Independent Measurements Research Articles

Triad of rehabilitation, nutrition support, and oral management improves activities of daily living and muscle health in hospitalized patients after stroke

The triad approach combining rehabilitation, nutrition support, and oral management has garnered increasing interest for improving outcomes in older adults. However, evidence is limited regarding its effectiveness in post-stroke patients, who are at high risk for malnutrition, sarcopenia, oral problems, and dysphagia. This study aims to investigate the association between the triad approach and improvement in activities of daily living (ADL), muscle strength, and skeletal muscle mass in these patients. A retrospective cohort study was conducted using post-stroke patients. Patients were divided into groups based on their exposure to the triad approach, defined as a combination of intensive chair-stand exercise (rehabilitation), personalized food prescriptions (nutrition support), and oral management by dental professionals. We investigated the association between the triad approach and outcomes using multiple linear regression analysis adjusted for covariates. Primary outcome was Functional Independence Measure motor score (FIM-motor) at discharge and its gain. Secondary outcomes were handgrip strength (HGS) and skeletal muscle mass index (SMI) at discharge. The study included 1,012 post-stroke patients (median age 75.6 years; 54.1% men). Multiple linear regression analysis revealed that the triad approach had the strongest association with higher FIM-motor at discharge (β=0.262, p<0.001) and FIM-motor gain (β=0.272, p<0.001) compared to the individual or combined interventions. The triad also showed the strongest associations with higher HGS (β=0.090, p=0.017) and SMI (β=0.041, p=0.028) at discharge. The triad approach of intensive rehabilitation, personalized nutrition support, and oral management by dental professionals is strongly associated with improved ADL, muscle strength, and skeletal muscle mass in post-stroke rehabilitation patients. Implementing this multidisciplinary strategy may maximize functional and muscle health recovery.

Central Bank Independence: Views from History and Machine Learning

We assemble an almost complete set of central bank statutes since 1800 to assess the legal independence of central banking institutions. We use these to extend existing indices of legal independence backward and forward in time. We document the trend toward increased independence post 1980 as well as an earlier, more limited movement in the direction of enhanced independence in the 1920s. We apply natural language processing to current statutes to corroborate our human-reader assessment. Using machine-learning methods, we quantify the extent to which topics in those statutes contribute to the independence measure based on our reading of the statutes. The topic with the largest positive contribution to explaining the cross-country variation in central bank independence encompasses disclosure, transparency, and reporting obligations. The topic with the largest negative contribution covers regulatory powers over inter alia securities markets that complicate the central bank's mandate, make accountability more complex, and render independence problematic.

Outcomes of the My Therapy self-management program in people admitted for rehabilitation: A stepped wedge cluster randomized clinical trial

BackgroundSelf-management programs can increase the time spent on prescribed therapeutic exercises and activities in rehabilitation inpatients, which has been associated with better functional outcomes and shorter hospital stays. ObjectivesTo determine whether implementation of a self-management program (‘My Therapy’) improves functional independence relative to routine care in people admitted for physical rehabilitation. MethodsThis stepped wedge, cluster randomized trial was conducted over 54 weeks (9 periods of 6-week duration, April 2021 - April 2022) across 9 clusters (general rehabilitation wards) within 4 hospitals (Victoria, Australia). We included all adults (≥18 years) admitted for rehabilitation to participating wards. The intervention included routine care plus ‘My Therapy’, comprising a sub-set of exercises and activities from supervised sessions which could be performed safely, without supervision or assistance. The primary outcomes were the proportion of participants achieving a minimal clinically important difference (MCID) in the Functional Independence Measure, (FIM™) and change in total FIM™ score from admission to discharge. Results2550 participants (62 % women) were recruited (control: n = 1458, intervention: n = 1092), with mean (SD) age 77 (13) years and 37 % orthopedic diagnosis. Under intervention conditions, participants reported a mean (SD) of 29 (21) minutes/day of self-directed therapy, compared to 4 (SD 14) minutes/day, under control conditions. There was no evidence of a difference between control and intervention conditions in the odds of achieving an MCID in FIM™ (adjusted odds ratio 0.93, 95 % CI 0.65 to 1.31), or in the change in FIM™ score (adjusted mean difference: -0.27 units, 95 % CI -2.67 to 2.13). ConclusionsMy Therapy was delivered safely to a large, diverse sample of participants admitted for rehabilitation, with an increase in daily rehabilitation dosage. However, given the lack of difference in functional improvement with participation in My Therapy, self-management programs may need to be supplemented with other strategies to improve function in people admitted for rehabilitation. Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12621000313831), https://www.anzctr.org.au/

Number- and size-controlled rainfall regimes in the Netherlands: physical reality or statistical mirage?

Abstract. An experimental study aimed at identifying special rainfall regimes with the help of co-located disdrometers is performed. Eight potentially special events (i.e., four number-controlled events and four size-controlled events) are identified and examined. However, a detailed cross-check with additional, independent radar measurements reveals no clear evidence of special rainfall dynamics. The research underscores the difficulty of experimentally confirming seemingly straightforward questions about rainfall patterns and dynamics that have been theorized in the literature for several decades but never formally validated experimentally. The study also questions the reliability of previous claims and serves as a reminder to approach such problems with more caution, emphasizing the need for rigorous uncertainty analysis and multiple cross-checks between sensors to avoid misinterpretation.

50 Hz Temporal Magnetic Field Monitoring from High-Voltage Power Lines: Sensor Design and Experimental Validation.

A low-cost, tri-axial 50 Hz magnetic field monitoring sensor was designed, calibrated and verified. The sensor was designed using off-the-shelf components and commercially available coils. It can measure 50 Hz magnetic fields originating from high-voltage power lines from 0.08 µT to 364 µT, divided into two measurement ranges. The sensor was calibrated both on-board and in-lab. The on-board calibration takes the circuit attenuation, noise and parasitic components into account. In the in-lab calibration, the output of the developed sensor is compared to the benchmark, a narrowband EHP-50. The sensor was then verified in situ under high-voltage power lines at two independent measurement locations. The measured field values during this validation were between 0.10 µT and 13.43 µT, which is in agreement with other reported measurement values under high-voltage power lines in literature. The results were compared to the benchmark, for which average deviations of 6.2% and 1.4% were found, at the two independent measurement locations. Furthermore, fields up to 113.3 µT were measured in a power distribution sub-station to ensure that both measurement ranges were verified. Our network, four active sensors in the field, had high uptimes of 96%, 82%, 81% and, 95% during a minimum 3-month interval. In total, over 6 million samples were gathered with field values that ranged from 0.08 µT to 45.48 µT. This suggests that the proposed solution can be used for this monitoring, although more extensive long-term testing with more sensors is required to confirm the uptime under multiple circumstances.

Improved trunk muscle quality in patients with stroke increases improvements in activities of daily living

BackgroundThis study aimed to determine whether an increased trunk muscle quality index (TMQI) is associated with activities of daily living (ADL) in patients ≥ 65 years of age with cerebral infarction in a convalescent rehabilitation ward. MethodsThis retrospective observational study included patients aged ≥ 65 years who were admitted for post-stroke rehabilitation in Okinawa, Japan, between May 2018 and December 2022. The TMQI was calculated at admission and discharge using bioelectrical impedance analysis. Patients were divided into two groups based on the change in the TMQI during hospitalization: increase-in-TMQI and no-increase-in-TMQI groups. Multiple regression analysis was employed to explore the impact of increased TMQI on functional independence measure (FIM) -motor gain. ResultsWe included a total of 315 patients (79.1 ± 7.9 years of age, 51.7% men) in our analyses. Over half (165 [52.4%]) of the patients exhibited an increase in TMQI scores, and 150 (47.6%) patients did not exhibit an increase. No significant difference was observed in motor FIM score and motor FIM gain at admission and discharge between the groups with and without increased TMQI. Increased TMQI was independently associated with increased FIM-motor gain (adjusted R2 = 0.340 and R2 = 0.357, coefficient = 1.736, 95% confidence interval: 0.52–2.95, P = 0.005). ConclusionsThe results of this study suggest that increased TMQI has a positive effect on the recovery of physical function in patients with stroke. Further prospective studies are needed to elucidate the relationship between increased TMQI and ADL.

Community integration after spinal cord injury rehabilitation: Predictors and causal mediators

Context/Objective: Community integration (CI) is a crucial rehabilitation goal after spinal cord injury (SCI). There is a pressing need to enhance our understanding of the factors associated with CI for individuals with traumatic or non-traumatic etiologies, with the latter being notably understudied. Accordingly, our research explores the associations and potential mediators influencing CI across these populations. Setting: Specialized neurological rehabilitation center. Participants: Community-dwelling individuals who were admitted as inpatients within 3 months post-injury (n = 431, 51.9% traumatic, 48.1% non-traumatic), assessed in relation to community integration within 1–3 years after discharge. Outcome Measure: Community Integration Questionnaire (CIQ). Covariates: American Spinal Injury Association Impairment Scale (AIS), Functional Independence Measure (FIM) and Hospital Anxiety and Depression Scale (HADS). Results: Multiple linear regression yielded age, B AIS grade, educational level (< 6 years and <12 years), time since injury to admission, length of stay, HADS-depression at discharge, total FIM at discharge and three social work interventions (support in financial, legal and transportation services) as significant predictors of total CIQ score (Adjusted R 2 = 41.4). Multiple logistic regression identified age, traumatic etiology, educational level (< 6 years and <12 years), length of stay, HADS depression at discharge, total FIM at discharge and one social work intervention (transportation support) as significant predictors of good community integration, AUC (95% CI): 0.82 (0.75-0.89), Sensitivity:0.76, Specificity:0.73. We identified motor FIM at discharge and motor FIM efficiency as causal mediators of total CIQ. Conclusions: We identified modifiable factors during rehabilitation—functional independence, depression, and social work interventions—that are associated with CI.

Dynamic reconstruction for digital tomosynthesis: a phantom proof of concept for breast care

Objective. Digital tomosynthesis (DTS) is a type of limited-angle Computed Tomography (CT) used in orthopedic and oncology care to provide a pseudo-3D reconstructed volume of a body part from multiple x-ray projections. Patient motion during acquisitions results in artifacts which affect screening and diagnostic performances. Hence, accurate reconstruction of moving body parts from a tomosynthesis projection series is addressed in this paper, with a particular focus on the breast. The aim of this paper is to assess the feasibility of a novel dynamic reconstruction technique for DTS and evaluate its accuracy compared to an available ground truth. Approach. The proposed method is a combination of a 4D dynamic tomography strategy leveraging the formalism of Projection-based Digital Volume Correlation (P-DVC) with a multiscale approach to estimate and correct patient motion. Iterations of two operations are performed: (i) a motion-corrected reconstruction based on the Simultaneous Iterative Reconstruction Technique (SIRT) algorithm and (ii) a motion estimation from projection residuals, to obtain motion-free volumes. Performance is evaluated on a synthetic Digital Breast Tomosynthesis (DBT) case. Three slabs of a CIRS breast phantom are imaged on a Senographe PristinaTM, under plate-wise rigid body motions with amplitudes ranging up to 10 mm so that an independent measurement of the motion can be accessed. Results. Results show a motion estimation average precision down to 0.183 mm (1.83 voxels), when compared to the independent measurement. Moreover, an 84.2% improvement on the mean residual error and a 59.9% improvement on the root mean square error (RMSE) with the original static reconstruction are obtained. Significance. Visual and quantitative assessments of the dynamically reconstructed volumes show that the proposed method fully restores conspicuity for important clinical features contained in the phantom.

The effectiveness of neurorehabilitation in inpatient department

The objective of the study is to evaluate the effectiveness of rehabilitation treatment in patients with neurological pathology in inpatient department.Materials and methods. The study included 101 patients undergoing hospital treatment due to an existing neurological disease. The mean age was 52.41 ± 13.49 years. The condition of each patient upon admission and after the course of inpatient treatment was assessed using special tools – scales, tests, indices and questionnaires, such as the Rehabilitation Routing Scale and the modified Rankin scale, and according to the clinical specifics and needs of rehabilitation treatment – the Ashworth scale, Caprini Scale, Muscle Strength Grading Scale, National Institutes of Health Stroke Scale, HAS-BLED Scale, Berg Scale, Functional Independence Measure, Waterlow Score, Numeric Pain Rating Scale, Frenchay Arm Test, Rivermead Mobility Index, Hauser Index, EQ-5D, Barthel Index. The dynamics of recovery were calculated by comparing scores obtained using special instruments upon admission to rehabilitation treatment and after it.Results. By analyzing the results of the study, a positive dynamic of recovery was established, confirming the effectiveness of an inpatient course of neurorehabilitation, which is expressed in an improvement in the condition of patients when assessed using the designated tools for its objectification.Conclusions. The study confirms the effectiveness of an inpatient course of medical rehabilitation in restoring neurological deficits, increasing the activity of daily living, reducing the degree of social maladjustment and improving the rehabilitation prognosis.

Anatomy of the uncertainty of satellite vicarious calibration using radiosondes: concepts and preliminary results for microwave radiometric observations

Calibration of satellite observations is crucial for ensuring the quality of retrieved products essential for meteorological and climate applications. Calibration is obtained and monitored through a cascade of stages, including postlaunch vicarious calibration/validation activities through comparison with independent reference measurements. Here, the vicarious calibration method using radiative transfer simulations based on reference radiosondes is considered in the framework of the calibration/validation activities for the Microwave Imager (MWI) and the Ice Cloud Imager (ICI) to be launched with the Second Generation of the EUMETSAT Polar System. This paper presents an overview of the uncertainty characterizing the vicarious calibration of MWI and ICI using radiosondes as performed within the EUMETSAT-funded VICIRS study. The uncertainty characterization is pursued following a metrological approach, providing a preliminary estimation of all the identified sources. The same approach is used to develop a rigorous method for estimating the number of comparison pairs (i.e., observations vs. simulations) needed to reach a certain level of accuracy in bias determination.

Efficacy of Motor Imagery in the Rehabilitation of Stroke Patients: A Scope Review

This review examines the efficacy of motor imagery (MI) as a supplementary rehabilitation technique for stroke patients. Nine randomized controlled trials (RCTs) were analyzed, highlighting MI's potential to enhance motor recovery, mobility, balance, and psychological well-being. Significant improvements in upper-limb function were observed with combined mental and physical practice, evidenced by notable gains in Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT) scores. MI-based exercise programs improved mobility and balance in elderly patients, reducing fall risk as measured by the Timed Up and Go (TUG) test and Berg Balance Scale (BBS). MI was also found to enhance self-efficacy and functional performance, with significant increases in Functional Independence Measure (FIM) and General Self-Efficacy Scale (GSES) scores. Neuroimaging studies revealed that MI activates cortical areas associated with motor control, supporting its role in promoting neural plasticity. Despite these promising results, the heterogeneity in participant characteristics, stroke severity, and MI protocols across studies poses challenges to standardization. Additionally, small sample sizes and reliance on self-report measures limit the generalizability of findings. Nevertheless, MI's low cost, minimal risk, and ease of integration into existing rehabilitation protocols make it a valuable adjunct to physical therapy. Standardized guidelines and personalized MI exercises tailored to individual needs are essential for maximizing benefits. Integrating MI into clinical practice can significantly enhance both physical and psychological recovery outcomes for stroke patients, offering a comprehensive approach to rehabilitation.

An Examination of Stream Water Quality Data from Monitoring of Forest Harvesting in the Eastern Highlands of Victoria

A large data set measuring surface stream turbidity, dissolved oxygen levels, and water temperature was developed by sampling 32 rivers and streams with forested catchments at weekly intervals for between two and three years. This was in response to allegations of possible water quality impairment by forest harvesting (“logging”). Additionally, nine rivers or streams external to the forests were sampled to form a “reference set”; concern was expressed that the water quality of these may be impaired by upstream forest harvesting. An unlogged forested control catchment was selected from the data set and used as a comparator to help reduce seasonal variation. Division of the data into “logged forested catchments” and “unlogged forested catchments” allowed for us to test the null hypothesis. The null hypothesis was that there was no difference between the means of the logged and unlogged sets by a “Student’s t test of difference between means”. The null hypothesis was supported for the three parameters. There was no discernible deterioration in water quality associated with the presence of logging in the stream catchments. It was concluded that logging in this environment was not a determinant of water quality, and that the presence or absence of logging in these catchments did not affect the measured water quality. Spearman rank correlation analysis was unable to detect any statistically significant correlations between the water quality parameters, suggesting they are substantially independent measures of water quality. The monitoring showed that the small upland streams had generally good-to-excellent water quality. The water quality in these was generally better than the “reference set”—this probably reflected agriculture and cultivation in the proximity of their sampling points.

Perceived Relational Empathy and Resilience in People with Spinal Cord Injury at the End of Acute Care: A Cross-Sectional Study.

In patients with spinal cord injury (SCI), patient-reported outcomes (PROMs) and experience of care measures (PREMs) are extremely relevant for the prognosis. However, there is a paucity of research on these topics. We conducted a cross-sectional study to investigate the relationships between these patient outcomes and other demographic and clinical variables in adult SCI patients discharged from the intensive care unit of an Italian tertiary rehabilitation hospital. We administered the Consultation and Relational Empathy (CARE) for perceived relational empathy, the Spinal Cord Independence Measure III self-report (SCIM-SR) for functional autonomy, the Numeric Rating Scale (NRS) for pain, and the Connor-Davidson Resilience Scale (CD-RISC-10) for resilience. Study participants consisted of 148 adults with SCI; 82.4% were male, with a mean age of 49.9 years (SD = 16.6). The lesion was traumatic in 82.4% and complete in 74.3% of cases. The median length of hospital stays was 35 days (interquartile range-IQR = 23-60). Perceived relational empathy was positively associated with resilience (r = 0.229, p = 0.005) and negatively associated with the length of the stay and lesion completeness. Resilience had a weak negative association with pain (r = -0.173, p = 0.035) and was unrelated to other variables. Clinicians should consider the routine assessment of PREMs and PROMs in order to personalize post-discharge therapeutic plans and identify appropriate measures to ensure continuity of care.

Relation of functional independence to balance, exercise capacity, and peripheral muscle strength in individuals with chronic stroke: A cross-sectional study

PurposeThis cross-sectional study determined the relationship between functional independence and balance, functional exercise capacity, and knee extensor strength in individuals with chronic stroke. Material and methodsThe study included fifty-four individuals with chronic stroke. A single physiotherapist evaluated clinical features. Assessments included the Functional Independence Measure (FIM), the Tinetti Performance Oriented Mobility Assessment (POMA), the Timed-Up and Go Test (TUG), the 6-min Walk Test (6MWT), and Knee Extensor Strength (KES). ResultsPatients' mean age and body mass index were 60.5 ± 7.13 years and 27.08 ± 4.65 kg/m2. FIM was significantly associated with the POMA (r = 0.644, p = 0.000), TUG (r = -0.723, p = 0.000), and 6MWT (r = 0.569, p = 0.000). FIM was not significantly associated with KES of the paretic side (r = 0.264, p = 0.054), and KES of the non-paretic side (r = 0.207, p = 0.133). However, mFIM was significantly associated with KES of the paretic side (r = 0.432, p = 0.001), and KES of the non-paretic side (r = 0.348, p = 0.010). OutcomesIt was established that there was no relationship between KES and FIM, but that a relationship existed between KES and mFIM. Functional independence is associated with balance ability and functional exercise capacity.

On-field Head Acceleration Exposure Measurements Using Instrumented Mouthguards: Multi-stage Screening to Optimize Data Quality.

Instrumented mouthguards (iMGs) are widely applied to measure head acceleration event (HAE) exposure in sports. Despite laboratory validation, on-field factors including potential sensor skull-decoupling and spurious recordings limit data accuracy. Video analysis can provide complementary information to verify sensor data but lacks quantitative kinematics reference information and suffers from subjectivity. The purpose of this study was to develop a rigorous multi-stage screening procedure, combining iMG and video as independent measurements, aimed at improving the quality of on-field HAE exposure measurements. We deployed iMGs and gathered video recordings in a complete university men's ice hockey varsity season. We developed a four-stage process that involves independent video and sensor data collection (Stage I), general screening (Stage II), cross verification (Stage III), and coupling verification (Stage IV). Stage I yielded 24,596 iMG acceleration events (AEs) and 17,098 potential video HAEs from all games. Approximately 2.5% of iMG AEs were categorized as cross-verified and coupled iMG HAEs after Stage IV, and less than 1/5 of confirmed or probable video HAEs were cross-verified with iMG data during stage III. From Stage I to IV, we observed lower peak kinematics (median peak linear acceleration from 36.0 to 10.9g; median peak angular acceleration from 3922 to 942rad/s2) and reduced high-frequency signals, indicative of potential reduction in kinematic noise. Our study proposes a rigorous process for on-field data screening and provides quantitative evidence of data quality improvements using this process. Ensuring data quality is critical in further investigation of potential brain injury risk using HAE exposure data.

“It means almost forgetting that you've got a disease”: An OMERACT study to define independence in the context of rheumatoid arthritis remission from the patient perspective

AimsOur previous work identified pain, fatigue, and independence as missing from the ACR/EULAR rheumatoid arthritis (RA) remission criteria from the patient perspective. Validated measures exist for pain and fatigue, but not for independence. As a first step towards developing such a measure, this study aimed to understand ‘Independence’ in the context of RA remission from the patient perspective. MethodsInternational qualitative research study comprising five focus groups of 19 participants with RA. Data were analysed using reflexive thematic analysis. ResultsFive overarching themes were identified, underpinned by a construct of “stages of independence”. Independence means at least being ‘physically and functionally able’ but may go beyond this and enable ‘participation beyond function’, ‘cognitive independence’, and ‘having or taking control’. There was no agreement on whether assistance is an aid to independence or undermines ability to achieve independence (‘assistance is complicated’). The construct “Stages of independence” acknowledges that Independence may mean different things to different patients and there may be other factors beyond disease activity that hold patients in each of these stages. ConclusionThese novel data suggest a desirable definition of independence includes full active participation without the need to consider or work around disease activity, and cognitive independence from thoughts of RA. Independence in RA remission is a complex concept and next steps will be to seek patient and professional agreement on the most important issues raised in these focus groups to take forward to developing a measure for independence in the context of RA remission from the patient perspective.

Data-driven prediction of spinal cord injury recovery: An exploration of current status and future perspectives

Spinal Cord Injury (SCI) presents a significant challenge in rehabilitation medicine, with recovery outcomes varying widely among individuals. Machine learning (ML) is a promising approach to enhance the prediction of recovery trajectories, but its integration into clinical practice requires a thorough understanding of its efficacy and applicability. We systematically reviewed the current literature on data-driven models of SCI recovery prediction. The included studies were evaluated based on a range of criteria assessing the approach, implementation, input data preferences, and the clinical outcomes aimed to forecast. We observe a tendency to utilize routinely acquired data, such as International Standards for Neurological Classification of SCI (ISNCSCI), imaging, and demographics, for the prediction of functional outcomes derived from the Spinal Cord Independence Measure (SCIM) III and Functional Independence Measure (FIM) scores with a focus on motor ability. Although there has been an increasing interest in data-driven studies over time, traditional machine learning architectures, such as linear regression and tree-based approaches, remained the overwhelmingly popular choices for implementation. This implies ample opportunities for exploring architectures addressing the challenges of predicting SCI recovery, including techniques for learning from limited longitudinal data, improving generalizability, and enhancing reproducibility. We conclude with a perspective, highlighting possible future directions for data-driven SCI recovery prediction and drawing parallels to other application fields in terms of diverse data types (imaging, tabular, sequential, multimodal), data challenges (limited, missing, longitudinal data), and algorithmic needs (causal inference, robustness).

Home-based Rehabilitation After Inpatient Rehabilitation: Utilization Rate and Characteristics of Referred Patients

ObjectiveTo determine the utilization rate of a home-based rehabilitation program after an inpatient rehabilitation stay, and to investigate the profile of users. DesignObservational study. SettingInpatient rehabilitation facility in a tertiary hospital. ParticipantsOlder patients (N=1913) discharged home between June 2018 and May 2021, after an inpatient rehabilitation stay. InterventionsNot applicable. Main Outcome MeasuresDischarge to home-based rehabilitation. ResultsOver the study period, 296 (15.5%) patients were discharged to home-based rehabilitation. Compared with the others, home-based rehabilitation patients were more frequently women (69.6% vs 61.5%; P=.008), and admitted after orthopedic surgery (elective or for fracture) (30.1% vs 16.1%; P<.001). They had worse functional performance at admission (mean Functional Independence Measure self-care score: 27.8±7.3 vs 30.8±6.7; P<.001), but greater gain in self-care during their inpatient stay (5.0±4.8 vs 4.4±4.7; P=.038). In multivariable analysis, being a woman (adjusted odds ratio [adjOR], 1.36; 95% confidence interval [CI], 1.01-1.82; P=.040), being admitted after orthopedic surgery (adjOR, 2.32; 95% CI, 1.64-3.27; P<.001), being admitted for gait disorders or falls (adjOR, 1.38; 95% CI, 1.01-1.88; P=.039), and showing greater gain in mobility during the inpatient stay (adjOR, 1.12; 95% CI, 1.07-1.17; P<.001) remained associated with discharge to home-based rehabilitation. In contrast, higher mobility at discharge decreased the odds of discharge to home-based rehabilitation (adjOR, 0.87; 95% CI, 0.83-0.91; P<.001). ConclusionsOne in 6 patients benefited from home-based rehabilitation after their inpatient stay. Although these patients had poorer functional performance at admission and discharge, they showed greater mobility improvement during their inpatient stay, suggesting that their good recovery potential was a key determinant of their orientation toward home-based rehabilitation.

Relationship between Improvement in Physical Activity and Three Nutritional Assessment Indicators in Patients Admitted to a Convalescent Rehabilitation Ward.

We investigated the relationship between three nutritional indicators, the Mini Nutritional Assessment-Short Form (MNA-SF), Geriatric Nutritional Risk Index (GNRI), and Controlling Nutrition Status (CONUT), and physical activity at discharge in patients admitted to convalescent rehabilitation wards. The study included 1601 patients (77 ± 12 years, male 46.2%) discharged from convalescent rehabilitation wards between April 2018 and September 2023. MNA-SF, GNRI, and CONUT scores were obtained on admission. Patients were divided into two groups according to their level of Functional Independence Measure (FIM) walk score at discharge. The walking group (n = 1181, FIM walk score ≥ 5, 76 ± 13 years, male 47.2%) was significantly younger than the wheelchair group (n = 420, 79 ± 12 years, FIM walk score < 5, male 43.8%) and had significantly higher MNA-SF (6.5 ± 2.5 vs. 4.7 ± 2.4) and GNRI (93.1 ± 12.4 vs. 86.7 ± 10.9) scores and significantly lower CONUT (3.1 ± 2.3 vs. 3.9 ± 2.3) scores than the wheelchair group (all p < 0.01). Multivariate logistic regression analysis showed that age, handgrip strength, Functional Oral Intake Scale, and MNA-SF score were independently associated with walking ability at discharge (all p < 0.01). In addition, MNA-SF scores were independently associated with Rehabilitation Effectiveness. These results suggest that nutritional status, particularly MNA-SF scores on admission, is associated with improvement of physical activity at discharge.

Baseline Nutritional Status and Rehabilitation Progress in Individuals Requiring Inpatient Rehabilitation: A Retrospective Cohort Study

ObjectiveTo evaluate the relationships between baseline nutritional status, medical events (MEs), and rehabilitation outcomes in individuals undergoing inpatient rehabilitation (IR). DesignA retrospective single center cohort study. SettingAn IR ward. ParticipantsThis study included 409 patients (mean age, 80 years; men, 170 [42%]) undergoing IR for hospital-associated deconditioning, neurologic disorders, or musculoskeletal diseases. Participants were grouped according to the Controlling Nutritional Status score at admission: normal nutrition (NN): 0 to 1, mild malnutrition (MM): 2 to 4, and moderate/severe malnutrition (M/SM): 5 to 12. InterventionsNone. Main Outcome MeasuresThe primary outcomes included MEs leading to death or acute illness requiring transfer to other hospitals for specialized treatments. The secondary outcomes were the rehabilitation efficiency scores (changes in Functional Independence Measure [FIM] score divided by length of stay) for motor function (FIM-M) and cognitive function (FIM-C). ResultsAmong the 409 participants, 300 (73%) were malnourished at admission. The adjusted hazard ratios (95% confidence interval) for MEs in the MM and M/SM groups relative to the NN group were 1.48 (0.67-3.27) and 0.98 (0.34-2.81), respectively. No significant differences were observed among the 3 groups in FIM-M efficiency scores (mean ± SD, NN: 0.49±0.51 vs MM: 0.41±0.57 vs M/SM: 0.44±1.06, P=.7) or FIM-C efficiency scores (0.04±0.06 vs 0.04±0.06 vs 0.08±0.4, P=0.1). Analysis of covariance showed no significant association between MM or M/SM group and FIM-M efficiency score (beta coefficient = -0.038, P=.6; beta coefficient = 0.15, P=.1, respectively) or FIM-C efficiency score (beta coefficient = 0.004, P=.8; beta coefficient = 0.047, P=.08, respectively). ConclusionNo significant associations were observed between the baseline nutritional status and MEs, FIM-M efficiency score, or FIM-C efficiency score in individuals undergoing IR.