Improvement In Functional Independence Measure Scores Research Articles

Early screening for post-stroke depression and its effect on functional outcomes, quality of life, and mortality: A meta-analysis

BACKGROUND Post-stroke depression (PSD) is a common and debilitating condition affecting stroke survivors, significantly impacting their recovery and overall quality of life. AIM To assess the effects of early PSD screening on functional outcomes, quality of life, and mortality. METHODS From an initial pool of 1065 articles, 6 studies met the inclusion criteria and were selected for analysis. Functional outcomes were measured using the functional independence measure (FIM). RESULTS The analysis revealed a significant improvement in FIM scores for a PSD screening group compared to controls [standardized mean difference (SMD) = 8.90, 95% confidence interval (CI): 4.65-13.15, P < 0.01]. Quality of life was assessed using the Stroke-Specific Quality of Life Scale, with the screening group showing significantly higher scores (SMD = 20.83, 95%CI: 15.27-26.38, P < 0.01). Mortality analysis indicated a reduction in five-year mortality rates for the PSD screening group. CONCLUSION Early PSD screening enhances functional recovery, improves quality of life, and reduces mortality rates in stroke survivors. Thus, integrating PSD screening into routine stroke care improves long-term outcomes for patients.

Transition of care from post-acute services for the older adults in Quebec: a pilot impact evaluation

BackgroundEarly discharge of frail older adults from post-acute care service may result in individuals’ reduced functional ability to carry out activities of daily living, and social, emotional, and psychological distress. To address these shortcomings, the Montreal West Island Integrated University Health and Social Services Centre in Quebec, Canada piloted a post-acute home physiotherapy program (PAHP) to facilitate the transition of older adults from the hospital to their home. This study aimed to evaluate: (1) the implementation fidelity of the PAHP program; (2) its impact on the functional independence, physical and mental health outcomes and quality of life of older adults who underwent this program (3) its potential adverse events, and (4) to identify the physical, psychological, and mental health care needs of older adults following their discharge at home.MethodsA quasi-experimental uncontrolled design with repeated measures was conducted between April 1st, 2021 and December 31st, 2021. Implementation fidelity was assessed using three process indicators: delay between referral to and receipt of the PAHP program, frequency of PAHP interventions per week and program duration in weeks. A battery of functional outcome measures, including the Functional Independence Measure (FIM) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 scale, as well as fall incidence, emergency visits, and hospitalizations were used to assess program impact and adverse events. The Patient’s Global Impression of Change (PGICS) was used to determine changes in participants’ perceptions of their level of improvement/deterioration. In addition, the Camberwell Assessment of Need for the Elderly (CANE) questionnaire was administered to determine the met and unmet needs of older adults.ResultsTwenty-four individuals (aged 60.8 to 94 years) participated in the PAHP program. Implementation fidelity was low in regards with delay between referral and receipt of the program, intensity of interventions, and total program duration. Repeated measures ANOVA revealed significant improvement in FIM scores between admission and discharge from the PAHP program and between admission and the 3-month follow-up. Participants also reported meaningful improvements in PGICS scores. However, no significant differences were observed on the physical or mental health T-scores of the PROMIS Global-10 scale, in adverse events related to the PAHP program, or in the overall unmet needs.ConclusionFindings from an initial sample undergoing a PAHP program suggest that despite a low implementation fidelity of the program, functional independence outcomes and patients’ global impression of change have improved. Results will help develop a stakeholder-driven action plan to improve this program. A future study with a larger sample size is currently being planned to evaluate the overall impact of this program.Clinical trial registrationRetrospectively registered NCT05915156 (22/06/2023).

Comparative Efficacy of Constrained Induced Movement Therapy and Motor-Relearning Program in Post Stroke Upper Extremity Function

Background: Stroke often leads to significant impairments in motor function, particularly in the upper extremities. Constraint-Induced Movement Therapy (CIMT) and Motor Relearning Program (MRP) are two rehabilitation approaches that have shown potential in addressing these deficits. This study aimed to compare the effectiveness of these two therapies in improving upper extremity function in post-stroke hemiplegia. Objective: To evaluate and compare the efficacy of CIMT and MRP in enhancing motor recovery and functional performance of the upper extremity in patients with post-stroke hemiplegia. Methods: This randomized controlled trial included patients aged 35-60 years diagnosed with ischemic or hemorrhagic stroke, confirmed by CT scans and MRI. Patients were randomly assigned to either the CIMT group or the MRP group, each comprising 16 participants. Both groups underwent respective therapies for two hours daily, six days a week, for four weeks. The Motor Assessment Scale and the Functional Independence Measure (FIM) Scale were employed for pre-, post-, and follow-up evaluations. Results: Both groups showed significant improvements in motor function and daily living activities. The CIMT group exhibited greater advancements, with notable increases in upper extremity strength and active range of motion in the shoulder, elbow, and wrist joints. Quantitative improvements in the CIMT group included an average increase of 2 points in Motor Assessment Scale scores and a 15% improvement in FIM scores. The MRP group demonstrated an average increase of 1.5 points in Motor Assessment Scale scores and a 10% improvement in FIM scores. Conclusion: While both CIMT and MRP are effective in improving motor function and daily living activities in patients with post-stroke hemiplegia, CIMT showed a slight edge in enhancing upper extremity strength and range of motion. These findings suggest that CIMT could be a more efficacious approach in the rehabilitation of upper extremity function in stroke patients.

108 TEIRIPE SA BHAILE TEAM (TSAB): AN EARLY SUPPORTED DISCHARGE SERVICE FOR HIP FRACTURES FROM AN ACUTE HOSPITAL

Abstract Background Due to increasing bed strain in hospitals, Early Supported Discharge (ESD) programmes have helped to reduce length of stay for hip fracture patients. Teiripe sa Bhaile Team (TsaB) provides a multi-disciplinary, patient centred approach to care for patients over 60 with hip fractures, in their own home. Methods Patient demographics and data has been collected on all TsaB patients to date with consent from the patients. We measured length of intervention with TsaB, patient directed SMART (Specific, measurable, achievable, relevant, time bound) goals, Functional Independence Measure (FIM) sores. We recorded the number of visits required, medical complications and number of readmissions post discharge from our service. Results Since formation in 2018 until April 2022, 33 patients have been treated by TsaB. The average age is 78 years old. The average length of stay prior to discharge was 17 days, compared to 54 days for inpatient hip fracture rehabilitation. Patients received an average of 11 MDT visits during the 6 weeks of rehabilitation. The average improvement in FIM score was 42. All set SMART goals, and only 5 (17%) patients did not achieve these goals. Only 5 (17%) patients were readmitted within 6 months. No patients required initiation of a home care package for discharge, or after our interventions. No patients developed pressure ulcers while on our service, or other medical complications. Conclusion Through TsaB, we are able to offer a rehabilitation service to patients based around their own needs in the home. Patients were able to set and achieve their own SMART goals. Patients were moderately frail on admission to our service, but after intervention were able to improve their FIM scores, marking reduced frailty after intervention. We had low readmission rates, and no patients required a change in home care package.

Rehabilitation of patients after COVID-19 recovery: An experience at the Physical and Rehabilitation Medicine Institute and Lucy Montoro Rehabilitation Institute

OBJECTIVES:As patients recovering from the novel coronavirus disease 2019 (COVID-19) present with physical, respiratory, cognitive, nutritional, and swallowing-related impairments and mental health complications, their rehabilitation needs are complex. This study aimed to describe the demographic, clinical, and functional status after the discharge of COVID-19 survivors who underwent intensive multidisciplinary inpatient rehabilitation at the Physical and Rehabilitation Medicine Institute of the University of Sao Paulo Medical School General Hospital and Lucy Montoro Rehabilitation Institute. We determined the most important factors related to the length of inpatient rehabilitation treatment and present the functional outcomes.METHODS:This was a retrospective study based on electronic medical records. In addition to the severity of COVID-19 and length of hospital stay for the management of COVID-19 and comorbidities, we collected sociodemographic data including age, sex, height, and weight. Functional assessments were performed using the Functional Independence Measure (FIM); Short Physical Performance Battery; Montreal Cognitive Assessment; Depression, Anxiety and Stress Scale; Revised Impact of Events Scale; bioelectrical impedance; Functional Oral Intake Scale; oropharyngeal dysphagia classification; and nutritional assessment.RESULTS:There was a significant improvement in FIM before and after inpatient rehabilitation treatment (p<0.0001). Muscle strength and walking capacity were significantly improved (p<0.01). The most important factors related to the length of inpatient rehabilitation treatment were improvement in FIM scores (Spearman’s r=0.71) and gain in lean mass (Spearman’s r=0.79).CONCLUSIONS:Rehabilitation of patients after COVID-19 recovery improves their functional status and should be considered in the post-acute phase for selected patients with COVID-19.

The Impact of Nutritional Status and Body Mass Index on Rehabilitation Outcomes in Patients Receiving Home-Based Medical Care

Background: Home-based medical care is expanding rapidly in Japan.Objectives: We aimed to identify the factors associated with outcomes of therapy in patients receiving home-visit rehabilitation.Methods: One hundred twenty-one patients receiving home-based rehabilitation were investigated. Nutritional status was assessed by the Mini Nutritional Assessment Short Form (MNA-SF). The Functional Independence Measure (FIM) was employed to assess the activities of daily living (ADL). The body mass index (BMI), medical history, and orthopedic disease-related pain were also recorded. The primary outcome was the improvement in FIM scores in one year.Results: A total of 19 (17%) patients were malnourished and 58 (48%) were at risk of malnutrition. Malnourished patients had a lower FIM score at initiation than those at risk of malnutrition or with normal nutritional status. Only changes in patients’ BMI and MNA-SF scores over one year were significantly associated with improved FIM scores (p = 0.0079 and p = 0.0049, respectively). No association was noted with the other factors.Conclusions: This is the first report to demonstrate that changes in MNA-SF scores and BMI are significantly associated with rehabilitation outcomes in home-based care. Nutritional management is essential along with rehabilitation to improve ADL in the long-term home care setting.

Effect of body mass index on functional outcome in patients with traumatic brain injury

Currently, there is a considerable body of literature that has reviewed the effect of body mass index (BMI) on the individual's health. However, there are few data on how BMI influences the outcome of people with traumatic brain injury (TBI). The purpose of this study was to investigate the association between body mass index (BMI) and functional outcome of patients admitted to a Rehabilitation Center, after TBI. This retrospective study included patients admitted with TBI between January 2016 and December 2017. Data collected included patient demographic features (age, sex, weight and height by admission), severity of TBI (Glasgow Coma Scale score), and functional outcome measured by the Functional Independence Measure (FIM) score, on admission and on discharge. Inclusion criteria consisted of age of 18 years or older and complete information on FIM score, height or weight. A total of 58 subjects met the criteria for inclusion in the study. The mean age was 43.31 ± 17.82 years (range, 19–86), 84.5% were male and 15.5% were female. Of these, 10 (17.2%) were underweight, 37 (63.8%) were normal weight, 11 (18.9%) were overweight and moderately obese. All groups showed similar improvement in FIM score: 31.00 ± 21.04 for the underweight group, 26.75 ± 19.26 for the normal weight group and 27.82 ± 15.80 for the overweight and moderately obese group ( P = 0.873). All groups showed similar FIM score by admission ( P = 0.633) and discharge ( P = 0.628). The weight showed a negative correlation with improvement of FIM score ( r = −0.326, P = 0.013). Among patients undergoing inpatient rehabilitation after TBI, BMI by admission had no impact on functional outcomes. This was found to be consistent with other study demonstrating no impact of obesity on motor functional outcomes of the TBI patients. However, this is contrary to previous studies in non-TBI patients that suggested that obesity hampered recovery of motor functions during rehabilitation.

Early Supported Discharge after stroke: a feasible and effective service model for a rural population

Background: Early Supported Discharge (ESD) services after stroke aim to accelerate discharge home, by providing intensive rehabilitation input as an alternative to a prolonged in-patient stay (Fisher et al, 2011). These services have demonstrated their efficacy in reducing length of stay, reducing the likelihood of being admitted to institutional care, and in improving long term functional outcome (Fearon & Langhorne, 2012) Although recommended in the majority of international clinical guidelines, the evidence to date primarily supports domiciliary-based rehabilitation in urban areas. The only RCT carried out among a rural population did not find a significant benefit for ESD when compared with in-patient rehabilitation. This gap in evidence may have hampered service provision within areas which have a predominantly rural, or mixed urban/rural population. In response to the high numbers of rural dwellers within our catchment area in the west of Ireland, an alternative ESD service model was developed, which combines domiciliary and out-patient rehabilitation. This model is now provided to approximately one-third of the ESD cohort. Methods: A total of 51 patients participated in ESD during 2014 and 2015. A retrospective audit was completed comparing urban and rural participants for the following variables: demographic profile, length of hospital stay, length of time on ESD, bed day savings and functional outcome. Results: Thirty-six patients lived in an urban setting, while 15 lived in a rural area. There were 32 males and 19 females. Six patients in the urban group lived alone, while none in the rural group did. Thirty-seven patients were discharged directly from the acute hospital, while 14 were discharged from the rehabilitation unit. The number of bed days saved was calculated based on the predicted length of stay were ESD not available. Using this method, the average number of bed days saved was 12.6 days per participant. The urban and rural groups did not differ in number of bed days saved or length of stay on the ESD programme. The Functional Independence Measure (FIM) was used to measure functional status and outcome, and was available for 37 patients. The average improvement in FIM score was 8.7 points between patients pre-ESD and post-ESD (p Conclusion: Rural dwellers in our ESD service had equivalent functional outcomes to those within the traditional ESD population demonstrating that this unique Irish model is both effective and feasible to deliver. Our findings suggest that further exploration of this service model should be considered in other centres with a similar catchment profile.

Factors affecting outcome of acute cervical spine injury: A prospective study

Background:Injury to the spine and spinal cord is one of the common cause of disability and death. Several factors affect the outcome; but which are these factors (alone and in combination), are determining the outcomes are still unknown. The aim of the study was to evaluate the factors influencing the outcome following acute cervical spine injury.Materials and Methods:A prospective observational study at single-center with all patients with cervical spinal cord injury (SCI), attending our hospital within a week of injury during a period of October 2011 to July 2013 was included for analysis. Demographic factors such as age, gender, etiology of injury, preoperative American Spinal Injury Association (ASIA) grade, upper (C2-C4) versus lower (C5-C7) cervical level of injury, imageological factors on magnetic resonance imaging (MRI), and timing of intervention were studied. Change in neurological status by one or more ASIA grade from the date of admission to 6 months follow-up was taken as an improvement. Functional grading was assessed using the functional independence measure (FIM) scale at 6 months follow-up.Results:A total of 39 patients with an acute cervical spine injury, managed surgically were included in this study. Follow-up was available for 38 patients at 6 months. No improvement was noted in patients with ASIA Grade A. Maximum improvement was noted in ASIA Grade D group (83.3%). The improvement was more significant in lower cervical region injuries. Patient with cord contusion showed no improvement as opposed to those with just edema wherein; the improvement was seen in 62.5% patients. Percentage of improvement in cord edema ≤3 segments (75%) was significantly higher than edema with >3 segments (42.9%). Maximum improvement in FIM score was noted in ASIA Grade C and patients who had edema (especially ≤3 segments) in MRI cervical spine.Conclusions:Complete cervical SCI, upper-level cervical cord injury, patients showing MRI contusion, edema >3 segments group have worst improvement in neurological status at 6 months follow-up.

Responsiveness of the functioning and disability parts of the International Classification of Functioning, Disability, and Health core sets in postacute stroke patients.

To study the responsiveness of the International Classification of Functioning, Disability, and Health (ICF) core set with respect to human functioning and disability in stroke patients. Postacute stroke patients who were admitted to the convalescent rehabilitation wards were included in this observational cohort study. The comprehensive ICF core set for neurological conditions for postacute care and the ICF rehabilitation set were evaluated at admission and discharge using five-grade qualifiers. Extension indexes were calculated for entire two ICF core sets. Responsiveness was measured as change in the extension indexes in the ICF core sets. The correlation between changes in ICF core sets and improvement in the Functional Independence Measure (FIM) was analyzed using Spearman's correlation coefficient. The study included 108 poststroke patients (49 women, mean age 70.8 years, mean FIM score improvement: 23.0). The mean percentage of categories that showed changes with at least one qualifier level was 19.5% in the comprehensive ICF core set for neurological conditions for postacute care and 35.9% in the ICF rehabilitation set. Effect sizes in each ICF core set were moderate to large (0.79-0.80). Improvement in the two ICF core sets correlated significantly with changes in the FIM score. Our results indicate that functioning and disability parts of these two ICF core sets can detect changes in functioning and disability in patients who receive an inpatient rehabilitation program for postacute stroke.

Erratum to: Outcome of Rehabilitation and Swallowing Therapy after Percutaneous Endoscopic Gastrostomy in Dysphagia Patients.

The objective of this study was to investigate the outcomes of rehabilitation (with swallowing therapy) after percutaneous endoscopic gastrostomy (PEG) in patients with neurogenic dysphagia. Forty-seven patients (29 males and 18 females) who were transferred to the rehabilitation ward of our hospital after receiving PEG tube placements during a 5-year period were enrolled in this study. Patients’ demographic data, comorbidities, nutritional statuses, and laboratory biomarkers before the PEG procedure were collected. Rehabilitation (with swallowing therapy) outcomes such as changes in Functional Independence Measure (FIM) and dysphagia grade (using Fujishima’s classification) were evaluated. Significant improvements in FIM scores and dysphagia grades after rehabilitation therapy were observed. Twenty-seven patients (57.4 %) were discharged with some oral intake and 10 patients (21.3%) were discharged PEG-free (defined as the PEG tube not being used or removed). Factors associated with being discharged with some oral intake were increase in FIM score (adjusted OR 1.10, 95 % CI 1.02–1.19) and higher baseline dysphagia grade (adjusted OR 1.88, 95 % CI 1.04–3.39). Factors associated with being discharged PEG-free were longer rehabilitation period (OR 1.03, 95 % CI 1.01–1.04), absence of respiratory disorders (OR 0.12, 95 % CI 0.03–0.35), and increase in FIM score (OR 1.17, 95 % CI 1.08–1.28). Changes in dysphagia grade were significantly correlated with changes in FIM score (r 2 = 0.46, p < 0.0001), indicating that improvement of FIM scores through general rehabilitation therapy may play an important role in the treatment of dysphagia.

Outcome of Rehabilitation and Swallowing Therapy after Percutaneous Endoscopic Gastrostomy in Dysphagia Patients.

The objective of this study was to investigate the outcomes of rehabilitation (with swallowing therapy) after percutaneous endoscopic gastrostomy (PEG) in patients with neurogenic dysphagia. Forty-seven patients (29 males and 18 females) who were transferred to the rehabilitation ward of our hospital after receiving PEG tube placements during a 5-year period were enrolled in this study. Patients' demographic data, comorbidities, nutritional statuses, and laboratory biomarkers before the PEG procedure were collected. Rehabilitation (with swallowing therapy) outcomes such as changes in Functional Independence Measure (FIM) and dysphagia grade (using Fujishima's classification) were evaluated. Significant improvements in FIM scores and dysphagia grades after rehabilitation therapy were observed. Twenty-seven patients (57.4%) were discharged with some oral intake and 10 patients (21.3%) were discharged PEG-free (defined as the PEG tube not being used or removed). Factors associated with being discharged with some oral intake were increase in FIM score (adjusted OR 1.10, 95%CI 1.02-1.19) and higher baseline dysphagia grade (adjusted OR 1.88, 95%CI 1.04-3.39). Factors associated with being discharged PEG-free were longer rehabilitation period (OR 1.03, 95%CI 1.01-1.04), absence of respiratory disorders (OR 0.12, 95%CI 0.03-0.35), and increase in FIM score (OR 1.17, 95%CI1.08-1.28). Changes in dysphagia grade were significantly correlated with changes in FIM score (r 2=0.46, p<0.0001), indicating that improvement of FIM scores through general rehabilitation therapy may play an important role in the treatment of dysphagia.

Effectiveness of multi-disciplinary rehabilitation for patients with Neuromyelitis Optica

Introduction: Neuromyelitis optica (NMO), previously considered a subtype of multiple sclerosis (MS), is now known to be a unique disorder associated with autoantibodies against aquaporin-4. The rehabilitation protocols for MS have been applied to NMO, without specific measures of efficacy.Purpose: The evaluation of the effectiveness of an MS type inpatient rehabilitation program for patients with NMO.Patient and Methods: Retrospective chart reviews of 15 inpatients with NMO and 32 inpatients with MS. Clinical severity was assessed by the Expanded Disability Status Scale (EDSS), functional assessments were scored using the Functional Independence Measure (FIM), the Montebello Rehabilitation Factor Score (MRFS), and the Functional Ambulation Category (FAC). There was a higher percentage of women in the NMO group (87% vs 56% P = 0.003). The MS group had significantly more cognitive and communication deficits (P = 0.003 and P = 0.00001). No significant differences were found in admission FIM, EDSS and FAC scores.Results: Both groups benefitted, however at discharge, the NMO group showed greater improvement in FIM scores (NMO admission 79 ± 24, discharge 98 ± 21; MS admission 80 ± 28, discharge 89 ± 28); and lower EDSS score (NMO from 7.2 ± 1.4 to 6.3 ± 1.4; MS from 7.4 ± 1.4 to 7 ± 1.5).Conclusions: Inpatient multidisciplinary rehabilitation programs available for the patients with MS may be successfully implemented for patients with NMO.

Functional level during the first 2 years after moderate and severe traumatic brain injury

Background: Long-term outcomes after TBI are examined to a large extent, but longitudinal studies with more than 1-year follow-up time after injury have been fewer in number. The course of recovery may vary due to a number of factors and it is still somewhat unclear which factors are contributing.Aim: The aim of this study was to describe the functional level at four time points up to 24 months after traumatic brain injury (TBI) and to evaluate the predictive impact of pre-injury and injury-related factors.Design: A cohort study.Setting: Outpatient.Population: Sixty-five patients with moderate (n = 21) or severe (n = 44) TBI.Methods: The patients with TBI were examined with Functional Independence Measure (FIM) and Glasgow Outcome Scale Extended (GOSE) at 3 months, 12 months and 24 months after injury. Possible predictors were analysed in a regression model using FIM total score at 24 months as the outcome measure.Results: FIM scores improved significantly from rehabilitation unit discharge to 24 months after injury, with peak levels at 3 and 24 months after injury (p < 0.001), for the whole TBI group and the group with severe TBI. The moderate TBI group did not show significant FIM score improvement during this time period. GOSE scores for the whole group and the moderate group improved significantly over time, but the severe group did not. FIM at admission to the rehabilitation unit and GCS score at admission to the rehabilitation unit were closest to being significant predictors of FIM total scores 24 months after injury (B = 0.265 and 2.883, R2 = 0.39, p = 0.073, p = 0.081).Conclusion: FIM levels improved during the period from rehabilitation unit discharge to 3 months follow-up; thereafter, there was a ‘plateauing’ of recovery. In contrast, GOSE ‘plateauing’ of recovery was at 12 months.Clinical rehabilitation impact: The study results may indicate that two of the most used outcome measures in TBI research are more relevant for assessment of the functional recovery in a sub-acute phase than in later stages of TBI recovery.

The Effect of Anemia on the Functional Outcomes of the Stroke Patients and the Efficiency of their Stroke Rehabilitation

There has been limited study focusing on the functional outcomes of stroke patients' after rehabilitation, such as functional improvement and discharge destination, length of stay (LOS), and complication rate. A retrospective study was conducted on 123 consecutive patients who were admitted to The Prince Charles Hospital Rehabilitation Unit from January 2011 to December 2012 with clinically defined stroke syndromes. Functional Independence Measure (FIM) score was used to measure the functional improvement. Anemia is defined by using the World Health Organization's criteria (hemoglobin concentration in men <120mg/dL and in women <110mg/dL). During the 2-year period, of the 123 stroke patients, 33 were found to be anemic (26.8%). The demographic factors, baseline admission FIM score, comorbidities, and the types of stroke were all comparable in both anemic and nonanemic groups. It was found that, when selecting only the patients with ischemic stroke for comparison (103 patients), there was a significantly higher FIM score improvement (discharge FIM-admission FIM) in nonanemic group (P=.042). FIM efficiency (FIM change/LOS) was also significantly higher in the nonanemic group (P=.027). Higher percentage of patients were discharged home in nonanemic group (94.3% versus 73.3%, P=.006). In addition, higher rateof complications was found in anemic group (60% versus 39%, P=.049). Anemia appears to have a significant effect on the functional improvement and discharge outcomes for patients who had an ischemic stroke. Anemia mayalso increase the complication rate and affect the efficiency of stroke rehabilitation for those patients.

Abstract T P127: Look Past the NIHSS! Rehabilitation Metrics that Predict Home Discharge in Ischemic Stroke Patients

Introduction: The goals of stroke rehabilitation are to restore functional ability and to return patients' home with a good quality of life. There is a paucity of data on stroke rehabilitation tools that both track improvements and help predict the likelihood of home discharge. Hypothesis: Improvement in functional independence measure (FIM) score increases home discharge rates, decreases acute care readmissions and decreases placement in skilled nursing facilities (SNF). Advanced age and infections such as symptomatic UTI (SUTI) negate FIM score improvement. Methods: We merged the prospectively collected Stroke and Neurorehabilitation Registries at our comprehensive stroke center, identifying ischemic stroke patients admitted between January 2011 and November 2013 (n=367). Demographics, rehabilitation metrics and NIHSS were collected. Age, SUTI, discharge FIM and rehabilitation length of stay (LOS Rehab) were included in the multivariate regression. Results: Of 367 ischemic stroke patients, 273 went home, 47 to a SNF, 25 to acute care and 22 to another facility (i.e.,assisted living, board and care). All patients tolerated 3 hours of daily therapy (PT, OT, SLP). Despite median NIHSS values of 9 in both groups (P=0.356), patients with SUTI had lower FIM scores on admission (49.2 ± 13.9 vs. 56.8±15.2; P&lt;0.0001) and discharge (68.5 ± 16.9 vs. 76.3 ± 17.0; P&lt;0.0001). For a one year age increase, there was a 5% increase in SNF admit (OR 1.05, 95%CI 1.02-1.08; P&lt;0.001) compared to home. For a one unit increase in FIM, there was a 4% decrease in another facility admit (OR 0.96, 95% CI 0.93 to 0.99; P&lt;0.01), a 6% decrease in SNF admit (OR 0.94, 95%CI 0.92-0.96; P&lt;0.001) and a 10% decrease in acute care readmit (OR 0.90, 95% CI 0.88-0.94; P&lt;0.0001) compared to home. For a one day increase in LOS Rehab, there was a 19% decrease in acute care readmit (OR 0.81, 95% CI 0.73-0.89; P&lt;0.0001) compared to home, and a 7% increase in home discharge compared to another facility (OR 1.07, 95% CI 1.02 to 1.12; P&lt;0.001). Conclusions: Improved FIM score and increased LOS Rehab were the primary criteria for home discharge after stroke rehabilitation. Advanced age increased the likelihood of SNF placement. SUTI impacted rehabilitation progress, but did not affect discharge to home.

Predictors of improved functional outcome in elderly inpatients after rehabilitation: a retrospective study.

PurposeThe number of elderly inpatients has been steadily increasing worldwide. However, the ability to predict the degree of improvement of functional capacity after comprehensive examination of elderly inpatients is still lacking. The purpose of this study was to investigate the predictors of improved functional outcome after rehabilitation of elderly inpatients.MethodsWe performed a retrospective cohort study with 1,079 patients (age <70 years: N=331, age ≥70 years: N=748) who had been admitted to Tottori Municipal Hospital. Functional Independence Measure (FIM) scores were measured both at admission and discharge to calculate FIM gain and efficiency. Of these patients, 262 patients had oral examinations on admission. The Mann–Whitney U-test or chi-square test was used for statistical analyses. Conditional logistic regression analysis was used to compute the odds ratio (OR) and 95% confidence interval (CI). Cut-off values of FIM scores to determine if elderly inpatients were able to return home after discharge were determined using a receiver operating characteristic curve.ResultsFIM scores, including FIM gain and efficiency, of elderly patients were significantly lower than those of middle-aged patients. Inability to close the lips and dysfunctional tongue movement, but not the loss of teeth, were correlated with a reduced improvement of FIM scores. Cognitive impairment and aspiration pneumonia, but not cerebrovascular disease, were also correlated with a reduced improvement of FIM scores. Interestingly, FIM scores were significantly lower in patients with both cerebrovascular disease and a loss of posterior occlusion. Factors shown to have a significant impact on the improvement of FIM scores included the stable posterior occlusion (OR: 2.23, 95% CI: 1.2–4.1), closed lips (OR: 5.15, 95% CI: 2.3–11.7), functional tongue movement (OR: 5.74, 95% CI: 3.0–11.0), presence of cognitive impairment (OR: 0.31, 95% CI: 0.17–0.49), and presence of aspiration pneumonia (OR: 0.27, 95% CI: 0.15–0.51).ConclusionAge and disorder of oral function may be significant predictors of improved functional capacity after rehabilitation for elderly inpatients.

Severe TBI Outcome Prediction: Usefulness of FIM Scores during Inpatient Rehabilitation (P01.187)

Objective: The goal of this study is to examine possible clinical predictors related to exceptional long-term functional outcomes in severe truamatic brain injury(STBI). Background Long-standing impairments are commonplace following STBI. There is plentiful literature on clinical predictors following STBI, but cases of greater than expected recovery following STBI have not as yet been a focus for research. Design/Methods: Case report series of three female participants with STBI initially admitted to inpatient rehabilitation(IR). Participants had initial Glascow Coma Scale scores of 3, post-traumatic amnesia durations of 18-115 days, time to follow commands of 16-100 days, abnormal initial brain CT scans, and initial pupil abnormalities. Outpatient rehabilitation ranged from three to six months. All resumed major life roles (gainful employment, ability to drive, ability to live independently). Participant IR Functional Independence Measure(FIM) score improvements were compared to national normative STBI FIM data from National Data Systems (NDS) for 2010 (n = 15,808). Results: All three participants were involved in gainful employment, resumed driving, and were living independently by 12 months post-injury. Initial FIM scores ranged from 12 to 42 (χ = 28; NDS = 51.8) with discharge scores ranging from 39 to 76 (χ = 59; NDS = 79.3). Total FIM gain from IR admission to discharge ranged from 27 to 34 points (χ = 31; NDS = 27.5). Cognitive FIM rating improved an average of 13.7 points, compared to 5.9 points for NDS. Sphincter (bowel and bladder) FIM rating improved an average of 5 points, compared to 3 points for NDS. Conclusions: IR FIM score changes may be useful in long-term STBI outcome prediction All three participants demonstrated marked improvements in FIM scores during inpatient rehabilitation and subsequent resumption of major life domains. Further research is necessary to validate whether sphincter and cognitive FIM score changes may be useful in long-term STBI outcome prediction. Disclosure: Dr. Kushner has nothing to disclose. Dr. Johnson-Greene has nothing to disclose.

Association Between Body Mass Index and Functional Independence Measure in Patients with Deconditioning

To assess the association of body mass index (BMI) with functional independence measure (FIM) score in patients with deconditioning. We also examined whether the association was different for motor and cognitive subscales of the FIM instrument. A retrospective study of 1077 inpatients admitted to the general medicine service for deconditioning at an acute rehabilitation hospital. Patients were classified into underweight (BMI < 18.5), normal range (BMI = 18.5-24.9), overweight (BMI = 25.0-29.9), obese class I (BMI = 30.0-34.9), obese class II (BMI = 35.0-39.9), and obese class III (BMI > or = 40). Median gain in FIM scores from admission to discharge was highest in obese class I patients (27 points), followed by obese class II patients (26 points). The most gain in FIM scores was accounted for by the motor subscale. Adjusting for age, gender, and length of in-hospital stay, obese class I patients had a 5.8-point (95% confidence limits = 1.2, 7.0) higher gain in FIM score compared with patients with BMI in the normal range. In an acute rehabilitation setting, obese patients had higher gains in FIM scores as compared with normal-range-BMI patients. Most of the improvements in FIM scores were accounted for by the motor subscale, with little or no improvement on the cognitive scale.

An Inpatient Rehabilitation Service for Deconditioned Older Adults

Objective: To determine whether deconditioned older adults referred from internal medicine units in an acute hospital setting benefited from inpatient rehabilitation services. Design: The design of this study was a retrospective review of consecutive admissions to a rehabilitation hospital. Setting: The rehabilitation setting was an 80-bed HealthSouth acute medical rehabilitation center adjacent to the Washington University Medical Center in mid-town St Louis, Mo, and affiliated with Barnes-Jewish Hospital. Patients: Participants were 88 patients aged 55 years and older, having a primary diagnosis of deconditioning or weakness admitted to an inpatient rehabilitation unit from February 2004 to February 2005. Main Outcome Measures: Medical diagnoses, laboratory data, medications prescribed, nutritional status, physical, occupational, and speech therapy interventions, and documentation of geriatric syndromes were obtained from the rehabilitation medical records. Outcomes measured were discharge disposition, the change in functional status as assessed by the Functional Independence Measure (FIM), and the FIM efficiency rating. Results: The majority of patients were referred from the hospital after an average length of stay of 9 days and stayed for an average of 12 days in the acute inpatient rehabilitation unit. The average FIM scores dramatically improved during inpatient rehabilitation (29.4 ± 16.2), the FIM efficiency rating was 3.0 ± 1.9, and 71% of patients were discharged home. Common geriatric syndromes in this sample included depression, cognitive impairment, pain, falls, and polypharmacy. When assessed, vitamin D deficiency/insufficiency was also common in this sample. Conclusions: An inpatient rehabilitation service, focused on the deconditioned older adult, was able to demonstrate significant improvement in FIM scores during an inpatient rehabilitation stay and the majority of these patients were discharged home. These outcomes occurred despite the presence of geriatric syndromes, comorbid illnesses, and a recent hospitalization for an acute medical illness. Further pilot studies on deconditioned patients who are admitted to inpatient rehabilitation service may confirm the need for trials that compare outcomes across other settings such as home and long-term care. Key words: deconditioned, older adults, rehabilitation