Mean Functional Independence Measure Score Research Articles

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

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

Characteristics and healthcare utilization of COVID-19 rehabilitation patients during the first and second waves of the pandemic in Toronto, Canada.

The objective of this study is to describe the healthcare utilization, and clinical and sociodemographic features of a cohort of 74 coronavirus disease 2019 (COVID-19) patients admitted to a tertiary rehabilitation hospital in Toronto, Canada. A retrospective chart review was performed using 74 charts from patients admitted to a COVID-19 rehabilitation unit between 11 April 2020 and 30 April 2021. Measures of central tendency, SDs, interquartile ranges, frequencies, and proportions were calculated to analyze clinical and sociodemographic data. A total of 74 patients were included in this study, including 33 males and 41 females. The mean age was 72.8 years, with Wave 1 patients being younger than Wave 2 patients. Sixty-six percent of total patients experienced hypertension. Mean functional independence measure score across both waves was 78 at admission and 100 at discharge. Mean length of stay was 14.6 days in Wave 1 and 18.8 days in Wave 2. This study represents some of the first data on the characteristics and outcomes of COVID-19 patients admitted to inpatient rehabilitation in Toronto, Canada across the initial waves of the COVID-19 pandemic.

Long-term trajectories of community integration: identification, characterization, and prediction using inpatient rehabilitation variables

ABSTRACT Background Community integration (CI) is often regarded as the foundation of rehabilitation endeavors after stroke; nevertheless, few studies have investigated the relationship between inpatient rehabilitation (clinical and demographic) variables and long-term CI. Objectives To identify novel classes of patients having similar temporal patterns in CI and relate them to baseline features. Methods Retrospective observational cohort study analyzing (n = 287) adult patients with stroke admitted to rehabilitation between 2003 and 2018, including baseline Functional Independence Measure (FIM) at discharge, follow-ups (m = 1264) of Community Integration Questionnaire (CIQ) between 2006 and 2022. Growth mixture models (GMMs) were fitted to identify CI trajectories, and baseline predictors were identified using multivariate logistic regression (reporting AUC) with 10-fold cross validation. Results Each patient was assessed at 2.7 (2.2–3.7), 4.4 (3.7–5.6), and 6.2 (5.4–7.4) years after injury, 66% had a fourth assessment at 7.9 (6.8–8.9) years. GMM identified three classes of trajectories: Lowest CI (n=105, 36.6%): The lowest mean total CIQ; highest proportion of dysphagia (47.6%) and aphasia (46.7%), oldest at injury, largest length of stay (LOS), largest time to admission, and lowest FIM. Highest CI (n=63, 21.9%): The highest mean total CIQ, youngest, shortest LOS, highest education (27% university) highest FIM, and Intermediate CI (n=119, 41.5%): Intermediate mean total CIQ and FIM scores. Age at injury OR: 0.89 (0.85–0.93), FIM OR: 1.04 (1.02–1.07), hypertension OR: 2.86 (1.25–6.87), LOS OR: 0.98 (0.97–0.99), and high education OR: 3.05 (1.22–7.65) predicted highest CI, and AUC was 0.84 (0.76–0.93). Conclusion Novel clinical (e.g. hypertension) and demographic (e.g. education) variables characterized and predicted long-term CI trajectories.

Relationship between Nutritional Status, Body Composition, Muscle Strength, and Functional Recovery in Patients with Proximal Femur Fracture

Sarcopenia is a major issue among the elderly. However, the effects of nutritional status and body composition on functional recovery in patients with proximal femur fractures (PFF) remain unclear. Hence, this study aimed to investigate the effects of nutritional status, body composition (skeletal muscle mass and muscle quality measured by phase angle [PhA] values), and muscle strength on the improvement in activities of daily living (ADL) in patients with PFF. We enrolled patients with PFF admitted to a rehabilitation unit. Nutritional status, body composition, grip strength, and motor Functional Independence Measure (FIM) score were assessed on admission day and at 4 weeks thereafter. Of 148 patients, 84 had femoral neck fractures, and 64 had trochanteric fractures. The mean motor FIM score was 49.2 points at admission and 64.9 points after 4 weeks. In multivariate analysis, higher geriatric nutritional risk index and PhA measured by anthropometry were associated with a significantly higher FIM score after 4 weeks. Muscle strength and quality changes significantly correlated with ADL improvement. Poor nutritional status and decreased muscle strength and quality interfered with ADL recovery. Nutritional management before injury and from the acute phase, and rehabilitation to maintain skeletal muscle status, are important for ADL recovery.

The impact of phacoemulsification surgery on vision-related quality of life in senile cataract patients.

Background:Phacoemulsification surgery may have beneficial effects on the quality of life of patients with senile cataract. These effects can be evaluated with the help of questionnaires and tests.Purpose:To evaluate the effect of the phacoemulsification surgery on the vision-related quality of life (VR-QOL) in patients with senile cataract using the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) and functional independence measure (FIM) tests.Methods:The data collection was prospective. NEI-VFQ-25 and FIM tests were measured by a masked ergo-therapist. The patients who underwent phacoemulsification surgery were included in this study. Mean best-corrected visual acuity (BCVA), NEI-VFQ-25 and FIM scores were compared in the preoperative period and at least 3 months after the surgery according to demographic properties including gender, age, education status, as well as the BCVA level and laterality.Results:Preoperative mean BCVA and NEI-VFQ-25 composite scores improved significantly (p < 0.001 and p = 0.001, respectively). All NEI-VFQ-25 subscale scores except the general health (p = 0.235) and driving (p = 0.226) showed a significant postoperative increase. The postoperative NEI-VFQ-25 composite scores showed a significant increase in all subgroup analyses (p < 0.05 for all). Patients with poorer BCVA, bilateral surgery, and low education status had lower preoperative NEI-VFQ-25 composite scores than the patients with better BCVA, unilateral surgery, and high education status (p = 0.026, p = 0.016, and p = 0.032, respectively). All FIM scores were similar in the preoperative and postoperative periods regardless of subgroup analyses (p > 0.05 for all).Conclusion:Phacoemulsification surgery can provide a satisfying improvement in VR-QOL in patients with cataracts. As a valid and reliable test, the NEI-VFQ-25 scale can be used to measure the visual function after the ocular surgeries.

Effect of Graded Early Mobilization on Psychomotor Status and Length of Intensive Care Unit Stay in Mechanically Ventilated Patients.

IntroductionThe main purpose of this study was to evaluate the effectiveness of graded early mobilization on psychomotor status and duration of ICU stay of patients with mechanical ventilation.Materials and methodsDesignQuasi-experimental study.SettingBRB Hospitals Limited, Dhaka, Bangladesh. A reputed 500-beddedgeneral hospital with 30 ICU beds.ParticipantsA total of 30 patients were selected as participants in the study from the hospital. 15 patients were included in the ICU treatment group and the remaining 15 were in the intervention group using the purposive sampling method.Scales usedFunctional independence measure (FIM) scale and 7 point generalized anxiety depression (GAD-7) scale.InterventionGraded early mobilization was provided as an intervention to all participants of the intervention group by a professionally qualified ICU physiotherapist for 10 sessions. Most of the patients received multiple sessions of intervention within a day.ResultsIn the control group mean FIM score was 17.40 (SD±4.88), and in the intervention group mean score was 65.70 (SD±12.18). The mean difference was statistically significant in the ‘t’ test (p-value > 0.001). In the control group, the mean GAD-7 score was 19.50 (SD±2.71), and in the intervention group the mean GAD-7 score was 7.5 (SD±2.59). The mean difference was statistically significant in the ‘t’ test. (p-value > 0.001). The mean length of ICU stay in the control group was 5.60 (SD±1.07) and in the intervention group it was 3.10 (SD±0.56). The mean difference was statistically significant in the ‘t’ test (p-value > 0.001).ConclusionThis research showed that graded early mobilization was highly effective to improve the motor and psychological status of mechanically ventilated patients and reduce their length of ICU stay.How to cite this articleDas B, Saha S, Kabir F, Hossain S. Effect of Graded Early Mobilization on Psychomotor Status and Length of Intensive Care Unit Stay in Mechanically Ventilated Patients. Indian J Crit Care Med 2021;25(4):416–420.

Functional Independence Measure score is associated with mortality in critically ill elderly patients admitted to an intermediate care unit

BackgroundAge alone is not a robust predictor of mortality in critically ill elderly patients. Chronic health status and functional status before admission could be better predictors. This study aimed to determine whether functional status, assessed using the Functional Independence Measure (FIM), could be an independent predictor of mortality in a geriatric population admitted to an intermediate care unit (IMCU).MethodsA monocentric, retrospective, observational study of all patients aged ≥75 years old admitted to Geneva University Hospitals’ geriatric IMCU between 01.01.2012 and 31.05.2016. The study’s primary outcome metrics were one-year mortality’s associations with a pre-admission FIM score and other relevant prospectively recorded prognostic variables.ResultsA total of 345 patients were included (56% female, mean age 85 +/− 6.5 years). Mean FIM score was 66 +/− 26. One-year mortality was 57%. Dichotomized low (≤ 63) and high FIM (> 63) scores were associated with one-year mortalities of 68 and 44%, respectively. Logistic regression calculations found an association between pre-admission FIM score and one-year mortality (p < 0.0001), including variables usually associated with mortality (e.g., age, sex, comorbidities, mini-mental health state score, renal function). Multivariate survival analysis showed a significant difference between groups, with a hazard ratio of 0.29 (95% CI: 0.13–0.65) for patients with high FIM scores.ConclusionsIn the present study, higher functional status, assessed using the FIM tool before admission to an IMCU, was significantly and independently associated with lower one-year mortality. This opens up perspectives on the potential value of FIM for establishing a finer prognosis and better triage of critically ill older patients.

Comparison of Outcomes of Severe Traumatic Brain Injury in 36,929 Patients Treated with or without Intracranial Pressure Monitoring in a Mature Trauma System

Severe traumatic brain injury (TBI) remains a major cause of morbidity and mortality with mortality rates reaching 35%. Intracranial pressure (ICP) monitoring is used to prevent secondary brain injury and death. However, while the association of elevated ICP and worsened outcomes is accepted, routine ICP monitoring has been questioned after the publication of several studies including the Benchmark Evidence from South American Trials: Treatment of Intracranial Pressure trial. We examined whether severe TBI patients in the trauma system of Pennsylvania fared better with or without ICP monitoring. We conducted a statewide retrospective analysis and included all TBI patients >18 years with an admission Glasgow Coma Scale (GCS) <9 from January 2000 through December 2017. The primary outcome was mortality. Secondary outcomes examined were intensive care unit length of stay (LOS) and discharge functional independence measure (FIM). A total of 36,929 patients matched our inclusion criteria and were included in the analysis. Of those, 6025 (16.3%) had ICP monitor placement. Mean ICU LOS was significantly higher in ICP-monitored patients (13.1 ± 11.6 days vs. 6.0 ± 10.8 days, P < 0.0001). Increasing age was a significant predictor of death (P < 0.0001). Mean FIM scores at discharge were significantly higher in patients without an ICP monitor (16.21 ± 4.91 vs. 9.53 ± 5.07, P < 0.0001). When controlling for injury severity score, GCS, age, and craniotomy, ICP monitoring conferred a hazard ratio of 0.85 (χ2= 32.63, P < 0.0001), a 25% reduction of in-hospital mortality compared with non-ICP-monitored patients. We found that ICP-monitored patients had a lower risk of in-hospital mortality. Our findings support the use of ICP monitors in eligible patients.

Functional independence of the elderly in multiprofessional home care

Functional evaluation is one of the pillars of elderly home care for planning of interventions targeting the autonomy of this population. To verify Functional Independence Measure (FIM) in senior patients on a home care program. Retrospective quantitative study with elderly patients assisted by a home care service in the city of Curitiba, from August 2012 to December 2016. The following information was collected: gender, age, clinical diagnosis, and mean FIM scores at admission and discharge. Inclusion and exclusion criteria were met, descriptive statistics was used and, for association of variables, Wilcoxon’s and Spearman’s tests were applied. 1,614 patients were included, with predominance of women (n = 953; 59.53%), mean age of 78.7 ± 9.2 years, clinical diagnoses of diseases mostly affecting the central nervous system (CNS), the respiratory system, the joint and musculoskeletal system, and the circulatory system. The initial mean FIM was 50.56 points, while the final one was 55.36 points, with significant difference – Z = -5.09, p = 0.0001. Most seniors presented maximum to moderate dependence; however, a significant improvement in FIM after the health care provided in their homes was observed in patients with minimum dependence or modified independence.

The relationship between the stroke survivors’ functional status and their informal caregivers’ burden and quality of life

<em>Background and purpose</em>: Stroke is a major cause of disability and affects the lives of both the patients and their caregivers. The purpose of the study was to determine the relationship between the functional status of stroke survivors and the care burden and quality of life of their informal caregivers. The relationship between selected socio-demographic variables and the caregivers’ caregiving experiences, quality of life, and care burden also was investigated. <em>Methods:</em> This &nbsp;cross-sectional study consisted of 100 patients and informal caregivers dyads. The Patient and Caregiver Information Form was used to collect demographic data; the Functional Independence Measure (FIM) and Barthel Index (BI) were used to assess functional status; the Caregiver Burden Scale (CBS) and 36-Item Short-Form Health Survey Quality of Life Scale (SF36-QLS) were used to assess the caregivers’ burden and quality of life. Data were evaluated using descriptive statistics, Kolmogorov-Smirnov test, and parametric and non-parametric tests. <em>Results:</em> The mean FIM and BI scores of the patients were 61.0 ± 30.0 and 42.6 ± 28.3, respectively. The caregivers’ average score in the SF36-QLS subscale of general health perception was 51.7 ± 22.7; their average CBS score was 39.2 ± 13.8. The caregivers’ quality of life was found to be moderate to high in the domains of physical function, social function, mental health, bodily pain, and general health, but low in the domains of physical role function, emotional role function, and vitality. There was a negative correlation between the average FIM and BI scores of stroke survivors and their caregivers’ CBS scores or scores on the SF36-QLS subscale of general health perception. <em>Conclusion:</em> There is a relationship between the stroke survivors’ functional status and their caregivers’ burden and quality of life. The caregivers’ quality of life decreased and their care burden increased as the functional status of the patients deteriorated.

Outcomes of patients with multiple sclerosis at a neurorehabilitation unit in Saudi Arabia.

Objectives:To assess the impact of inpatient multidisciplinary rehabilitation on a Saudi Arabian population of patients with multiple sclerosis (MS).Methods:We retrospectively analyzed the data of patients with MS who underwent inpatient rehabilitation between 2009 and 2015 at King Fahad Medical City (KFMC). Differences in Functional Independence Measure (FIM) scores (used in rehabilitation settings to assess the functional independence of patients) and length of stay (LOS) were measured between patients of different ages, sexes, and types of MS and analyzed using the independent t-test. The Pearson correlation coefficient was used to investigate the correlation between FIM, LOS, and other variables.Results:In total, 24 patients were identified, with an average age of 36 years. The average age at disease onset was 31 years. Disease duration ranged from 1-20 years, with a mean of 7 years. The most common type of MS was relapsing-remitting (45.8%). The mean FIM score at admission was 77.5 and at discharge 97.25. Functional independence measure gain ranged from 2-51, with a mean of 18.58. Functional independence measure efficiency (FIM gain divided by LOS) ranged between 0.09-0.95. The length of stay ranged between 21-95 days, with a mean of 37.79 days. There was a significant association between age and FIM efficiency (p=0.043).Conclusions:Inpatient rehabilitation is an important intervention that improves the functional independence of patients with chronic MS.

Functional outcome of ischemic stroke in relation to site of lesion: A prospective cohort study

Background: Accurate prediction of motor recovery and functional outcome is difficult, but it is important for proper rehabilitative planning and poststroke care. Infarct location may be more important for some patients in determining eventual clinical outcome. Objectives: To study the functional outcome of ischemic stroke in relation to the site of lesion. Materials and Methods: A prospective cohort study was conducted in the Department of Physical Medicine and Rehabilitation, Regional Institute of Medical Sciences, Imphal, Manipur. All computed tomography confirmed ischemic stroke patients attending the outpatient department within 7 days of stroke onset were included in the study. Functional Independence Measure (FIM) scoring was done on 7, 30, and 90 days poststroke. Site was categorized as cortical (C), subcortical (S), combined cortical and subcortical (CS), basal ganglia (BG), or combined cortical, subcortical, and BG. Results: Ninety patients with mean age of 58.26 ± 7.021 years in the range of 45–70 years were studied. Males constituted 55.6% of the total participants. The site of lesion was in BG in majority of cases 37 (41.1%), subcortical in 31 (34.4%) cases, and cortical in 20 (22.2%) cases. Mean FIM score was highest 53.70 (±13.2) when the site of lesion was in BG. The mean FIM scores differed significantly between the different sites of lesion (P = 0.000) at subsequent follow-up examinations. Post hoc test further revealed that there was statistically significant differences in the FIM scores between BG and all the other sites of lesion at baseline and at subsequent follow-up. Conclusion: Site of lesion influenced the functional outcome significantly early on and at 30 days and 90 days after stroke, and the most favorable outcome was observed when the site of lesion was in BG.

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

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

Epidemiology, neurological and functional outcome of concomitant traumatic brain and spinal cord injury: An Oswestry experience

Background Concomitant traumatic brain injury with spinal cord injury is likely to worsen prognosis and increase hospital length of stay. This study assessed the duration of in-patient rehabilitation and outcome in patients with both traumatic brain injury and spinal cord injury. Methods Retrospective study of all patients with concomitant traumatic brain injury and spinal cord injury over a 3-year period who had 5 years of subsequent follow-up at the Midlands Centre for Spinal Injuries. Results Twenty-seven patients had concomitant injuries of which five had severe traumatic brain injury, nine had moderate traumatic brain injury and the remaining thirteen had mild traumatic brain injury with spinal cord injury of grades A–D; commonest mechanisms of injury were motor vehicle collision (55%) and falls (37%). Thirteen (48%) had tetraplegia and 14 (52%) had paraplegia. Mean functional independence measure score at admission was 52.1 and 103.4 at 5 years. Patients with mild traumatic brain injury gained a mean functional independence measure score of 67.1; the moderate and severe traumatic brain injury patients gained mean functional independence measure score of 60.1 and 69.2, respectively. The mean length of stay was 138.3, 139.4 and 153.4 days for mild, moderate and severe traumatic brain injury, respectively. Conclusion Hospital length of stay and patient’s functioning at 5 years were not affected by traumatic brain injury severity in this subgroup; however, functional independence measure on its own may not be very sensitive to cognitive deficits.

Use of the Postural Assessment Scale for Stroke Patients in Determining Acute Care Discharge Recommendations

Purpose/Hypothesis: Acute care therapists face many barriers that limit the use of screening tools including time constraints and lack of measures appropriate for use in this setting. The Postural Assessment Scale for Stroke patients (PASS) was developed to assess sitting, lying, and standing balance in persons who experienced a stroke. The StrokEDGE taskforce highly recommends the PASS for acute care, as it has excellent psychometric properties and clinical utility. This project used the PASS and the modified Rankin Scale (mRS) to assess mobility in persons with an acute stroke. The purpose of this quality improvement project was to assess the feasibility of physical therapists' use of the PASS as a screening tool to assist with discharge recommendations. Description: Data were collected during a 6-month period from the neurology floor of a 782-bed acute care hospital. Persons admitted with an acute stroke and had received a therapy evaluation were included in the cohort. The goal was to assess the PASS during the initial evaluation within 48 hours of hospital admission. Concurrent data collected during this time included mRS scores, Functional Independence Measure (FIM) transfer and ambulation scores, and therapist discharge recommendations. Results/Conclusions: One hundred fifty-three subjects, with a mean age of 64.5 ± 15.5 years, were included in this cohort. The mean PASS score was 19.7 ± 11.1, the mean mRS score was 3.7 ± 2.2, and the mean FIM scores was 2.7 ± 2.4 for transfers and 3.7 ± 1.6 for ambulation. Of the persons discharged home (N = 40), mean PASS scores were 31.8 for those recommended for home physical therapy (N = 14), 32.6 for an outpatient therapy recommendation (N = 12), and 34.9 for those requiring no therapy at discharge (N = 14). The mean PASS scores for persons with an acute rehabilitation recommendation (N = 100) was higher than those recommended for a skilled nursing facility/subacute rehabilitation (N = 13), 15.7 as compared with 9.5, respectively. Using the Pearson correlation coefficient, the PASS had a strong correlation with the FIM transfers at r = 0.90 and ambulation at r = 0.86, with a strong negative correlation to the mRS at r =−0.77 (P &lt; .001). Clinical Relevance: Acute care therapists should consider using the PASS to help guide clinical decision making and discharge recommendations for persons hospitalized with a stroke.

Identification of the components associated with functioning using the international classification of functioning, disability and health comprehensive core set for stroke in Indian stroke survivors

Objectives: Rehabilitation interventions are expected to ensure best possible recovery and minimize functional disability in stroke survivors. However, not many studies have investigated patterns of recovery and outcomes after stroke in low-income countries. The objective of this study is to identify the biological, psychological, and social components associated with functioning over time in Indian stroke patients using the International Classification of Functioning, Disability and Health (ICF)-based tools and the Functional Independence Measure (FIM).Methods: The functioning profile of stroke survivors who received a standard multi-disciplinary rehabilitation was prospectively assessed using the ICF and the FIM at admission (baseline), at 12 & 24 weeks. Descriptive analyses were performed to identify changes in the frequencies of ICF categories and qualifiers from admission to follow-up.Results: One hundred and twenty-seven participants (mean age of 56 years) with mean FIM score 68 at baseline participated and completed the study. The mean FIM score at follow-up was 108. The numbers and frequency of ICF categories for activities and participation reduced after rehabilitation. More numbers of environmental factors were identified as barriers at follow-up (15 out of 33) compared to baseline. Within the components of Activities and Participation, significant improvement in functioning was found in 43 out of 51 categories.Conclusion: The results show a reduction in frequencies in ICF activities and participation categories corresponding to basic activities of daily living. Categories corresponding to employment and social integration showed little or no improvement.

A randomized placebo-controlled trial of progesterone with or without hypothermia in patients with acute severe traumatic brain injury.

Among newer neuroprotectant modalities, hypothermia and progesterone have shown a beneficial role in preliminary studies enrolling patients with severe traumatic brain injury (sTBI). The primary objective of this study was to evaluate the efficacy of progesterone with or without prophylactic hypothermia in acute sTBI patients. This is a prospective, outcome assessor, statistician blinded, randomized, and placebo-controlled phase II trial of progesterone with or without hypothermia (factorial design). All adult patients (18-65 years) with acute sTBI (Glasgow coma score of 4-8) and presenting to trauma center within 8 h after injury were included in the trial. Computer-generated randomization was done after exclusion; sequentially numbered, opaque, sealed envelope technique was used for allocation concealment. The enrollment duration was from January 2012 to October 2014. The primary endpoint was dichotomized Glasgow outcome score (GOS) [poor recovery = GOS 1-3; good recovery = GOS 4-5], and secondary endpoints were functional independence measure (FIM) score and mortality rate at 6 and 12 months follow-up after recruitment. A total of 107 patients were randomized into four groups (placebo [n = 27], progesterone [n = 26], hypothermia alone [n = 27], and progesterone + hypothermia [n = 27]). The study groups were comparable in baseline parameters except for a higher incidence of decompressive craniectomy in the placebo group (P = 0.001). The analysis of GOS at 6 months revealed statistically significant better outcome in the hypothermia group (82%; P = 0.01) and a weaker evidence for progesterone group (74%; P = 0.07) as compared with the placebo group (44%). However, the outcome benefit was marginal at 1-year follow-up for the hypothermia group (82% vs. 58%, P = 0.17). The adjusted odds ratio of poor recovery at 6 months in the hypothermia group was 0.21 (confidence interval = 0.05-0.84, P = 0.03), as compared with the placebo group. Although mean FIM scores at 6 and 12 months respectively were marginally higher in the hypothermia and progesterone groups compared with the placebo group (P = 0.06 and 0.27), the proportion of functionally independent individuals were similar in all the groups (P = 0.79 and 0.51). The mortality rates were similar in all the groups at 6 and 12 months (P = 0.78 and 0.52 respectively). A strong evidence for prophylactic hypothermia and a weak evidence for progesterone therapy was observed for a better primary outcome at 6 months as compared to the placebo. A similar trend was observed at a 1-year follow-up. Contrary to our hypothesis, prophylactic hypothermia therapy suppressed the beneficial effects of progesterone therapy in sTBI patients. The complex cascades of factors responsible for such interactions are still unknown and need to be further determined.

Prevalence of unmet needs and correlated factors in advanced-stage cancer patients receiving rehabilitation.

Although rehabilitation for patients with cancer is currently being provided throughout all phases of the disease, including the advanced stage, much remains unknown about the needs of such patients. The aims of this study were to identify the supportive care and unmet needs of cancer patients receiving rehabilitation interventions and to investigate the factors associated with those unmet needs. A total of 45 patients with cancer receiving rehabilitation interventions participated in this study between June 2013 and December 2015. Measures included the Japanese version of the Short-Form Supportive Care Needs Survey Questionnaire (SCNS-SF34), the Functional Independence Measure (FIM), the Hospital Anxiety and Depression Scale (HADS), and various other medico-social factors. The mean age of the cancer patients was 66.6years, the mean (±standard deviation) FIM score was 111.8 (±16.1), and the mean HADS score was 13.9 (±8.2). The patients had a mean of 17.4 (±10.3) unmet needs. The top ten unmet needs related to rehabilitation intervention included seven psychological needs, two health system and information needs, and one physical and daily living need. Multiple regression analysis revealed that psychological distress (HADS ≥11), marital status, and sex were significantly associated with physical and daily living needs. These results suggest that psychosocial factors are important in understanding the supportive care and unmet needs of cancer patients receiving rehabilitation interventions.

An Analysis of Inpatient Rehabilitation Approval Among Private Insurance Carriers at a Cancer Center

BackgroundAcute inpatient rehabilitation is often used by cancer patients to assist with discharge home and/or preparation for further treatment. Private insurance patients often require approval before transfer to acute inpatient rehabilitation. ObjectiveTo analyze the approval rate of private insurance carriers for acute inpatient cancer rehabilitation. DesignRetrospective analysis. SettingTertiary referral-based cancer center. PatientsA total of 96 consecutive patients with private insurance who had acute inpatient rehabilitation authorization requests made between April 1, 2014, and September 17, 2014. InterventionPatient cases were assessed by a physiatrist, deemed clinically appropriate for acute inpatient rehabilitation, and submitted to private insurance payers for an approval request. ResultsIn all, 84 of 96 requests (87%) for private insurance authorization for inpatient rehabilitation transfer were approved. Of the 96 cases, 14 cases (14.6%) were initially denied. Nine of 96 (9.4%) progressed to a peer-to-peer appeal, of which only 2 of 9 (11.1%) resulted in approval for inpatient rehabilitation transfer (P = .222). The insurance carriers represented were designated as insurance A (46 patients, 48%), insurance B (18 patients, 19%), insurance C (12 patients, 13%), and other insurances (20, 21%). Two of 46 insurance A requests were initially denied, as compared to 7 of 18 for insurance B, 0 of 12 for insurance C, and 4 of 20 for other insurances (P = .001). Patients with insurance B (P = .002, odds ratio = 14) and other insurances (P = .062, odds ratio = 5.50) were more likely to be denied inpatient rehabilitation approval compared to patients with insurance A. No significant difference between mean Functional Independence Measure scores for approved and denied patients were found for transfers (P = .239) and mobility (P = .129), respectively. ConclusionAccess to acute inpatient rehabilitation is unfortunately limited by insurers rather than clinical indicators. Future multicenter studies and universally accepted guidelines regarding inpatient rehabilitation criteria are needed.

Prevalence and Types of Anemia and Associations with Functional Decline in Geriatric Inpatients.

The prevalence of anemia in hospitalized seniors has been linked to poor functional outcomes, increased mortality, and longer hospital stays, and has been associated with advancing age, male sex, and cognitive impairment. Despite the potential for complications, anemia often is undiagnosed and/or untreated in seniors. Examine (a) the distribution of anemia diagnosis and treatment in patients in a rehabilitation hospital, and (b) patients' cognitive and functional outcomes. Retrospective chart review of medical records of 132 patients. The presence and type of anemia were determined based on the World Health Organization criteria for adults and Smith's algorithm, respectively. The Mini-Mental State Exam (MMSE) was used to measure cognitive status. Functional impairment was assessed using the Functional Independence Measure (FIM). The mean age of the sample was 82.20 years, with 68% being female, the mean MMSE and FIM scores were 23.95 (SD = 4.3) and 82.82 (SD = 15.63), respectively. In total, 67% of males and 46% of females were anemic (P < 0.05). The majority of anemias were caused by nutritional deficiencies. The percent of anemic females receiving treatment for anemia was higher (71%) than the percent of anemic males (46%) (P < 0.05). The majority of the patients improved functionally regardless of anemia status. Results indicated that a substantial number of patients in a geriatric hospital were anemic, with significant percentage going untreated. The overall improvement in patients' functional abilities suggests that remedial rehabilitation of frail seniors has an impact on recovery during their hospital stay.