Recovery Of Physical Function Research Articles

Efficacy and safety of neridronate in paediatric type I complex regional pain syndrome: a multicentre experience.

Evidence regarding the efficacy of neridronate in the treatment of complex regional pain syndrome type I (CRPS I) is increasing, however, very little data are available in paediatric age. Our aim was to analyse the safety and the efficacy of neridronate in a case series of children with CRPS I, according to the Budapest criteria, who did not respond to previous pharmacological and physical therapy. We collected data of children affected by CRPS I from three paediatric rheumatology centres who received neridronate. Efficacy was evaluated by changes in pain intensity, vasomotor changes, physical function, need for pain medications and MRI findings. Adverse effects were also documented. Five children (3 females and 2 males, mean age 10.4 years, range 7-13 years) who received neridronate (4 intravenous, 1 intramuscular) were included. All patients had failed previous medical treatments (NSAIDs in 4, local steroids in 2, gabapentin, vitamin D and calcium supplementation in 1) and non-medical therapies (physiotherapy in 4, magnetotherapy in 2, laser in 1). Four out of five patients reported a significant improvement in pain (average VAS pre-treatment 9.6, post-treatment 2.6), recovery of physical function, and a reduced need for pain medications. Before treatment, all patients underwent MRI which revealed bone oedema that disappeared in the three of them after treatment. Neridronate was well-tolerated as only one patient experienced mild flu-like symptoms. Our data suggest that in children as in adults with CRPS I, neridronate may represent an effective and safe treatment option, particularly in those who do not respond to other pain treatments.

The impact of changes in physical activity on functional recovery for older inpatients in post-acute rehabilitation units.

The effect of increased physical activity duration on functional recovery in older inpatients in subacute settings is not well established. This study aimed to investigate the relationship between physical activity and functional recovery in older patients receiving post-acute and subacute care. We analyzed cohort data of hospitalized older patients (age ≥ 65years) in the post-acute rehabilitation units. The main outcome was functional independence measure (FIM) gain. Physical activity was measured using a triaxial accelerometer. Changes in sedentary behavior and total physical activity time from admission to discharge were measured as changes in each physical activity time. Logistic regression analysis was performed to examine the relationship between changes in physical activity and FIM gain. A total of 210 patients were eligible for analysis. The mean age of the study patients was 83.6 ± 7.2years, and 63.8% (n = 134) were female. According to the multivariate regression analysis, changes in sedentary behavior time were significantly associated with high recovery of FIM gain (odds ratio [OR] 0.996, 95% confidence interval [CI]: 0.993-1.000; p = 0.026), and changes in total physical activity time also showed a similar association (OR 1.006, 95% CI 1.000-1.011; p = 0.041). Decreased sedentary behavior time and increased total physical activity time were significantly associated with high functional recovery in post-acute rehabilitation units. These results suggest that interventions for physical activity duration may be effective in improving activities of daily living in older post-acute and subacute patients.

Relevance of therapist feedback in the context of group‑based exercise programs in medical rehabilitation – Results from a qualitative study with patients and exercise therapists

Background Although group-based exercise programs account for nearly half of exercise therapy services provided in German medical rehabilitation facilities, information regarding the application and effects of therapist feedback in this setting is sparse. Therefore, the aim of this qualitative study was to develop an understanding of the relevance of therapist feedback in the context of group-based exercise programs from the patients’ and therapists’ perspective. Methods Semi-structured interviews were conducted with five rehabilitation patients as well as five exercise therapists with work experience in group-based exercise therapy. Data were analysed using structuring content analysis. Results Three types of therapist feedback with respective modalities and characteristics were identified. Besides corrective feedback to support the patients’ exercise instruction, motivational feedback and performance feedback were used to aid the strengthening of psychological resources. Although therapist feedback constituted an important component of patient-therapist-interaction, evidence suggesting a facilitation of coping strategies, participation or long-term physical activity adherence was sparse. Conclusions While therapist feedback in group-based exercise programs likely aids the recovery of physical and psychological functions, its potential to promote the long-term goals of exercise therapy in medical rehabilitation appears to be underutilised.

Staying Ahead of the Curve: The Case for Recovery Curves in Total Knee Arthroplasty

BackgroundSensor technology embedded within the total knee arthroplasty (TKA) implant has the potential to record data that can track recovery and provide diagnostic information. In this study, we introduce the concept of physical function recovery curve analytics, which are created from daily spatial-temporal gait metrics and step counts from a large cohort of TKA patients. MethodsIn our study population, 258 patients underwent a primary TKA with a smart implanted tibial extension between October 4, 2021, and July 15, 2022, by 33 surgeons. The average age was 63 years, with 138 (54%) women. All kinematic data was collected on a Health Insurance Portability and Accountability Act (HIPAA)-compliant cloud data management platform. ResultsSummaries of the gait parameters at 6 weeks are suggestive of differences between people over and under 65 years, with the older patients walking more slowly and having shorter stride lengths. The 6-week percentiles demonstrated a strong, linear correlation to the 12-week percentiles for each gait parameter, with correlation coefficients ranging from 0.87 to 0.92. ConclusionsA novel screening gait test at 6 weeks shows promising results for predicting patients who will likely have poor recovery based on at least 1 gait parameter recovery curve at 12 weeks with high sensitivity and specificity. A future study is needed to validate the screening tool with an independent set of patients.

Improved trunk muscle quality in patients with stroke increases improvements in activities of daily living

This study aimed to determine whether an increased trunk muscle quality index (TMQI) is associated with activities of daily living (ADL) in patients ≥ 65 years of age with cerebral infarction in a convalescent rehabilitation ward. This retrospective observational study included patients aged ≥ 65 years who were admitted for post-stroke rehabilitation in Okinawa, Japan, between May 2018 and December 2022. The TMQI was calculated at admission and discharge using bioelectrical impedance analysis. Patients were divided into two groups based on the change in the TMQI during hospitalization: increase-in-TMQI and no-increase-in-TMQI groups. Multiple regression analysis was employed to explore the impact of increased TMQI on functional independence measure (FIM) -motor gain. We included a total of 315 patients (79.1 ± 7.9 years of age, 51.7% men) in our analyses. Over half (165 [52.4%]) of the patients exhibited an increase in TMQI scores, and 150 (47.6%) patients did not exhibit an increase. No significant difference was observed in motor FIM score and motor FIM gain at admission and discharge between the groups with and without increased TMQI. Increased TMQI was independently associated with increased FIM-motor gain (adjusted R2 = 0.340 and R2 = 0.357, coefficient = 1.736, 95% confidence interval: 0.52-2.95, P = 0.005). The results of this study suggest that increased TMQI has a positive effect on the recovery of physical function in patients with stroke. Further prospective studies are needed to elucidate the relationship between increased TMQI and ADL.

Relationship between prehabilitation responsiveness and postoperative physical functional recovery in cardiovascular surgery

BackgroundThe purpose of this study was to examine the relationship between responsiveness to prehabilitation and postoperative recovery of physical function in cardiac surgery patients. MethodsNinety-three cardiac surgery patients (mean age: 76.4 years) were included in this retrospective cohort study. Preoperative physical function was measured using the Short Physical Performance Battery (SPPB), and a prehabilitation exercise program was implemented for the SPPB domains with low scores. Among the patients, those whose SPPB score was over 11 from the start of prehabilitation and remained over 11 on the day before surgery were defined as the high-functioning group, and those whose SPPB score improved by 2 points or more from the start of prehabilitation and exceeded 11 points were defined as the responder group. Those whose SPPB score did not exceed 11 immediately before surgery were classified as non-responders. The characteristics of each group and postoperative recovery of physical function were investigated. ResultsThere were no serious adverse events during prehabilitation. Mean days of prehabilitation was 5.4 days. The responder group showed faster improvement in postoperative physical function and shorter time to ambulatory independence than the non-responder group. The non-responder group had lower preoperative skeletal muscle index, more severe preoperative New York Heart Association classification, and a history of musculoskeletal disease or stroke. ConclusionThere were responders and non-responders to prehabilitation among cardiac surgery patients. Cardiac surgery patients who respond to prehabilitation had faster recovery of physical function. Further research is needed to determine what type of prehabilitation is more effective in postoperative recovery of physical function in cardiac surgery patients.

The effects of continuing care based on WeChat platform and MDT on outcomes and negative emotions in young and middle-aged patients with stroke sequelae

Objective: This study aimed to investigate the effect of continuing care based on WeChat platform and MDT (multidisciplinary team) on outcomes and negative emotions in young and middle-aged patients with stroke sequelae. Methods: A retrospective study was conducted on clinical data of 109 young patients with post-stroke sequelae in our hospital. Based on the nursing approach, the patients were divided into two groups. Group A received conventional continued care (including reinforcing health education upon discharge, providing relevant precautions after discharge, regular follow-up of patients, and others), while Group B received continued care based on the WeChat platform and multidisciplinary team (MDT) collaboration. A comparative analysis was performed on NHISS (National Institutes of Health Stroke Scale) scores, Barthel Index (activities of daily living), FMA (Fugl-Meyer Assessment of Motor Recovery after Stroke) scores, disease awareness and attitude scores, self- efficacy scores, self-care ability scores, SAS (Self-Rating Anxiety Scale) scores, SDS (Self-Rating Depression Scale) scores, quality of life scores, and social support levels before intervention and 6 months after interventions in both groups. Results: Compared with Group A, Group B had lower NHISS scores (30.08 vs. 17.08) and higher Barthel Index (73.35 vs. 94.48) and FMA scores (68.06 vs. 90.08) (P<0.05); higher disease awareness scores (40.18±2.15 vs. 48.96±3.66) (P<0.05), higher self-efficacy scores (105.56 vs. 119.26) and self-care scores (98.18 vs. 110.06) (P<0.05), lower SAS scores (56.06 vs. 40.06) (P<0.05), higher quality of life (125.63±3.12 vs. 185.12±2.52) as well as higher nursing satisfaction scores (56.63±3.16 vs. 92.15±3.15) (P<0.05). Conclusions: Continuing care based on the WeChat platform and MDT is beneficial to promote the recovery of neurological and physical functions, improve abilities of daily living, self-efficacy, self- care and quality of life in young and middle-aged patients with stroke sequelae, and relieve the impact of negative emotions on the recovery.

Sports Injuries Support: Towards a Proposed Intervention Program for Soccer Training

The aim of this study was to explore the relationship between university football students' experiences of sports injuries and rehabilitation support, and the effectiveness of rehabilitation support provided to this group. The study adopted a mixed research method combining quantitative and qualitative methods, and data were collected through questionnaires and semi-structured interviews. The study population consisted of 180 football students from Jiaqing College and Guangzhou Sports Institute. It was found that the students demonstrated high levels of knowledge, preparation, and application of sports injuries, as well as positive attitudes towards all aspects of rehabilitation support (including physical rehabilitation, psychological support, functional recovery, rehabilitation goals and social support). Correlation analyses with the correlation between sports injuries and rehabilitation support showed a significant positive correlation, emphasizing the importance of rehabilitation support in dealing with sports injuries.

Effects of Rehabilitation Robot Training on Physical Function, Functional Recovery, and Daily Living Activities in Patients with Sub-Acute Stroke.

Stroke often results in sensory deficits, muscular weakness, and diminished postural control, thereby restricting mobility and functional capabilities. It is important to promote neuroplasticity by implementing task-oriented exercises that induce changes in patients. Therefore, this study aimed to investigate the effects of rehabilitation robot training on physical function, functional recovery, and activities of daily living (ADLs) in patients with subacute stroke. The study participants were patients with subacute stroke receiving treatment at Hospitals A and B. They were selected as research subjects based on selection and exclusion criteria. The experimental group received rehabilitation robot training in sessions of 30 min, five times weekly, for a total of 20 sessions over four weeks. Conversely, the control group underwent standard rehabilitation equipment training with an identical frequency, duration, and number of sessions. Measurements were taken before and after the training period to assess changes in physical function, functional recovery, and activities of daily living using tools such as the MMT, BBS, FBG, FAC, FIM, and MBI. The results were as follows: in the within-group comparison, the rehabilitation robot training group showed significant differences in MMT, BBS, FBG, FAC, FIM, and MBI (p < 0.05), while the control group showed significant differences in FIM (p < 0.05). Statistically significant differences were observed in the time, group, and time × group interaction effects among the MMT, static seated FBG, dynamic seated FBG, FIM, and MBI (p < 0.05). Based on these results, rehabilitation robotic training resulted in significant improvements in physical function, functional recovery, and activities of daily living in patients with subacute stroke. Based on these findings, providing a basic protocol for a rehabilitation program that applies rehabilitation robot training to patients with subacute stroke may offer more effective treatment and outcomes in the future.

The Impact of Caregiver Support on Symptom Improvement in Post-Stroke Patients

The Impact of Caregiver Support on Symptom Improvement in Post-Stroke Patients

Association between the initial physical activity and functional recovery after 1 month of inpatient rehabilitation for subacute stroke: stratified analysis by nutritional status.

Objectively measured physical activity volume serves as a predictive factor for functional recovery in patients with stroke. Malnutrition, a frequent complication of stroke, may influence the relationship between physical activity and functional recovery. This study aimed to examine the association between physical activity volume and functional recovery in patients with stroke, stratified by their nutritional status. This multicenter prospective observational study included 209 patients with stroke admitted to two Japanese convalescent rehabilitation hospitals. Participants were categorized based on the geriatric nutritional risk index (GNRI) at admission [≥92, high GNRI group ( n = 133); <92, low GNRI group ( n = 76)]. Physical activity levels were measured as the duration of total physical activity (TPA), which is the sum of light-intensity physical activity and moderate-to-vigorous physical activity, using a triaxial accelerometer during the first 7 days after admission. Outcome measures are represented as the relative gain of the motor score on functional independence measure (M-FIM effectiveness) during the first month after admission. The multiple regression analysis, adjusting for age, sex, comorbidity, onset to admission intervals, motor paralysis, initial M-FIM, and cognitive FIM, showed that the duration of TPA in the first 7 days was significantly associated with the M-FIM effectiveness over the first month in both low GNRI [ B = 0.12, 95% confidential intervals (CI) = 0.01; 0.24, P = 0.049] and high GNRI group ( B = 0.11, 95% CI = 0.01; 0.21, P = 0.027). This study demonstrates a positive predictive association between early TPA level and functional recovery in stroke patients, irrespective of their nutritional status.

Development and external validation of preoperative clinical prediction models for postoperative outcomes including preoperative aerobic fitness in patients approaching elective colorectal cancer surgery

IntroductionPreoperative aerobic fitness is associated with postoperative outcomes after elective colorectal cancer (CRC) surgery. This study aimed to develop and externally validate two clinical prediction models incorporating a practical test to assess preoperative aerobic fitness to distinguish between patients with and without an increased risk for 1) postoperative complications and 2) a prolonged time to in-hospital recovery of physical functioning after elective colorectal cancer (CRC) surgery. Materials and methodsModels were developed using prospective data from 256 patients and externally validated using prospective data of 291 patients. Postoperative complications were classified according to Clavien-Dindo. The modified Iowa level of assistance scale (mILAS) was used to determine time to postoperative in-hospital physical recovery. Aerobic fitness, age, sex, body mass index, American Society of Anesthesiologists (ASA) classification, neoadjuvant treatment, surgical approach, tumour location, and preoperative haemoglobin level were potential predictors. Areas under the curve (AUC), calibration plots, and Hosmer-Lemeshow tests evaluated predictive performance. ResultsAerobic fitness, sex, age, ASA, tumour location, and surgical approach were included in the final models. External validation of the model for complications and postoperative recovery presented moderate to fair discrimination (AUC 0.666 (0.598–0.733) and 0.722 (0.651–0.794), respectively) and good calibration. High sensitivity and high negative predictive values were observed in the lower predicted risk categories (<40 %). ConclusionBoth models identify patients with and without an increased risk of complications or a prolonged time to in-hospital physical recovery. They might be used for improving patient-tailored preoperative risk assessment and targeted and cost-effective application of prehabilitation interventions.

Effectiveness of Art Therapy Programs in Enhancing Recovery and Rehabilitation in Sports Medicine

Purpose: The general aim of the study was to examine the effectiveness of art therapy programs in enhancing recovery and rehabilitation in sports medicine.&#x0D; Methodology: The study adopted a desktop research methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library.&#x0D; Findings: The findings reveal that there exists a contextual and methodological gap relating to the effectiveness of art therapy programs in enhancing recovery and rehabilitation in sports medicine. Preliminary empirical review revealed that art therapy interventions offer a holistic approach to healing, addressing athletes' physical, emotional, and social needs during the recovery process. Through a comprehensive review of empirical studies, the findings demonstrated consistent positive outcomes, including improved physical function, pain management, psychological well-being, and overall recovery among athletes. The study highlighted the importance of interdisciplinary collaboration and patient-centered care in sports medicine rehabilitation, as well as the potential cost-effectiveness of incorporating art therapy into standard practice. These findings underscored the value of art therapy as a complementary intervention in optimizing athletes' recovery and facilitating their successful return to sport.&#x0D; Unique Contribution to Theory, Practice and Policy: The Social Cognitive theory, Self- Determination theory and Biopsychosocial model may be used to anchor future studies on the effectiveness of art therapy programs in enhancing recovery and rehabilitation in sports medicine. The study provided recommendations that contributed to theory, practice, and policy. The findings emphasized the importance of grounding art therapy interventions in established theoretical frameworks, integrating them into standard rehabilitation protocols, advocating for policy support and reimbursement, fostering collaboration and partnerships, developing standardized protocols and outcome measures, and advancing research and evaluation efforts. These recommendations aimed to optimize the use of art therapy as a holistic and effective intervention for athletes recovering from sports injuries, ensuring equitable access to these services and fostering a culture of innovation in sports medicine rehabilitation.

Zokumeito similar medicine, which is composed of makyokansekito and juzentaihoto, contributed to a rapid recovery of consciousness and physical functions for the sequelae of cerebral infarction: A case report

Zokumeito similar medicine, which is composed of makyokansekito and juzentaihoto, contributed to a rapid recovery of consciousness and physical functions for the sequelae of cerebral infarction: A case report

What are the differences in the recovery of physical function and clinical score between patients with steroid-related osteonecrosis of the femoral head and hip osteoarthritis undergoing total hip arthroplasty? A propensity score-matched study.

Steroid-related osteonecrosis of the femoral head (ONFH), arising from steroid administration for underlying diseases, represents a unique pathology for total hip arthroplasty (THA) and typically affects a younger demographic compared to osteoarthritis (OA). Given the significant age-related differences, this study aims to employ propensity score matching to align patient backgrounds between these two diseases and compare physical function. Additionally, our objective is to scrutinize the patterns of clinical score recovery over the course of one year following THA. Using propensity score matching, 29 patients each with steroid-related ONFH and OA were selected. Muscle strength (hip abductor and knee extensor) were assessed before and after THA. Additionally, recovery of the Harris Hip Score (HHS) and Oxford Hip Score (OHS) up to one year postoperatively was analyzed. The steroid-related ONFH group exhibited gender bias and significantly younger age compared to the OA group. Propensity score matching achieved balanced patient backgrounds. Physical function showed trends of lower hip abduction and knee extensor strength on the operative side in the steroid-related ONFH group. Notably, nonoperative knee extensor strength decreased significantly after matching. HHS and OHS were poor in steroid-related ONFH up to three months postoperatively but recovered after six months. Patients with steroid-related ONFH experience positive outcomes in clinical score following THA. Propensity score matching effectively identified muscle weakness on both operative and nonoperative sides, highlighting its utility in comparative analyses.

Physical functional recovery in the early period after hospitalization for COVID-19: impact of hypertension and outcome prediction model

The aim – to study the influence of hypertension (HT) on the dynamics of natural recovery of physical functional status in the early period after hospitalization for COVID-19 and to develop a model for predicting recovery results at 1 month after discharge.Materials and methods. 221 hospitalized patients with COVID-19 (age 53.4±13.6 years, 53 % women) were included in the study, 176 of whom underwent the 6-minute walk test (6MWT) using an extended protocol within 1-2 days before discharge. A repeat visit to assess the dynamics of natural recovery was performed at 1 month after discharge.Results and discussion. Pre-discharge 6-minute walk distance was 378±57 m in patients with HT and 418±75 m without it, p=0.001, during the second visit – 440±52 versus 478±68, p=0.002; the achieved percentage of the individually predicted distance was 67.4±10.5 vs. 69.5±13.6 % and 81.6±9.9 vs. 81.9±15.7 %, respectively, p&gt;0.05 for both visits. The increase in heart rate during the test at visit 1 was 18.5±8.3 versus 30.1±19.3 bpm, p&lt;0.001, the percentage of chronotropic reserve utilizatoin was 21.3±9.6 % versus 29.2±11.4 %, p&lt;0.001. During the second visit, residual manifestations of this trend were observed, with an increase in HR by 24.0±9.5 vs. 30.8±12.1, p=0.003 and the use of chronotropic reserve of 28.1±10.1 % vs. 33.4±12.4 %, respectively, p=0.029. The developed multivariate linear regression model explained 59 % of the variability in the achieved percentage of the individually predicted 6-minute walk distance at 1 month after discharge. The use of machine learning allowed to create an artificial neural network based regression model that used age, height, use of remdesivir in treatment, and SBP and DBP values at the time of discharge as predictors, and explained 90 % of observed variability.Conclusions. Hospitalized patients with COVID-19 were characterized by a decrease in the general physical functional status as assessed by 6MWT at the time of discharge and incomplete recovery after 1 month. Presence of hypertension was associated with more pronounced disturbances of the autonomic regulation of heart rate, but did not affect the reached percentage of the distance walked. The proposed artificial neural network based regression model allows for a high accuracy prediction of the 6MWT results at 1 month after discharge, which can be used in the selection of candidates for cardiopulmonary rehabilitation programs.

Essential amino acids in total knee and hip joint replacement: a narrative review

The increasing availability of total joint replacement especially for knee and hip joints has increased their rates substantially across the globe. It is associated with increased risk of sarcopenia with loss of muscle mass and strength in the postoperative period. The supplementation of proteins along with exercises have been mainframe strategy to improve the functional ability after total knee arthroplasty and total hip arthroplasty. However, supplementation of proteins necessitates effective proteolytic digestion and conversion to amino acids for exerting substantial effects. In overcoming this challenge, supplementation with essential amino acids can be an attractive approach In this article, we review the clinical evidence with use of essential amino acids in patients undergoing TKA and THA. In the nine studies included in the review, seven assessed EAAs in TKA and two in THA. In TKA studies, improvement in muscle mass, muscle strength and functional recovery has been significant over 6 weeks postoperatively in majority of the studies. Over long term (2 years), improved recovery of rectus femoris and quadriceps had been reported. In THA as well, significant improvement in hip function and stability has been reported. Thus, EAAs in addition to the existing rehabilitation program are helpful to improve sarcopenia and enhances the recovery to perform activities of daily living. We propose from current evidence that administration of EAAs 7 to 10 days prior to planned TKA or THA and continued for 14 to 20 days in the postoperative period along with rehabilitation program is optimal in enhancing the muscle strength and help in physical functional recovery. Current evidence indicates supplementation with EAAs should be a part of routine management protocol in patients undergoing TKA or THA.

Life-Space of Older Adults after Discharge from Skilled Nursing Facilities

ObjectivesDescribe (1) patient or caregiver perceptions of physical function in 30 days after skilled nursing facility (SNF) discharge indicated by Life-Space Assessment (LSA) scores, and (2) patient and caregiver factors associated with LSA scores. DesignSecondary analysis of baseline and outcomes data from the cluster randomized trial of the Connect-Home transitional care intervention. Setting and ParticipantsSix SNFs in North Carolina. Patient and caregiver dyads with LSA scores (N = 245). MethodsSNF patients or their caregivers serving as proxy reported the life-space of the SNF patient using the LSA tool, a measure of environmental and social factors that influence physical mobility. Simple scores for highest life-space attained depending on equipment and/or caregiver support range from 0 to 5, with higher scores indicating greater mobility. Multiple linear regression models for simple LSA scores and Composite Life-Space (0-120), adjusted for treatment, time via a COVID pandemic indicator, and treatment × COVID effect as fixed effects, were used to estimate the association of patient and caregiver variables and life-space. ResultsPatients had a mean age of 76.3 years, 62.6% were female, and 74.7% were white. Caregivers were commonly female (73.9%) and adult children of the patient (46.5%). The mean Composite Life-Space score was 22.6 (16.09). The mean Assisted Life-Space score (range: 0-5) was 1.6 (1.47), and 76.3% of patients could not move beyond their bedroom, house, and yard without assistance of another person. Higher Composite Life-Space scores were associated with lower levels of cognitive impairment and shorter SNF length of stay. Conclusions and ImplicationsSNF patients and their caregivers reported very low LSA scores in 30 days after SNF care. Findings indicate the need for care redesign to promote recovery of physical function of older adults after SNF discharge, such as optimizing SNF rehabilitative therapy and adding postdischarge rehabilitative supports at home.

Comparison of Four Nutritional Screening Tools for Predicting Postoperative Adverse Events Following Degenerative Spinal Deformity Surgery.

A retrospective study. To compare the mini nutritional assessment-short form (MNA-SF), geriatric nutritional risk index, prognostic nutritional index (PNI), and preoperative serum albumin level as predictors of postoperative adverse events (AEs) in degenerative spine deformity (DSD) patients. Although various nutritional screening tools have been well evaluated in patients undergoing spinal fusion surgery, the most suitable tool for the DSD population remains uncertain at present. The authors reviewed consecutive patients who underwent thoracolumbar fusion surgery for DSD between August 2016 and May 2023. Four screening tools were used to assess preoperative nutritional status. Patients were divided into two categories according to each screening tool, and the four screening tools were compared regarding their predictive power for postoperative AEs, including the rates of extended length of hospital stays (LOS), complications, and readmission within three months. Physical functional indicators such as time to first ambulation, nonhome discharge, and postoperative LOS were assessed as secondary outcome measures. A multivariable logistic regression analysis was used to identify factors associated with postoperative AEs. A total of 228 patients were included. The demographic characteristics, underlying disease, and magnitude of correction were not significantly different between well-nourished and malnourished groups. The nutritional risks shown by MNA-SF and albumin level were significantly associated with infectious complications ( P <0.05). The nutritional risk shown by MNA-SF was significantly associated with nonhome discharge, prolonged postoperative LOS (12.5±8.2 vs. 10.3±6.1, P =0.039), and delayed ambulation (3.7±2.1 vs. 2.2±1.8, P =0.001). Multivariable logistic regression revealed that PNI <50 was significantly associated with total AEs and minor AEs after DSD surgery. PNI was significantly associated with the incidence of total AEs and minor AEs, while preoperative albumin level and MNA-SF were more effective in predicting postoperative infectious complications and delayed recovery of physical function, respectively. Level III.

Predicting Delayed In-Hospital Recovery of Physical Function After Total Knee Arthroplasty

ObjectiveTo identify patients at high risk of delayed in-hospital functional recovery after knee replacement surgery by developing and validating a prediction model, including a combination of preoperative physical fitness parameters and patient characteristics. DesignRetrospective cohort study using binary logistic regression. SettingUniversity hospital, orthopedic department. Participants260 adults (N=260) (≥18y) with knee osteoarthritis awaiting primary unilateral total knee arthroplasty and assessed during usual care between 2016 and 2020. InterventionNot applicable. Main Outcome MeasuresTime to reach in-hospital functional independence (in days), measured by the modified Iowa Level of Assistance Scale. A score of 0 means completely independent. Potential predictor variables are a combination of preoperative physical fitness parameters and patient characteristics. ResultsBinary logistic regression modeling was applied to develop the initial model. A low de Morton Mobility Index (DEMMI), walking aid use indoors, and a low handgrip strength (HGS) were the most important predictors of delayed in-hospital recovery. This model was internally validated and had an optimism-corrected R2 of 0.07 and an area under curve of 61.2%. The probability of a high risk of delayed in-hospital recovery is expressed by the following equation:Phighrisk=(1/(1+e(−(2.638−0.193×DEMMI+0.879×indoorwalkingaid−0.007×HGS))))×100%. ConclusionsThe model has a low predictive value and a poor discriminative ability. However, there is a positive association between preoperative physical fitness and postoperative recovery of physical function. The validity of our model to distinguish between high and low risk, based on preoperative fitness values and patient characteristics, is limited.