Activities Of Daily Living Recovery Research Articles

The impact of an enhanced recovery after surgery protocol for major head and neck oncologic surgery on postoperative complications and adjuvant treatment delivery.

The Commission on Cancer (CoC) recently introduced a quality metric to optimize time between major head and neck surgery and adjuvant treatment (TAT) ≤6 weeks, as TAT delay adversely impacts patient survival. This study evaluates whether enhanced recovery after surgery (ERAS) for this population reduces the rate of postoperative complications, length of stay (LOS), and TAT. Patients undergoing larynx or oral cavity resection with free flap reconstruction, ERAS, and adjuvant treatment after 2018 were compared to a historical pre-ERAS cohort. Patients underwent surgery at a single-institution tertiary referral center for complex head and neck oncology. Differences between groups were compared by chi-square, Fisher's exact, or Wilcoxon rank-sum test. TAT >6 weeks was evaluated with univariate and multivariable logistic regression. Thirty-nine pre-ERAS patients were compared to 39 ERAS patients. No demographic differences existed between groups. LOS was improved with ERAS (p = 0.005). ERAS patients were discharged to home and returned to their activities of daily living (ADL) earlier (p = 0.004, 0.001). ADL recovery was associated with on-time TAT ≤42 days on univariate analysis (OR 1.36, 95% CI 1.13-1.63, p = 0.001). TAT delay was less frequent with ERAS (51.3% vs. 69.2%), but this was not significant after multivariable logistic regression (p = 0.11). ERAS decreases LOS and returns advanced head and neck cancer patients to their ADL sooner. Postoperative ADL recovery independently predicts on-time adjuvant treatment. Still, compliance beyond 50% with the TAT ≤6 weeks CoC quality metric remains a major treatment barrier.

Effectiveness of acupuncture in the governor vessel and Yangming meridian for the treatment of acute ischemic stroke: A systematic review and network meta-analysis.

Acupuncture of the governor vessel and Yangming meridian are widely used in the treatment of acute ischemic stroke (AIS). However, the optimal meridian for acupuncture in the treatment of AIS remains uncertain. This network meta-analysis study aimed to compare the clinical effectiveness of acupuncture at governor vessel and Yangming meridian in the treatment of AIS. All relevant studies published in CNKI, WANFANG, VIP, Sinomed, Cochrane Library, Web of Science, Pub Med, and Embase before January 13, 2024 were systematically retrieved. The two researchers independently screened the studies and extracted the data. Cochrane ROB tool was used to evaluate the quality of the studies, and Stata 14.0 software was used to conduct a network meta-analysis of neurological deficit score, activities of daily living (ADL), clinical effective rate and Fugl-meyer motor function evaluation (FMA). A total of 401 studies were obtained, and 17 studies met the inclusion criteria. The surface under the cumulative ranking curve (SUCRA) values of the four outcome indexes were all ranked by "Governor vessel acupuncture + Conventional neurology treatment(GVAc+CT) > Yangming meridian acupuncture + Conventional neurology treatment(YMAc+CT) > Conventional neurology treatment (CT)". Compared to YMAc+CT and CT, GVAc+CT had the best effect in reducing the degree of neurological deficit score (SMD = -0.72, 95%CI = [-1.22,-0.21] and SMD = -1.07,95%CI = [-1.45,-0.69], respectively) and promoting the recovery of ADL((SMD = 0.59,95%CI = [0.31,0.88] and SMD = 0.96,95%CI = [0.70,1.21], respectively). Compared to CT, GVAc+CT also had a better clinical effective rate in the treatment of AIS (RR = 1.14,95%CI = [1.04,1.25]). Governor vessel acupuncture combined with conventional neurology treatment has the best effect in reducing the degree of neurological deficit score and promoting the recovery of ADL in AIS patientscompared to YMAc+CT and CT. Governor Vessel acupuncture is the most preferable acupoint scheme for clinical acupuncture treatment of AIS.

Increased intramuscular adipose tissue of the quadriceps at admission is more strongly related to activities of daily living recovery at discharge compared to muscle mass loss in older patients with aspiration pneumonia

BackgroundRecent studies reported that an increase in intramuscular adipose tissue of the quadriceps in older patients negatively affects the recovery of activities of daily living (ADL) more than the loss of muscle mass. However, whether intramuscular adipose tissue of the quadriceps in older patients with aspiration pneumonia is related to ADL recovery remains unclear. This study aimed to determine the relationship between intramuscular adipose tissue of the quadriceps and ADL recovery in older patients with aspiration pneumonia.MethodsThirty-nine older inpatients who were diagnosed with aspiration pneumonia participated in this prospective study. The main outcome of this study was ADL at discharge. ADL were assessed using the Barthel Index (BI). The intramuscular adipose tissue and muscle mass of the quadriceps were evaluated at admission using echo intensity and muscle thickness observed on ultrasound images. A multiple linear regression analysis was performed to confirm whether the quadriceps echo intensity was related to the BI score at discharge, even after adjusting for confounding factors.ResultsThe medians [interquartile range] of the BI score at admission and discharge were 15.0 [0.0–35.0] and 20.0 [5.0–55.0], respectively. The BI score at discharge was significantly higher than that at admission (p = 0.002). The quadriceps echo intensity (β = − 0.374; p = 0.036) and BI score at admission (β = 0.601; p < 0.001) were independently and significantly related to the BI score at discharge (R2 = 0.718; f2 = 2.546; statistical power = 1.000). In contrast, the quadriceps thickness (β = − 0.216; p = 0.318) was not independently and significantly related to the BI score at discharge.ConclusionsIncreased intramuscular adipose tissue of the quadriceps at admission is more strongly and negatively related to ADL recovery at discharge than the loss of muscle mass among older patients with aspiration pneumonia. Interventions targeting the intramuscular adipose tissue of the quadriceps may improve ADL among these patients.

Biopsychosocial Factors Influencing Mortality and Functional Recovery in COVID-19 Patients Undergoing Prone Positioning: A Prospective Observational Study

To identify social, health, and hospital factors associated with mortality and functional recovery in activities of daily living (ADL) in patients admitted to the ICU due to COVID-19 who were in the prone position. We conducted a prospective observational study between June 2021 and March 2022 at the San José Clinical Hospital. The study included people 18 years of age or older admitted to the ICU due to COVID-19 who were in the prone position. Using logistic regression, we searched for factors associated with the risk of in-hospital mortality. Using linear regression, we also analyzed factors associated with functional recovery in ADL at discharge and post-discharge. In 85 patients included, being men, older age, history of mental health, cardiorespiratory disease, and living in a commune of high social priority were associated with a higher risk of in-hospital mortality. A greater number of days of hospitalization was associated with less functional recovery at discharge and post-discharge. In contrast, more cycles in prone position during hospitalization and higher education level were associated with greater post-discharge functional recovery. The survival and functional prognosis of patients with severe COVID-19 can be predicted early through a biopsychosocial evaluation of their characteristics. Intrahospital actions could improve functional recovery in ADL in the short term in critically ill patients surviving COVID-19.

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.

Minimal Contact Robotic Stroke Rehabilitation on Risk of COVID-19, Work Efficiency and Sensorimotor Function.

Patients with hemiparetic stroke undergo direct, labor-intensive hands-on conventional physical therapy to improve sensorimotor function, spasticity, balance, trunk stability, and activities of daily living (ADLs). Currently, direct, intensive hands-on therapeutic modalities have increased concerns during the coronavirus (COVID-19) global pandemic. We developed an innovative Walkbot to mitigate the issues surrounding conventional hands-on physical therapy. We aimed to compare the effects of minimal-contact robotic rehabilitation (MRR) and full-contact conventional rehabilitation (FCR) on static and dynamic balance, trunk stability, ADLs, spasticity, and cognition changes in patients with hemiparetic stroke. A total of 64 patients with hemiparetic stroke (mean age = 66.38 ± 13.17; 27 women) underwent either MRR or FCR three times/week for 6 weeks. Clinical outcome measurements included the Trunk Impairment Scale (TIS), the Berg Balance Scale (BBS), the modified Ashworth Scale (MAS), the Fugl—Meyer Assessment (FMA), and the modified Barthel Index (MBI) scores. A 2 × 2 repeated analysis of variance (ANOVA) was performed, and an independent t-test was used to determine statistical differences in the physiotherapists’ work efficiency and COVID-19 transmission risk. The ANOVA showed that MRR had effects superior to those of FCR on the TIS, the BBS, the FMA, and the MBI (p < 0.05), but not on the MAS (p = 0.230). MRR showed a greater decrease on the physiotherapist’s work efficiency and COVID-19 transmission risk (p < 0.05). Our results provide clinical evidence that robot-assisted locomotor training helps maximize the recovery of sensorimotor function, abnormal synergy, balance, ADLs, and trunk stability, and facilitates a safer environment and less labor demand than conventional stroke rehabilitation.

Age-Related Recovery of Daily Living Activity After 1-Stage Complete Corpus Callosotomy: A Retrospective Analysis of 41 Cases

Recovery time after corpus callosotomy (CC) is known to be longer in elderly than in younger patients. To evaluate the relationship between patient age and recovery time of activities of daily living (ADL) after 1-stage complete CC. This study included 41 patients (22 women; aged 13 months-34 years, median 7 years) who underwent 1-stage complete CC for medically intractable seizures with drop attacks, infantile spasms, and/or bilaterally synchronized electroencephalographic discharges between August 2009 and April 2019. The timing of restart of competence in 5 ADL categories and surgical outcomes were recorded. Patients (1) restarted speech at 2.2 ± 1.3 (mean ± 2 standard deviations; range 1-5) days, (2) restarted replying with their own name on request at 5.5 ± 8.6 (2-33) days, (3) restarted oral intake at 1.6 ± 1.7 (1-11) days, (5) discontinued intravenous feeding at 6.0 ± 3.0 (2-16) days, and (5) restarted ambulation or wheelchair movement at 5.8 ± 3.4 (2-10) days. Younger patients showed significantly (P < .0223) earlier recovery of ambulation or wheelchair movement, but no age difference was found in the other 4 ADL categories. Overall seizure freedom was achieved in 5 patients, excellent (>80%) seizure reduction in 11, good (50%-80%) seizure reduction in 5, and poor (<50%) seizure reduction in 20. Early ADL recovery after 1-stage complete CC is favorable in both young and adult patients. These findings, with good surgical outcomes, will encourage more positive consideration of 1-stage complete CC in both pediatric and adult patients.

Prognostic Factors for Mortality, Activity of Daily Living, and Quality of Life in Taiwanese Older Patients within 1 Year Following Hip Fracture Surgery.

Background. Hip fractures among older adults are a major public health concern worldwide. This study investigated the potential clinical factors that predict postoperative 1-year activities of daily living (ADL), quality of life (QoL), and mortality in Taiwanese older adults following hip fracture. Methods. This is a prospective cohort study enrolling older adults (≥60 years) who had undergone hip fracture surgery in a single medical center. The comprehensive clinical history of each patient was examined. QoL, ADL, and mortality events were recorded consecutively at 3, 6, and 12 months after operation. The multiple logistic regression model and the generalized estimating equation (GEE) were adopted to identify contributing factors for mortality and postoperative ADL and QoL prognosis, respectively. Results. Among 377 participants with hip fracture, 48 died within 1 year of the index operation. ADL and QoL considerably decreased at 3 months following hip surgery. Old age, high Charlson Comorbidity Index, and American Society of Anesthesiologists grading were crucial predictors for mortality at the 1-year follow-up. The generalized estimating equation analysis indicated that the length of postoperative follow-up time, serum albumin level, patient cognitive status, and handgrip strength were considerably associated with QoL and ADL recovery prognosis in the Taiwanese older adults following hip fracture. Conclusions. Hip fractures have long-lasting effects on the older adults. Our data imply several prognosis predicting parameters that may assist clinicians in accounting for an individual’s personalized risks in order to improve functional outcomes and reduce mortality.

Early walking time is associated with recovery of activities of daily living during hospitalization in older patients with community-acquired pneumonia: A single-center prospective study.

Pneumonia is a common disease with a high mortality rate among older adults that is associated with a decline in activities of daily living (ADL) during hospitalization. The aims of this study were to investigate the following: (i) early physical activity time among older patients hospitalized with community-acquired pneumonia; and (ii) the association of physical activity time with the recovery of ADL. A prospective observational study was carried out in patients aged ≥65 years hospitalized with community acquired pneumonia. We measured the time spent standing and walking as physical activity time using the activPAL accelerometer from the third to the ninth day of admission. Patients underwent rehabilitation during their hospitalization, and rehabilitation effectiveness was calculated using the motor Functional Independence Measure on admission and at day 10. We used stepwise multiple regression to examine the relationship between physical activity time and rehabilitation effectiveness. A total of 87 patients were included in the analysis. Median (interquartile range) physical activity time was 69 min/day (43-103 min/day). In the multiple regression model, a greater daily walking time, higher cognitive and physical function, and ADL at admission were independently associated with rehabilitation effectiveness (adjusted R2 =0.32, P < 0.0001). For every increase of 10 min/day of walking time, ADL improved by 7.8% (B=7.8, 95% CI 1.3-14.2, P=0.02). Older patients hospitalized with community-acquired pneumonia have low levels of physical activity, and increasing early walking time might be an effective strategy to accelerate the recovery of ADL. Geriatr Gerontol Int 2021; 21: 1099-1104.

Longitudinal relationship between intramuscular adipose tissue of the quadriceps and activities of daily living in older inpatients.

BackgroundThe longitudinal relationship between intramuscular adipose tissue of the quadriceps and activities of daily living (ADL) in older inpatients remains unclear. This study aimed to examine whether decrease of intramuscular adipose tissue of the quadriceps in older inpatients is related to the recovery of ADL than increase of muscle mass.MethodsThis longitudinal study included 202 inpatients aged ≥65 years [median age: 83.0 (77.0–88.0), 56.4% female]. Recovery of ADL during hospital stay was assessed using the change in Barthel index (BI) score (i.e. BI score at discharge minus BI score at admission) and BI score at discharge. Intramuscular adipose tissue and muscle mass of the quadriceps were assessed using echo intensity and muscle thickness on ultrasound images, respectively. Higher echo intensity indicates greater intramuscular adipose tissue. Multiple regression analysis was performed to identify the factors independently associated with the change in BI score and BI score at discharge. Changes in quadriceps echo intensity and thickness and subcutaneous fat thickness of the thigh, quadriceps echo intensity and thickness, and subcutaneous fat thickness of the thigh at admission, age, sex, days from onset disease, BI score at admission, and disease were set as independent variables.ResultsThe means of the change in quadriceps echo intensity and thickness were −2.3 ± 15.7 and 0.1 ± 0.4 cm, respectively. The median of the change in BI score was 15.0 (0.0–30.0). The quadriceps echo intensity at discharge was significantly lower than at admission (P = 0.043). The quadriceps thickness (P = 0.004) and BI score at discharge (P < 0.001) were significantly higher than those at admission. Change in quadriceps echo intensity was independently and significantly associated with the change in BI score (β = −0.25, P = 0.006) and BI score at discharge (β = −0.18, P = 0.006). In contrast, change in quadriceps thickness was not independently and significantly associated with the change in BI score (β = 0.09, P = 0.244) and BI score at discharge (β = 0.06, P = 0.244).ConclusionsOur study indicates that a decrease of intramuscular adipose tissue of the quadriceps is related to the recovery of ADL than an increase of muscle mass in older inpatients. Intramuscular adipose tissue of the quadriceps in older inpatients is considered to be a predictor for the recovery of ADL, and intervening for intramuscular adipose tissue may be important for improving ADL in older inpatients.

Sarcopenia affects activities of daily living recovery and hospitalization costs in older adults in convalescent rehabilitation wards.

This study aimed to investigate the impact of sarcopenia on activities of daily living (ADL) recovery and hospitalization costs in older patients admitted to convalescent rehabilitation wards. This prospective cohort study included 104 patients aged ≥ 65years who were admitted to convalescent rehabilitation wards. The primary outcome was ADL recovery as evaluated by the Functional Independence Measure (FIM) efficiency during hospitalization, and the secondary outcome was hospital-related costs. Univariate and multivariate analyses were performed to identify whether sarcopenia was associated with FIM-motor efficiency and hospitalization costs. Among the patients, 68.3% were females, and the mean age was 82.3 ± 8.3years. The prevalence of sarcopenia was 73.1%. The FIM-motor efficiency score was significantly lower in patients with sarcopenia (median 0.38; interquartile range 0.27-0.52) than in those without sarcopenia (median 0.55; interquartile range 0.34-0.87) (P = 0.009). Hospitalization costs were higher in patients with sarcopenia (32,813 ± 15,184 dollars) than in those without sarcopenia (26,879 ± 10,248 dollars) (P = 0.058). Multivariate analysis showed that sarcopenia was independently associated with FIM-motor efficiency (standardized β = - 0.236, P = 0.014, R2 = 0.40) and hospitalization costs (standardized β = 0.15, P = 0.027, R2 = 0.70) after adjusting for confounding factors. We found that sarcopenia reduces the FIM-motor efficiency and increases direct hospitalization costs in older patients admitted to convalescent rehabilitation wards. Therefore, it is necessary to design interventions to prevent sarcopenia and improve the efficiency of ADL recovery and reduce direct hospitalization cost.

Comparison of seizure outcomes and ADL recovery period after total or anterior corpus callosotomy in adolescent and young adults with drop attacks and severe mental retardation

PurposeThe aim of this study was to evaluate seizure outcomes and postoperative neurologic complications, with an emphasis on the recovery period of activities of daily living (ADL) between anterior partial corpus callosotomy (ACC) and total corpus callosotomy (TCC) in adolescent and young adults with drop attacks and severe mental retardation. MethodsWe retrospectively reviewed the clinical records of consecutive patients with intractable epilepsy who underwent corpus callosotomy (CC) for drop attacks between 2010 and 2019 in the Department of Neurosurgery, Hiroshima University hospital, with a minimum follow-up of one year. Inclusion criteria of this study were 1) age at surgery: 11–39 years, 2) preoperative intelligence quotient <35, and 3) preoperative Barthel index (BI) ≥30. Postoperative full ADL recovery was defined as complete recovery to the preoperative BI score. We compared the postoperative days required for 1) recovery of oral intake ability, 2) discharge from our hospital, 3) returning home from any hospital, 4) returning home with full ADL recovery, and 5) seizure outcomes in patients with ACC versus those with one-stage TCC. ResultsTen patients with ACC and 14 patients with one-stage TCC met the inclusion criteria. The period for returning home with full ADL recovery was a median of 15 days (range 9−45 days) after ACC, while the median was 21.5 days (range 10−62 days) after one-stage TCC (p = 0.2904). Although there was a tendency for the ADL recovery period to be longer after one-stage TCC, there were no statistically significant differences in any category of ADL recovery period. Eleven of 14 (78.6 %) patients who received a one-stage TCC showed favorable seizure outcomes, with drop attack cessation, which was significantly better than 1 of 10 (10 %) patients with ACC (p = 0.0009). ConclusionsFrom the viewpoint of postoperative seizure outcomes and ADL recovery period, one-stage TCC is preferred to ACC for adolescent and young adults with severe mental retardation.

Intramuscular adipose tissue in the quadriceps is more strongly related to recovery of activities of daily living than muscle mass in older inpatients.

BackgroundThe relationship between intramuscular adipose tissue at admission and recovery of activities of daily living (ADL) remains unclear. This study aimed to examine the relationship between intramuscular adipose tissue in the quadriceps at admission and recovery of ADL in older inpatients.MethodsThis prospective study included 404 inpatients aged ≥65 years (54.7% female). Recovery of ADL during hospital stay was assessed using the Barthel Index (BI) score at discharge, BI score change, and BI efficiency. Higher BI at discharge, BI score change, and BI efficiency indicate more improvement in ADL. Intramuscular adipose tissue and muscle mass of the quadriceps were assessed using echo intensity and muscle thickness on ultrasound images, respectively. Multiple regression analysis was performed to identify factors independently associated with BI score at discharge, BI score change, and BI efficiency. The independent variables were BI score at admission, echo intensity and muscle thickness of the quadriceps, age, sex, number of medications, C‐reactive protein concentration, updated Charlson Comorbidity Index score, Food Intake Level Scale, Geriatric Nutritional Risk Index score, days from onset disease, length of hospital stay, number of units of rehabilitation therapy, and subcutaneous fat thickness of the thigh.ResultsThe medians (inter‐quartile range) of the BI score at discharge, BI score change, and BI efficiency were 60.0 (35.0–80.0), 10.0 (0.0–25.0), and 0.11 (0.00–0.37), respectively. The median (inter‐quartile range) of the length of hospital stay (days) and days from onset disease were 58.0 (39.0–92.0) and 79.0 (49.0–112.0), respectively. Quadriceps echo intensity was independently and significantly associated with the BI score at discharge (β = −0.13, P < 0.01), BI score change (β = −0.23, P < 0.01), and BI efficiency (β = −0.21, P < 0.01). Quadriceps thickness was not independently and significantly associated with the BI score at discharge (β = −0.02, P = 0.68), BI score change (β = −0.02, P = 0.79), and BI efficiency (β = 0.03, P = 0.67).ConclusionsOur study indicates that greater intramuscular adipose tissue in the quadriceps at admission is more strongly related to worse recovery of ADL than less muscle mass in older inpatients. Greater intramuscular adipose tissue in the quadriceps in older inpatients is considered to be a predictor of worse recovery of ADL, and intervening for greater intramuscular adipose tissue may be important for improving ADL in older inpatients.

Pan-European Study on Functional and Medical Recovery and Geriatric Rehabilitation Services of Post-COVID-19 Patients: Protocol of the EU-COGER Study

ObjectivesThere is insufficient knowledge about the functional and medical recovery of older people infected with SARS-CoV-2. This study aims to gain insight into the course of functional and medical recovery of persons who receive geriatric rehabilitation (GR) following SARS-CoV-2 infection across Europe. Special attention will be paid to the recovery of activities of daily living (ADL) and to the GR services offered to these patients.DesignA multi-center observational cohort study.Setting and participantsThis study will include several European countries (EuGMS member states) each providing at least 52 comparable routine datasets (core dataset) of persons recovering from a SARS-CoV-2 infection and receiving geriatric rehabilitation. The routine data will be anonymously collected in an online CASTOR database. The ethical regulations of each participating country will be followed.Primary outcomeADL functioning.Secondary outcomesLength of stay, discharge destination, hospital readmission and mortality. Other variables that will be collected are quality of life, treatment modalities, complications, cognition, frailty, mood/anxiety, BMI, nutrition and pain. All variables will be reported at admission and compared with follow-up scores (discharge, 6 weeks and 6 months follow-up).ConclusionThis study will explore the effect of geriatric rehabilitation on post-COVID-19 patients, especially on ADL recovery, and the variety of geriatric rehabilitation services across Europe. Information from this study may help improve recovery of older persons infected with SARS-CoV-2 and improve geriatric rehabilitation services in the ongoing COVID-19 pandemic.

Improvement in Activities of Daily Living during a Nursing Home Stay and One-Year Mortality among Older Adults with Sepsis.

To describe the recovery of activities of daily living (ADLs) during a skilled nursing facility (SNF) stay and the association with 1-year mortality after SNF discharge among Medicare beneficiaries treated in intensive care for sepsis. Retrospective cohort study. Skilled nursing facilities in the United States. Medicare fee-for-service beneficiaries admitted to an SNF within 3 days of discharge from a hospitalization that included an intensive care unit (ICU) stay for sepsis between January 1, 2013, and September 30, 2015 (N = 59,383). Data from the Minimum Data Set (MDS) were used to calculate a total score for seven ADLs. Improvement was determined by comparing the total ADL scores from the first and last MDS assessments of the SNF stay. Proportional hazard models were used to estimate the association between improvement in ADL function and 1-year mortality after SNF discharge. Approximately 58% of SNF residents had any improvement in ADL function. Residents who had improvement in ADL function had 0.72 (95% confidence interval (CI) = 0.69-0.74) lower risk for mortality following SNF discharge than residents who did not improve. Residents who improved 1-3 points (hazard ratio (HR) = 0.82, 95% CI = 0.79-0.84) and four or more points (HR = 0.57, 95% CI = 0.55-0.60) in ADL function had significantly lower mortality risk than residents who did not improve. Older adults treated in an ICU with sepsis can improve in ADL function during an SNF stay. This improvement is associated with lower 1-year mortality risk after SNF discharge. These findings provide evidence that ADL recovery during an SNF stay is associated with better health outcomes for older adults who have survived an ICU stay for sepsis.

MOTOR PROGRAMMING PREDICTS THE FUNCTIONAL RECOVERY GAIN IN PATIENTS WITH RIGHT HEMISPHERIC FRONTAL STROKE

Executive functioning significantly affects the functional rehabilitation progress in stroke patients. The current study are aimed to examine the impact of executive functions on functional recovery gain in a sample of right hemispheric (RH) frontal stroke patients. A total of 50 inpatients admitted to the Theseus Rehabilitation Center and diagnosed with RH frontal stroke were included in this study. The initial assessment of executive functioning was conducted using the Frontal Assessment Battery (FAB). Functional recovery of basic activities of daily living (ADLs) was computed by the difference between follow-up and baseline Barthel Index (BI) scores. Pearson’s analysis revealed that the FAB global scores significantly correlated with the BI gain scores. Additionally, multiple regression analysis showed a significant contribution of only motor programming to the basic ADLs recovery gain. The global status of executive function was found to be significantly associated with functional recovery gain, and motor programming was the strongest predictor in RH frontal stroke patients. These findings are discussed for the treatment rehabilitation prognosis.

2020 Chitranjan S. Ranawat Award: Perioperative essential amino acid supplementation suppresses rectus femoris muscle atrophy and accelerates early functional recovery following total knee arthroplasty.

The aim of this study was to assess the effectiveness of perioperative essential amino acid (EAA) supplementation to prevent rectus femoris muscle atrophy and facilitate early recovery of function after total knee arthroplasty (TKA). The study involved 60 patients who underwent unilateral TKA for primary knee osteo-arthritis (OA). This was a double-blind, placebo-controlled, randomized control trial with patients randomly allocated to two groups, 30 patients each: the essential amino acid supplementation (9 g daily) and placebo (lactose powder, 9 g daily) groups. Supplementation and placebo were provided from one week before to two weeks after surgery. The area of the rectus femoris muscle were measured by ultrasound imaging one month before surgery and one, two, three, and four weeks postoperatively. The serum albumin level, a visual analogue knee pain score, and mobility were also measured at each time point. The time to recovery of activities of daily living (ADLs) was recorded. Postoperative nutrition and physiotherapy were identical in both groups. The mean relative change from baseline was as follows for the amino acid group: 116% in rectus femoris muscle area (71% to 206%); 95% in serum albumin (80% to 115%) and 39% in VAS pain (0% to 100%) at four weeks after surgery. These values in the placebo group were: 97% in muscle area (68 to 155); 89% in serum albumin (71% to 100%) and 56% in VAS pain four weeks after surgery (0% to 100%). All changes were statistically significant (p < 0.05). The mean time to recovery of ADLs was shorter in the amino acid group compared with the placebo group (p = 0.005). Perioperative essential amino acid supplementation prevents rectus femoris muscle atrophy and accelerates early functional recovery after TKA. Cite this article: Bone Joint J 2020;102-B(6 Supple A):10-18.

ADL recovery trajectory after discharge and its predictors among baseline-independent older inpatients

BackgroundAmong the previous studies about the ADL recovery and its predictors, the researches and resources used to study and protect the baseline-independent older patients from being permanently ADL-dependent was few. We aimed to describe the level of activities of daily living (ADL) at discharge and ADL change within 6 months after discharge in older patients who were ADL-independent before admission but became dependent because of acute illness, and to identify the predictors of early rehabilitation,so as to provide the basis to early intervention.MethodsStratified cluster sampling was used to recruit 520 hospitalised older patients who were ADL-independent from departments of internal medicine at two tertiary hospitals from August 2017 to May 2018. Demographics, clinical data, and ADL status at 1, 3, and 6 months after discharge were collected. Data were analysed using descriptive statistics, Student’s t-test, Pearson’s chi-square test,Spearman’s correlation analysis, binary logistic regression analysis, and receiver operating characteristic (ROC) curve analysis.ResultsThere were 403 out of 520 patients completing the 6-month follow-up, and 229 (56.8%) regained independence at 6 months after discharge. There was an overall increasing trend in ADL with time. The recovery rate was the highest within the first month after discharge, gradually declined after 1 month, and changed less obviously from 3 to 6 months after discharge (p < 0.001). ADL score at discharge (OR = 1.034, p < 0.001), age (OR = 0.269, p = 0.001), post-discharge residence (OR = 0.390, p < 0.05), and cognition status at discharge (OR = 1.685, p < 0.05) were predictors of ADL recovery. The area under the curve of the four predictors combined was 0.763 (p < 0.001).ConclusionStudying ADL recovery rate and its predicting indicators of the baseline independent inpatients at different time points provide a theoretical reference for the formulation of nursing plans and allocation of care resources.

Risk factors for poor outcomes of early rehabilitation after total en bloc spondylectomy: a retrospective chart review of 140 patients.

A retrospective chart review. Total en bloc spondylectomy (TES) has been reported to decrease the rate of local recurrence and increase survival. Although it is important to achieve early recovery of physical functions after surgery, no studies have evaluated rehabilitation outcomes during the acute phase after TES. This study evaluated ambulatory functions and activities of daily living (ADLs) after surgery and analyzed the prognostic significance of variables affecting rehabilitation outcomes at 1 month after TES. University hospital in Kanazawa, Japan. This study included 140 patients with spinal tumors who underwent TES between April 2010 and April 2017. Demographic characteristics, neurological functions, perioperative complications functional status as measured by the Functional Independent Measure, and independent indoor walking based on the Spinal Cord Independent Measure were extracted from medical records. Multivariate analyses were performed to assess factors associated with the recovery of ambulation and ADL at 1 month after TES. Preoperative neurological deficits were observed in 51 patients (36%), and postoperative neurological deterioration was found in 41 patients (29%). Multivariate analyses indicated that preoperative neurological deficits (odds ratio [OR], 5.23; 95% confidence interval [CI], 2.07-15.99), postoperative cerebrospinal fluid leakage (OR, 13.42; 95% CI, 2.93-78.82), surgical site infections (OR, 15.27; 95% CI, 2.26-127.7), and postoperative neurological deterioration (OR, 4.86; 95% CI, 1.33-19.99) were risk factors for walking ability and recovery of ADL (P < 0.01). This study identified preoperative neurological dysfunction and perioperative complications as independent risk factors for poor recovery of ambulation and ADL early after TES.

Abstract TP159: Unilateral Spatial Neglect as an Independent Prognostic Factor for Poor Fim Efficiency in Patients With Mild to Moderate Ischemic Stroke

Background and Purpose: Unilateral spatial neglect (USN) is often observed in ischemic stroke patients suffered their right parietal lobe. USN is an obstacle to undergo rehabilitation smoothly, then might influence the recovery of activities of daily living (ADL) after stroke. We aimed to clarify the association between the presence of USN after ischemic stroke and the ADL improvement. Methods: Consecutive patients with first-ever ischemic stroke and left limb paralysis who admitted to within 7 days from onset during February 2011 and March 2019 were included. Patients met the following criteria were excluded: mRS ≥3 before onset, NIHSS &gt;15 on admission, without left limb paralysis, and missing NIHSS or functional independence measure (FIM) score on admission. Multiple regression analysis was performed to investigate the association between FIM efficiency score of acute phase and following factors: age, sex, acute reperfusion therapy (using an intravenous infusion of recombinant tissue plasminogen activator and/or endovascular therapy), FIM score on admission, and other clinical characteristics. All data were collected retrospectively using our electrical health record. Results: 721 ischemic stroke patients with left limb paralysis (320 women, median age 76) were included. Median FIM efficiency score was significantly lower in patients with USN than without USN (n=240, 481; 0.83 vs 1.63, respectively). Multiple regression analysis showed that USN, age, and acute reperfusion therapy were significant prognostic factors of FIM efficiency (coefficient and 95% confidence interval [CI]: -0.135 [-0.771 to -0.153], -0.106 [-0.022 to -0.002], and 0.224 [0.136 to 0.305], respectively). Conclusions: USN significantly influence the recovery of ADL after ischemic stroke. Clinicians should adequately evaluate USN after stroke and undergo USN-specific rehabilitation for them to optimize the effect of post-stroke rehabilitation. USN-specific rehabilitation might lead to better FIM efficiency.