Functional Independence Measure Motor Research Articles

Machine Learning Web Application for Predicting Functional Outcomes in Patients With Traumatic Spinal Cord Injury Following Inpatient Rehabilitation.

Accurately predicting functional outcomes in patients with spinal cord injury (SCI) helps clinicians set realistic functional recovery goals and improve the home environment after discharge. The present study aimed to develop and validate machine learning (ML) models to predict functional outcomes in patients with SCI and deploy the models within a web application. The study included data from the Japan Association of Rehabilitation Database from January 1, 1991, to December 31, 2015. Patients with SCI who were admitted to an SCI center or transferred to a participating post-acute rehabilitation hospital after receiving acute treatment were enrolled in this database. The primary outcome was functional ambulation at discharge from the rehabilitation hospital. The secondary outcome was the total motor Functional Independence Measure (FIM) score at discharge. We used binary classification models to predict whether functional ambulation was achieved, as well as regression models to predict total motor FIM scores at discharge. In the training dataset (70% random sample) using demographic characteristics and neurological and functional status as predictors, we built prediction performance matrices of multiple ML models and selected the best one for each outcome. We validated each model's predictive performance in the test dataset (the remaining 30%). Among the 4181 patients, 3827 were included in the prediction model for the total motor FIM score. The mean (standard deviation [SD]) age was 50.4 (18.7) years, and 3211 (83.9%) patients were male. There were 3122 patients included in the prediction model for functional ambulation. The CatBoost Classifier and regressor models showed the best performances in the training dataset. On the test dataset, the CatBoost Classifier had an area under the receiver operating characteristic curve of 0.8572 and an accuracy of 0.7769 for predicting functional ambulation. Likewise, the CatBoost Regressor performed well, with an R2 of 0.7859, a mean absolute error of 9.2957, and a root mean square error of 13.4846 for predicting the total motor FIM score. The final models were deployed in a web application to provide functional predictions. The application can be found at http://3.138.174.54:8501. In conclusion, our prediction models developed using ML successfully predicted functional outcomes in patients with SCI and were deployed in an open-access web application.

Concurrent Negative Impact of Undernutrition and Heart Failure on Functional and Cognitive Recovery in Hip Fracture Patients.

Evidence on the effects of frailty, undernutrition, and heart failure (HF) on patients with hip fractures is scarce. This retrospective cohort study aimed to examine the effects of undernutrition and HF on outcomes in patients who underwent convalescent rehabilitation after hip fracture. Undernutrition was defined as body mass index (BMI) < 20.0 (Low BMI). Heart failure (HF) was defined as a B-type natriuretic peptide (BNP) > 100 (High BNP). The study outcomes included the Functional Independence Measure motor domain (FIM-motor) and cognitive domain (FIM-cognition) at discharge. To consider the effects of low BMI, high BNP, and the simultaneous presence of both ("low BMI and high BNP"), we used multivariate linear regression analyses to examine whether these were associated with the outcomes. A total of 110 (mean age 87.4 years, 24.8% male) were analyzed. As a result, low BMI (β = -0.088, p = 0.027) and high BNP (β = -0.053, p = 0.015), each alone, were significantly associated with the FIM motor at discharge, whereas the simultaneous presence of "low BMI and high BNP" was significantly associated with the FIM motor at discharge, while the strength of the association was greater than each association alone (β = -0.152, p = 0.010). Further, the simultaneous presence of "low BMI and high BNP" was significantly associated with FIM cognition at discharge (β = -0.109, p = 0.014). Comprehensive multidisciplinary management is needed, including preoperative or early postoperative nutritional support and rehabilitation, followed by rehabilitation nutrition care management, in patients with hip fracture.

The Association between Oral Health Management and the Functional Independence Measure Scores at the Time of Admission of Inpatients to a Convalescent Hospital.

Many older patients admitted to convalescent hospitals present with impaired oral function, which is an important function of daily life. This study aimed to investigate the actual status of the oral healthcare needs of inpatients in a convalescent hospital and to clarify the relationship between the level of independence at admission and the oral function. The participants were 147 patients (94 males, 53 females, mean age: 74.6 ± 13.1 years) who received dental visits during their stay at a convalescent hospital. Information regarding general and oral health was extracted from medical records. Most patients were found to have low Functional Independence Measure motor scores, and approximately 70% had some form of oral intake, but approximately 80% had nutritional problems. The mean number of present and functional teeth were 16.6 and 20.8, respectively, and 65% of patients lost molar occlusal support. Multiple regression analysis showed significant positive correlations of high functional independence measure with age, eating status, nutritional status, and the number of functional teeth. This implied that oral health management is important for patients in a convalescent hospital and that enhancing oral health may be related to improved eating textures and better nutritional status.

Effect of rehabilitation motivation on improving activities of daily living in subacute stroke patients

ObjectivesTo determine the effect of rehabilitation motivation on activities of daily living improvement in subacute stroke patients starting intensive rehabilitation. Materials and methodsThis was a single-center cohort study involving patients with a subacute stroke who were admitted to or discharged from a Recovery Rehabilitation Unit between February 2021 and August 2022. Improvement in Activity of Daily Living was evaluated using the Functional Independence Measure. We calculated the corrected motor Functional Independence Measure effectiveness using its motor-related items at admission and discharge. The Behavioral Regulation in Exercise Questionnaire 2 was used to evaluate admission rehabilitation motivation, and the Relative Autonomy index was calculated. Hierarchical multiple regression analysis was used to examine the relationship between the corrected motor Functional Independence Measure effectiveness and the Relative Autonomy Index. ResultsEighty-six of the 231 patients (37.2 %) were included in the analysis. Hierarchical multiple regression analysis adjusted for demographic and clinical variables demonstrated that age, comorbidities, and Relative Autonomy Index were significantly associated with corrected motor Functional Independence Measure effectiveness (R2 = 0.423, p ≺ .001). ConclusionMotivation at intensive rehabilitation initiation in patients with a subacute stroke influences Activities of Daily Living improvement. These results may help develop rehabilitation programs aimed at improving Activities of Daily Living in patients with subacute strokes.

A data-driven approach to categorize patients with traumatic spinal cord injury: cluster analysis of a multicentre database.

Conducting clinical trials for traumatic spinal cord injury (tSCI) presents challenges due to patient heterogeneity. Identifying clinically similar subgroups using patient demographics and baseline injury characteristics could lead to better patient-centered care and integrated care delivery. We sought to (1) apply an unsupervised machine learning approach of cluster analysis to identify subgroups of tSCI patients using patient demographics and injury characteristics at baseline, (2) to find clinical similarity within subgroups using etiological variables and outcome variables, and (3) to create multi-dimensional labels for categorizing patients. Retrospective analysis using prospectively collected data from a large national multicenter SCI registry. A method of spectral clustering was used to identify patient subgroups based on the following baseline variables collected since admission until rehabilitation: location of the injury, severity of the injury, Functional Independence Measure (FIM) motor, and demographic data (age, and body mass index). The FIM motor score, the FIM motor score change, and the total length of stay were assessed on the subgroups as outcome variables at discharge to establish the clinical similarity of the patients within derived subgroups. Furthermore, we discussed the relevance of the identified subgroups based on the etiological variables (energy and mechanism of injury) and compared them with the literature. Our study also employed a qualitative approach to systematically describe the identified subgroups, crafting multi-dimensional labels to highlight distinguishing factors and patient-focused insights. Data on 334 tSCI patients from the Rick Hansen Spinal Cord Injury Registry was analyzed. Five significantly different subgroups were identified (p-value ≤0.05) based on baseline variables. Outcome variables at discharge superimposed on these subgroups had statistically different values between them (p-value ≤0.05) and supported the notion of clinical similarity of patients within each subgroup. Utilizing cluster analysis, we identified five clinically similar subgroups of tSCI patients at baseline, yielding statistically significant inter-group differences in clinical outcomes. These subgroups offer a novel, data-driven categorization of tSCI patients which aligns with their demographics and injury characteristics. As it also correlates with traditional tSCI classifications, this categorization could lead to improved personalized patient-centered care.

Feasibility and outcomes of supplemental gait training by robotic and conventional means in acute stroke rehabilitation

IntroductionPracticality of implementation and dosing of supplemental gait training in an acute stroke inpatient rehabilitation setting are not well studied but can have positive impact on outcomes.ObjectivesTo determine the feasibility of early, intense supplemental gait training in inpatient stroke rehabilitation, compare functional outcomes and the specific mode of delivery.Design and settingAssessor blinded, randomized controlled trial in a tertiary Inpatient Rehabilitation Facility.ParticipantsThirty acute post-stroke patients with unilateral hemiparesis (≥ 18 years of age with a lower limb MAS ≤ 3).InterventionLokomat® or conventional gait training (CGT) in addition to standard mandated therapy time.Main outcome measuresNumber of therapy sessions; adverse events; functional independence measure (FIM motor); functional ambulation category (FAC); passive range of motion (PROM); modified Ashworth scale (MAS); 5 times sit-to-stand (5x-STS); 10-m walk test (10MWT); 2-min walk test (2MWT) were assessed before (pre) and after training (post).ResultsThe desired supplemental therapy was implemented during normal care delivery hours and the patients generally tolerated the sessions well. Both groups improved markedly on several measures; the CGT group obtained nearly 45% more supplemental sessions (12.8) than the Lokomat® group (8.9). Both groups showed greater FIM improvement scores (discharge – admission) than those from a reference group receiving no supplemental therapy. An overarching statistical comparison between methods was skewed towards a differential benefit (but not significant) in the Lokomat® group with medium effect sizes. By observation, the robotic group completed a greater number of steps, on average. These results provide some evidence for Lokomat® being a more efficient tool for gait retraining by providing a more optimal therapy “dose”.ConclusionsWith careful planning, supplemental therapy was possible with minimal intrusion to schedules and was well tolerated. Participants showed meaningful functional improvement with relatively little supplemental therapy over a relatively short time in study.

Traumatic Brain Injury Rehabilitation Outcome Prediction Using Machine Learning Methods

ObjectiveTo investigate the performance of machine learning (ML) methods for predicting outcomes from inpatient rehabilitation for subjects with TBI using a dataset with a large number of predictor variables. Our second objective was to identify top predictive features selected by the ML models for each outcome and to validate the interpretability of the models. DesignSecondary analysis using computational modeling of relationships between patients, injury and treatment activities and 6 outcomes, applied to the large multi-site, prospective, longitudinal observational dataset collected during the traumatic brain injury inpatient rehabilitation study. SettingAcute inpatient rehabilitation. Participants1946 patients aged 14 years or older, who sustained a severe, moderate, or complicated mild TBI, and were admitted to 1 of 9 US inpatient rehabilitation sites between 2008 and 2011 (N=1946). Main Outcome MeasuresRehabilitation length of stay, discharge to home, FIM cognitive and FIM motor at discharge and at 9-months post discharge. ResultsAdvanced ML models, specifically gradient boosting tree model, performed consistently better than all other models, including classical linear regression models. Top ranked predictive features were identified for each of the 6 outcome variables. Level of effort, days to rehabilitation admission, age at rehabilitation admission, and advanced mobility activities were the most frequently top ranked predictive features. The highest-ranking predictive feature differed across the specific outcome variable. ConclusionsIdentifying patient, injury, and rehabilitation treatment variables that are predictive of better outcomes will contribute to cost-effective care delivery and guide evidence-based clinical practice. ML methods can contribute to these efforts.

Factors Associated with Improvement in Activities of Daily Living during Hospitalization: A Retrospective Study of Older Patients with Hip Fractures.

In this study, we aimed to examine the changes in delirium during hospitalization of patients and its association with behavioral and psychological symptoms of dementia (BPSD), as well as improvements in activities of daily living (ADL). A longitudinal, retrospective cohort study was conducted involving 83 older adults (≥65 years) with hip fractures. We collected Mini-Mental State Examination (MMSE) and Functional Independence Measure-motor domain (m-FIM) assessment results from the medical charts at two time points: baseline (first week of hospitalization) and pre-discharge (final week before discharge). Additionally, we collected data on delirium and BPSD at three points: baseline, week 2 post-admission, and pre-discharge. We performed univariate logistic regression analysis using changes in m-FIM scores as the dependent variable and MMSE and m-FIM scores at baseline and pre-discharge, along with delirium and BPSD subtypes at baseline, week 2 post-admission, and pre-discharge, as the explanatory variables. Finally, we performed a multivariate logistic regression analysis incorporating the significant variables from the univariate analysis to identify factors associated with ADL improvement during hospitalization. We observed significant correlations between ADL improvement during hospitalization and baseline m-FIM and MMSE scores, hypoactive delirium state, and BPSD subtype pre-discharge. Notably, all participants with hypoactive symptoms before discharge exhibited some subtype of delirium and BPSD at baseline. Besides ADL ability and cognitive function at admission, the presence of hypoactive delirium and BPSD subtype before discharge may hinder ADL improvement during hospitalization.

Hospital-associated sarcopenia and the preventive effect of high energy intake along with intensive rehabilitation in patients with acute stroke

ObjectivesHospital-associated sarcopenia is prevalent and associated with poor outcomes in acutely admitted patients. Prevention of developing sarcopenia during hospitalization is an important factor in stroke management. Therefore, this study aimed to investigate whether energy intake and rehabilitation duration contribute to the prevention of hospital-associated sarcopenia in patients with acute stroke. MethodsPatients with acute stroke were included in this study. Energy intake during the first week of hospitalization was classified as “high” or “low” based on the reported cutoff value. Rehabilitation time during hospitalization was classified as “intense” or “mild” based on the median. The four groups were compared based on the combinations of high or low energy intake and intense or mild rehabilitation. The primary outcome was the development of sarcopenia during hospitalization. The secondary outcome was the Functional Independence Measure motor item gain during hospitalization. Multivariate analysis was performed with the primary or secondary outcome as the dependent variable and the effect of each group on the outcome was examined. ResultsA total of 112 participants (mean age = 70.6 y; 63 men) were included in the study. Multivariate analysis found that high × intense (odds ratio = 0.113; P = 0.041) was independently associated with the development of sarcopenia during hospitalization (i.e., hospital-related sarcopenia). High × intense (β = 0.395; P < 0.001) was independently associated with the gain of Functional Independence Measure motor items. ConclusionsIn patients with acute stroke, the combination of high energy intake and adequate rehabilitation time is associated with prevention of hospital-associated sarcopenia.

Respiratory Rehabilitation Improves Quality of Life and Functionality of Covid 19 Patients

Abstract Respiratory rehabilitation leads to reduction of symptoms, strengthens extremity musculature and improves emotional state and management of daily activities in patients with respiratory diseases. Aim of our study was to determine quality of life and functionality of COVID 19 patients before and after respiratory rehabilitation program. The study was conducted at the Clinical Center, Kragujevac, from June to July 2020. The study was a prospective clinical trial and included 62 patients with the acutephase of COVID-19. Respiratory rehabilitation program started at hospital and continued at home for three months overall. Quality of life was measured by the EQ-5D-5L and patient’s functionality by The FIM score. All five dimension of EQ-5D-5L were higher after respiratory rehabilitation program as well as EQ-5D index score and VAS score (0.8516±0.202 and 53.31±17.129 before rehabilitation, 0.9147±0.074 and 64.53±8.368 after rehabilitation). Respiratory exercise showed significantly improvement in FIM total score from 104.48±12.880 to 106.21±9.791, as well as in FIM motor and cognitive subscores. Respiratory rehabilitation program improves quality of life and functionality of COVID 19 patients.

The impact of body mass index changes on traumatic brain injury patients’ outcomes during hospitalization

PurposeObesity is a complex multifactorial disease with increasing prevalence worldwide. The present study was conducted, since there were different results on the effect of obesity on the prognosis of patients with moderate and severe brain trauma, and the issue was less investigated. MethodsThe present descriptive-analytical study was conducted in 2 hospitals, Al-Zahra and Kashani in year 2022. Patients with Glasgow coma scale (GCS) score of 9 – 12 (moderate concussion) and patients with a GCS score of < 8 (severe concussion) who consented to participate in the study were included in the study. Patients who died; had serious injuries related to the chest, abdomen, pelvis, spine, and organs, in addition to the concussion; had a part of their body amputated during the same incident; received medications; or had diseases which caused obesity like diabetes were excluded from the study. Patients’ height and weight were extracted for calculating the body mass index (BMI). Their functional independences were measured at admission and discharge according to the Glasgow outcome scale-extended (GOSE) scale. All the data were analyzed in SPSS 26. ResultsThis study examined a total of 287 traumatic brain injury (TBI) patients (251 with moderate concussion and 36 with severe concussion). In total, 91 (36.3%) patients with moderate TBI had a lower BMI, and 14 (38.9%) patients with severe TBI had a constant BMI. There was a significant difference between the mean changes of BMI and the GOSE, functional independence measure (FIM) motor (p = 0.006), FIM cognitive (p = 0.023), and FIM total scores (p = 0.002) in patients with severe TBI; however, significant difference was found only between the mean changes of BMI, GOSE and FIM motor scores (p = 0.001) in patients with moderate TBI. ConclusionBMI is a risk factor affecting treatment results in patients with TBI, which should be controlled.

Concurrent Validation of the Inpatient Rehabilitation Facility Patient Assessment Instrument Version 1.4; Sections GG, B, and C

ObjectiveTo validate Sections GG (Self-Care and Mobility Assessment), B (Hearing, Speech, and Vision), and C (Cognitive Patterns) of the Centers for Medicare and Medicaid Services Inpatient Rehabilitation Facility Patient Assessment Instrument (CMS-IRF PAI) Version 1.4 in comparison with Functional Independence Measure (FIM) motor subscale (FIMm) and cognitive subscale (FIMc). DesignRetrospective cohort. SettingSingle inpatient rehabilitation facility. ParticipantsCohort of 1296 patients admitted for rehabilitation after stroke, between October 1, 2016, and October 1, 2019. InterventionsNot applicable. Main Outcome MeasuresSections GG, B, and C scores were compared with FIMm and FIMc using Spearman's and Bland-Altman Analyses. ResultsSections GG and FIMm were highly correlated on admission (ρ=0.919, P<.001) and discharge (ρ=0.929, P<.001). Ceiling effects at discharge were more pronounced for Section GG (8.6%). Bland-Altman analyses revealed a bias toward higher scores on Section GG vs FIMm on admission (Bias=2.3%, P<.001), and discharge (Bias=6.2%, P<.001). Section GG showed bias toward greater gains in function (Bias=3.9%, P<.001), particularly in walking and stairs (bias=3.71%, P<.001). Comparable self-care items accounted for a smaller percentage of the Section GG gains compared with FIMm (bias=-7.5%, P<.001).The internal validity of a scale consisting of Section B and C (B+C scale) was good, (Cronbach's alpha=0.868) and was highly correlated with FIMc (ρ=0.745), but rated patients at a higher level of cognition (bias=20.0%, P<.001) and had a greater ceiling effect (20.4%) on admission compared with the FIMc (0.6%). ConclusionThe B+C scale and Section GG were correlated with FIMc and FIMm subscales but biased toward higher ratings of ability. Ceiling effects may limit discrimination at higher level of cognition/functional independence. The clinical acceptability of Section GG total scores as an outcome measure and predictor of long-term outcomes requires further study.

Clinical efficacy of assessment of swallowing ability for pneumonia and other assessment tools for occurrence and mortality from pneumonia among older inpatients in a long-term care hospital

BackgroundAspiration pneumonia is an important condition in elderly patients and detecting dysphagia early can help clinicians identify patients with a high risk of aspiration pneumonia. We previously reported the usefulness of the Assessment of Swallowing Ability for Pneumonia (ASAP) in predicting the occurrence of and mortality from pneumonia in patients in acute care hospitals; however, there are very few reports on the utility of this screening test for patients in stable condition. MethodsElderly patients in stable condition (n = 133) without pneumonia were prospectively enrolled. Associations between ASAP, Functional Independence Measure (FIM), Controlling Nutrition Status (CONUT), and Charlson Co-morbidity Index (CCI) scores and occurrence of/mortality from pneumonia during hospitalization were evaluated. ResultsThe occurrence of pneumonia was observed in 27 (20.3%) patients, and 18 (13.5%) died during hospitalization. Multivariate analysis showed that low ASAP score and low FIM motor were independent predictors for the occurrence of pneumonia, and low ASAP score was an independent predictor for mortality from pneumonia. Areas under the curve for ASAP, FIM motor, FIM cognition, and CONUT scores were 0.895 (95% confidence interval [CI], 0.829–0.960), 0.913 (95% CI, 0.860–0.968), 0.841 (95% CI, 0.761–0.921), and 0.753 (95% CI, 0.649–0.858), respectively, for occurrence, and 0.881 (95% CI, 0.807–0.955), 0.904 (95% CI, 0.860–0.949), 0.829 (95% CI, 0.727–0.931), 0.746 (95% CI, 0.617–0.874), respectively, for mortality. ConclusionThe ASAP and FIM motor are useful for predicting the occurrence of and mortality from pneumonia in elderly inpatients in long-term care hospitals.

Predictors of patient length of stay post stroke rehabilitation.

There is little research on length of hospital stay (LOS) in patients post stroke in South African rehabilitation facilities. As LOS is an important indicator of cost-of-care, this information may be useful to all stakeholders. To determine the predictors of hospital LOS in patients post stroke rehabilitation. A retrospective file review of 243 patients. Patient functional ability was measured using the Functional Independence Measure (FIM). Predictors of LOS were determined with multiple regression analysis. The median admission and discharge FIM scores were 43 (range: 16-119) and 75 (range: 16-120) points respectively. The median LOS was 43 (range: 3-112) days. Predictors of LOS were premorbid psychiatric conditions, impaired speech, requiring oxygen support, the development of pneumonia and admission FIM motor score, with admission FIM motor score being the strongest individual predictor of LOS (41%). Admission FIM score had an influence on patient outcomes and LOS. Patients with higher admission FIM motor scores may be able to participate in rehabilitation better and thus have shorter LOS. Being able to predict LOS on admission allows facility administrators to manage bed occupancy, human and clinical resources in post stroke rehabilitation.

Physical functioning factors predicting a return home after stroke rehabilitation: A systematic review and meta-analysis.

This systematic review and meta-analysis sought to identify the physical functioning factors associated with home discharge after inpatient stroke rehabilitation. A search of PubMed, Embase, CINHAL, The Cochrane Library (Trials), Web of Science, and PEDro were conducted up until May 2023. Two independent reviewers selected studies for population (patients with stroke), predictive factors (physical functioning), outcome (discharge destination), setting (inpatient rehabilitation), and study designs (observational and experimental studies). Predictive factors were identified among assessments of the "body function" and "activity" components of the International Classification of Functioning. Methodological quality was assessed with the Newcastle-Ottawa Scale. The findings used quantitative and narrative syntheses. Meta-analyses were performed with the inverse variance method and the random-effects model using included studies with sufficient data. Forty-five studies were included with 204,787 participants. Included studies assessed the association of independence in activities of daily living, walking, rolling, transferring, and balance on admission with a probability of returning home. Motor (odds ratio = 1.23, 95% confidence interval: 1.12-1.35, p < .001) and total (odds ratio = 1.34, 95% confidence interval: 1.14-1.57, p < .001) Functional Independence Measure scores on admission were significantly associated with home discharge in meta-analyses. Additionally, included studies showed that independence in motor activities, such as sitting, transferring, and walking, and scores above thresholds for the Functional Independence Measure and Berg Balance Scale on admission were associated with discharge destination. This review showed that higher independence in activities of daily living on admission is associated with home discharge after inpatient stroke rehabilitation.

Assessing functional recovery for individuals with spinal cord injury post-discharge from inpatient rehabilitation

Objective To determine the associations between trauma variables, acute phase-related variables, and patient-level characteristics with functional recovery during the first-year post-discharge from inpatient rehabilitation facilities (IRF) for individuals with spinal cord injury (SCI). Design Retrospective cohort analysis. Setting Two SCI Model Centers in Pennsylvania, United States. Methods We were able to link 378 individuals with traumatic SCI between the Pennsylvania Trauma Systems Outcomes Study and the National SCI Model Systems databases. Nineteen individuals with SCI were excluded due to missing data. We estimated functional recovery based on changes in functional independence measure (FIM) total motor score during the first-year post-discharge from IRF in 359 individuals with SCI, who did not have any missing data, using ordinary least squares regression (OLS). Results After discharge from IRF the majority of individuals with SCI improved over the first-year post-injury. Individuals with cervical A-C (injury severity group) who were older had a slight decrease in motor FIM at 1-year post-injury. Regression analysis indicated that lower functional recovery was associated with being of Black and Hispanic race and ethnicity, higher injury severity group, occurrence of non-pulmonary infection during acute care, and longer length of stay at IRF (R 2 = 0.36). Conclusions Patient-level characteristics, trauma variables, and acute phase-related variables were associated with functional recovery post-discharge from IRF. Further research is necessary to collect and assess post-rehabilitation and socio-economic factors that play a critical role in continued functional recovery in the community.

Quantitative measurement of finger usage in stroke hemiplegia using ring-shaped wearable devices

BackgroundIn post-stroke rehabilitation, positive use of affected limbs in daily life is important to improve affected upper-limb function. Several studies have quantitatively evaluated the amount of upper-limb activity, but few have measured finger usage. In this study, we used a ring-shaped wearable device to measure upper-limb and finger usage simultaneously in hospitalized patients with hemiplegic stroke and investigated the association between finger usage and general clinical evaluation.MethodsTwenty patients with hemiplegic stroke in an inpatient hospital participated in this study. All patients wore a ring-shaped wearable device on both hands for 9 h on the day of the intervention, and their finger and upper-limb usage were recorded. For the rehabilitation outcome assessments, the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), Simple Test for Evaluating Hand Function (STEF), Action Research Arm Test (ARAT), Motor Activity Log-14 (MAL), and Functional Independence Measure Motor (FIM-m) were performed and evaluated on the same day as the intervention.ResultsFinger usage of the affected hand was moderately correlated with STEF (r=0.48, p<0.05) and STEF ratio (r=0.47, p<0.05). The finger-usage ratio was moderately correlated with FMA-UE (r=0.56, p<0.05) and ARAT (r=0.53, p<0.05), and strongly correlated with STEF (r=0.80, p<0.01) and STEF ratio (r=0.80, p<0.01). The upper-limb usage of the affected side was moderately correlated with FMA-UE (r=0.46, p<0.05), STEF (r=0.55, p<0.05) and STEF ratio (r=0.54, p<0.05), and strongly correlated with ARAT (r=0.57, p<0.01). The upper-limb usage ratio was moderately correlated with ARAT (r=0.48, p<0.05) and STEF (r=0.55, p<0.05), and strongly correlated with the STEF ratio (r=0.61, p<0.01). By contrast, there was no correlation between MAL and any of the measurements.ConclusionsThis measurement technique provided useful information that was not biased by the subjectivity of the patients and therapists.

Rehabilitation after Hip Fracture Surgery Improves Physical and Cognitive Function in Patients with or Without Sarcopenia.

Sarcopenia is a prevalent risk factor for falls and fractures, and it affects the physical function and mortality of older people. The present study was performed to assess the prevalence of sarcopenia in patients who underwent rehabilitation after hip fracture surgery and to examine the association of sarcopenia with physical and cognitive function outcomes. This case-control study involved 132 patients who were admitted to a convalescent rehabilitation ward at a single hospital after surgical treatment of hip fractures from April 2018 to March 2020. The skeletal muscle mass index was examined using whole-body dual-energy X-ray absorptiometry. The Asian Working Group for Sarcopenia 2019 diagnostic criteria were applied on admission. We compared the walking speed, Mini-Mental State Examination (MMSE) score, and Functional Independence Measure (FIM) score between the sarcopenia group and non-sarcopenia group on admission and on discharge. The prevalence of sarcopenia was 59.8%. In the non-sarcopenia group, the walking speed, MMSE score, FIM total score, FIM motor score, and FIM cognitive score were significantly lower on admission than those on discharge (P < .05). In the sarcopenia group, the walking speed, MMSE score, FIM total score, and FIM motor score were significantly lower on admission than those on discharge (P < .05); there was no significant difference in the FIM cognitive score between admission and discharge. On both admission and discharge, the MMSE score, FIM total score, FIM motor score, and FIM cognitive score were significantly better in the non-sarcopenia group than those in the sarcopenia group. After postoperative rehabilitation of hip fractures in patients with and without sarcopenia, physical and cognitive function outcomes on discharge were significantly better than those on admission. Patients with sarcopenia had significantly worse physical and cognitive function outcomes than patients without sarcopenia both on admission and on discharge.

Interrater Reliability of the Scale for the Assessment and Rating of Ataxia, Berg Balance Scale, and Functional Independence Measure Motor Domain in Individuals With Hereditary Cerebellar Ataxia

ObjectiveTo determine the interrater reliability of the Scale for the Assessment and Rating of Ataxia (SARA), Berg Balance Scale (BBS), and motor domain of the FIM (m-FIM) administered by physiotherapists in individuals with a hereditary cerebellar ataxia (HCA). DesignParticipants were assessed by 1 of 4 physiotherapists. Assessments were video-recorded and the remaining 3 physiotherapists scored the scales for each participant. Raters were blinded to each other's scores. SettingAssessments were administered at 3 clinical locations in separate states in Australia. ParticipantsTwenty-one individuals (mean age=47.63 years; SD=18.42; 13 male and 8 female) living in the community with an HCA were recruited (N=21). Main Outcome MeasuresTotal and single-item scores of the SARA, BBS, and m-FIM were examined. The m-FIM was conducted by interview. ResultsIntraclass coefficients (2,1) for the total scores of the m-FIM (0.92; 95% confidence interval [CI], 0.85-0.96), SARA (0.92; 95% CI, 0.86-0.96), and BBS (0.99; 95% CI, 0.98-0.99) indicated excellent interrater reliability. However, there was inconsistent agreement with the individual items, with SARA item 5 (right side) and item 7 (both sides) demonstrating poor interrater reliability and items 1 and 2 demonstrating excellent reliability. ConclusionsThe m-FIM (by interview), SARA, and BBS have excellent interrater reliability for use when assessing individuals with an HCA. Physiotherapists could be considered for administration of the SARA in clinical trials. However, further work is required to improve the agreement of the single-item scores and to examine the other psychometric properties of these scales.

Improvement of predictive accuracies of functional outcomes after subacute stroke inpatient rehabilitation by machine learning models.

Stepwise linear regression (SLR) is the most common approach to predicting activities of daily living at discharge with the Functional Independence Measure (FIM) in stroke patients, but noisy nonlinear clinical data decrease the predictive accuracies of SLR. Machine learning is gaining attention in the medical field for such nonlinear data. Previous studies reported that machine learning models, regression tree (RT), ensemble learning (EL), artificial neural networks (ANNs), support vector regression (SVR), and Gaussian process regression (GPR), are robust to such data and increase predictive accuracies. This study aimed to compare the predictive accuracies of SLR and these machine learning models for FIM scores in stroke patients. Subacute stroke patients (N = 1,046) who underwent inpatient rehabilitation participated in this study. Only patients' background characteristics and FIM scores at admission were used to build each predictive model of SLR, RT, EL, ANN, SVR, and GPR with 10-fold cross-validation. The coefficient of determination (R2) and root mean square error (RMSE) values were compared between the actual and predicted discharge FIM scores and FIM gain. Machine learning models (R2 of RT = 0.75, EL = 0.78, ANN = 0.81, SVR = 0.80, GPR = 0.81) outperformed SLR (0.70) to predict discharge FIM motor scores. The predictive accuracies of machine learning methods for FIM total gain (R2 of RT = 0.48, EL = 0.51, ANN = 0.50, SVR = 0.51, GPR = 0.54) were also better than of SLR (0.22). This study suggested that the machine learning models outperformed SLR for predicting FIM prognosis. The machine learning models used only patients' background characteristics and FIM scores at admission and more accurately predicted FIM gain than previous studies. ANN, SVR, and GPR outperformed RT and EL. GPR could have the best predictive accuracy for FIM prognosis.