Inpatient Rehabilitation Center Research Articles

Efficacy of a digital lifestyle intervention on health-related QUAlity of life in non-small cell LUng CAncer survivors following inpatient rehabilitation: protocol of the QUALUCA Swiss multicentre randomised controlled trial

IntroductionNon-small cell lung cancer (NSCLC) survivors suffer from impaired physical and psychological functioning and reduced health-related quality of life (HRQoL) that persist after active treatment ends. Sustaining rehabilitation benefits, promoting...

Who Can Be Discharged Home after Adult Spinal Deformity Surgery?

Introduction: After adult spinal deformity (ASD) surgery, patients often require postoperative rehabilitation at an inpatient rehabilitation (IPR) center or a skilled nursing facility (SNF). However, home discharge is often preferred by patients and hsas been shown to decrease costs. In a cohort of patients undergoing ASD surgery, we sought to (1) report the incidence of discharge to home, (2) determine the factors significantly associated with discharge to home in the form of a simple scoring system, and (3) evaluate the impact of discharge disposition on patient-reported outcome measures (PROMs). Methods: A single-institution, retrospective cohort study was undertaken for patients undergoing ASD surgery from 2009 to 2021. Inclusion criteria were ≥ 5-level fusion, sagittal/coronal deformity, and at least 2-year follow-up. Exposure variables included preoperative, perioperative, and radiographic data. The primary outcome was discharge status (dichotomized as home vs. IPR/SNF). Secondary outcomes included PROMs, such as the numeric rating scales (NRSs) for back and leg pain, the Oswestry Disability Index (ODI), and EQ-5D. A subanalysis comparing IPR to SNF discharge was conducted. Univariate analysis was performed. Results: Of 221 patients undergoing ASD surgery with a mean age of 63.6 ± 17.6, 112 (50.6%) were discharged home, 71 (32.2%) were discharged to an IPR center, and 38 (17.2%) were discharged to an SNF. Patients discharged home were significantly younger (55.7 ± 20.1 vs. 71.8 ± 9.1, p < 0.001), had lower rate of 2+ comorbidities (38.4% vs. 45.0%, p = 0.001), and had less hypertension (57.1% vs. 75.2%, p = 0.005). Perioperatively, patients who were discharged home had significantly fewer levels instrumented (10.0 ± 3.0 vs. 11.0 ± 3.4 levels, p = 0.030), shorter operative times (381.4 ± 139.9 vs. 461.6 ± 149.8 mins, p < 0.001), less blood loss (1101.0 ± 977.8 vs. 1739.7 ± 1332.9 mL, p < 0.001), and shorter length of stay (5.4 ± 2.8 vs. 9.3 ± 13.9 days, p < 0.001). Radiographically, preoperative SVA (9.1 ± 6.5 vs. 5.2 ± 6.8 cm, p < 0.001), PT (27.5 ± 11.1° vs. 23.4 ± 10.8°, p = 0.031), and T1PA (28.9 ± 12.7° vs. 21.6 ± 13.6°, p < 0.001) were significantly higher in patients who were discharged to an IPR center/SNF. Additionally, the operating surgeon also significantly influenced the disposition status (p < 0.001). A scoring system of the listed factors was proposed and was validated using univariate logistic regression (OR = 1.55, 95%CI = 1.34-1.78, p < 0.001) and ROC analysis, which revealed a cutoff value of > 6 points as a predictor of non-home discharge (AUC = 0.75, 95%CI = 0.68-0.80, p < 0.001, sensitivity = 63.3%, specificity = 74.1%). The factors in the scoring system were age > 56, comorbidities ≥ 2, hypertension, TIL ≥ 10, operative time > 357 mins, EBL > 1200 mL, preop SVA > 6.6 cm, preop PT > 33.6°, and preop T1PA > 15°. When comparing IPR (n = 71) vs. SNF (n = 38), patients discharged to an SNF were significantly older (74.4 ± 8.6 vs. 70.4 ± 9.1, p = 0.029) and were more likely to be female (89.5% vs. 70.4%, p = 0.024). Conclusions: Approximately 50% of patients were discharged home after ASD surgery. A simple scoring system based on age > 56, comorbidities ≥ 2, hypertension, total instrumented levels ≥ 10, operative time > 357 mins, EBL > 1200 mL, preop SVA > 6.6 cm, preop PT > 33.6°, and preop T1PA > 15° was proposed to predict non-home discharge. These findings may help guide postoperative expectations and resource allocation after ASD surgery.

Experiences of fatigued persons with multiple sclerosis with multimodal agility-based exercise training and the ReFEx study protocol: a qualitative extension of a feasibility study

Objectives(1) To explore experiences of fatigued persons with multiple sclerosis (pwMS) with a new multimodal agility-based exercise training (MAT) framework and (2) to investigate the demands of the Rehabilitation, Fatigue,...

The Temporal Relationship Between Moderate to Vigorous Physical Activity and Secondary Conditions During the First Year After Moderate to Severe Traumatic Brain Injury

ObjectiveTo determine the cross-sectional and temporal relationships between minutes per week of moderate to vigorous physical activity (MVPA) as measured by a wrist-worn accelerometer and secondary conditions in the first year after moderate to severe traumatic brain injury (TBI). DesignProspective longitudinal cohort study. SettingFour inpatient rehabilitation centers. ParticipantsIndividuals (N = 180) with moderate-severe TBI enrolled in the TBI Model Systems Study. InterventionsParticipants wore a wrist accelerometer for 7 days immediately post discharge, and for 7 consecutive days at 6- and 12-months post injury. Main Outcome MeasuresMinutes per week of MVPA from daily averages based on wrist worn accelerometer. Secondary conditions included depression (Patient Health Questionnaire-9), fatigue (PROMIS Fatigue), Pain (Numeric Rating Scale), Sleep (Pittsburgh Sleep Quality Index), and cognition (Brief Test of Adult Cognition by Telephone). ResultsAt baseline, 6 and 12 months, 61%, 70% and 79% of the sample achieved at least 150 minutes per week of MVPA. The correlations between minutes of MVPA between baseline, 6 and 12 months were significant (r = 0.53-0.73), as were secondary conditions over these time points. However, no significant correlations were observed between minutes of MVPA and any secondary outcomes cross-sectionally or longitudinally at any time point. ConclusionsGiven the robust relationships physical activity has with outcomes in the general population, further research is needed to understand the effect of physical activity in individuals with moderate-severe TBI.

Selenium in Cancer Rehabilitation-A Retrospective Study from a Specialized Clinic.

Micronutrient deficiencies are common at the time of cancer diagnosis and are associated with worse prognosis. Little is known about them in cancer rehabilitation. Data from routine health-related quality of life (HRQOL) were analyzed at an inpatient cancer rehabilitation center. Rehabilitation patients completed the EORTC QLQ-C30 questionnaire before and after multidisciplinary rehabilitation treatment and three months after discharge. Selenium and zinc status were measured in whole blood at these three time points. In case of selenium deficiency, up to 600 µg selenium per day as sodium selenite was supplemented for three weeks during and for three months after rehabilitation. A total of 271 patients (breast, colon, and pancreatic cancer) were included in the analysis. There was clinically meaningful improvement in many domains of the EORTC QLQ-C30 during rehabilitation. However, the effect often waned in the three months after. Prevalence for selenium deficiency varied between 34 to 90% depending on cancer type (breast < colon < pancreas). In contrast, zinc deficiency was rare. Daily selenium supplementation of 600 µg was more efficient to correct selenium deficiency compared to 300 µg selenium per day. Rehabilitation and increasing selenium status after rehabilitation were associated with improved global quality of life, physical and emotional functioning, and fatigue. In cancer patients with decreasing selenium status, values of global quality of life, physical and emotional functioning, and fatigue were back to the values at the beginning of rehabilitation. Selenium deficiency is common in cancer patients admitted to a cancer rehabilitation clinic. Selenium supplementation during rehabilitation effectively corrected selenium deficiency in most cases. The positive effects of rehabilitation persisted longer when selenium status did not decrease after rehabilitation.

Clinical Manifestations of COVID-19 Infection in Persons with Disabilities (PWDs) at Inpatient Rehabilitation Center –A Hospital-Based Study

Objective: To describe clinical manifestations of COVID-19 infection in Persons with disability (PWD) in Pakistan.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Inpatient Rehabilitation Facility (IRF) of Armed Forces Institute of Rehabilitation Medicine (AFIRM), Rawalpindi, from Feb to Oct 2021&#x0D; Methodology: All PWDs admitted in IRF of AFIRM who tested positive for COVID-19 infection were included by convenience sampling. Patients who tested negative for COVID-19 by PCR were excluded. Data of patients and laboratory and radiological investigations, were recorded. Follow-up after one month was done via phone call. &#x0D; Results: Twenty patients tested positive for COVID-19, of which 20(95%) were males. The mean age of patients was 38.6 ± 2.5 years. Most patients had Spinal Cord Injuries followed by amputations, and five had co-existing disorders. 11(52.4%) of patients were asymptomatic. Fever, myalgias and cough were common among symptomatic patients. Those who were symptomatic had only one symptom at the time of presentation. All patients had mild disease and recovered gradually without complications at one month of follow-up.&#x0D; Conclusion: A high index of suspicion of SARs CoV-2 infection should be kept when PWDs present with myalgias or fever inthe current scenario and post-COVID-19 era since PWDs have fewer symptoms of COVID-19 as compared to their peers.Keyswords: Amputations, COVID-19, Pakistan, Persons with disability, Spinal cord injury.

Association of clozapine treatment and rate of methamphetamine or amphetamine relapses and abstinence among individuals with concurrent schizophrenia spectrum and amphetamine use disorder: A retrospective cohort study.

Preliminary evidence suggest clozapine is associated with more favorable impact on concurrent substance use disorder related outcomes in patients with concurrent schizophrenia spectrum disorders (SSD). At the same time, there is a dearth of evidence with regards to clozapine outcomes in the context of concurrent methamphetamine or amphetamine use disorder (MAUD). To examine whether clozapine use decreases rate of methamphetamine or amphetamine (MA) relapses and increases the likelihood of maintaining abstinence from any MA use. A descriptive-analytic retrospective cohort study was conducted on individuals with SSD-MAUD in an inpatient provincial treatment and rehabilitation center for concurrent disorders. Antipsychotic exposure was categorized as "on clozapine" or "on other antipsychotic(s)." Data were collected using electronic health records. Logistic regression was used to examine association of clozapine treatment with likelihood of complete abstinence from MA use for the duration of antipsychotic exposure. Negative binomial regression was used to examine association of clozapine treatment with rate of MA relapses for the duration of antipsychotic exposure. The majority of the 87 included patients were male. Ethnicity was diverse, with the largest groups self-identifying as Indigenous and European. Clozapine use was both associated with increased likelihood of maintaining abstinence from MA use (adjusted odds ratio (aOR) = 3.05, 95% confidence intervals (CI) = 1.15-8.1, p = 0.025), and decreased rate of MA relapses (aRR = 0.45, 95% CI = 0.25-0.82, p = 0.009) for the duration of antipsychotic exposure. Co-prescription of psychostimulants was associated with increased rate of MA relapses (aRR = 2.43, 95% CI = 1.16-5.10, p = 0.019). In this study, clozapine use compared with other antipsychotics in SSD was associated with improved outcomes related to severe concurrent MAUD. Co-prescription of psychostimulant medications was associated with a poor outcome.

Feasibility of ballistic strength training to improve mobility of inpatients with traumatic brain injury

The objective of this study was to investigate the feasibility of ballistic strength training (BST) to improve the mobility of individuals recovering from traumatic brain injury (TBI) in an inpatient rehabilitation centre. Participants had a maximum of eight usual physiotherapy sessions substituted with BST sessions. The feasibility of BST was assessed in terms of recruitment, attendance, adverse events (AEs), and participant acceptability of the intervention. The clinical aspects of feasibility were assessed by recording the ability of participants to complete the exercises and acquire skills. Secondary measures included the 10-metre walk test, the 6-minute walk test, and the Global Rating of Change scale. Fourteen of 22 eligible individuals with TBI in an inpatient rehabilitation centre consented to participate in the study, of whom two were excluded. No intervention-related AEs occurred. Participants attended 97% (71/73) of the total sessions. Participants positively accepted the intervention as rated on a visual analogue scale, M (SD) = 9.2 (0.9). All participants were able to complete the BST exercises. Participants significantly improved comfortable walking speed and walking capacity (p &lt; 0.01). Participants perceived a meaningful change in walking ability. BST appears to be a promising rehabilitation method that may improve the walking outcomes of individuals with TBI in an inpatient rehabilitation setting. Larger-scale clinical trials are warranted.

Randomized controlled trial to compare conventional physiotherapy with task-oriented exercises after total hip replacement.

Different interventions are used during rehabilitation after hip replacement surgery, but it is unclear if task-oriented exercise is more effective than conventional physiotherapy. This study compared the effectiveness of conventional physiotherapy (CPT) programme with task-oriented exercise (TOE) on hip pain, function, static and dynamic balance during the early rehabilitation stage after total hip replacement. This randomized controlled parallel-group trial was executed in an inpatient physical medicine and rehabilitation centre. The study included 40 patients who were randomly classified into CPT and TOE groups (n= 20 in each). Hip pain (assessed by visual analogue scale), function in the operated leg (assessed by modified Harris Hip Score, mHHS), static balance (assessed by Abili Balance analyser system) and dynamic balance (assessed by Berg Balance Scale) were evaluated at baseline and after 18 days of rehabilitation. Cohen's effect size (d) was calculated. Greater pain reduction (p< 0.05; d= 0.08) was observed after TOE (1.6 ± 0.68 scores) compared with the CPT programme (2.2 ± 0.83 scores). Hip function assessed by the modified mHHS improved more (p< 0.05; d= 0.30) in the TOE group (73.45 ± 6.23 scores) than in the CPT group (54.90 ± 6.28 scores). Static balance improved significantly in both groups after the interventions but did not differ significantly between the groups. The improvement in dynamic balance was significantly greater (p< 0.05; d= 0.45) after TOE (50.55 ± 1.57 scores) than after CPT (38.55 ± 3.43 scores). Both interventions reduced pain and improved function of the operated leg and static and dynamic balance. The effect on hip function was superior for TOE compared with CPT.

Functional Ability, Psychological Factors, and Rehabilitation Outcomes After Elective Total Hip Replacement.

Background. The role of positive psychological factors in acute rehabilitation after total hip replacement (THR) is unclear. Purpose. (a) Examine the trajectory of functional ability among older adults after THR from presurgery to discharge from acute rehabilitation and (b) determine which physical and psychological factors at admission would predict functional ability at discharge and length of stay in rehabilitation. Methods. This prospective cohort study included 30 participants (age M = 76.20 years) from an inpatient geriatric rehabilitation center. They completed the Geriatric Depression Scale and Positive Affect questionnaire. The FIM® Motor domain of Functional Independent Measure (mFIM) was recorded presurgery, at admission, and upon discharge. Findings. Functional ability improved at discharge; however, the presurgery functional ability was not regained. Positive affect explained the length of stay in rehabilitation above and beyond the presurgery mFIM. Implications. Occupational therapists should improve ways to enhance self-care and positive affect in acute rehabilitation.

Anxiety in Response to Sustaining Spinal Cord Injuries and Disorders: When Should Clinicians Be Concerned?

ObjectiveTo recommend a cut-off score for the brief 2-item Generalized Anxiety Disorder (GAD-2) measure for persons with spinal cord injuries/disorders (PwSCI/D) and to estimate anxiety occurrence within this population using the full 7-item Generalized Anxiety Disorder (GAD-7). DesignMulticenter retrospective analyses. SettingOne inpatient rehabilitation center and 2 community sites for PwSCI/D. ParticipantsPwSCI/D 18 years or older (N=909) were included for analysis using retrospectively collected GAD-2 and GAD-7 data. InterventionsNot applicable. Main Outcome Measure(s)Occurrence of anxiety symptoms were compared using cut-off scores of ≥8 and ≥10 on the GAD-7. A cut-off score recommendation for the GAD-2 was determined using ROC curve, and sensitivity and specificity analyses. ResultsOccurrence of anxiety symptoms was 21% using a GAD-7 cut-off of ≥8 and 15% using a cut-off of ≥10. Analyses indicated optimal sensitivity for a GAD-2 score of ≥2 when a GAD-7 cut-off of ≥8 was used. ConclusionsAnxiety occurrence is elevated among PwSCI/D compared with the general population. For PwSCI/D, it is recommended that a cut-off score of ≥2 is used for the GAD-2 to maximize sensitivity and that a threshold of ≥8 is used for the GAD-7 to ensure the maximum number of individuals presenting with symptoms of anxiety are recognized for diagnostic interview. Study limitations are discussed.

Lesional Antibody Synthesis and Complement Deposition Associate With De Novo Antineuronal Antibody Synthesis After Spinal Cord Injury.

Spinal cord injury (SCI) disrupts the fine-balanced interaction between the CNS and immune system and can cause maladaptive aberrant immune responses. The study examines emerging autoantibody synthesis after SCI with binding to conformational spinal cord epitopes and surface peptides located on the intact neuronal membrane. This is a prospective longitudinal cohort study conducted in acute care and inpatient rehabilitation centers in conjunction with a neuropathologic case-control study in archival tissue samples ranging from acute injury (baseline) to several months thereafter (follow-up). In the cohort study, serum autoantibody binding was examined in a blinded manner using tissue-based assays (TBAs) and dorsal root ganglia (DRG) neuronal cultures. Groups with traumatic motor complete SCI vs motor incomplete SCI vs isolated vertebral fracture without SCI (controls) were compared. In the neuropathologic study, B cell infiltration and antibody synthesis at the spinal lesion site were examined by comparing SCI with neuropathologically unaltered cord tissue. In addition, the CSF in an individual patient was explored. Emerging autoantibody binding in both TBA and DRG assessments was restricted to an SCI patient subpopulation only (16%, 9/55 sera) while being absent in vertebral fracture controls (0%, 0/19 sera). Autoantibody binding to the spinal cord characteristically detected the substantia gelatinosa, a less-myelinated region of high synaptic density involved in sensory-motor integration and pain processing. Autoantibody binding was most frequent after motor complete SCI (grade American Spinal Injury Association impairment scale A/B, 22%, 8/37 sera) and was associated with neuropathic pain medication. In conjunction, the neuropathologic study demonstrated lesional spinal infiltration of B cells (CD20, CD79a) in 27% (6/22) of patients with SCI, the presence of plasma cells (CD138) in 9% (2/22). IgG and IgM antibody syntheses colocalized to areas of activated complement (C9neo) deposition. Longitudinal CSF analysis of an additional single patient demonstrated de novo (IgM) intrathecal antibody synthesis emerging with late reopening of the blood-spinal cord barrier. This study provides immunologic, neurobiological, and neuropathologic proof-of-principle for an antibody-mediated autoimmunity response emerging approximately 3 weeks after SCI in a patient subpopulation with a high demand of neuropathic pain medication. Emerging autoimmunity directed against specific spinal cord and neuronal epitopes suggests the existence of paratraumatic CNS autoimmune syndromes.

Remote monitoring of motor mode for monitoring and evaluating the effectiveness of rehabilitation and spa treatment

The introduction of remote monitoring of the health status of patients is one of the priorities of the national project «Healthcare», provided for by Decree of the President of the Russian Federation No. 204 dated May 7, 2018 «On national goals and strategic objectives for the development of the Russian Federation for the period up to 2024», as well as one of the key measures for the modernization of primary health care, presented by the Ministry of Health of Russia to the President of the Russian Federation V. V. Putin. Purpose of the study: To develop, scientifically substantiate an information model for remote monitoring of the motor regime and evaluate its therapeutic effectiveness in terms of the dynamics of the main physiological parameters of patients with chronic coronary heart disease, myocardial infarction (I25.2 according to ICD-10) and patients with a condition after COVID-19 (U09.9 according to ICD-10) in a round-the-clock inpatient rehabilitation center. To control and evaluate the ongoing medical rehabilitation programs, the concepts of the recommended «zone of intensity of motor physical activity» and «motor density of rehabilitation measures» are introduced, calculated by the ratio of the total time of daytime wakefulness to the time spent on active physical rehabilitation procedures, which should become the central axis of building rehabilitation and spa programs. Results. The DM software and hardware complex has a wide range of functions and an intuitive interface. It is easy to use, both for the attending physician and for patients. Nevertheless, for the wide distribution of this technology in the Russian Federation, it is recommended to switch to the use of hardware equipment and smart watch devices from a domestic manufacturer. Conclusion. The software package DM of the motor mode and the main physiological parameters of patients has demonstrated the possibility of its use in medical practice for patients at the 2nd stage of medical rehabilitation in a round-the-clock hospital and sanatorium.

Plasma bioactive adrenomedullin predicts outcome after acute stroke in early rehabilitation

An early and reliable prediction of outcomes after stroke is important for early effective stroke management and the adequate optimal planning of post-stroke rehabilitation and long-term care. Bioactive adrenomedullin (bio-ADM) is a 52-amino acid peptide that is an important peptide hormone in nervous system diseases. The aim of this study was to investigate the prognostic value of bio-ADM on outcomes after rehabilitation in patients with stroke. A total of 557 consecutive patients with a primary diagnosis of ischemic or hemorrhagic stroke (age 69.6–12.9 years, male 51.3%, ischemic stroke 72.5%), who were admitted to an in-patient early rehabilitation center directly after discharge from acute stroke hospital care, were enrolled in this prospective observational study. Plasma concentrations of bio-ADM were determined by using a chemiluminescence immunoassay (functional assay sensitivity 8 pg/ml). The early rehabilitation barthel index (ERBI) was used for the neurological assessment of the patients. The plasma bio-ADM level was analyzed in association with 6-month all-cause mortality as well as a composite outcome of all-cause mortality, unscheduled re-hospitalization, or transfer to a long-term care facility in a vegetative or minimally conscious state. Bio-ADM levels significantly increased in patients with ischemic stroke who died compared to surviving patients (40.4 pg/ml vs. 23.8 pg/ml, p < 0.001) or in those with composite outcomes compared to those with no events (36.9 pg/ml vs. 23.5 pg/ml, p < 0.001). Six-month all-cause mortality was higher in all patients with bio-ADM levels > 70 pg/ml (HR 4.83 [CI 2.28–10.2]). Patients with bio-ADM levels > 70 pg/ml also had higher rates of 6-month composite outcomes (HR 3.82 [CI 2.08–7.01]). Bio-ADM was an independent predictor of all-cause mortality and 6-month composite outcomes after adjusting for age, gender, and ERBI (adjusted OR 1.5; 95% CI 1.0–2.1; p = 0.047 and adjusted OR 1.48; 95% CI 1.1–2.0; p = 0.01, respectively). Bio-ADM may be a suitable novel biomarker to assess the outcomes of patients in rehabilitation after acute stroke. Elevated bio-ADM concentrations may have prognostic value for fatal and nonfatal events in patients with ischemic stroke during early rehabilitation.

"Beyond waking and walking. Intensive rehabilitation in patients requiring extended durations of advanced mechanical circulatory support: A case series".

Physical therapy (PT) utilization in patients requiring mechanical circulatory support (MCS) and extracorporeal membrane oxygenation (ECMO) has been reported; however, little is known about intensive rehabilitation and associated outcomes in patients requiring extended complex MCS and/or ECMO support. Authors sought to explore safety, feasibility and outcomes associated with active rehabilitation in patients requiring prolonged advanced MCS/ECMO support. Single-center retrospective series evaluated functional, clinical, and longitudinal outcomes of sample of eight critically ill, adult (≥18 years of age) patients who underwent a intensive rehabilitation while receiving prolonged MCS/ECMO through advanced configurations including: venovenous (VV-ECMO), venoarterial (VA-ECMO), oxygenator with right ventricular assist device (Oxy-RVAD) and right ventricular assist device (RVAD). 406 sessions were conducted; 246 during provision of advanced MCS/ECMO support. Incidence of major adverse events-accidental decannulation, migration of cannulas, circuit failure, hemorrhage, major flow limitations, and major hemodynamic instability-was 1.2 events per 100 sessions. None of reported major adverse events impeded longitudinal ability to participate in PT. Increased time to PT initiation was associated with a statistically significant increase in intensive care unit (ICU) length-of-stay (β1 1.93, CI 0.55–3.30) and reduced ambulatory distance during last session on MCS/ECMO (β1 -47.64, CI - 93.93, −1.66). All patients survived to hospital discharge and 12 months from sentinel hospitalization. Amongst those patients discharged to an inpatient rehabilitation center ( n = 4), all were discharged home within 3 months. Findings support the safety and feasibility of active rehabilitational PT in patients requiring extended durations of advanced MCS/ECMO support. Moreover, it highlights potentially associated benefits of this degree of intensive rehabilitation for these unique patients. Further investigation is needed to identify associations with longitudinal clinical outcomes, as well as predictors of success in this population.

Abstract HUP16: Disparities In Stroke Care In The Metro Detroit Area

Introduction: According to the AHA, approximately 795,000 people suffer a stroke per year. Studies have also shown that people with a lower socioeconomic status (SES) have a higher mortality rate at 1 year following a stroke. Rehabilitation is fundamental to stroke recovery but requires adequate access to health care and support systems. Patient with lower socioeconomic status may not have adequate access to health care or the support systems leading to delays in transfer to rehabilitation centers, longer hospital stays, increased complication rates, and poorer outcomes. Hypothesis: Patients with lower SES have longer hospital stays and are more likely to be discharged home rather than to inpatient rehabilitation centers. Methods: Retrospective observational cohort study of 744 patients discharged from Neurology units with primary diagnosis of acute ischemic stroke. Patients were grouped by zip code into bottom 50 median household income (lower SES) and top 50 median household income (higher SES). Income data was obtained from the United States Census Bureau. Results: Fewer patients with lower SES were discharged by hospital day 5 compared to those with higher SES (58% vs. 68%). Additionally, more patients with lower SES were discharged home rather than to a rehabilitation center after hospital day 5 (15% vs. 7%). Conclusion: Those from communities with lower SES had longer hospital stays and were less likely to be discharged to rehabilitation centers after longer hospital stays. Longer hospital stays suggests those with lower SES encounter obstacles that prevent and even preclude transfer to rehabilitation centers. Larger studies should be performed to identify and ameliorate factors that limit access to proper post-stroke care such as adequate rehabilitation.

The Outcome of Psychiatric Rehabilitation Treatment Depends on Affective State at the Time of Admission.

In Austria, new approaches of rehabilitation programs focus on the prevention of mental illness and offer treatment not only for acute psychiatric patients, but also for those who are at risk of developing a mental disorder or have recovered from one.The aim of this study was to determine the effects of a psychiatric rehabilitation program on individuals with different mood states. 600 patients with a history of affective disorder were tested at the time of admission to an Austrian inpatient psychiatric rehabilitation center. Data of extreme groups - patients who were depressed (n=59; BDI-II<9 and HAMD<8) or euthymic (n=59; BDI<18 and HAMD>19) at the time of therapy start - were analyzed. The participants completed the Maslach Burnout Inventory - General Survey, the Symptom Checklist - Revised and the Stress Coping Questionnaire at the beginning and the end of the 6-weeks rehabilitation program. After 6 weeks, both groups showed significantly less psychiatric symptoms (BDI-II, HAMD, SCL-90, and negative coping strategies (SVF). Importantly, work-related stress symptoms ("burnout" symptoms) improved significantly in the euthymic group. Euthymic patients seem to be able to focus on work-related stress symptoms including reduced emotional exhaustion through treatment, while currently depressed patients primarily benefit by an improvement in general psychiatric symptomatology. The results indicate the crucial role of mood state validated with standardized psychological questionnaires BDI-II and HAMD at time of admission to such programs. These findings could have implications on treatment decisions for psychiatric patients and assist in making a forecast concerning ability to recover and treatment prognosis.

Polysomnographic Differences Following Moderate-Severe Traumatic Brain Injury (TBI) Among Individuals With Chronic Pain

Research Objectives To determine is differences in objectively measured sleep related respiration exists between chronic pain cohorts post-TBI. Design Longitudinal, retrospective cohort study. Setting Six TBI Model Systems inpatient rehabilitation centers. Participants 66 patients (mean age 42, 60% Caucasian, 82% male) admitted for neurorehablitation following injury were recruited to participate in a diagnostic effectiveness trial of polysomnography (PSG) and were followed between one and two-years post-injury as part of the TBIMS Pain Collaboratory study. Interventions Non-intervention study. Fully attended, level-1 PSG, the criterion standard for sleep apnea diagnosis. Main Outcome Measures PSG-derived respiratory indices and chronic pain status. Results Three-quarters of participants met criteria for sleep apnea shortly after injury and approximately 61% endorsed chronic pain following TBI. Pairwise comparisons between those who did versus those who did not endorse chronic pain at follow-up revealed that chronic pain was associated with categorically worse apnea hypopnea indices (AHI) for both obstructive (15.7 versus 11.1 events per hour of sleep) and central sleep apneas (2.6 versus 0.8 events per hour). Additionally, those who went on to experience chronic pain were found to have worse oxygenation indices (19.6 events per hour), relative to their no pain counterparts (7.9 events per hour). Conclusions This study is the first to report on an association between objective, PSG-derived respiratory indices and chronic pain status following moderate to severe TBI, finding that worse sleep-related respiratory indices early in the recovery from TBI is associated with chronic pain at long-term follow-up. Sleep apnea is an important modifiable factor following that may contribute to long-term pain-related outcomes, but further research is needed to determine whether a causal link exists. Author(s) Disclosures PCORI, CER-1511-33005; VA TBI Model Systems Program of Research; GDIT; NIDILRR 90DPTB0008. Clinicaltrial.gov Registration Number: NCT03033901 To determine is differences in objectively measured sleep related respiration exists between chronic pain cohorts post-TBI. Longitudinal, retrospective cohort study. Six TBI Model Systems inpatient rehabilitation centers. 66 patients (mean age 42, 60% Caucasian, 82% male) admitted for neurorehablitation following injury were recruited to participate in a diagnostic effectiveness trial of polysomnography (PSG) and were followed between one and two-years post-injury as part of the TBIMS Pain Collaboratory study. Non-intervention study. Fully attended, level-1 PSG, the criterion standard for sleep apnea diagnosis. PSG-derived respiratory indices and chronic pain status. Three-quarters of participants met criteria for sleep apnea shortly after injury and approximately 61% endorsed chronic pain following TBI. Pairwise comparisons between those who did versus those who did not endorse chronic pain at follow-up revealed that chronic pain was associated with categorically worse apnea hypopnea indices (AHI) for both obstructive (15.7 versus 11.1 events per hour of sleep) and central sleep apneas (2.6 versus 0.8 events per hour). Additionally, those who went on to experience chronic pain were found to have worse oxygenation indices (19.6 events per hour), relative to their no pain counterparts (7.9 events per hour). This study is the first to report on an association between objective, PSG-derived respiratory indices and chronic pain status following moderate to severe TBI, finding that worse sleep-related respiratory indices early in the recovery from TBI is associated with chronic pain at long-term follow-up. Sleep apnea is an important modifiable factor following that may contribute to long-term pain-related outcomes, but further research is needed to determine whether a causal link exists.

Field-Testing an Occupational Therapy Clinical Intervention Manual to Guide Electrical Stimulation in Spinal Cord Injury

<h3>Research Objectives</h3> Evaluate the utility of a manual to guide occupational therapists who administer Electrical stimulation (ES) in SCI. <h3>Design</h3> Field test to assess the manual's impact on participants' ES clinical knowledge and its value for supporting episodic OT treatments. <h3>Setting</h3> Three geographically dispersed inpatient rehabilitation centers. <h3>Participants</h3> 18 occupational therapists were recruited from three geographical dispersed inpatient rehabilitation units. Inclusion criteria includes current OT or OTA license, (b) state-level eligibility to administer ES in an occupational therapy treatment session, and (c) active treatment of SCI within the previous 6 months. <h3>Interventions</h3> Participants received a face-to-face educational in-service, where existing evidence was shared that would guide OT clinical intervention in SCI, and the contents of the clinical intervention manual, with strategies to incorporate the manual into daily practice were also provided. <h3>Main Outcome Measures</h3> Outcome measures included: (1) pre-study survey, (2) field study survey, and (3) a post-study survey. The pre- and post-study survey consisted of 12 questions, identifying current use of ES, current knowledge and comfort using ES, as well as questions on the impact of the manual on their clinical practice patterns. Post-study survey participants completed the field survey after each treatment episode of ES application that explored their ES perceived impact on therapy, patient response, and overall therapist satisfaction of application. <h3>Results</h3> 18 OT clinicians submitted field surveys for 88 intervention episodes. 57% of participants indicated that their patients responded as anticipated by the manual. Participants consulted the manual for 34% of the episodes to promote consistency of ES application, aid in clinical decision making, to ensure consistency with evidence, to guide pad placement, and to solve parameter issues. Qualitative data gathered provided insight into participants' utilization of manual use. <h3>Conclusions</h3> The OT ES clinical intervention manual successfully demonstrated as a method to convey evidence-informed, comprehensible, and clinically relevant information, guiding occupational therapists to greater clinical competence and improved treatment fidelity. <h3>Author(s) Disclosures</h3> No conflict of interests exists.

Hemiballismus–hemichorea syndrome in an acute rehabilitation setting: two case reports

BackgroundWe report two similar cases of patients diagnosed with hemiballismus–hemichorea syndrome secondary to uncontrolled hyperglycemia. Both patients were treated at an inpatient rehabilitation center and made a significant recovery in both function and activities of daily living. Although hemiballismus–hemichorea syndrome has known pharmacological treatments, little has been reported on the effectiveness of acute rehabilitation on managing and treating this syndrome.Case presentationThe first case involves a 44-year-old Hispanic male with past medical history of type 2 diabetes mellitus, hypertension, anxiety, and depression who presented with continuous, uncontrollable, unilateral movements 1 month following a hospital admission for hyperglycemia. Magnetic resonance imaging findings showed lesions in the basal ganglia, confirming the diagnosis of hemiballismus–hemichorea syndrome. The patient was started on antipsychotic medications and antihyperglycemic medications controlling glucose levels, but continued to have hemiballismus symptoms. The second case involves a 78-year-old Haitian female with past medical history of type 2 diabetes mellitus and hypertension who presented with weakness and continuous, involuntary movements in her upper and lower extremities 1 month following a hospital admission for hyperglycemia and encephalopathy. Magnetic resonance imaging findings were positive for bilateral lesions in the basal ganglia, establishing a diagnosis of hemiballismus–hemichorea syndrome. After a 2-week stay at an acute rehabilitation center, both patients made a significant recovery in function and activities of daily living.ConclusionThe aim in presenting these cases is to elucidate the etiology and progression of a rare disease process known as hemiballismus–hemichorea syndrome and to provide evidence for the potential positive impact of acute rehabilitation on patients with unresolved hemiballismus–hemichorea following an episode of hyperglycemia.