in the first 3 months, 24.0 (95% CI, 22.5-25.4), followed by no change in the following 9 months, -0.3 (95% CI, -2.3 to 1.7), similar to the optimistic/with depression group with rapid recovery in 0 to 3 months, 21.1 (95% CI, 18.6-23.6) followed by minimal change in 3 to 12 months, 0.7 (95% CI, -2.8 to 4.1). The nonoptimistic groups demonstrated slow but continued recovery throughout the 12-month period, with overall change, 25.4 (95% CI, 17.6-33.2) in the nonoptimistic/without depression group and 17.6 (95% CI, 12.0-23.1) in the nonoptimistic/with depression group. There was robust effect modification between optimism and depression (Pinteraction<0.001). Conclusions In this longitudinal cohort, optimism and depression are synergistically associated with functional recovery after stroke. Measuring optimism status may help identify individuals at risk for worse poststroke recovery.

A Simplified Clinical Prediction Rule for Prognosticating Dependent Daily Living in Patients with Thoracic Spinal Cord Injury: A Multicenter Nationwide Japan Registry Study

Introduction: Clinical prediction rule (CPR) using decision tree analysis is able to show the branching of the variables under consideration in a clear, hierarchical manner, including specific reference values, which can be used as classifiers in clinical practice. However, CPRs developed by decision tree analysis for predicting the degree of independent living of patients with thoracic spinal cord injury (SCI) are few. The purpose of this study was to develop a simplified CPR for prognosticating dependent daily living in patients with thoracic SCI. Methods: We extracted data on patients with thoracic SCI from a national multicenter registry database, the Japan Rehabilitation Database (JRD). All patients with thoracic SCI who were hospitalized within 30 days after the injury onset were included. The independent living was categorized in the JRD as follows: independent socially, independent at home, needing care at home, independent at the facility, and needing care at the facility. These categories were used as the objective variables in classification and regression tree (CART) analysis. The CART algorithm was applied to develop the CPR for predicting whether patients with thoracic SCI achieve independent living at hospital discharge. Results: Three hundred ten patients with thoracic SCI were included in the CART analysis. The CART model identified, in a hierarchical order, patient’s age, residual function level, and the bathing sub-score of Functional Independence Measure as the top three factors with moderate classification accuracy and area under the curve. Conclusions: We developed a simplified, moderately accurate CPR for predicting whether patients with thoracic SCI achieve independent living at hospital discharge.

Investigating the long-term clinical effectiveness of post-acute care cerebrovascular disease rehabilitation

&lt;p&gt;背景與目的：台灣國家健康保險局中風急性後期整合照護計畫(PAC-CVA)於住院期之臨床效益已獲證實，然而長期的效益則未被完全探討。本研究之目的在探討其一年期追蹤之日常活動表現、認知能力、平衡、和心肺表現等功能性恢復。方法：共有13位受試者參與本研究。他們皆接受PAC-CVA之復建計畫，並於病發後之3、6、12月接受成效評估。以功能獨立量表、動作活動量表、柏格氏平衡量表、六分鐘行走測驗、聲音數字廣度測試、空間數字廣度測試、和符號數字測驗進行功能量測。結果：本研究於聲音數字廣度測試、柏格氏平衡量表、六分鐘行走測驗測驗皆發現顯著的持續功能進步，然而在動作活動量表品質分量表和總分量表則呈現顯著的退步。結論：根據長期觀察指出，個案的聲音工作記憶、平衡、和心肺能力等在一年之內由持續進步。PAC-CVD復健計畫改善個案之平衡、心肺功能、和聽覺工作記憶能力，然而在一年之長期評估中亦發現未促進患側肢體之使用。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Background and purpose: The clinical effectiveness of a post-acute care cere-brovascular disease program (PAC-CVD) in Taiwan&amp;rsquo;s National Health Insurance (NHI) system has been evidenced during hospitalization, but the long-term effectiveness has not been thoroughly investigated. The purpose of this research was to investigate functional recovery in daily living performance, cognitive ability, balance, and cardiorespiratory capacity at one-year follow-up. Methods: Thirteen participants were recruited. Participants received rehabilitation according to the PAC-CVD program, and outcome measures were collected at 3 months, 6 months, and 12 months after onset. Several functional measurements were used: the Functional Independent Measurement (FIM) and motor activity log (MAL) for daily living performance, the Berg Balance Scale (BBS) for balance, and the 6-minute walk test (6-MWT) for car-diorespiratory capacity. Cognitive ability was measured with the auditory digit span test (DS&amp;ndash;auditory), spatial digit span test (DS&amp;ndash;visual), and Symbolic Digit Modalities Test (SDMT). Results: The DS&amp;ndash;Auditory, BBS, and 6-MWT indicated significant improvements in function over time, but the MAL-Quality subscale and MAL-total subscale revealed significant declines. Conclusion: Long-term observation indicated functional recovery in auditory working memory, balance, and cardiorespiratory ca-pacity that persisted for one year. At the 12-month follow-up, improvements in bal-ance, cardiorespiratory capacity, and auditory working memory, could be ascribed to the PAC-CVD program, but no treatment effect was found on the use of the affected upper extremity.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Ankle contracture in people with acquired brain injury (ABI), intervention, and outcome following inpatient neurorehabilitation categorized by severity

Background: Acquired brain injury frequently causes difficulty with moving and walking, which if not actively managed, can lead to secondary contracture and deformity. Intervention to manage ankle contracture may include conservative methods (eg, serial casting, standing) or more invasive methods (eg, Achilles-tendon lengthening surgery). Methods: Data were extracted from the UK Rehabilitation Outcomes Collaborative database for all admissions from 2015 to 2018 with a diagnosis of acquired brain injury from 1 tertiary rehabilitation center. Clinical records were reviewed to identify the 101/357 (28%) with ankle contracture. Categorization according to the degree of contracture was performed, as mild (>plantigrade), moderate (<plantigrade to −20°), or severe (>−21°) based on ankle range of movement. Data were analyzed to determine the change in the range of movement, function, outcome, and categorize intervention type. Primary measures: range of movement, UK Functional Independence Measure+Functional Assessment Measure, and Functional Ambulatory Category. Results: In the cohort, significant improvement in range of movement occurred following treatment (54.17; P=0.000). Treatment interventions applied included stretch interventions such as serial casting. Standing programmes, orthotics, and task practice were the most frequently applied interventions. Achilles-tendon lengthening surgery was used in a small number of cases (n=13). A statistically significant change in the range of movement was not seen in the mild category (1.05; P=0.29) but was in the moderate (5.436; P=0.001) and severe categories (10.4; P=0.001). Improvement in locomotion was noted in all 3 groups (6.10; P=0.001) but was most pronounced in the moderate and severe groups. Discussion: Improved functional outcome was observed in mild contracture with less change in joint range. In those categorized as moderate and severe, greater improvement in joint range of movement as well as function were identified following intervention.

Effects of comorbidity on post-acute outcomes in acquired brain injury: ABI-RESTaRT 1991-2020.

Current understanding of comorbidities associated with acquired brain injury (ABI) and the effects on post-acute ABI outcomes is poor. To describe the prevalence, severity and patterns of comorbidity for the pre-injury, acute and post-acute phases, and to examine the effects of post-acute comorbidities on functional independence and length of stay (LOS) at discharge from post-acute care. Retrospective whole-population cohort study of n=1,011 individuals with traumatic (TBI) or non-traumatic brain injury (NTBI), or eligible neurologic conditions admitted to a post-acute neurorehabilitation and disability support service in Western Australia (WA) between 1991 and 2020. Comorbidities were ascertained from internal electronic medical records and linked hospital and emergency department data from the WA Data Linkage System. We measured comorbidities across 14 body systems using the Cumulative Illness Rating Scale (CIRS) and Elixhauser Comorbidity Index (ECI), and functional independence with the UK Functional Independence Measure and Functional Assessment Measure (UK FIM+FAM). We used multilevel mixed-effect regression models to determine the effects of comorbidity on post-acute outcomes. NTBI was the most common diagnosis (54%), followed by TBI (34%) and neurologic conditions (10%). Pre-injury comorbidities were present in over half the cohort. Comorbidity prevalence increased significantly from 57% to 84% (∆+27%) and severity (mean ECI score) increased significantly from 2.1 to 13.8 (∆+11.7) between pre-injury and the acute phase and remained elevated at admission to post-acute services (82%, mean ECI score 7.3). Psychiatric comorbidity was the most prevalent (56%) and was associated with significantly poorer functional outcomes at discharge and an increase in LOS of 6.5 months. Genitourinary, musculoskeletal, eye, ear nose and throat, and renal comorbidities also had significant effects on post-acute outcomes. ABI has a long-term impact on multiple body systems. Identification and management of comorbidities is critical to maximize functional outcomes and reduce the cost of post-acute care.

Influence of Foreign Versus US Nativity on the Trajectory of Functional Independence Over the 10 Years After Traumatic Brain Injury: A Model Systems Study.

Although racial/ethnic disparities have been documented in numerous outcomes after traumatic brain injury (TBI), research has yet to explore differences in rehabilitation outcomes based upon nativity (foreign-born vs US-born individuals). The purpose of this study was to compare the functional outcomes over the first 10 years after TBI for individuals born in the United States with those who were foreign-born. A sample of 10 695 individuals in the TBI Model Systems database with a coding for country of birth the United States ( n = 9435) versus other than the United States ( n = 1260) was used. Outcome measures at 1, 2, 5, and 10 years after TBI included the Motor and Cognitive subscales of the Functional Independence Measure and the Supervision Rating Scale. Foreign-born individuals exhibited lower motor functional independence trajectories than those born in the United States, even after controlling for demographic and injury-related covariates. However, foreign-born individuals generally showed a stronger upward quadratic trajectory in motor functional independence with the greatest gains between the 5- and 10-year time points, whereas those born in the United States improved more quickly but then plateaued between the 5- and 10-year time points; these differential effects over time dissipated with the addition of demographic and injury-related covariates. Foreign-born individuals also exhibited lower cognitive functional independence trajectories, as well as greater supervision needs trajectories, than those born in the United States, even after controlling for demographic and injury-related covariates. These findings dovetail with literature suggesting that racially/ethnically diverse groups exhibit reduced functional independence after TBI. The findings may also suggest potential systematic barriers such as healthcare access and language barriers that may influence the frequency, rate, and quality of care received. The results highlight the importance of uncovering cultural distinctions and can aid in facilitating research examining foreign nativity-based disparities following TBI.

Do Knee Joint Orthoses Affect the Functional Status of Stroke Patients? A Literature Review

Stroke is the leading cause of adult disability in developed countries. As a result of damage to the central nervous system, the patient's independence in performing everyday activities is reduced, which often leads to dependence on the environment. The symptoms of syndromes affect many functions, including: speech, the upper limb, gait, balance and coordination disorders. These disorders lead to a decrease in the patient's quality of life. Many patients require knee braces to learn to walk. In this review article, the most commonly used scales used to assess the functional status of patients after stroke are discussed, with particular attention being paid to gait assessment. We described simple (basic ADL) and instrumental (extended) scales of activities of daily living (instrumental, extended ADL), methods of clinical gait and balance assessment, International Classification of Functioning, Disability and Health, ICF), as well as recommendations of the European Stroke Organisation (ESO, Neurorehabilitation Committee). These guidelines regard methods of evaluating the results of post-stroke rehabilitation for clinical use - Outcome Measures for Clinical Use, in which, among others, the Berg scale and the timed Up &amp; Go test are recommended for the lower limb, the Barthel scale and the Functional Independence Measure for ADL, and the Stroke Impact Scale for the participation column in all 3 ICF domains. In the article, the current state of knowledge is presented regarding the impact of knee braces on the functional status of people after stroke. Mechanical knee and ankle orthoses are called KAFO (Knee Ankle Foot Orthosis). Their main tasks include immobilisation of the knee joint and aid in learning to walk.

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.

The validity and reliability of the interviewer-administered EQ-5D-Y-3L version in young children

ObjectivesThe aim of this study was to determine the validity and reliability of the EQ-5D-Y-3L interviewer-administered (IA) version in South African children aged 5–7-years compared to 8–10-years.MethodsChildren aged 5–10-years (n = 388) were recruited from healthcare facilities, schools for learners with special educational needs and mainstream schools across four known condition groups: chronic respiratory illnesses, functional disabilities, orthopaedic conditions and the general population. All children completed the EQ-5D-Y-3L IA, Moods and Feelings Questionnaire (MFQ), Faces Pain Scale-Revised (FPS-R) and a functional independence measure (WeeFIM) was completed by the researcher. Cognitive debriefing was done after the EQ-5D-Y-3L IA to determine comprehensibility. Test–retest of the EQ-5D-Y-3L IA was done 48 h later and assessed using Cohen’s kappa (k).ResultsResults from children aged 5–7-years (n = 177) and 8–10-years (n = 211) were included. There were significantly higher reports of problems in the Looking After Myself dimension in the 5–7-year-olds (55%) compared to the 8–10-year-olds (28%) (x2 = 31.021; p = 0.000). The younger children took significantly longer to complete the measure (Mann-Whitney U = 8389.5, p < 0.001). Known-group validity was found at dimension level with children receiving orthopaedic management reporting more problems on physical dimensions across both age-groups. Convergent validity between Looking After Myself and WeeFIM items of self-care showed moderate to high correlations for both age-groups with a significantly higher correlation in the 8–10-year-olds for dressing upper (z = 2.24; p = 0.013) and lower body (z = 2.78; p = 0.003) and self-care total (z = 2.01; p = 0.022). There were fair to moderate levels of test-retest reliability across age-groups.ConclusionThe EQ-5D-Y-3L IA showed acceptable convergent validity and test–retest reliability for measuring health in children aged 5–7-years. There was more report of problems with the dimension of Looking After Myself in the 5–7-year group due to younger children requiring help with dressing, including buttons and shoelaces due to their developmental age, rather than their physical capabilities. Therefore, it may be useful to include examples of age-appropriate dressing tasks. There was further some reported difficulty with thinking about the dimensions in the younger age-group, most notably for Usual Activities which includes a large number of examples. By decreasing the number of examples it may reduce the burden of recall for the younger age-group.

Psychosocial functioning mediates change in motor and cognitive function throughout neurorehabilitation for adults with acquired brain injury (ABI-RESTaRT)

ObjectivesThis study aimed to evaluate the mediational role of change in psychosocial abilities, adjustment and participation on change in motor and cognitive function from admission to discharge from a staged community-based brain injury rehabilitation (SCBIR) service in Western Australia, 2011–2020.MethodsA retrospective cohort study of n = 324 adults with ABI enrolled in SCBIR using routinely collected rehabilitation outcome measures data. Motor and cognitive function were assessed with the UK Functional Independence and Assessment Measure and psychosocial function with the Mayo-Portland Adaptability Inventory-4. Six multilevel mediation regression analyses were conducted to determine whether change in psychosocial function (abilities, adjustment and participation) mediated change in motor and cognitive function from admission to discharge.ResultsParticipants demonstrated clinically significant improvements in both motor (+ 11.8, p < 0.001) and cognitive (+ 9.5, p < 0.001) functioning from admission to discharge. Statistically significant improvements in psychosocial abilities (− 4.8, p < 0.001), adjustment (− 2.9, p = 0.001) and participation (− 2.5, p < 0.001) were also seen but were not clinically significant. Mediation analyses showed that participation accounted for 81% of improvements in motor function at discharge and 71% of cognitive function improvements. Adjustment accounted for 26% and 32% of change in motor and cognitive function, respectively. Abilities accounted for 60% of change in cognitive function but did not significantly influence change in motor function. Changes in psychosocial participation fully mediated change in motor function during neurorehabilitation.ConclusionsPsychosocial function, particularly participation, is an important driver of motor and cognitive recovery throughout neurorehabilitation. Functional rehabilitation programs should target psychosocial improvement as an important mechanism of change.

Predicting Dropout and Mobility Achievements during in-Patient Geriatric Rehabilitation

Aims: To predict, at the beginning of geriatric rehabilitation, patients who will not complete the in-patient rehabilitation and patients who will walk independently at the end of this period. Methods: Participants: A total of 40 older adults. Primary outcomes: Dropout rate, score 6–7 in the walking sub-items of the Functional Independence Measure (FIM) at the end of rehabilitation. Predictors: Heart rate (HR) at rest, the Modified Borg Scale (MBS) while walking, and FIM walking at admission. Results: Twelve of the participants dropped out. An MBS > 5 best predicted who did not complete the rehabilitation intervention (accuracy = 0.70). At the end of the rehabilitation period, 24 were independent in mobility. A baseline FIM walking >2 and MBS < 7 predicted independence in walking (accuracy 0.84 and 0.82, respectively). Conclusion: Simple measures taken at the beginning of geriatric rehabilitation may contribute to estimating early not completion of rehabilitation and mobility independence at the end of the program.

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.

Functional Recovery During Inpatient Rehabilitation in Children With Anoxic or Hypoxic Brain Injury

ObjectivesTo (1) describe characteristics of children with anoxic or hypoxic brain injuries (AnHBI) who presented to an inpatient rehabilitation unit, (2) explore functional outcomes of children with AnHBI at discharge, and (3) examine differences between children with AnHBI associated with cardiac arrest (CA) vs those with respiratory arrest (RA) only. DesignRetrospective cohort study. SettingPediatric inpatient rehabilitation hospital in the Northeast United States. ParticipantsA total of 46 children and adolescents ages 11 months to 18 years admitted to an inpatient rehabilitation brain injury unit (1994-2018) for a first inpatient admission after AnHBI. InterventionsNot applicable. Main Outcome MeasuresPediatric Cerebral Performance Category Scale (PCPC), Pediatric Overall Performance Category, and Functional Independence Measure for Children developmental functional quotients (WeeFIM DFQs) total and subscale scores. ResultsMost children had no disability before injury (PCPC=normal, n=37/46) and displayed significant functional impairments at admission to inpatient rehabilitation (PCPC=normal/mild, n=1/46). WeeFIM and PCPC scores improved significantly during inpatient rehabilitation (WeeFIM DFQ Total, P=.003; PCPC, P<.001), although many children continued to demonstrate significant impairments at discharge (PCPC=normal/mild, n=5/46). Functioning was better for the RA-only group relative to the CA group at admission (WeeFIM DFQ Total, P=.006) and discharge (WeeFIM DFQ Total, P<.001). Ongoing gains in functioning were noted 3 months after discharge compared with discharge (WeeFIM DFQ Cognitive, P=.008). ConclusionsIn this group of children with AnHBI who received inpatient rehabilitation, functional status improves significantly between rehabilitation admission and discharge. By discharge, many children continued to display significant impairments, a minority of children had favorable neurologic outcomes, and children with CA have worse outcomes than those with RA-only. Given the small sample size, future research should examine functional recovery during inpatient rehabilitation in a larger, multisite cohort and include longer-term follow-up to examine recovery patterns over time.

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.