Rehabilitation Length Research Articles

Opioid Utilization and Management in the Setting of Stewardship During Inpatient Rehab Care.

BackgroundOpioid utilization and management in an inpatient rehabilitation setting have not been widely described, despite the unique opportunities that exist in this setting to support opioid stewardship across transitions in care. We aimed to characterize opioid utilization and management by interprofessional teams across a large, inpatient rehabilitation setting after incorporation of opioid stewardship principles by pharmacists as part of their daily practice.Patients and methodsThis was a retrospective chart review at Toronto Rehab, University Health Network, Toronto, Canada. Patients with admission orders for any opioid from November 2017 to February 2018 were included. Complex continuing care and palliative care patients were excluded. Descriptive statistics were primarily used to describe the data as well as univariate linear regression to compare associations with milligram morphine equivalent (MME) reduction.ResultsA total of 448 patients were included. A reduction in total daily MME was seen in 49% (n=219) of the patients during their inpatient stay, with 73% (n=159) of these patients having a reduction of ≥50%. Sixty-nine percent (n=311) of the patients received an opioid prescription at discharge, with most scheduled (90%, n=98) with a supply of less than 30 days. Rehabilitation length of stay was correlated with a MME decrease during rehab (p<0.01), suggesting that longer lengths of stay contributed to a greater reduction in MME. Patients with chronic opioid use prior to acute care admission (p=0.01), and those who started extended-release opioids during acute care (p=0.02) were significantly less likely to discontinue opioids during rehab stay.ConclusionOpioid utilization and management in the setting of opioid stewardship across inpatient rehab and transitions of care were characterized. Opportunities exist for further quality improvement initiatives within inpatient rehabilitation and acute care settings to identify and support patients with complex pain management needs.

P153. Long term assessment of the functional independence measure on sports spinal cord injury patients

<h3>BACKGROUND CONTEXT</h3> Patients with spinal cord injury (SCI) secondary to traumatic sports-related etiology potentially face loss of independence. The Functional Independence Measure (FIM) assesses the degree to which patients require assistance. Overall FIM score and subcomponents have shown sensitivity to changes in patient's functional status during the period after injury. <h3>PURPOSE</h3> Long-term functional outcomes are poorly explored among patients that had a sports-related SCI based on surgical (SS) or non-surgical (NSS) status. We investigated subscales of the FIM at 1-year and 5-years post rehabilitation to identify factors associated with long-term independence. <h3>STUDY DESIGN/SETTING</h3> The 1973-2016 National Spinal Cord Injury Model Systems (SCIMS) Database was used to develop our cohort of sports SCI patients. Patients who had an etiology of sports-related trauma and a completed FIM at 1-year and 5-years followup were included in the final analysis. <h3>PATIENT SAMPLE</h3> Analysis was performed on 491 patients, 60 (12.2%) were female and 452 (92%) underwent surgery. <h3>OUTCOME MEASURES</h3> Primary outcomes of interest were functional independence, defined by FIM individual scores of 6 or 7, for each subcomponent of FIM evaluated at 1-year and 5-years. <h3>METHODS</h3> Multiple multivariable logistic regressions were performed to identify significant factors. <h3>RESULTS</h3> Initial multivariable analysis showed that patients that are younger in age (P=0.012), white race (P=0.033), not married (P=0.021), and with more severe injury (P=0.011) were more likely to undergo surgery. The cohort was stratified by patients with and without spine surgery and evaluated by multivariate logistic regression for independence in FIM subcategories including self-care, sphincter control, mobility, and locomotion. Spine surgery was associated with poorer outcomes in all FIM subcategories at 1-year followup, but was insignificant at 5-year followup. Rehabilitation length of stay was significantly associated with improved independence at 1-year followup. Lesser severity of injury indicated by ASIA scale was associated with better independence outcomes at 5-year followup while mechanical ventilation at med/surg admission was associated with poorer 5-year independence outcomes. <h3>CONCLUSIONS</h3> Our study demonstrated that patients undergoing spine surgery had lower odds of achieving independent status across all FIM subcategories at 1-year followup, yet when evaluated at 5-year, spine surgery patients had no statistically significant differences in outcomes when compared to medically managed patients. Additionally, we identified that factors repeatedly associated with improved independence at 1-year followup are strictly dissimilar to those associated with improved independence at 5-year followup. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Relationship Between Length of Rehabilitation and Quality of Life for Psychoactive Substance Users in Yogyakarta

The background of this research is the use of psychoactive substances causes complex problems and becomes a threat to the state. Rehabilitation can reduce the risk of relapse of psychoactive substance abuse and the risk of crime, thereby improving quality of life. Understanding rehabilitation with quality of life has a positive impact on users of psychoactive substances. Therefore, it is essential to study the relationship between the length of rehabilitation and the quality of life of users of psychoactive substances. The purpose of this study was to determine the relationship between the size of rehabilitation and the quality of life for users of psychoactive substances. This research method is a non-experimental observational analytic study with a cross-sectional design. The subjects of the study were users of psychoactive substances who were undergoing the rehabilitation process at the Class IIA Narcotics Prison in Yogyakarta. Quality of life was measured by the World Health Organization Quality of Life BREF (WHOQOL-BREF) instrument. The significance level of the statistical test was stated at p&lt;0.05. Data analysis used the Spearman Rank correlation test and multiple linear regression. The results of this study carried out for two months (March to April 2021) obtained a total of 77 subjects using psychoactive substances. The length of rehabilitation has a significant positive correlation with the quality of life, indicated by the value of p = 0.048 (p &lt;0.05) and r = 0.220, which means that the longer the respondent undergoes rehabilitation, the better the quality of his life. This study concludes that there is a significant relationship between the length of repair and quality of life for users of psychoactive substances.&#x0D;

The health service impact of an occupational therapy practice placement model: Student-resourced service delivery of groups

Introduction: Student-resourced service delivery of groups is a practice education placement model in which students deliver therapy to groups, with graded supervision. This study examined an application of this model in occupational therapy to determine its costs to the health service and impact on hospital rehabilitation throughput and patient outcomes. Methods: Retrospectively collected data were compared between periods when groups were student-resourced and staff-resourced. Patient data were analysed separately to group data. Results: Seventeen patients received staff-resourced group therapy, and 52 patients received student-resourced group therapy, with no statistically significant differences identified in the characteristics of patients between group types. There was no evidence student-resourced therapy was associated with change in patient rehabilitation outcomes or length of rehabilitation stay. Student-resourced therapy groups had an average duration of 10.8 minutes per session shorter (95% CI: 3.7, 18.0 P: 0.002) than staff-resourced groups. Under the student-resourced groups placement model, mean clinician time per group—both direct patient time and time spent on group facilitation—was not adversely affected and was reduced for occupational therapy assistants’ direct time (mean difference -7.6 minutes, 95% CI: 0.8, -16.0 P: 0.04) and for occupational therapists’ indirect time (mean difference -30.28 minutes 95% CI: -1.0, -59.6 P:0.02). Despite an implied mean cost savings per group of $49.61 under the student-resourced model, there was no evidence of any statistically significant impact on overall costs. Conclusions: Student-resourced service delivery of rehabilitation groups provide an opportunity for student practice education placements and do not appear to negatively impact occupational therapists’ time, costs or patient outcomes.

Association Between Delayed Discharge From Acute Care and Rehabilitation Outcomes and Length of Stay: A Retrospective Cohort Study

ObjectiveTo examine the association between discharge delays from acute to rehabilitation care because of capacity strain in the rehabilitation units, patient length of stay (LOS), and functional outcomes in rehabilitation. DesignRetrospective cohort study using an instrumental variable to remove potential biases because of unobserved patient characteristics. SettingTwo campuses of a hospital network providing inpatient acute and rehabilitation care. ParticipantsPatients admitted to and discharged from acute care categories of Medicine and Neurology/Musculoskeletal (Neuro/MSK) and subsequently admitted to and discharged from inpatient rehabilitation between 2013 and 2019 (N=10486). InterventionsNone. Main Outcome MeasuresRehabilitation LOS, FIM scores at admission and discharge, and rehabilitation efficiency defined as FIM score improvement per day of rehabilitation. ResultsThe final cohort contained 3690 records for Medicine and 1733 for Neuro/MSK categories. For Medicine, 1 additional day of delayed discharge was associated with an average 5.1% (95% confidence interval [CI], 3%-7.3%) increase in rehabilitation LOS and 0.08 (95% CI, 0.03-0.13) reduction in rehabilitation efficiency. For Neuro/MSK, 1 additional day of delayed discharge was associated with an average 11.6% (95% CI, 2.8%-20.4%) increase in rehabilitation LOS and 0.08 (95% CI, −0.07 to 0.23) reduction in rehabilitation efficiency. ConclusionsDelayed discharge from acute care to rehabilitation because of capacity strain in rehabilitation had a strong association with prolonged LOS in rehabilitation. An important policy implication of this “cascading” effect of delays is that reducing capacity strain in rehabilitation could be highly effective in reducing discharge delays from acute care and improving rehabilitation efficiency.

The implementation of a precision case management model in a Canadian inpatient rehabilitation center: The 12-months post-implementation findings of a quality improvement project.

Despite recommendations, few have reported on quality improvement initiatives to implement length of rehabilitation stay benchmarks, while actively monitoring functional outcomes. This article describes the development, implementation, and evaluation of a precision case management model across all inpatient rehabilitation client groups in a Canadian facility. To develop the length of rehabilitation-stay (LoRS) benchmarks, patient data was retrospectively analyzed. A severity specific method was used to stratify median length of stay. A target reduction on 8.6 days in LoRS was established. Functional discharge targets were also set and monitored at specific intervals via the Functional Independence Measure (FIM®). The implementation used an incremental quality improvement phased approach. Following 12-months, a statistically significant reduction in mean LoRS of 13.2 days was achieved, along with a small increase in FIM® change across all rehabilitation client groups. A similar pattern was seen across the three main client groups, where a LoRS reduction greater than the target was achieved, along with important improvements in LoRS efficiency. This study demonstrates how the implementation of a precision case management model can assist a facility in markedly reducing LoRS across inpatient groups, without compromising functional change or community discharge rates and begin its transformation to a value-based organization.

Additional saturday occupational therapy for adults receiving inpatient physiotherapy rehabilitation: a prospective cohort study

BackgroundThe first aim of this study was to investigate the impact of providing an additional four hours of Saturday occupational therapy to patients receiving Saturday physiotherapy in an inpatient setting on length of stay, functional independence, gait and balance. The second aim was to conduct an economic evaluation to determine if the introduction of a Saturday occupational therapy service in addition to physiotherapy resulted in a net cost savings for the rehabilitation facility.MethodsA prospective cohort study with a historical control was conducted in an Australian private mixed rehabilitation unit from 2015–2017. Clinical outcomes included the Functional Independence Measure (Motor, Cognitive, Total), gait speed (10 Meter Walk test) and five balance measures (Timed Up and Go test, Step test, Functional Reach, Feet Together Eyes Closed and the Balance Outcome Measure of Elder Rehabilitation). Economic outcomes were rehabilitation unit length of stay and additional treatment costs.ResultsA total of 366 patients were admitted to the rehabilitation unit over two 20-week periods. The prospective cohort (receiving Saturday occupational therapy and physiotherapy) had 192 participants and the historical control group (receiving Saturday physiotherapy only) had 174 participants. On admission, intervention group participants had higher cognitive (p < 0.01) and total (p < 0.01) Functional Independence Measure scores. Participation in weekend therapy by the intervention group was 11% higher, attending more sessions (p < 0.01) for a greater length of time (p < 0.01) compared to the historical control group.After controlling for differences in admission Functional Independence Measure scores, rehabilitation length of stay was estimated to be reduced by 1.39 (p = 0.08) days. The economic evaluation identified potential cost savings of AUD1,536 per patient. The largest potential savings were attributed to neurological patients AUD4,854. Traumatic and elective orthopaedic patients realised potential patient related cost savings per admission of AUD2,668 and AUD2,180, respectively.ConclusionsImplementation of four hours of Saturday occupational therapy in addition to physiotherapy results in a more efficient service, enabling a greater amount of therapy to be provided on a Saturday over a shorter length of stay. Provision of multidisciplinary Saturday rehabilitation is potentially cost reducing for the treating hospital.

Optimisation of postoperative X-ray acquisition for orthopaedic patients.

Postoperative X-rays are a key part of management of orthopaedic patients. These X-rays serve to check stability of orthopaedic fixation as well as to ensure that there are no peri-implant fractures and periprosthetic fractures following surgical fixation of fractures and arthroplasty procedures, respectively. Timely accurate interpretation of postoperative X-rays are crucial in guiding weight-bearing status as well as rehabilitation. Therefore, delays in X-ray acquisition may impact initiation of postoperative rehabilitation and overall length of stay negatively. The aim of this project is to optimise acquisition of postoperative X-rays in patients undergoing implant surgery and as a result increase efficiency of deployed healthcare staff. A multidisciplinary team was formed to study the efficacy of a new workflow for patients to undergo X-rays immediately after surgery while en-route to the ward. Pretrial and in-trial delays in acquiring X-rays and total man-hours spent on transport were recorded. These processes were refined and integrated to optimise the new workflow. Compared with the old workflow, delays in obtaining X-rays were significantly reduced from the longest of 20 hours and 40 min to no delays at all. Overall man-hours spent on transport of these patients were reduced by a mean of 12 and 16 min for nurses and porters, respectively. The trial workflow has since been adopted successfully by our institution and since inception has become standard practice, allowing timely review of postoperative X-rays. This has led to increased workforce efficiency as well as timely rehabilitation and discharge of patients.

Does Wait Time During Acute Care for Transfer to Rehabilitation Admission Impact the Outcomes After a Traumatic Spinal Cord Injury?: A Retrospective Cohort Study.

The objective of this study was to determine the impact of wait time in acute care for inpatient functional rehabilitation admission on the inpatient functional rehabilitation length of stay and functional outcome after a traumatic spinal cord injury. A retrospective cohort including 277 patients admitted to a single level 1 spinal cord injury acute care center was completed. Partial correlations were used between wait time (in days) for transfer to inpatient functional rehabilitation, the inpatient functional rehabilitation length of stay, and the Spinal Cord Independence Measure total score in the chronic period, adjusting for confounding variables. Stratified analyses were carried out based on the age group and severity of the injury. Patients had to wait a mean of 7.3 ± 6.4 days (median = 6 days, interquartile range = 2-10 days, max = 29 days) for inpatient functional rehabilitation admission after rehabilitation readiness, which was not associated with the outcomes when adjusted ( P > 0.05). However, individuals 65 yrs or older with a motor-complete injury showed a lower functional status when exposed to wait time for transfer ( r = -0.87, P = 0.02). Wait time up to 29 days may have no impact on the inpatient functional rehabilitation length of stay nor functional outcome after traumatic spinal cord injury. However, additional resources and/or prioritization should be considered for vulnerable subgroups.

Ability to detect history of falls among individuals with spinal cord injury using upper limb loading during a seated push-up test.

A history of falls is an important risk factor for future falls, including for individuals with spinal cord injury (SCI) who often experience falls and subsequent injuries. This may be even more pronounced during the current COVID-19 pandemic because of the extreme shortage of hospital admission and restricted access to important services. Therefore, the ability of detecting a history of falls that can be applied to wheelchair users and ambulatory individuals with SCI in various settings are essential. To investigate the discriminative ability of three clinical measures-the handgrip (HG) test, Spinal Cord Independence Measure (SCIM) III and Upper Limb Loading During a Seated Push-Up Test (ULL-SPUT)-in discriminating individuals with SCI with and without a history of falls over the past six months. A 6-month retrospective observational cohort study. Inpatient tertiary rehabilitation center. One hundred and fourteen wheelchair users and ambulatory individuals with SCI. The participants were interviewed and assessed for their demographics, SCI characteristics and fall data over the past six months, with data confirmation from related events, their caregivers and medical records. Subsequently, they were assessed using the HG test, SCIM III, and ULL-SPUT. In total, 29 participants (25%) fell during the past six months (with the number of falls ranging from 1-20, with minor consequences after the falls). Among the three clinical measures assessed in this study, the ULL-SPUT data of faller participants were significantly higher than those of non-fallers (P<0.05). The limited rehabilitation length and increased staying home and social isolation prompted by the COVID-19 pandemic may have reduced the fall rates of the participants. The findings suggest a higher likelihood of falls among wheelchair users and ambulatory individuals with SCI who have good mobility as determined using ULL-SPUT data. Apart from being an important rehabilitation strategy, the present findings suggest an additional benefit of ULL-SPUT to identify individuals with SCI with a likelihood of future falls. The measurement can be done easily using digital bathroom scales placing over a flat and smooth surface. Therefore, it would enable the timely initiation of fall prevention strategies in various clinical, community, home and research settings; particularly in this COVID-19 pandemic of limited beds and hospital services for these individuals.

The Impact of Body Mass Index Classification on Outcomes After Stroke Rehabilitation: A Retrospective Study.

With improving stroke mortality rates, more individuals are living with the consequences of stroke. Obesity is a known risk factor for stroke, but its effect on functional outcomes poststroke is less clear. The aim of this study was to determine the association between body mass index classification (underweight, normal weight, overweight, and obese) and functional outcomes, as measured by Functional Independence Measure change, Functional Independence Measure efficiency, and rehabilitation length of stay after inpatient stroke rehabilitation. A retrospective cohort study of individuals with a diagnosis of stroke admitted to a high-intensity inpatient rehabilitation program was performed. Patients were divided into 4 groups based on body mass index category using normal body mass index as the reference. Overall, 34 individuals (4.5%) were classified as underweight, 303 (40.1%) had body mass indices within the normal range, 269 (35.6%) were overweight, and 149 (19.7%) were obese. Ischemic stroke was the most common stroke type across all body mass index categories. Patients in the overweight and obese groups tended to be younger. There were no statistically significant differences in rehabilitation length of stay, Functional Independence Measure change, or Functional Independence Measure efficiency with all groups demonstrating significant functional improvements. Based on these findings, patients admitted for inpatient rehabilitation after stroke can be expected to make similar functional improvements regardless of BMI class.

Acute Inpatient Rehabilitation Improves Function Independent of Comorbidities in Medically Complex Patients

Objectives(1) To evaluate the benefits of acute inpatient rehabilitation for a medically complex patient population and (2) to assess the effect of comorbid conditions on rehabilitation outcomes. DesignRetrospective cohort study. SettingFreestanding inpatient rehabilitation facility. ParticipantsA total of 270 medically complex adult patients including those with cardiac, pulmonary, and orthopedic conditions, with mean age of 73.6 years; 52.6% were female and 47.4% were male (N=270). InterventionsNot applicable. Main Outcome MeasuresFunctional Independence Measure (FIM) gain, FIM efficiency, rehabilitation length of stay (RLOS), home discharge rate, and readmission to acute care (RTAC). ResultsAmong 270 medically complex patients, mean total FIM gain, mean RLOS, and mean FIM efficiency with SD were 26.0±13.6 points, 12.6±5.9 days, and 2.3±1.6, respectively. A total of 71.9% of patients were discharged to home, 12.2% for RTAC, and 15.9% to a skilled nursing facility (SNF). Hypertension (HTN) was the only comorbidity significantly associated with FIM gain (53.7% [total FIM gain ≥27] vs 67.2% [total FIM gain <27]; P=.024) and FIM efficiency (53.3% [FIM efficiency ≥2.12] vs 67.4% [FIM efficiency <2.12]; P=.025), independent of age, body mass index, sex, race, ethnicity, insurance type, and Charlson Comorbidity Index. The 5 most common reasons for RTAC were cardiac, pulmonary, acute blood loss anemia, infection, and neurologic conditions. ConclusionsAmong 270 medically complex patients, 71.9% were discharged to home, 15.9% to an SNF, and 12.2% for RTAC with a mean RLOS 12.6 days, mean total FIM gain of 26 points, and mean FIM efficiency of 2.3, which were all better than those of all admissions at our facility in 2018. Furthermore, RLOS, total FIM gain and FIM efficiency in this study were all better than their corresponding eRehabData weighted national benchmarks (RLOS, 15.82 days; FIM gain, 25.57; FIM efficiency, 2.13) for a total of 202,520 discharges in 2018. These findings support acute inpatient rehabilitation for this patient population. With the exception of HTN, no medical comorbidities or demographic variables were associated with rehabilitation outcomes.

Accuracy of the Australian National Sub-Acute and Non-Acute Patient Classification in predicting rehabilitation length of stay for stroke survivors who are ≥65 years of age and have lateropulsion

ABSTRACT Background Lateropulsion is a common impairment after stroke. Regardless of stroke severity, functional recovery is slower in people with lateropulsion, resulting in requirement for longer rehabilitation duration. In Australia, inpatient rehabilitation funding is determined via the Australian National Sub-Acute and Non-Acute Patient Classification (AN-SNAP). AN-SNAP class is determined using age, diagnosis, weighted Functional Independence Measure (FIM) motor score, and FIM cognitive score. Objectives To explore accuracy of the AN-SNAP to predict length of stay (LOS) for people with poststroke lateropulsion. Methods A retrospective database audit was undertaken. AN-SNAP predicted LOS for each participant was calculated based on 2019 calendar year national benchmarks. A multivariable linear regression model estimated mean differences in reported LOS and AN-SNAP predicted LOS after adjusting for lateropulsion severity (Four Point Pusher Score). A separate logistic regression model assessed whether FIM change during admission was associated with reported LOS exceeding AN-SNAP predicted LOS. Results Data were available from 1126 admissions. Reported LOS exceeding AN-SNAP predicted LOS was associated with greater lateropulsion severity on admission. Where AN-SNAP predicted LOS was longer, those with no lateropulsion on admission showed shorter reported than predicted LOS. Greater improvement in FIM during rehabilitation was associated with increased odds of reported LOS exceeding AN-SNAP predicted LOS (OR 1.02, 95%CI 1.01–1.03, p < .001). Conclusions Inclusion of a measure of poststroke lateropulsion in the AN-SNAP classification model would result in more accurate LOS predictions to inform funding. Costs of longer rehabilitation LOS may be countered by optimized long-term physical function, reducing requirement for ongoing care.

Influence of the Primary and Secondary Lower Leg War Amputations on the Length of Hospitalization and Rehabilitation

Influence of the Primary and Secondary Lower Leg War Amputations on the Length of Hospitalization and Rehabilitation

Association of material deprivation with discharge location and length of stay after inpatient stroke rehabilitation in Ontario: a retrospective, population-based cohort study

Background:Low socioeconomic status is associated with increased risk of stroke and worse poststroke functional status. The aim of this study was to determine whether socioeconomic status, as measured by material deprivation, is associated with direct discharge to long-term care or length of stay after inpatient stroke rehabilitation.Methods:We performed a retrospective, population-based cohort study of people admitted to inpatient rehabilitation in Ontario, Canada, after stroke. Community-dwelling adults (aged 19–100 yr) discharged from acute care with a most responsible diagnosis of stroke between Sept. 1, 2012, and Aug. 31, 2017, and subsequently admitted to an inpatient rehabilitation bed were included. We used a multivariable logistic regression model to examine the association between material deprivation quintile (from the Ontario Marginalization Index) and discharge to long-term care, and a multivariable negative binomial regression model to examine the association between material deprivation quintile and rehabilitation length of stay.Results:A total of 18 736 people were included. There was no association between material deprivation and direct discharge to long-term care (most v. least deprived: odds ratio [OR] 1.07, 95% confidence interval [CI] 0.89–1.28); however, people living in the most deprived areas had a mean length of stay 1.7 days longer than that of people in the least deprived areas (p = 0.004). This difference was not significant after adjustment for other baseline differences (relative change in mean 1.02, 95% CI 0.99–1.04).Interpretation:People admitted to inpatient stroke rehabilitation in Ontario had similar discharge destinations and lengths of stay regardless of their socioeconomic status. In future studies, investigators should consider further examining the associations of material deprivation with upstream factors as well as potential mitigation strategies.

Impact of Diabetes, Hypertension and Heart Failure on Stroke Rehabilitation Care

Background: Stroke patients who have multiple comorbidities at inpatient rehabilitation admission might experience poorer outcomes than those without comorbidities. Some differences in outcomes between these two groups may be based on age and type of comorbidity. Materials and Methods: Retrospective administrative data from an inpatient stroke rehabilitation unit in a Southwestern Ontario hospital were examined to determine the independent associations between diabetes, hypertension, and heart failure in stroke patients and rehabilitation length of stay (LOS), functional gains in rehabilitation, and discharge destination. We also examined the associations between CHADS2 score and rehabilitation LOS, functional gains in rehabilitation, and discharge destination. Results: Seven hundred and seven cases of stroke subcategorized as experiencing mild (n = 193), moderate (n = 454), and severe (n = 60) stroke were included in the study. Of these patients, 16.4% (n = 116) had type 2 diabetes, 58.7% (n = 415) had hypertension, and 5.8% (n = 41) had congestive heart failure (CHF) prior to stroke. CHF patients were significantly (p = 0.02) older, had significantly (p = 0.014) lower mean FIM gains and were discharged to residential care facilities compared to non-CHF cases. A higher CHADS2 score was significantly associated with Lower FIM gains and discharge to longer term settings. Conclusion: Significant differences exist in the functional gains and discharge disposition of stroke patients based on age of patient, type of comorbidity in stroke, and CHADS2 score.

The effectiveness of a co-management care model on older hip fracture patients in China – A multicentre non-randomised controlled study

SummaryBackgroundClinical guidelines recommend orthogeriatric care to improve older hip fracture patients’ outcomes, but few studies have been conducted in China. This study evaluated the effects of an orthogeriatric co-management care model in six Chinese hospitals.MethodsThis non-randomised controlled study was designed as an exploratory trial and was conducted in 3 urban and 3 suburban hospitals. Eligible patients were aged ≥ 65 years with X-ray confirmed hip fracture and admitted to hospital within 21 days of injury. All patients received three times follow-ups within one year (1-month, 4-month and 12-month post admission). Co-management care was implemented in 1 urban hospital, while usual care continued in 5 urban and suburban hospitals. Patient demographics, pre-, peri- and post-operative information, complications and mortality were collected at baseline and follow-ups. The primary outcome was proportion of patients receiving surgery within 48 hours from ward arrival. Secondary outcomes included osteoporosis assessment, in-hospital rehabilitation, length of hospital stay, in-hospital mortality and one-year cumulative mortality.FindingsThere were 2,071 eligible patients enrolled (1,110 intervention, 961 control). Compared to usual care, a significantly higher proportion of intervention patients received surgery within 48 hours (75% vs 27%, p<0.0001), osteoporosis assessment (99.9% vs 60.6%, p<0.0001), rehabilitation (99.1% vs 3.9%, p<0.0001) and shorter length of hospital stay (6.1 days vs 12.0 days, p<0.0001). The intervention group saw a significant lower in-hospital mortality rate than the control group (adjusted relative risk 0.021, 95% CI 0.001 to 0.45, P=0.01). One-year cumulative mortality was also significantly reduced in the intervention group (hazard ratio 0.59, 95% CI 0.38 to 0.80, p=0.01).InterpretationCo-management care of older hip fracture patients resulted in better outcomes, including decreased time to surgery, improved clinical management, and reduced one-year mortality. A randomised controlled trial is needed to provide definitive evidence.FundingThe study is supported by Capital's Funds for Health Improvement and Research (2018-1-2071).

Outcomes of psychiatric rehabilitation – a retrospective study of young adults with severe mental disorders after psychiatric rehabilitation

Aims The aim of this study was to analyze the changes in functioning and psychiatric symptoms of young adults who participated psychiatric rehabilitation. Methods The rehabilitation program included active engagement of the individual, coaching, rehabilitation groups and functional rehabilitation in, for example ADL-activities and work/education. The main goal of the program was that the individual would be able to reach independent and meaningful living. The sample consisted of individuals aged 18–29 years who had been in rehabilitation between 2011–2017 (n = 39). The data consisted of information collected during rehabilitation and interRAI-CMH-evaluations. From InterRAI-CMH-instrument we gathered and analyzed scales focusing on psychiatric symptoms and functioning. Explorative statistics, a paired samples t-test or a Wilcoxin`s rank order test was used for analyzes. Results Median age of the participants was 23 years and average length of rehabilitation was 2,5 years. Of the participants 92% had several diagnoses, most common anxiety disorders. Antipsychotics were the most commonly used medication by 72%. Symptoms of depression decreased, and independent living increased statistically significantly from baseline to the end of the rehabilitation. Conclusion This was the first Nordic study on outcomes of psychiatric rehabilitation using interRAI-CMH-instrument. Even though the sample size was small, using clinical sample is an important contribution. Independent living was the primary target of the rehabilitation and a result of a significant increase in independent living is an important marker of effectiveness of rehabilitation. Based on this study, psychiatric rehabilitation has positive effect on the functioning and mental health of young adults with severe mental disorders.

Risk Factors, Clinical Features, and Outcomes among Stroke Patients Presenting to Spinal Injury Rehabilitation Centre.

Worldwide, stroke is the second leading cause of death and disability. The burden of stroke in countries like Nepal is increasing. The purpose of this study is to describe the epidemiology, clinical features, and functional outcomes of individuals with stroke in a rehabilitation hospital in Nepal. A prospective descriptive study was conducted among individuals with stroke presenting for inpatient rehabilitation to the Nepal's first interdisciplinary inpatient stroke rehabilitation unit over a one-year period; from 1 April 2018 - 30 March 2019. Twenty-four individuals were enrolled, with average age of 56.8 years (SD 11.9, range 38-79). Seventeen patients (71%) presented with ischemic stroke. Hypertension was the most common modifiable stroke risk factor observed, present in 21 (88%) of individuals. Median rehabilitation length of stay was 32.5 days (IQR 15.3 - 68.8). Median Modified Barthel Index at admission was 25.0 (IQR 8.5-57.0) and at discharge was 67.0 (IQR 46.0-88.0), a statistically significant improvement (Z = -3.408, p = 0.001). Median Modified Rankin Scale on admission was 5.0 (IQR 4.0-5.0) and at discharge was 4.0 (IQR 3.6-4.8; Z = -3.276, p = 0.001). Most individuals with stroke admitted for interdisciplinary stroke rehabilitation demonstrated "severe" levels of disability and dependency on admission, and "moderate" levels of disability and dependency at the time of discharge. Hypertension represents a strategic target for primary and secondary prevention of stroke. With the burden of stroke increasing in Nepal, it is imperative to improve long-term availability and access to comprehensive stroke care for all affected individuals.

A Pilot Study Quantifying Center of Mass Trajectory during Dynamic Balance Tasks Using an HTC Vive Tracker Fixed to the Pelvis.

Fall rates are increasing among the aging population and even higher falls rates have been reported in populations with neurological impairments. The Berg Balance Scale is often used to assess balance in older adults and has been validated for use in people with stroke, traumatic brain injury, and Parkinson’s disease. While the Berg Balance Scale (BBS) has been found to be predictive of the length of rehabilitation stay following stroke, a recent review concluded the BBS lacked predictive validity for fall risk. Conversely, sophisticated measures assessing center of mass (COM) displacement have shown to be predictive of falls risk. However, calculating COM displacement is difficult to measure outside a laboratory. Accordingly, we sought to validate COM displacement measurements derived from an HTC Vive tracker secured to the pelvis by comparing it to COM derived from ‘gold’ standard laboratory-based full-body motion capture. Results showed that RMS between the COM calculated from HTC Vive tracker and full body motion capture agree with an average error rate of 2.1 ± 2.6 cm. Therefore, we conclude measurement of COM displacement using an HTC Vive tracker placed on the pelvis is reasonably representative of laboratory-based measurement of COM displacement.