Inpatient Rehabilitation Research Articles

Rehabilitative subacute inpatient care-Optimizing posthospital care for geriatric patients with rehabilitation needs: results of the REKUP study

Geriatric patients in subacute inpatient care (SC) with rehabilitation needs after hospitalization seldom utilize rehabilitative services and are often transitioned to long-term care (LTC), suggesting that their care in SC can be optimized. To evaluate the effectiveness of rehabilitative subacute inpatient care (REKUP) in improving the care of geriatric patients in SC with rehabilitation needs after hospitalization. The study was conducted as anonrandomized intervention trial with an historical control group (CG). The intervention group (IG: n = 49) received REKUP (activating therapeutic care, functional rehabilitative therapy, psychosocial services, medical care), while the CG (n = 57) received usual care during SC. Primary outcomes were transition to inpatient rehabilitation, home, and LTC, deteriorated care setting, care level, and mortality within 3months after SC. Secondary outcomes were functional, motor and psychological variables. The transition rate to inpatient rehabilitation (82% vs.37%) and home (86% vs.65%) was higher (p < 0.05) in the IG than in the CG. The proportion of persons utilizing LTC (12% vs.35%) and with deteriorated care setting (35% vs.60%) was lower (p < 0.01) in the IG than in the CG. The Barthel Index, visual analogue scale of the EQ-5D, and numerical pain scale improved (p < 0.05) during the SC stay in the IG but not in the CG. REKUP as anew care model for SC promotes the transition to inpatient rehabilitation, reduces the utilization of LTC and improves the chances of returning home and achieving greater independence in geriatric patients with rehabilitation needs after hospitalization.

Hyperbaric oxygen for moderate-to-severe traumatic brain injury: outcomes 5-8 years after injury.

The use of hyperbaric oxygen (HBO 2 ) in the field of traumatic brain injury (TBI) is becoming more widespread and increasing yearly, however there are few prognostic reports on long-term functional efficacy. The aim of this study was to assess the functional prognosis of patients with moderate-to-severe TBI 5-8 years following HBO 2 treatments and to explore the optimal HBO 2 regimen associated with prognosis, using a retrospective study. Clinical data were retrospectively collected as a baseline for patients with moderate-to-severe TBI treated with HBO 2 during inpatient rehabilitation from January 2014 to December 2017. The primary outcome measure was the Disability Rating Scale (DRS) and the secondary outcome measure was the Glasgow Outcome Scale. A total of 133 patients enrolled, with 9 (6.8%) dying, 41 (30.8%) remaining moderately disabled or worse (DRS scores 4-29), 83 (62.4%) remaining partially/mildly disabled or no disability (DRS scores 0-3). Logistic regression analysis revealed that age at injury (odds ratio (OR), 0.96; 95% confidence interval (CI), 0.92-0.99), length of intensive care unit stay (OR, 0.94; 95% CI, 0.88-0.99), and HBO 2 sessions (OR, 0.97; 95% CI, 0.95-0.99) were variables that independently influenced long-term prognosis. Cubic fitting models revealed that 14 and 21.6 sessions of HBO 2 could be effective for moderate and severe TBI, respectively. This study highlighted that HBO 2 in moderate-to-severe TBI may contribute to minimize death and reduce overall disability in the long-term. However, clinicians should be cautious of the potential risk of adverse long-term prognosis from excessive HBO 2 exposure when tailoring individualized HBO 2 regimens for patients with moderate-to-severe TBI. The study was registered on ClinicalTrials.gov (NCT05387018) on March 31, 2022.

The Pediatric Physiatric Posterior Fossa Symptoms scale (3PFSs): Impairments and outcome in pediatric inpatient rehabilitation for posterior fossa brain tumors.

Clinical recognition of the post-operative neurologic sequelae of posterior fossa tumors is inconsistent. This study aimed to characterize functional impairments and recovery trajectories in pediatric patients admitted to inpatient rehabilitation following surgical resection of posterior fossa brain tumors. This study also introduces the Pediatric Physiatric Posterior Fossa Symptom scale (3PFSs) for serial assessment of post-operative symptoms in pediatric posterior fossa brain tumors. This retrospective cohort study included 49 patients aged 1.1 to 19.9 years admitted to a pediatric unit of a free-standing rehabilitation hospital following resection of a posterior fossa brain tumor. Functional Independence Measure for Children (WeeFIM) and 3PFSs scores at admission and discharge were the primary outcome measures. Across the group, WeeFIM score improved from 51.5±23.5 points at admission to 74.2±28.2 points at discharge (t=4.34, p<0.001). The 3PFSs score also showed improvement from 10[IQR=9-12] points at admission to 8[7-10] points at discharge (t=9.3, p<0.0001). While change in both the WeeFIM and 3PFSs captured statistically significant improvement in function, there was low inter-rating correlation (p>0.7). In addition, mortality was correlated with higher discharge 3PFSs score (p=0.007) but not discharge WeeFIM score. In pediatric patients with post-operative neurologic sequelae due to posterior fossa brain tumors, inpatient rehabilitation resulted in global and domain specific functional improvements. This initial application of the 3PFSs demonstrates potential applicability for stratifying patients to appropriate levels of rehabilitation, capturing functionally relevant response to rehabilitation treatment, and prognosticating long-term outcomes. These initial results are promising but require additional validation in a larger cohort.

Adding a Mobility Champion to an Existing Progressive Mobility Protocol: An Evidence-Based Initiative.

This evidence-based initiative assessed the effect of adding a mobility champion to an existing progressive mobility protocol on functional decline in hospitalized older adults as evidenced by recommended discharge to home versus an inpatient rehabilitation facility. Older adults admitted from home to a 47-bed medical-surgical telemetry unit who were assessed as ambulatory, either independently or with assistance (Level 5), and with a progressive mobility order in the electronic health record were included in the initiative. Patient care associates who volunteered to be mobility champions were trained how to safely ambulate patients. Patients who worked with a mobility champion were less likely to be referred to inpatient rehabilitation post discharge for further care due to functional decline. Mobility has a critical role in the maintenance of hospitalized older adults' functional abilities and is a determinate of their post discharge disposition. [Journal of Gerontological Nursing, xx(x), xx-xx.].

Role of inpatient rehabilitation facility functional measures to predict community discharge after stroke.

This study investigated the association between stroke severity, functional status measured by the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI), and community discharge from IRF. Aim one examined the association between National Institutes of Health Stroke Scale (NIHSS) scores measured during the acute care stay and IRF admission functional status, measured by the admission IRF-PAI self-care and mobility functional measures, to deduce if functional measures can serve as a proxy for stroke severity. Aim two investigated the ability of the NIHSS and IRF-PAI admission functional measures to predict community discharge from IRF after stroke. Retrospective cohort study using electronic health records and Uniform Data System. Medical Record file data from January 1, 2018, to December 30, 2019. Academic hospital-based IRF. Five hundred forty-four patients transferred from acute care hospital to IRF after an ischemic or hemorrhagic stroke. Exclusion criteria included a transient ischemic attack, discharge against medical advice, death during IRF stay, or readmission to acute care within 48 hoursof IRF admission. Not applicable. Admission IRF-PAI self-care and mobility scores and discharge status from IRF. Of the 544 patients, 76.7% had community discharge. NIHSS scores were significantly associated with IRF-PAI admission self-care scores across each NIHSS stroke category. There was no statistically significant association between NIHSS and IRF-PAI admission mobility score. IRF admission self-care and mobility scores were each statistically significant predictors of community discharge (odds ratio [OR] = 1.10, 95% confidence interval [CI]: 1.03-1.17; OR = 1.10, CI: 1.03-1.18, respectively). NIHSS scores were not a statistically significant predictor of community discharge (OR = 0.70, CI: 0.47-1.04) from IRF. IRF-PAI self-care functional measure is associated with the NIHSS and can serve as a proxy for stroke severity. IRF-PAI self-care and mobility measures each predict community discharge.

The impact of delays in transfer to specialist rehabilitation on outcomes in patients with acquired brain injury.

To determine the effect of time waiting for admission to inpatient neurorehabilitation following acquired brain injury on rehabilitation outcomes. A retrospective observational case series. A specialist brain injury inpatient rehabilitation service. Consecutive 235 admissions to specialist brain injury rehabilitation following acutely-acquired brain injury between 2019 and 2022. Waiting time from the point of injury to admission, diagnostic category, admission complexity (patient categorisation tool), functional status (functional independence measure/functional attainment measure), care needs (Northwick Park Care Needs Assessment), change in functional status and care needs over duration of admission (efficiency). Subgroup analysis was performed for patients with a tracheostomy, enteral feeding, anticonvulsant treatment and prior neurosurgery. There was no relationship between admission wait and initial complexity (rs = 0.006; p = 0.923), functional status (rs = -0.070; p = 0.284) or care needs (rs = 0.019; p = 0.768). Longer waiting times were significantly associated with reduced efficiency of rehabilitation (rs = -0.240; p = 0.0002) and change of care needs (rs = -0.246; p = 0.0001). Longer waits were associated with reduced rehabilitation efficiency for patients prescribed anticonvulsants (n = 115; rs = -0.243; p = 0.009), with a tracheostomy (n = 46; rs = -0.362; p = 0.013), requiring enteral nutrition (n = 137; rs = -0.237; p = 0.005) or having had intracranial surgery (n = 97; rs = -0.344; p = 0.0006). There was a negative association between waiting times and reduction in care needs for patients admitted on anticonvulsants (rs = -0.319; p = 0.0005) and requiring enteral nutrition (rs = -0.269; p = 0.001). Longer wait for transfer to rehabilitation following brain injury is associated with reduced improvement in functional status and care needs over time. Attention should be given to ensuring rapid transfer into inpatient rehabilitation services.

Predictors of Psychiatric Hospitalization After Discharge From Inpatient Neurorehabilitation for Traumatic Brain Injury.

To examine, among persons discharged from inpatient rehabilitation for traumatic brain injury (TBI), the degree to which pre-TBI factors were associated with post-TBI hospitalization for psychiatric reasons. The authors hypothesized that pre-TBI psychiatric hospitalization and other pre-TBI mental health treatment would predict post-TBI psychiatric hospitalization following rehabilitation discharge, up to 5years post-TBI. Five Veterans Affairs Polytrauma Rehabilitation Centers. Participants with nonmissing rehospitalization status and reason, who were followed at 1 year (N=1006), 2years (N =985), and 5years (N =772) post-TBI. A secondary analysis of the Veterans Affairs TBI Model Systems, a multicenter, longitudinal study of veterans and active-duty service members with a history of mild, moderate, or severe TBI previously admitted to comprehensive inpatient medical rehabilitation. This study examined participants cross-sectionally at 3 follow-up timepoints. Psychiatric Rehospitalization was classified according to Healthcare Cost and Utilization Project multilevel Clinical Classifications diagnosis terminology (Category 5). Rates of post-TBI psychiatric hospitalization at years 1, 2, and 5 were 4.3%, 4.7%, and 4.1%, respectively. While bivariate comparisons identified pre-TBI psychiatric hospitalization and pre-TBI mental health treatment as factors associated with psychiatric rehospitalization after TBI across all postinjury timepoints, these factors were statistically nonsignificant when examined in a multivariate model across all timepoints. In the multivariable analysis, pre-TBI psychiatric hospitalization was significantly associated with increased odds of post-TBI psychiatric hospitalization only at 1-year post-TBI (adjusted odds ratio=2.65; 95% confidence interval, 1.07-6.55, P =.04). Posttraumatic amnesia duration was unrelated to psychiatric rehospitalization. Study findings suggest the limited utility of age, education, and pre-TBI substance use and mental health utilization in predicting post-TBI psychiatric hospitalization. Temporally closer social and behavior factors, particularly those that are potentially modifiable, should be considered in future research.

Waiting for surgery after hip fracture-Health and/or economic risk?

Waiting for surgery is a disconcerting experience. It can have a negative impact on patients' outcomes and length of stay (LOS) as driver for treatment costs. Process-optimisation may be a strategy to improve quality and cost-efficacy. The study investigates the correlation between waiting for hip fracture surgery and patient characteristics, organisational variables, outcomes, LOS, and the distribution of waiting times and LOS over time, including cost estimates. Thereby the study aims to identify the potential for organisational improvements with respect to managing the waiting time. Ten-year routine health data (patient characteristics and follow-up information) and process-indicators that is, waiting time and LOS from a Swiss trauma-centre were analysed retrospectively. Cost-estimates were calculated based on Swiss diagnosis related groups and daily costs to evaluate hospital revenues. In total, 2572 patients aged ≥60years with low-energy hip fractures were included. Waiting times >48h were associated with sub-optimal outcomes. Over the years long waiting times decreased. This reduction was not reflected by a reduction in LOS which remained stable around 10days, primarily driven by late discharge to in-patient rehabilitation. Reimbursement persisted at an average revenue in the low 4-5-digit range, depending on implant costs. While there has been a reduction of waiting times, this has not translated into a reduction of LOS or potential savings in health care costs, due to the various dependencies along the patient journey. Managing waiting times may be an area for improvement, increasing cost-efficacy, especially since long waiting times are still associated with inferior outcomes and LOS.

Cognitive Performance is Associated With 1-Year Participation and Life Satisfaction Outcomes: A Traumatic Brain Injury Model Systems Study.

To determine, in persons with traumatic brain injury (TBI), the association between cognitive change after inpatient rehabilitation discharge and 1-year participation and life satisfaction outcomes. Secondary analysis of prospectively collected TBI Model Systems (TBIMS) data. Inpatient rehabilitation and community. 499 individuals with TBI requiring inpatient rehabilitation who completed the Brief Test of Adult Cognition by Telephone (BTACT) at inpatient rehabilitation discharge (ie, baseline) and 1-year postinjury. Participation Assessment with Recombined Tools-Objective (PART-O) and Satisfaction with Life Scale (SWLS). Of 2,840 TBIMS participants with baseline BTACT, 499met inclusion criteria (mean [standard deviation] age=45 [19] years; 72% male). Change in BTACT executive function (EF) was not associated with 1-year participation (PART-O; β=0.087, 95% CI [-0.004, 0.178], P =.061) when it was the sole model predictor. Change in BTACT episodic memory (EM) was associated with 1-year participation (β=0.096, [0.007, 0.184], P =.035), but not after adjusting for demographic, clinical, and functional status covariates (β=0.067, 95% CI [-0.010, 0.145], P =.089). Change in BTACT EF was not associated with life satisfaction total scores (SWLS) when it was the sole model predictor (β=0.091, 95% CI [-0.001, 0.182], P =.0503). Change in BTACT EM was associated with 1-year life satisfaction before (β=0.114, 95% CI [0.025, 0.202], P =.012) and after adjusting for covariates (β=0.103, [0.014, 0.191], P =.023). In secondary analyses, change in BTACT EF was associated with PART-O Social Relations and Out and About subdomains before (Social Relations: β=0.127, 95% CI [0.036, 0.217], P =.006; Out and About: β=0.141, 95% CI [0.051, 0.232], P =.002) and after (Social Relations: β=0.168, 95% CI [0.072, 0.265], P <.002; Out and About: β=0.156, 95% CI [0.061, 0.252], P <.002) adjusting for functional status and further adjusting for covariates (Social Relations: β=0.127, 95% CI [0.040, 0.214], P =.004; Out and About: β=0.136, 95% CI [0.043, 0.229], P =.004). However, only the models adjusting for functional status remained significant after multiple comparison correction (ie, Bonferroni-adjusted alpha level=0.002). EF gains during the first year after TBI were related to 1-year social and community participation. Gains in EM were associated with 1-year life satisfaction. These results highlight the potential benefit of cognitive rehabilitation after inpatient rehabilitation discharge and the need for interventions targeting specific cognitive functions that may contribute to participation and life satisfaction after TBI.

Utilization frequency and patient-reported effectiveness of symptomatic therapies in post-COVID syndrome

BackgroundTo date there is no causal treatment for post-COVID syndrome, leaving symptomatic treatments as the primary recourse. However, the practical implementation and effectiveness of these interventions remain underexplored. This study aimed to investigate the utilization frequency of symptomatic therapies and patient-reported effectiveness across various treatment modalities at a German post-COVID center.MethodsAs the baseline investigation we conducted a single-cohort retrospective study to analyze the frequency of symptomatic therapies among post-COVID patients who attended the post-COVID center of the University Hospital of Erlangen, between December 2022 to July 2023. Additionally, we administered a follow-up at least 3 months after the initial presentation, using a questionnaire to assess patient-reported improvements in post-COVID symptoms associated with the symptomatic therapies received.ResultsOur study included 200 patients (mean age: 44.6 ± 12.6 years; 69.0% women; mean duration since acute infection: 15.3 ± 8.3 months). Pharmacotherapy was the predominant symptomatic treatment (79.5%), with psychotropic drugs (32.5%) and analgesics (31.5%) being the most frequently prescribed. Over half of the patients (55.5%) utilized vitamins and nutritional supplements. Hospital admission rates to acute care occurred in 35.5% of cases; 33.0% underwent inpatient rehabilitation and 31.0% pursued outpatient psychotherapy. Cardiologists (76.5%), pulmonologists (67.5%), and neurologists (65.5%) were the most consulted specialists. Therapies involving medical devices were infrequently employed (12.0%). In a follow-up questionnaire (response rate: 82.5%, 6.3 ± 2.2 months post-baseline), beta-blockers were the most effective pharmacological intervention with 31.5% of patients reporting strong to very strong symptom improvement, followed by antibiotics (29.6%). Furthermore, 33.0% of the patients perceived plasmapheresis to strongly alleviate symptoms. Only a small proportion of the sample attributed a strong or very strong symptom improvement to outpatient psychotherapy (11.0%).ConclusionThis study provides initial insights into symptomatic therapy utilization and patient-reported symptom improvement in post-COVID syndrome. Further research into symptoms clusters and interdisciplinary collaboration are warranted to comprehensively address the multifaceted physical and psychological symptomatology.Trial registrationThe study was registered at the German Clinical Trials Register (DRKS-ID: DRKS00033621) on March 20, 2024.

Xylazine-induced Skin Necrosis, Emerging Public Health Crisis and the Ethical Considerations in Surgical Reconstruction: A Case Report

Xylazine, a non-opioid veterinary sedative, is increasingly being used to adulterate illicit fentanyl. Injection into the extremities causes progressive necrotic wounds, resulting in a compromised limb and life. Managing xylazine-induced skin necrosis may require extensive surgical intervention, including serial debridements and soft tissue reconstruction. Moreover, managing these complex wounds requires a multi-disciplinary approach, including hospital medicine, infectious disease, psychiatry, addiction medicine, pain/palliative care, ethics, wound care, orthopedic surgery, and plastic surgery. A 38-year-old female with a history of intravenous drug use presented with severe bilateral dorsal forearm wounds, and despite initial non-compliance with surgical debridement, she eventually underwent successful skin grafting after extensive treatment, including antibiotics and negative pressure therapy, but was later lost to follow-up. She relapsed into fentanyl use, leading to severe bilateral lower extremity wounds requiring further debridement and skin grafting, and later returned with new forearm wounds, at which point further reconstruction was deemed inappropriate without addressing her addiction; she refused inpatient rehabilitation and ultimately being lost to follow-up again.

Legal regulation of rehabilitation in the field of health care

The article notes that the law guarantees everyone the right to health care and medical assistance. A full-scale invasion calls for the development and updating of legal acts on ensuring a person’s right to medical assistance, in particular, to the provision of rehabilitation services. It is noted that rehabilitation assistance is aimed at a number of main areas, firstly, at supporting the functions of the patient’s body during the exacerbation of chronic diseases. Secondly, for warning, early diagnosis of disorders of the organs and systems of the patient’s body. The third direction is aimed at full or partial restoration of damaged organs or systems and compensation of lost functions of affected organs or systems. The fourth direction is related to the prevention and reduction of the degree of disability. The author emphasizes that the lack of competent and effective medical rehabilitation in Ukraine is a multifactorial problem: there is an insufficient number of inpatient and outpatient rehabilitation departments; lack of medical personnel - rehabilitation specialists, psychologists; there is not enough rehabilitation equipment; there is a need for adequate educational programs for physicians. In the article, the author emphasizes that one of the tasks of the state is to help persons with disabilities realize their constitutional rights; implementation of state policy in the field of rehabilitation of persons with disabilities, support for their integration into society, and the full-scale war on the territory of Ukraine causes an increasing urgency and need for the rehabilitation of persons injured as a result of hostilities. Such factors of the population’s health, such as the increase in morbidity, injuries, temporary loss of working capacity, premature mortality of the population require the development of the rehabilitation medicine market of Ukraine and its legal regulation. The article notes that the positive aspects are the development of new medical rehabilitation technologies, including those based on telemedicine and IT technologies, the preparation of new professional standards for medical rehabilitation at the modern level in accordance with international recommendations. All this requires the effective functioning of the system, which first of all requires the improvement and development of regulatory and legal support in the field of rehabilitation.

Predictive utility of self-efficacy in early stroke rehabilitation

ABSTRACT Introduction A biopsychosocial approach entailing person-centered factors provides valuable insight to post-stroke rehabilitation potential. The consideration of an individual’s belief in their capabilities, known as self-efficacy, may prove especially informative in the inpatient rehabilitation setting where motor learning often occurs. Objective To assess the predictive utility of self-efficacy in functional independence status change during inpatient rehabilitation. Methods Individuals with stroke admitted to an inpatient rehabilitation facility (IRF) completed an assessment battery near IRF admission and discharge involving motor assessments, participant-reported self-efficacy (Stroke Self-Efficacy Questionnaire), and functional independence status evaluation (sum of self-care and mobility Quality Indicators (QI) from the IRF-Patient Assessment Instrument). Linear regression was performed to determine the predictive performance of self-efficacy on QI change during IRF stay while accounting for age, time post-stroke, and IRF length of stay. Regression procedures were repeated for separate subgroups based on initial motor impairment level. Results Thirty individuals with stroke (14 females, age = 67.0 ± 9.80 years, 10.4 ± 3.46 days post-stroke) were enrolled. Self-efficacy at IRF admission explained a significant percentage of variance in QI Change for the cohort (R2 = 30.7%, p = .001) and for the moderate to severe motor impairment subgroup (n = 12; R2 = 49.9%, p = .010). After accounting for confounders, self-efficacy remained a significant predictor for the cohort (n = 30) model. Discussion Findings generated from this work support the predictive utility of self-efficacy in early post-stroke motor recovery. The inclusion of self-efficacy in a multi-faceted evaluation framework may therefore optimize rehabilitation outcomes by providing therapists with additional knowledge to better tailor an individual’s care.

Post Stroke Rehabilitation Awareness Among Stroke Patients - A Questionnaire Study

Background: The burden of stroke is increasing in India. Stroke is now the fourth leading cause of death and the fifth leading cause of disability. Following the acute phase of stroke management, rehabilitation becomes a cornerstone of recovery. However, despite the advancements in stroke rehabilitation, there exists a notable gap in patient awareness, with many individuals and their caregivers lacking sufficient knowledge about post-stroke rehabilitation options and the significance of their involvement in the recovery journey. Therefore, this survey was done to investigate the post stoke rehabilitation awareness among stroke patients and their family. Aims: The objective of this survey is to assess stroke rehabilitation awareness among family members and individuals undergoing inpatient or outpatient post-stroke rehabilitation, focusing on knowledge of stroke risk factors, warning signs, prevention measures, and available rehabilitation services. Method: From September’2023 to October’2023, 97 Participants were chosen, who underwent stroke rehabilitation either in-patient or out-patient rehabilitation for stroke recovery. Participants were made to fill out a structured questionnaire through an online link which consisted of 13 multiple-choice questions. Results: Out of 97 respondent 40% of respondents were fully aware of the key symptoms of a stroke. 80% of respondents were aware of physical therapy importance post stroke; 58% awareness on speech therapy. Only 27% and 26% were aware about occupational therapy &amp; robotic therapy as a post stroke rehabilitation option respectively. Around 73% of the respondents felt that post stroke rehabilitation at the Center is more effective than post stroke rehabilitation care at home. Conclusion: These findings underscore the need for improved education and outreach efforts to enhance rehabilitation access for stroke survivors. The data utilized in this research article are accessible upon reasonable request to the corresponding author, contingent upon adherence to applicable data protection regulations and ethical guidelines.

The Effect of Smoking on the Functional Gain After Inpatient Rehabilitation in People with Spinal Cord Injury

The Effect of Smoking on the Functional Gain After Inpatient Rehabilitation in People with Spinal Cord Injury

Risk Categories for Discharge Planning Using AM-PAC "6-Clicks" Basic Mobility Scores in Non-Surgical Hospitalized Adults.

Early discharge planning is important for safe, cost-effective, and timely hospital discharges.Patients with deconditioning are at risk for prolonged lengths of stay related to discharge needs. Functional mobility outcome measures are associated with discharge disposition. The purpose of this study is to examine the clinical usefulness of risk categories based on the Activity Measure for Post-Acute Care (AM-PAC) "6-clicks" Basic Mobility (6cBM) scores on predicting discharge destination. A retrospective cohort study of 3739 adults admitted to general medical units at an urban, academic hospital between January 1, 2018 and February 29, 2020 who received at least twophysical therapy visits and had an AM-PAC 6cBM recorded within 48 hours of admission and before discharge. The outcome variable was discharge destination dichotomized to post-acute care facilities (PACF); inpatient rehabilitation, skilled nursing facility, or subacute rehabilitation) or home (with or without home care services). The predictor variables were 6cBM near admission and discharge. Logistic regression was used to estimate the odds of being discharged to PACF compared to home, based on the Three-level risk categorization system: (a) low (6cBM score > 20), (b) moderate (6cBM score 15-19), or (c) high (6cBM score < 14) risk. Analysis indicated important differences between the three risk categories in both time periods. Based on 6cBM at admission, patients in the high-risk category were nine times more likely to be discharged to PACF than those in the low-risk category. At discharge, those in the high-risk category were 29 times more likely to go to PACF than those in the low-risk category. Other characteristics differentiating patients who went to PACF were sex (males), age (older) and longer hospitalization. Predicting risk for discharge to a PACF using risk categories based on AM-PAC 6cBM can be useful for early discharge planning.

Cognitive assessment during inpatient rehabilitation after spinal cord injury, a retrospective cross-sectional study.

Cross-sectional study. Cognitive screening is underdeveloped in spinal cord injury (SCI). Therefore, the objectives of our study were: (1) to evaluate cognitive functioning of rehabilitation inpatients with recently acquired spinal cord injury (SCI) with the Montreal Cognitive Assessment (MoCA); (2) to analyse associations between patient and lesion characteristics and the MoCA scores and (3) to compare the MoCA with the cognitive domain of the Utrecht scale for Evaluation of Rehabilitation (USER). Inpatient rehabilitation in a specialized rehabilitation centre in the Netherlands. MOCA and USER data of inpatients between November 2020 and December 2021 were used. Correlation and regression analysis were used. Included were 98 adults aged (median) 61.6 years (range 19.5-83.6), 66% male, 26.5% traumatic SCI, 63% persons with paraplegia. MoCA and USER scores were available for 83 and 92 individuals, respectively. In 44.6% of the participants, the MoCA score was below the cut-off. Age (r = 0.31, p = 0.005) and educational level (r = 0.54 P < 0.00) were significantly correlated to the MoCA score. The MoCA and the cognitive domain of the USER were moderately correlated (r = 0.25, p = 0.03). Almost half of the inpatients scored below the cut-off score on the MoCA. Since the MoCA is a validated cognitive screening tool, the moderate correlation of the MoCA and the cognitive domain of the USER suggests that the USER alone is not sufficient in detecting cognitive deficits. We recommend to screen for cognitive deficits in all people with new SCI. None.

A Pilot Randomized Controlled Trial to Examine the Impact of a Therapy Dog Intervention on Loneliness in Hospitalized Older Adults

Abstract Background and Objectives Loneliness is linked to significant health threats and is potentially more dangerous than obesity; it affects as many as 29% of noninstitutionalized older adults. Loneliness is exacerbated for those who require inpatient rehabilitation, are displaced from their social networks, spend little time receiving therapy, and are physically inactive and socially isolated. Emerging evidence suggests that companion animals provide a number of health and wellbeing benefits and that interacting with a trained therapy dog may reduce loneliness. Research Design and Methods Older adult (59+ years) medical inpatients (N=42) were randomly assigned to receive one of three conditions: dog and handler interaction (AAI), handler-only Conversational Control (CC), or Usual Care (UC), for 20 minutes per day over three days. The UCLA Loneliness Scale (UCLA-LS) and Short Form (UCLA-SF) as well as an analog rating scale were used to assess loneliness. Linear Mixed Models with random intercepts were applied to examine differences in the changes from before to after the conditions. Results Changes in the UCLA-SF [t (200.356) = 1.851, p = 0.033] and the analog loneliness scale [t (194.407) = 2.651, p = 0.004], differed significantly between the AAI condition and the UC conditions but not between the CC and UC conditions (p = .175). Trajectories of changes in loneliness showed more improvement in the AAI than in the UC condition. Discussion and Implications These results indicate that AAI was effective for reducing loneliness in hospitalized older adults. Human handler only visits did not result in similar findings, indicating that there is something unique and beneficial about the presence of the dog.

Quality indicators prospectively associated with falls in inpatient rehabilitation facilities.

Retrospective studies suggest quality indicators (QI) are associated with falls in inpatient rehabilitation facilities (IRFs), but this claim has not yet been validated prospectively. The aim of this study was to analyze the associations between QI codes and falls in a prospective sample. For this prospective observational cohort study, we followed 658 patients from 4 IRFs who were consecutively admitted and discharged over a 6-month period. On admission, we collected patients' QI codes, and then, tracked whether they fell during their IRF stay. Univariable logistic regressions revealed that most individual QI items for communication, self-care, and mobility were significantly associated with falls. In a multivariable model with 6 different QI items, only patients' performance going up and down 1 step was significantly associated with falls. To explain this finding, we investigated the relationships between these QI items and found 3 of them to be highly correlated. Most individual QI items appear prospectively associated with falls. Patients with lower QI codes are more likely to fall. Combining QI items (such as expression and toileting) may improve fall-risk assessment, but some QI items may be too interrelated to use together.

B - 43 Utility of the Activity Measure for Post-Acute Care (AM-PAC) as a Measure of Functional Recovery across the TBI Rehabilitation Continuum

Abstract Objective To evaluate the utility of the AM-PAC (Activity Measure for Post-Acute Care) for functional assessment of patients with Traumatic Brain Injury (TBI) across inpatient and outpatient rehabilitation settings. We evaluated (1) Longitudinal changes (1-year) in cognitive and physical recovery patterns across the rehabilitation continuum (2) Concurrent validity of AM-PAC as compared to traditional measures. Method A prospective repeated measures cohort study of adults with TBI (n = 186), where 87 participants received inpatient rehabilitation (IR), and 99 participants received outpatient cognitive rehabilitation (CR). Functional recovery was assessed at IR admission, discharge, 6 months and 1 year, and at admission/discharge from CR for post-acute participants. Functional measures included AM-PAC-Basic Mobility (BM), Daily Activities (DA), and Applied Cognitive (AC) domains, Neuropsychological Assessment Battery (NAB), Texas Functional Living Scale (TFLS), Functional Independence Measure (FIM), Participation Assessment with Recombined Tools-Objective (PART-O), and Mayo-Portland Adaptability Inventory (MPAI-4: self-awareness). Results The AMPAC was sensitive to changes throughout the care continuum, demonstrating medium effect sizes across all three functional domains. Notably, AMPAC scores showed greater change compared to traditional tools (90% and 68% confidence levels). Additionally, analysis of Minimum Detectable Change thresholds demonstrated significant improvements, across settings and within moderate/severe TBI (p &amp;lt; 0.05), followed by predictably smaller gains in the mild TBI population (p &amp;lt; 0.05), underscoring the clinical relevance of these findings. Conclusions Results demonstrate that the AM-PAC is a practical, valid and sensitive scale responsive to longitudinal ecological and functional change in TBI. Analysis confirms the effectiveness of functional assessments, particularly emphasizing strengths of the AMPAC.