Functional Independence Measure Scores Research Articles

469 Recovery Rate of Motor Function During Rehabilitation After Traumatic Cervical Spinal Cord Injury Predicts Functional Status at Years 1 and 5 After Surgery: A Multicenter, Longitudinal Cohort Study

INTRODUCTION: Traumatic spinal cord injury (SCI) is a devastating condition. Early surgical decompression and rehabilitative efforts in cervical SCI patients has been shown to improve neurological outcomes. METHODS: A longitudinal, retrospective cohort study was conducted from the multicenter Spinal Cord Injury Model Systems (SCIMS) database on patients with motor Functional Independence Measure (FIM) scores at admission to and discharge from rehabilitation, year 1, and year 5. Patients who underwent surgical decompression with neurological levels of injury limited to the cervical region and those with American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades of A and B were included. The FIM score was utilized to calculate changes in motor FIM scores over each respective time period. Multivariate logistical regression was performed to identify longitudinal predictors associated with functional independence. RESULTS: A total of 351 patients met the inclusion criteria. The change in motor FIM score during the inpatient rehab period was a significant predictor of achieving FI at 1 and 5 years (year 1: aOR = 15.6, 95% CI 3.94-77.6, p < 0.0001; year 5: aOR = 28.0, 95% CI 6.13-173.6, p < 0.0001). For patients not achieving FI at year 1, the change in motor FIM score during inpatient rehab was a greater predictor of FI at year 5 (aOR = 64.7, 95% CI 5.15-1717.3, p = 0.0004). CONCLUSIONS: Inpatient rehabilitation efforts may lead to greater long-term functional status and carry emphasized importance for patients who do not attain functional independence by year 1.

Transcranial Doppler ultrasonography can predict inpatient rehabilitation functional outcome in patients with stroke.

Despite advances in imaging techniques and treatment modalities, tools to predict recovery after stroke remain limited. To determine if transcranial Doppler (TCD) mean flow velocities were predictive of functional recovery following ischemic stroke. Data were collected from patients with stroke admitted to an academic tertiary care facility in the southeastern region of the United States between 2012 and 2019 who had a middle cerebral artery distribution ischemic stroke, TCD, and were discharged to our inpatient rehabilitation facility. Mean flow velocities were categorized as low (<40 cm/s), normal (40-80 cm/s), or high (>80 cm/s). Functional Independence Measure (FIM) scores were collected on admission to and discharge from inpatient rehabilitation. Multiple linear regression models were used to assess the differences in mean FIM score changes by categories of mean flow velocities. We enrolled 57 patients, mean age 60 years, 73.7% male. Compared to the normal velocity group, those with abnormally low velocities had a significantly smaller change in their FIM score (adjusted β = -8.42; p = .01). Compared to the normal velocity group, those with abnormally high velocities experienced a greater change in FIM score, but this association was not statistically significant (beta = 1.12; p = .77). In this limited population, we found that low mean flow velocity as measured by TCD ultrasonography after a middle cerebral artery stroke is associated with poorer functional recovery following inpatient rehabilitation. Our results suggest that the value of TCD ultrasonography as a tool to predict motor recovery after stroke warrants further investigation.

Low muscle mass in patients with stroke on admission reduces walking ability at discharge

Reduced skeletal muscle mass may negatively influence postural retention and walking function. This study aimed to examine the influence of the skeletal muscle mass index on walking function in patients with stroke. This study included patients with cerebral infarction aged ≥65 years. The Asian Working Group for Sarcopenia's skeletal muscle mass index criteria were used to classify the participants into the low and high skeletal muscle mass index groups. The patient characteristics of the two groups were compared. The primary and secondary outcome measures were independent walking and walking speed, respectively. In total, 174 participants were included. There were no significant differences in the length of hospital stay, rehabilitation volume, or functional independence measure score at discharge between the males and females. Multivariate logistic regression analysis revealed that independent walking was independently associated with the skeletal muscle mass index on admission. The SMI, as an explanatory variable, was independently associated with the comfortable and fastest walking speeds. Faster walking was associated with higher skeletal muscle mass indexes on admission for both males and females. A low skeletal muscle mass index negatively influences walking function improvement in patients with stroke. A strategy aimed at increasing skeletal muscle mass can have beneficial effects on walking function in patients with stroke.

Identifying characteristics of stroke patients benefiting from interprofessional collaboration

Introduction: This study identifies the patient population that may benefit from interprofessional collaboration in the support of patients with cerebrovascular diseases. Method: This study involved 170 patients who received treatment in Japan’s recovery rehabilitation wards in December 2019–June 2020. Participants were categorized into three groups based on their functional independence measure (FIM) scores at admission, distinguishing between complete dependence, modified dependence, and independence groups. They were classified into the group with higher collaborative practice (HCP) and the group with lower collaborative practice (LCP) based on the median value of the therapist collaborative practice scale (TCPS). The primary outcomes measured were FIM efficiency and FIM effectiveness. The main effects and interactions of the level of independence with activities of daily living (ADL) and collaboration were examined using a two-way analysis of variance and Bonferroni multiple comparison tests. Results: The level of independence with ADL and collaboration had an interaction effect related to FIM effectiveness ( F(2, 164) = 3.191, p = 0.044). Within the independence group, HCP and LCP differed significantly ( F(1, 164) = 15.562, p &lt; 0.001). Conclusion: Interprofessional collaboration may improve ADL in patients with high ADL independence at admission. Furthermore, the interprofessional collaboration quality impacted patients’ ADL improvement.

Effectiveness and efficiency of telerehabilitation on functionality after spinal cord injury: A matched case-control study.

Telerehabilitation in spinal cord injury (teleSCI) is a growing field that can improve access to care and health outcomes in patients with spinal cord injury (SCI). The clinical effectiveness of teleSCI is not known. To compare independence in activities of daily living and mobility capacity in patients following teleSCI and matched controls undergoing traditional rehabilitation. Matched case-control study. TeleSCI occurring in home setting (cases) versus traditional rehabilitation on inpatient unit (controls). Forty-two consecutive patients with SCI followed with teleSCI were compared to 42 historical rehabilitation inpatients (controls) matched for age, time since injury to rehabilitation admission, level of injury (paraplegia/tetraplegia), complete or incomplete injury, and etiology (traumatic/nontraumatic). The teleSCI group (n = 42) was also compared to the complete cohort of historical controls (n = 613). The teleSCI group followed home-based telerehabilitation (3.5 h/day, 5 days/week, 67 days average duration) and historical controls followed in-person rehabilitation. The Functional Independence Measure (FIM), the Spinal Cord Independence Measure (SCIM) and the Walking Index for Spinal Cord Injury (WISCI). We formally compared gains, efficiency and effectiveness. International Standards for Neurological Classification of Spinal Cord Injury and the American Spinal Injury Association Impairment Scale (AIS) were used. The teleSCI group (57.1% nontraumatic, 71.4% paraplegia, 73.8% incomplete, 52.4% AIS grade D) showed no significant differences compared with historical controls in AIS grades, neurological levels, duration, gains, efficiency and effectiveness in FIM, SCIM, or WISCI, although the teleSCI cohort had significantly higher admission FIM scores compared with the complete cohort of historical controls. TeleSCI may provide similar improvements in mobility and functional outcomes as traditional rehabilitation in medically stable patients (predominantly with paraplegia and motor incomplete SCI) when provided with appropriate support and equipment.

Functional prognosis following spontaneous intracerebral hemorrhage in patients on hemodialysis: a retrospective study of 100 consecutive cases

BackgroundRecently, discussions have increasingly focused on “withdrawal from dialysis” among patients undergoing dialysis who experience severe brain dysfunction as post-stroke sequelae. In this context, the lack of understanding regarding functional prognosis after spontaneous intracerebral hemorrhage in patients undergoing hemodialysis becomes a particularly important issue. Therefore, we aimed to evaluate the functional prognosis of intracerebral hemorrhage in patients undergoing hemodialysis when life-saving was prioritized and dialysis was not withdrawn. Furthermore, we sought to identify factors influencing life and functional prognosis.MethodsWe retrospectively analyzed data of 100 consecutive hemodialysis patients who experienced spontaneous intracerebral hemorrhage between 2012 and 2021. The in-hospital mortality rates and modified Rankin Scale (mRS) and Functional Independence Measure (FIM) scores at discharge and 90 days after onset were examined.ResultsThe mean age of the patients was 65.7 years, with 29% of them undergoing life-saving brain surgery. The mRS score at discharge was 0, 1, 2, 3, 4, 5, and 6 (indicating death) in 0, 1, 13, 9, 26, 20, and 31 cases, respectively. Among the 69 surviving patients, the median FIM score at discharge was 37 (19–81), with 14 patients having an FIM score of 18 (i.e., complete dependence). Patients who underwent life-saving brain surgery showed a higher median mRS score [5, interquartile range (IQR) 5–6] and a lower FIM score (18, IQR 18–22) at discharge compared with those who did not undergo the surgery. Patients discharged with mRS and FIM scores of 5 and 18, respectively, had the same functional status at 90 days. The Functional Outcome in Patients With Primary Intracerebral Hemorrhage (FUNC) score and intraventricular extension at admission were predictive of a mRS score ≥ 5 (area under the receiver operating characteristic curve = 0.92, p < 0.0001) and FIM score at discharge (adjusted R2 = 0.3, p = 0.0003).ConclusionIn our single-center study, more than 14% of patients on hemodialysis with cerebral hemorrhage incurred severe, irreversible neurological and functional impairments, necessitating discussions on hemodialysis withdrawal. Moreover, FUNC score and intraventricular extension at admission were highly accurate predictors of functional prognosis.

Identifying Racial and Ethnic Disparities in Acute Inpatient Rehabilitation

ObjectiveTo investigate whether racial, ethnic, and linguistic disparities exist at discharge from an acute inpatient rehabilitation facility (IRF) by examining change in Functional Independence Measure (FIM) scores and discharge destination. DesignThis is a retrospective study using our IRF's data from the Uniform Data System for Medical Rehabilitation from 2013-2019. FIM scores and discharge destination were compared between race, language, and ethnic groups, with adjustment for patient characteristics. SettingAn urban hospital with a level 1 trauma center, comprehensive stroke center, and IRF with Commission on Accreditation of Rehabilitation Facilities (CARF) certification. Participants2518 patients admitted to the IRF from 2013-2019 (N=2518). InterventionsNot applicable. Main Outcome MeasuresChange in FIM score and discharge destination. ResultsAfter adjusting for covariates, non-White patients and patients with limited English proficiency had significantly lower functional recovery, as measured by smaller changes in FIM scores from IRF admission to discharge. Additionally, both groups were more likely to be discharged home with home health care than to a skilled nursing facility, compared with White and English-speaking patients. Disparities in discharge destination persisted within patients with noncommercial insurance (Medicaid or Medicare) and a stroke diagnosis but not within those who had commercial insurance or a nonstroke diagnosis. ConclusionsRacial and linguistic disparities were identified within our CARF certified IRF; however, the organization is committed to reducing health care disparities. Next steps will include investigating interventions to reduce disparities.

Safety and Efficacy of Bone Marrow Mesenchymal Stem Cells in the Treatment of Ischemic Stroke: A Meta-Analysis.

We aimed to systematically evaluate the efficacy and safety of bone marrow mesenchymal stem cells (BMMSCs) in the treatment of ischemic stroke. Six Chinese and English databases were searched for related randomized controlled trials from the establishment of the databases to 28 February 2023. Two investigators performed screening and a comprehensive analysis and evaluated the quality of the studies. They extracted information from the included studies, and managed and analzsed the data using RevMan 5.4.1 software (The First College of Clinical Medical Science, China Three Gorges University). Finally, they performed meta and heterogeneity analyses and created a risk-of-bias map. A total of 13 high-quality articles were included. The National Institute of Health Stroke Scale (NIHSS) scores of the experimental group differed significantly from those of the control group at 3 months (I2 <50%, mean difference [MD] = -2.88, P < 0.001) after treatment. The Fugl-Meyer assessment (FMA) scores of the experimental group varied significantly from that of the control group at 1 month (I2 >50%, MD = 15.94, P < 0.001), 3 months (I2 >50%, MD = 12.71, P < 0.001), and 6 months (I2 >50%, MD = 13.76, P < 0.001) after treatment, and the overall difference (I2 >50%, MD = 14.38, P ≤ 0.001) was significant. The functional independence measure (FIM) scores were significantly different from that of the control group at 1 month (I2 >50%, MD = 20.04, P = 0.02), 3 months (I2 >50%, MD = 15.51, P < 0.001), and 6 months (I2 >50%, MD = 13.46, P = 0.03). There was no significant increase in adverse events compared with the traditional treatment regimen. To some extent, BMMSC transplantation can improve the neurological deficit, motor function, and daily living ability of patients with ischemic stroke.

Is the isokinetic strength of nonparetic lower limb related to fatigue in stroke survivors? A cross-sectional study.

The study aimed to investigate the correlation between nonparetic knee muscle strength and fatigue in a cohort of stroke survivors. Thirty-two stroke survivors (17 females, 15 males; median age 62 (interquartile range [IQR] 51-69), (min: 45, max: 81) years were recruited in this cross-sectional study between January 2012 and September 2012. Sociodemographic, clinical, and stroke-related parameters were recorded. All participants underwent an isokinetic measurement of the nonparetic knee flexion and extension. Functional independence measure, functional ambulation category, and Mini-Mental State Examination scores were used to evaluate the functional status, ambulation, and mental status of the patients. Anxiety, depression, and fatigue severity were measured using the Hospital Anxiety and Depression Scale and fatigue severity scale (FSS), respectively. The median duration of stroke was 3.1 (IQR: 2.5-6.5) months. Stroke survivors with reduced muscle strength were older and had lower motor and total functional independence measure scores than those with normal strength (p=0.026, p=0.034, and p=0.034, respectively). There were more patients with lower functional ambulation category scores in the group with reduced muscle strength (p=0.023). Peak torque values of knee flexors at 60°/sec and 180°/sec correlated negatively with FSS (r= -0.360, p=0.043 and r= -0.452, p=0.009, respectively). There was also a negative correlation between the work of knee extensor and flexors at 180°/sec and FSS (r= -0.398, p=0.024 and r= -0.451, p=0.010, respectively). Anxiety and depression scores were not significantly correlated with fatigue. The lower strength of nonparetic knee extensor muscles was related to greater disability and worse ambulatory scores. The lower strength of knee flexor muscles and the work of both knee muscles in the nonparetic limb were related to higher fatigue levels in stroke survivors. Therefore, fatigue management and strengthening of both knee flexor and extensor muscles in the nonparetic limb is emphasized during stroke rehabilitation.

Impact of possible sarcopenia on functional prognosis in patients with acute stroke with premorbid disability.

How possible sarcopenia affects functional prognosis in patients with premorbid disability remains unclear. This study aimed to compare and investigate the impact of possible sarcopenia at admission on functional outcomes at discharge in patients with acute stroke with and without premorbid disability. This cohort study enrolled patients who were consecutively admitted to a single center for acute stroke. Calf circumference and grip strength were measured within 7 days of admission, and possible sarcopenia was determined using the Asian Working Group for Sarcopenia 2019 criteria. The Functional Independence Measure (FIM) score at discharge during the acute phase was the primary outcome. To examine the impact of possible sarcopenia on FIM scores at discharge, patients were divided into two groups according to being with or without premorbid disability according to the modified Rankin Scale, and multiple linear regression analysis was performed in each group. This study included 456 patients with acute stroke (median age, 80 years). In the premorbid-disability group (n = 166), possible sarcopenia was present in 140 patients (84%). Patients without possible sarcopenia had significantly higher FIM scores at discharge compared with those with possible sarcopenia (P < 0.001). However, multiple linear regression analysis showed that possible sarcopenia was not associated with FIM scores at discharge in the premorbid-disability group (β = -0.054, P = 0.346). The results of this study demonstrated that a high rate of possible sarcopenia was observed in patients with stroke with premorbid disability; however, this did not affect functional prognosis. Geriatr Gerontol Int 2024; 24: 359-363.

Concomitant traumatic brain injury as a determinant of survival, and neurological and functional outcomes after traumatic spinal cord injury: A retrospective cohort study.

Although concomitant traumatic brain injury (TBI) is not infrequently associated with spinal cord injury (SCI), there is relatively scarce information about the effects of concomitant TBI on outcomes after SCI. To assess the impact of concomitant mild-to-moderate TBI on survival, and neurological and functional outcomes within the first year after acute traumatic SCI. Retrospective cohort study. Acute spine trauma centers in the United States. This study includes all individuals who were enrolled into the Third National Spinal Cord Injury Study (NASCIS-3). The study population was classified into SCI + TBI group and SCI-alone group. TBI was defined as a Glasgow Coma Scale score <15 on admission. Not applicable. Both groups were compared regarding their survival and neurological outcomes (ie, NASCIS motor, sensory and pain scores) and functional outcome (ie, Functional Independence Measure score) within the first year following SCI. Data analyses were adjusted for major potential confounders. There were 413 individuals in the SCI-alone group and 86 individuals in the SCI + TBI group (17.2%). Both groups were comparable regarding gender distribution (p = .621). However, the SCI + TBI group was older (p < .001), had a higher proportion of complete (p = .006) and cervical SCI (p = .003), and had a higher blood alcohol level (p < .001) than the SCI-alone group. The SCI + TBI group did not significantly differ from the SCI-alone group regarding survival within the first year after SCI (p = .768). Among the survivors, concomitant mild-to-moderate TBI did not significantly affect neurological and functional outcomes at 1 year after SCI in the multiple regression analyses after adjusting for major potential confounders. The results of this study suggest that concomitant mild-to-moderate TBI did not have a significant impact on survival, neurological recovery, and functional outcomes at 1 year after SCI, even though there were some epidemiological differences between SCI-alone and SCI + TBI groups.

Long-Term Functional Outcome in Patients With Isolated Thalamic Stroke: The KOSCO Study.

Information on the long-term prognosis in patients with isolated thalamic stroke is sparse. We report the functional outcomes of patients with thalamic stroke up to 24 months from the KOSCO (Korean Stroke Cohort for Functioning and Rehabilitation) study. Isolated thalamic stroke was defined as the presence of lesions solely in the thalamus, excluding cases with lesions in other brain parenchyma areas apart from the thalamus, as identified by brain magnetic resonance imaging or computed tomography scans. The Fugl-Meyer Assessment, the Functional Ambulatory Category, the Korean Mini-Mental State Examination, the American Speech-Language-Hearing Association National Outcome Measurement System Swallowing Scale, and the short version of the Korean Frenchay Aphasia Screening Test were used to assess physical impairment. The Functional Independence Measure and modified Rankin Scale were used to assess functional outcomes. All measurements were conducted up to 24 months poststroke. A total of 297 patients were included, consisting of 235 with ischemic and 62 with hemorrhagic stroke. Except for the Functional Ambulatory Category and Functional Independence Measure, all physical impairments showed significant improvement up to 3 months poststroke (P<0.001) and reached a plateau. The Functional Ambulatory Category and Functional Independence Measure scores continued to improve up to 12 months poststroke (P<0.05) and reached a plateau. At 7 days poststroke, 47.5% of patients had no disability (modified Rankin Scale score<2), whereas at 24 months poststroke, 76.4% of patients had no significant disability. Patients showed rapid recovery from physical impairment up to 3 months poststroke, with additional improvements in ambulatory function and independence observed up to 12 months poststroke. Additionally, relatively favorable long-term functional prognosis at 24 months after onset was demonstrated. These results could provide insights into the proper management regarding functional outcomes of patients with isolated thalamic stroke.

Veterans with familial ALS and bulbar and respiratory presentations at onset had shorter survival.

We sought to characterize the clinical prognostic factors in veterans with amyotrophic lateral sclerosis (ALS) followed in our ALS clinic. ALS is a rare, progressive neurodegenerative condition associated with decreased survival compared to that in the normal population. The electronic medical records of 105 veterans diagnosed with ALS who are followed in our ALS clinic between 2010 and 2021 were reviewed. Approval from the institutional review board was obtained from the study protocol. Demographic and clinical variables included age at symptom onset, age at initial evaluation, survival (from symptom onset to death), gender, site of onset (appendicular, bulbar, and respiratory), initial amyotrophic lateral sclerosis functional-related score-revised (ALSFRS-R), total functional independence measure (TFIM) scores, initial forced vital capacity (FVC), and interventions (Riluzole, gastrostomy, noninvasive ventilation [NIV], and tracheostomy). Normally distributed data was expressed as mean ± standard deviation. Fischer's exact analysis of the distribution differences of categorical data. The Kaplan-Meier plot analyzed the time-to-event. The mean (SD) age at symptom onset was 62.0 (11.1) years, age at diagnosis was 65 (11) years, with 72% of the patients being over 60 years at diagnosis. The median survival time from symptom onset was 4.12 (3) years. Limb-onset ALS (appendicular) was the most frequent (52%) followed by bulbar-onset ALS (43%). The mean ALSFRS-R and TFIM scores were 31 (8) and 91 (25), respectively. Family history (familial), bulbar, and respiratory presentation at diagnosis were associated with shorter survival times. This study suggests that of the clinical prognostic factors veterans with familial ALS, bulbar, and respiratory onset at presentations had shorter survival. The presence of Agent Orange, PEG placement, and NIV did not affect survival.

Relationship between Anemia and Readmission among Older Patients in Rural Community Hospitals: A Retrospective Cohort Study.

Readmission rates among older adults are a growing concern, and the association of readmission with anemia and the potential benefits of a systematic assessment and intervention remain unclear. This study investigated the association between anemia and readmission within 28 and 90 days in an older population. Data from 1280 patients admitted to the Department of General Medicine of Unnan City Hospital between April 2020 and December 2021 were retrospectively analyzed. Variables such as anemia status, Charlson comorbidity index (CCI) score, Functional Independence Measure (FIM) score, and dependent status were evaluated. Multivariate logistic regression was used to determine the associations between 28-day and 90-day readmissions. The average age was 84.9 years, and the prevalence of anemia was 36.4%. The readmission rates within 28 and 90 days were 10.4% and 19.1%, respectively. Anemia was significantly associated with readmission in both periods (28-day adjusted odds ratio, 2.28; 90-day adjusted odds ratio, 1.65). CCI score, FIM score, and dependent status were also identified as significant factors. Anemia is significantly associated with short- and medium-term readmissions in older patients. Addressing anemia, along with other identified factors, may help reduce readmission rates.

Effects of robotic-assisted gait training on physical capacity, and quality of life among chronic stroke patients: A randomized controlled study

BackgroundEven though robotic therapy is becoming more commonly used in research protocols for lower limb stroke rehabilitation, there still is a significant gap between research evidence and its use in clinical practice. Therefore, the present study was designed assuming that the wearable mobile gait device training for chronic stroke patients might have different effects on functional independence when compared to training with a stationary gait device. The present study aims to examine the effects of gait training with ExoAthlet exoskeleton and Lokomat Free-D on functional independence, functional capacity, and quality of life in chronic stroke patients. MethodsThe present study included 32 chronic stroke patients. Participants were randomly divided into two groups. Functional independence of patients was evaluated by using Functional Independence Measure (FIM), physical function was assessed by using the 30-second chair stand test (30-CST), functional capacity was measured by using the 6-Minute Walk Test (6MWT), and quality of life was assessed by using Short Form 36 (SF36). All participants underwent a conventional physiotherapy program for eight weeks, three sessions per week, and each session lasted 60 min. After the physiotherapy program, one group received gait training by using ExoAthlet exoskeleton (ExoAtlet 1 model/2019, Russia), while the other group received training by using Lokomat Free-D (Hocoma, Lokomat Pro Free-D model/2015, Switzerland). Participants were assessed at baseline and post-intervention. ResultsResults achieved in this study revealed that there was a statistically significant difference between FIM, 30-CST, 6MWT, and SF36 scores before and after the treatment in both groups (p < 0.05).There was no difference in FIM, 30-CST, and 6MWT results between Exoskeleton ExoAthlet and Lokomat Free-D groups (p > 0.05). However, there was a statistically significant difference between Exoskeleton ExoAthlet and Lokomat Free-D groups in terms of SF-36 sub-parameters “vitality”, “mental health”, “bodily pain”, and “general health perception” (p < 0.05). ConclusionsThis study demonstrated that the use of ExoAthlet exoskeleton and Lokomat Free-D in addition to conventional physiotherapy, was effective in improving functional independence, physical function, functional capacity, and quality of life among chronic stroke patients. Incorporation of robotic gait aids into rehabilitation for chronic stroke patients might offer significant advantages.

One-Leg Robotic-Assisted Gait Training Efficiently Improves Gait Independence for Acute Stroke Hemiplegic Patients: A Prospective Pilot Study.

Welwalk is a one-leg robotic-assisted gait system for stroke hemiplegic patients. This study examined the feasibility and efficacy of gait training using Welwalk (Welwalk training) for hemiplegic patients in the early phase after stroke onset, via cooperation between acute care and rehabilitation hospitals. Seven acute stroke patients (mean number of days from onset = 7.9) with severe lower extremity paralysis participated. Patients underwent Welwalk training for 40 min/d, 5 d/wk in an acute care hospital, then 7 d/wk in a rehabilitation hospital with a seamless transition. Functional Independence Measure scores for walking were assessed weekly. The endpoint was reaching Functional Independence Measure walk score of 5 (supervision level). The primary outcome was improvement efficiency of Functional Independence Measure walk, which was the increase in Functional Independence Measure walk score divided by the number of weeks required. Functional Independence Measure walk score for all patients improved from 1.1 to 5 ( P = 0.01, r = 0.96). The mean number of weeks to achieve Functional Independence Measure walk score of 5 was 5 wks, and the improvement efficiency of Functional Independence Measure walk had a mean value of 0.9. No adverse events were reported during Welwalk training. Hemiparetic patients' gait independence may be safely and rapidly improved by starting Welwalk training in the early phase after stroke onset.

Decreased Bed Mobility Function Is Associated With Postdischarge Mortality for Cancer Patients in Inpatient Rehabilitation.

The establishment of rehabilitation goals for hospitalized cancer patients depends on accurate medical prognosis and matching goals to clinical timelines. Current tools for estimating prognosis are limited. We hypothesized that bed mobility is a predictor of mortality in cancer patients admitted to inpatient rehabilitation. In a retrospective cohort of 187 subjects with nonneurologic cancer admitted to inpatient rehabilitation, Functional Independence Measure scores and 6-mo mortality were analyzed. In the cohort, survival rate was 71% at 6 mos. In univariate analysis, discharge bed mobility score (odds ratio = 0.75, 95% confidence interval = 0.61-0.90, P = 0.003), bed mobility Functional Independence Measure gain (odds ratio = 0.66, 95% confidence interval = 0.51-0.85, P = 0.002), and bed mobility Functional Independence Measure efficiency (odds ratio = 0.011, 95% confidence interval = 0.00032-0.21, P = 0.006) were inversely associated with 6-mo mortality after discharge from inpatient rehabilitation facility. In multivariate analysis with additional motor Functional Independence Measure items, only bed mobility (odds ratio = 0.73, 95% confidence interval = 0.54-0.97, P = 0.029) and grooming (odds ratio = 0.79, 95% confidence interval = 0.63-0.99, P = 0.041) were independently associated with mortality. Lower discharge and lower change in bed mobility Functional Independence Measure scores are associated with mortality in cancer patients in inpatient rehabilitation. Bed mobility could serve as a clinical tool for estimating medical prognosis in hospitalized cancer patients and should be validated in prospective studies.

Association between oral health status and functional independence measure on admission in convalescent hospitalized patients

BackgroundOral health management has become increasingly important for acute inpatients. Older patients often require extended periods of medical care, and oral health management is necessary in the convalescent period following the acute period. During the convalescent period, oral health management remains unclear as convalescent hospitals have limited dental resources, and effective dental care must be provided if the objective of hospitalization is to improve life functions. This study aimed to clarify the relationship between daily functioning and oral health status at the time of admission to a convalescent hospital to aid in improving daily functioning in the convalescent period.MethodsWe included patients admitted to the rehabilitation department of a specific convalescent hospital from January to December 2021. A total of 375 patients were included in the study, with complete data records. At admission, we gathered information from the medical records, including the patient’s age, sex, primary disease, Charlson Comorbidity Index, Mini Nutritional Assessment Short-Form (MNA-SF), Functional Oral Intake Scale (FOIS), Functional Independence Measure (FIM), number of teeth, and Oral Health Assessment Tool (OHAT). Statistical analysis was conducted using SPSS Ver. 27, with a significance level of 5%.ResultsThe mean age of the 375 participants (189 men and 186 women) was 75.0 ± 12.1 years (range, 42–97 years), and over 80% were > 65 years. About 30% of major diseases could be attributed to strokes and fractures, followed by spinal cord and spine diseases. In non-stroke patients, multiple regression analysis using FIM motor, FIM cognitive, and FIM and OHAT total scores as objective variables showed that higher total scores of MNA-SF, FOIS, and lower modified Rankin Scale and OHAT were significantly associated with better FIMs. Lower OHAT scores were significantly associated with lower FOIS and MNA-SF scores, male sex, having fewer teeth, and poor dietary patterns.ConclusionsThe convalescent period is an opportune time to provide intensive dental care due to the generally stable condition and extended hospital stay. Our results suggest that oral health management, such as dysphagia rehabilitation and denture treatment, is important for maintaining and improving independence, a key objective of convalescent rehabilitation, and malnutrition improvement.

Performance of a prediction method for activities of daily living scores using influence coefficients in patients with stroke.

Recently, a method was developed to predict the motor Functional Independence Measure (FIM) score at discharge in patients with stroke by stratifying the effects of factors such as age and cognitive function and multiplying those by the influence coefficients of these factors. However, an evaluation of the predictive performance of the method is required for clinical application. The present study aimed to evaluate the predictive performance of this prediction method. Patients with stroke discharged from a rehabilitation ward between April 2021 and September 2022 were included. Predicted values of the motor FIM score at discharge were calculated after data collection from the hospital's patient database. The concordance between predicted and actual values was evaluated using the interclass correlation coefficient; moreover, the residual values were calculated. In total, 207 patients were included in the analysis. The median age was 79 (69-85) years, and 112 (54.1%) patients were male. The interclass correlation coefficient between predicted and actual values was 0.84 (95% confidence interval 0.75-0.89) for the motor FIM score at discharge. Meanwhile, the median residual value was 5.3 (-2.0-10.3) for the motor FIM score at discharge. The prediction method was validated with good performance. However, the residual values indicated that some cases deviated from the prediction. In future studies, it will be necessary to improve the predictive performance of the method by clarifying the characteristics of cases that deviate from the prediction.

Prognostic Value of Dysphagia for Activities of Daily Living Performance and Cognitive Level after Stroke.

The purpose of this study was to examine the association between baseline dysphagia and the improvement of activities of daily living performance and cognitive level among inpatients after stroke. This was a retrospective cohort study of patients undergoing convalescent rehabilitation after stroke. Dysphagia was assessed using the Food Intake LEVEL Scale. Outcomes were the motor and cognitive scores of the Functional Independence Measure (FIM) at discharge. Multiple regression analysis was performed to examine the association between dysphagia at admission and these outcomes. There were 499 participants with a median age of 74 years. A multiple regression analysis was carried out after adjusting for potential confounders including age and sex. Dysphagia at admission was independently and negatively associated with motor (β=-0.157, P<0.001) and cognitive (β=-0.066, P=0.041) FIM scores at discharge. Baseline dysphagia in patients after stroke was negatively associated with improvement in performance of activities of daily living and cognitive level.