Risk Factors For Poor Recovery Research Articles

Twelve-month recovery following road trauma: Results from an inception cohort in Vancouver, Canada

BackgroundInjury-related disability following road trauma is a major public health concern. Unfortunately, outcome following road trauma and risk factors for poor recovery are inadequately studied, especially for road trauma survivors with minor injuries that do not require hospitalization. ObjectivesThis manuscript reports 12-month recovery outcomes for a large cohort of road trauma survivors. MethodsThis was a prospective, observational inception cohort study of 1,480 road trauma survivors recruited between July 2018 and March 2020 from 3 trauma centres in British Columbia, Canada. Participants were aged ≥16 years and arrived in a participating emergency department within 24 h of a motor vehicle collision. Data on baseline health and injury severity were collected from structured interviews and medical records. Outcome measures, including the SF-12, were collected during follow-up interviews at 2, 4, 6 and 12 months. Predictors of recovery outcomes were identified using Cox proportional hazards models and summarized using hazard ratios. ResultsOnly 42 % of participants self-reported full recovery and only 66 % reported a return to usual daily activities. Females, older individuals, pedestrians, and those who required hospital admission had a poorer recovery than other groups. Similar patterns were observed for the SF-12 physical component. For the SF-12 mental component, no significant differences were observed between participants admitted to hospital and those discharged home from the ED. Return to work was reported by 77 % of participants who had a paying job at baseline, with no significant differences between sex and age groups. ConclusionsIn a large cohort of road trauma survivors, under half self-reported full recovery one year after the injury. Poor mental health recovery was observed in both participants admitted to hospital and those discharged home from the ED. This finding may indicate a need for early intervention and continued mental health monitoring for all injured individuals, including for those with less serious injuries.

Exploring perioperative risk factors for poor recovery of postoperative gastrointestinal function following gynecological surgery: A retrospective cohort study

PurposeTo investigate perioperative risk factors that affect the recovery of postoperative gastrointestinal function in patients undergoing gynecological surgery and to establish a preoperative risk prediction scoring system. MethodsIn this retrospective cohort study, characteristics and perioperative factors of patients who underwent elective gynecological surgery at Union Hospital from January 2021 to March 2022 were extracted from electronic medical records. Patients were grouped according to the Intake, Feeling nauseated, Emesis, physical Exam, and Duration of symptoms (I-FEED) scoring system to compare collected data. ResultsIn total, clinical data from 208 gynecological patients were extracted. The incidence of poor postoperative gastrointestinal recovery was 7.21 %. The number of previous abdominal surgeries (0.73 ± 0.06 vs 1.20 ± 0.24, p = 0.044), the incidence of malignant disease (20.2 % vs 53.3 %, p = 0.003), postoperative maximum WBC count (9.15 vs 12.44, p = 0.005) and postoperative minimum potassium (3.97 ± 0.36 vs 3.76 ± 0.37, p = 0.036) were not only associated with poor postoperative gastrointestinal recovery, but also malignant disease (p = 0.000), postoperative maximum WBC count (p = 0.027) and postoperative minimum potassium (p = 0.024) were significantly associated with the severity of postoperative gastrointestinal function. An increased number of previous abdominal surgeries and malignant primary disease could increase the risk of an I-FEED score >2 as independent risk factors. ConclusionPatients with poor postoperative GI function had poorer postoperative recovery outcomes. A preoperative score prediction system was established, in which patients with ≥2 points had a 19.4 % risk of poor postoperative gastrointestinal recovery. Higher-quality prospective studies should be performed to achieve more precise risk stratification and to construct a more accurate prediction system.

Association between Insomnia and Mental Health and Neurocognitive Outcomes Following Traumatic Brain Injury.

To describe the association between five previously identified trajectories of insomnia (each defined by a distinct pattern of insomnia severity over 12 months following TBI) and trajectories of mental health and neurocognitive outcomes during the 12 months after TBI. N=2,022 adults from the Federal Inter-agency Traumatic Brain Injury Repository (FITBIR) database and Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study. The following outcome measures were assessed serially at 2 weeks, and 3, 6, and 12 months post-injury: Insomnia Severity Index, Patient Health Questionnaire, PTSD Checklist for DSM-5, PROMIS-PAIN, and Quality of Life After Brain Injury-Overall Scale. Neurocognitive performance was assessed at 2 weeks, 6 and 12 months using the Wechsler Adult Intelligence Scales Processing Speed Index and the Trails Making Test Parts A and B. Greater insomnia severity was associated with greater abnormality in mental health, quality of life, and neuropsychological testing outcomes. The pattern of insomnia over time tracked the temporal pattern of all these outcomes for all but a very small number of participants. Notably, severe insomnia at 3 or 6 months post-TBI was a risk factor for poor recovery at 12 months post-injury. In this well-characterized sample of individuals with TBI, insomnia severity generally tracked severity of depression, pain, PTSD, quality of life, and neurocognitive outcomes over 12 months post-injury. More intensive sleep assessment is needed to elucidate the nature of these relationships and to help inform best strategies for intervention.

Demographic and clinical profile of an inception cohort of road trauma survivors

BackgroundRoad trauma is a major public health concern, often resulting in reduced health-related quality of life and prolonged absenteeism from work even after so-called ‘minor’ injuries that do not result in hospitalization. This manuscript compares pre-injury health, sociodemographic characteristics and injury details between age, sex, and road user categories in a cohort of 1,480 road trauma survivors.MethodsThis was a prospective observational inception cohort study of road trauma survivors recruited between July 2018 and March 2020 from three trauma centres in British Columbia, Canada. Participants were aged ≥ 16 years and arrived in a participating emergency department within 24 h of involvement in a motor vehicle collision. Data were collected from structured interviews and review of medical records.ResultsThe cohort of 1,480 road trauma survivors included 280 pedestrians, 174 cyclists, 118 motorcyclists, 683 motor vehicle drivers, and 225 passengers. Median age was 40 (IQR = [27, 57]) years; 680 (46%) were female. Males and younger patients were significantly more likely to report better pre-injury physical health. Motorcyclists and cyclists tended to report better physical health and less severe somatic symptoms, whereas pedestrians and motor vehicle drivers reported better mental health. Injury severity and hospital admission rates were higher in pedestrians and motorcyclists and lower in motorists. Upper and lower extremity injuries were most common in pedestrians, cyclists and motorcyclists, whereas neck injuries were most common in motor vehicle drivers and passengers.ConclusionsIn a large cohort of road trauma survivors, overall injury severity was low. Motorcyclists and pedestrians, but not cyclists, had more severe injuries than motorists. Extremity injuries were more common in vulnerable road users. Future research will investigate one-year recovery outcomes and identify risk factors for poor recovery.

A national study of 23 major trauma centres to investigate the effect of frailty on clinical outcomes in older people admitted with serious injury in England (FiTR 1): a multicentre observational study

Older people are the largest group admitted to hospital with serious injuries. Many older people are living with frailty, a risk factor for poor recovery. We aimed to examine the effect of preinjury frailty on outcomes. In this multicentre observational study (FiTR 1), we extracted prospectively collected data from all 23 adult major trauma centres in England on older people (aged ≥65 years) admitted with serious injuries over a 2·5 year period from the Trauma Audit and Research Network (TARN) database. Geriatricians assessed the preinjury Clinical Frailty Scale (CFS), a 9-point scale of fitness and frailty, with a score of 1 indicating a patient is very fit and a score of 9 indicating they are terminally ill. The primary outcome was inpatient mortality, with patients censored at hospital discharge. We used a multi-level Cox regression model fitted with adjusted hazards ratios (aHRs) to assess the association between CFS and mortality, with CFS scores being grouped as follows: a score of 1-2 indicated patients were fit; a score of 3 indicated patients were managing well; and a score of 4-8 indicated patients were living with frailty (4 being very mild, 5 being mild, 6 being moderate, and 7-8 being severe). Between March 31, 2019, and Oct 31, 2021, 193 156 patients had records were held by TARN, of whom 16 504 had eligible records. Median age was 81·9 years (IQR 74·7-88·0), 9200 (55·7%) were women, and 7304 (44·3%) were men. Of 16 438 patients with a CFS score of 1-8, 11 114 (67·6%) were living with frailty (CFS of 4-8). 1660 (10·1%) patients died during their hospital stay, with a median time from admission to death of 9 days (IQR 4-18). Compared in patients with a CFS score of 1-2, risk of inpatient death was increased in those managing well (CFS score of 3; aHR 1·82 [95% CI 1·39-2·40]), living with very mild frailty (CFS score of 4: 1·99 [1·51-2·62]), living with mild frailty (CFS score of 5: 2·61 [1·99-3·43]), living with moderate frailty (CFS score of 6: 2·97 [2·26-3·90]), and living with severe frailty (CFS score of 7-8: 4·03 [3·04-5·34]). Our findings support inclusion of the CFS in trauma pathways to aid patient management. Additionally, people who exercise regularly (CFS of 1-2) have better outcomes than those with lower activity levels (CFS of ≥3), supporting exercise as an intervention to improve trauma outcomes. None.

Melatonin pretreatment prevents propofol-induced sleep disturbance by modulating circadian rhythm in rats

Postoperative sleep disorder frequently occurs in patients after surgery. Sleep disturbance aggravates pain, anxiety, and delirium, which is an important risk factor for poor recovery. Circadian rhythm disorder induced by general anesthesia plays important role in postoperative sleep disorders. A large number of clinical studies have shown that various forms and duration of general anesthesia can lead to postoperative sleep disorders. In this study, the effect of prolonged propofol anesthesia on biological rhythm was comprehensively evaluated by wireless physiological telemetry system, and the therapeutic effect of exogenous melatonin pretreatment was further investigated. The results showed that prolonged propofol anesthesia had significant impacts on the circadian rhythm of sleep, body temperature, locomotor activity and endogenous melatonin secretion within 24 h following anesthesia, resulting in diminished oscillation amplitude. In hypothalamus, the expression of circadian factor PER and CRY were inhibited by propofol, possibly through activation of CAMK-CREB signaling pathway. Post-translational factors GSK-3β, SIRT1, AMPK were also involved in the regulation of circadian factors after propofol anesthesia. Melatonin pretreatment could restore circadian rhythm process by regulating circadian factor expression through post-translational modulation and prohibit the over-synthesis of melatonin in pineal gland. This study verified the effects of anesthetics on circadian rhythm and further evaluated the potential therapeutic effect of melatonin on postoperative circadian rhythm and sleep disorders.

Functional Outcome in Patients with Chronic Subdural Hematoma: Postoperative Delirium and Operative Procedure.

Chronic subdural hematoma (CSDH) is a common neurosurgical condition and neurological condition improves after treatment in most patients. Recently more patients have poor prognosis because of aging of the population and presence of multiple comorbidities. The risk factors for poor prognosis, including postoperative delirium, were retrospectively evaluated to assess appropriate operative procedures. This study included 108 patients who underwent primary surgery from 2016 to 2017 at a single center. Operative procedures were drainage with or without irrigation. Functional outcome at discharge assessed the effect of various factors including postoperative delirium and operative procedure. Twenty-nine of 108 patients (27%) had worsened modified Rankin Scale (mRS) score at discharge, most with mobility disturbance or deteriorated cognitive function. Multivariate analysis found higher age (odds ratio [OR] = 5.13; 95% confidence interval [CI] = 1.0-1.14), poor pre-hospital mRS score (OR = 1.57; 95% CI = 1.0-2.46), and preoperative consciousness disturbance caused by CSDH (OR = 5.13; 95% CI = 1.27-20) were significant predictors of poor outcome. Operative procedure was not significantly related to functional outcome or recurrence, but irrigation was significantly related to postoperative delirium (OR = 4.83; 95% CI = 1.09-21.7). Patients with postoperative delirium were likely to require longer hospitalization stays (P = 0.028). Higher age, poor pre-hospital mRS, and preoperative consciousness disturbance caused by CSDH are the risk factors for poor recovery after CSDH. Irrigation is significantly likely to cause postoperative delirium and longer hospital stay.

Effects and influencing factors of vestibular rehabilitation in 171 cases

Objective: To explore the effect of vestibular rehabilitation and to identify factors that can affect rehabilitation outcomes. Methods: From December 2018 to October 2020, patients who underwent vestibular rehabilitation in the Eye, Ear, Nose and Throat Hospital of Fudan University were prospectively followed up. A battery of vestibular function examinations and psychological status evaluations were applied before and after rehabilitation initiation. The main outcomes were vertigo/dizziness and unsteadiness, measured by visual analogue scale (VAS); Secondary outcomes were daily activities and participation, assessed by vestibular activities and participation measure (VAP). Paired t-test was used to compare the effects before and after rehabilitation. Binary logistic regressions were applied to analyze the influencing factors of rehabilitation outcomes. Results: A total sample of 171 patients was followed up regularly with a median time of 11 months. Of the 171 patients evaluated, 72 were males and 99 were females; age ranged from 10 to 89 years old with a median age of 55 years old. At 6-month follow-up, the difference of VAS score of vertigo/dizziness and unsteadiness pre-post rehabilitation was 1.79±1.80 and 1.56±1.76, respectively; The difference of activity and participation domain of VAP score was 2.51±13 and 1.27±3.75, respectively. All differences pre-post rehabilitation exhibited statistically significant with P values<0.01. Regression analysis demonstrated that the length of symptom onset was a significant predictor of poor balance recovery (OR=6.52; 95%CI:2.10, 20.27). Visual dependence (OR=5.44; 95%CI: 1.38, 21.47) and suspectable anxiety (OR=6.45; 95%CI: 1.49, 28.30) were identified as risk factors for poor recovery of vertigo/dizziness. Conclusions: Vestibular rehabilitation effectively reduces dizziness, promotes balance, and improves the function of daily activities. Time from the onset, visual dependence and suspectable anxiety are the main factors hindering a desirable rehabilitation outcome.

Identifying clinical clusters with distinct trajectories in first-episode psychosis through an unsupervised machine learning technique

The extreme variability in symptom presentation reveals that individuals diagnosed with a first-episode psychosis (FEP) may encompass different sub-populations with potentially different illness courses and, hence, different treatment needs. Previous studies have shown that sociodemographic and family environment factors are associated with more unfavorable symptom trajectories. The aim of this study was to examine the dimensional structure of symptoms and to identify individuals’ trajectories at early stage of illness and potential risk factors associated with poor outcomes at follow-up in non-affective FEP. One hundred and forty-four non-affective FEP patients were assessed at baseline and at 2-year follow-up. A Principal component analysis has been conducted to identify dimensions, then an unsupervised machine learning technique (fuzzy clustering) was performed to identify clinical subgroups of patients. Six symptom factors were extracted (positive, negative, depressive, anxiety, disorganization and somatic/cognitive). Three distinct clinical clusters were determined at baseline: mild; negative and moderate; and positive and severe symptoms, and five at follow-up: minimal; mild; moderate; negative and depressive; and severe symptoms. Receiving a low-dose antipsychotic, having a more severe depressive symptomatology and a positive family history for psychiatric disorders were risk factors for poor recovery, whilst having a high cognitive reserve and better premorbid adjustment may confer a better prognosis. The current study provided a better understanding of the heterogeneous profile of FEP. Early identification of patients who could likely present poor outcomes may be an initial step for the development of targeted interventions to improve illness trajectories and preserve psychosocial functioning.

Risk Factors for Poor Recovery After Total Knee Replacement Among Older Adults in the FORCE-TJR Cohort

Total knee replacement (TKR) is a common procedure in older adults with broad variability in outcomes. We sought to identify factors that contribute to resilient outcomes in 7,239 older adults (age 60 or older) who underwent TKR in the TJR-FORCE, a prospective registry of total joint replacement. Outcomes utilized were bodily pain and physical component score (PCS) from the Short Form 36 Health Survey (SF-36), at pre-op, 1-year, and 2-year post-procedure. Participants were grouped according to their outcome trajectories as “improving”, “worsening”, “variable,” or “stable.” Multinomial regression (with 4 outcome categories) was used to evaluate demographic risk factors (age, gender, BMI, marital status, education, smoking history, comorbidity count, household income). Older age, larger comorbidity count, low-income, smoking, and being unmarried were significant risk factors for poor recovery (not “improving”) in terms of bodily pain and physical component score. Next steps include evaluating risk factors for resilience outcomes in prospective studies.

Physical Performance and Risk of Postoperative Delirium in Older Adults Undergoing Aortic Valve Replacement.

BackgroundDelirium is a major risk factor for poor recovery after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). It is unclear whether preoperative physical performance tests improve delirium prediction.ObjectiveTo examine whether physical performance tests can predict delirium after SAVR and TAVR, and adapt an existing delirium prediction rule for cardiac surgery, which includes Mini-Mental State Examination (MMSE), depression, prior stroke, and albumin level.DesignProspective cohort, 2014–2017.SettingSingle academic center.SubjectsA total of 187 patients undergoing SAVR (n=77) or TAVR (n=110).MethodsThe Short Physical Performance Battery (SPPB) score was calculated based on gait speed, balance, and chair stands (range: 0–12 points, lower scores indicate poor performance). Delirium was assessed using the Confusion Assessment Method. We fitted logistic regression to predict delirium using SPPB components and risk factors of delirium.ResultsDelirium occurred in 35.8% (50.7% in SAVR and 25.5% in TAVR). The risk of delirium increased for lower SPPB scores: 10–12 (28.2%), 7–9 (34.5%), 4–6 (37.5%) and 0–3 (44.1%) (p-for-trend=0.001). A model that included gait speed <0.46 meter/second (OR, 2.7; 95% CI, 1.2–6.4), chair stands time ≥11.2 seconds (OR, 3.5; 95% CI, 1.0–12.4), MMSE <24 points (OR, 2.9; 95% CI, 1.3–6.4), isolated SAVR (OR, 5.4; 95% CI, 2.1–13.8), and SAVR and coronary artery bypass grafting (OR, 15.8; 95% CI, 5.5–45.7) predicted delirium better than the existing prediction rule (C statistics: 0.71 vs 0.61; p=0.035).ConclusionAssessing physical performance, in addition to cognitive function, can help identify high-risk patients for delirium after SAVR and TAVR.

Preoperative hypoalbuminemia: Poor functional outcomes and quality of life after hip fracture surgery.

Hip fracture patients have severe deterioration of their quality of life and function after their injury. Markers of malnutrition such as low albumin and low body mass index (BMI) have been shown to increase mortality and complication rates but their effect on recovery of quality of life and function after hip fracture surgery is unclear. The main aim of this paper is to further investigate if low albumin affects recovery after hip fracture surgery, while additionally studying low BMI as a possible risk factor for poor recovery. Retrospective analysis of 971 patients who underwent surgery for fragility hip fractures between January 2012 and December 2016 was performed. Demographic data, preoperative serum albumin and haemoglobin levels, BMI, Charlson Comorbidity Index (CCI), type of surgery (fixation vs replacement) and site of surgery were obtained. Patients were assessed using the Parker Mobility Scale (PMS), Harris Hip Score(HHS), Medical Outcomes Study 36-item Short-Form Health Survey (SF36) at pre-fracture, 6weeks and 6months after surgery. HHS was not available pre-operatively. Patients were grouped according to their albumin levels (low ≤35g/L or normal) and BMI (underweight <18.5 or normal). Univariate and multivariate analyses were performed to examine the association between albumin and BMI and 6-month scores. On univariate analysis, patients with low albumin ≤35g/L had lower baseline PMS and SF36 Physical Functioning (PF) score. On multivariate analysis, preoperative hypoalbuminemia was associated with lower 6-month HHS, PMS and SF36 PF scores even after accounting for baseline scores and other confounders. BMI had no effect on 6-month scores. Low albumin (≤35g/L) is prevalent in elderly hip fracture patients and is associated with slower recovery of function and quality of life after surgery. Low albumin can be a useful prognostic tool to identify patients with poor recovery for further intervention or rehabilitation after hip fracture surgery.

Comparison of Clinical and Radiographic Outcomes of Laminoplasty, Anterior Decompression With Fusion, and Posterior Decompression With Fusion for Degenerative Cervical Myelopathy: A Prospective Multicenter Study.

Prospective multicenter study. The aim of this study was to compare the clinical and radiographic results of laminoplasty (LAMP), anterior decompression with fusion (ADF), and posterior decompression with fusion (PDF) for degenerative cervical myelopathy (DCM). Although ADF, LAMP, and PDF have been performed for DCM, little is known about the difference in impact of these surgical treatments on clinical and radiographic outcomes. We prospectively enrolled patients who were scheduled for surgery for DCM and compared the clinical and radiographic results of ADF, LAMP, and PDF. In total, 171 patients completed the 1-year follow-up. Regarding clinical outcomes, the Japanese Orthopedic Association score for the assessment of cervical myelopathy (C-JOA score), European Quality of Life-5 Dimensions (EQ-5D), and Neck Disability Index (NDI) scores improved in all groups postoperatively. However, no significant differences were found in C-JOA, EQ-5D, and NDI scores and recovery rate among the groups. Regarding radiographic parameters, although the operation had no effect on cervical lordosis (CL) and the C2-7 sagittal vertical axis (SVA) in the ADF group, they worsened in the LAMP and PDF group. Although there were no significant differences in any preoperative radiographic parameters within the ADF and LAMP group, CL was significantly lower and the C2-7 SVA was significantly higher in the nonrecovery group within the PDF group. Logistic regression analysis showed that preoperative lower CL was an independent risk factor for poor recovery in the PDF group. Although groups showed no significant differences in clinical outcomes, cervical alignment worsened after surgery in the LAMP and PDF groups. Within the PDF group, lower CL was an independent risk factor for poor recovery. Therefore, the indications for PDF in DCM patients with preoperative kyphotic alignment should be carefully considered. 3.

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.

MP38-09 PREOPERATIVE IMMUNONUTRITION IN PATIENTS TREATED WITH RADICAL CYSTECOTMY, RESULTS FROM A PHASE 1, “ORAL IMMUNONUTRITION TO ENHANCE RECOVERY AFTER SURGERY” FEASIBILITY TRIAL

INTRODUCTION AND OBJECTIVES:Patients undergoing cystectomy continue to have poor outcomes despite multiple interventions to enhance recovery. Risk factors for poor recovery are limited and patients...

Longitudinal trajectory of early functional recovery in patients with first episode psychosis

BackgroundThere is a large variability in the recovery trajectory and outcome of first episode of psychosis [FEP] patients. To date, individuals' outcome trajectories at early stage of illness and potential risk factors associated with a poor outcome trajectory are largely unknown. This study aims to apply three separate predictors (positive symptoms, negative symptoms, and soft neurological signs) to identify homogeneous function outcome trajectories in patients with FEP using objective data-driven methods, and to explore the potential risk /protective factors associated with each trajectory. MethodsA total of 369 first episode patients (93% antipsychotic naive) were included in the baseline assessments and followed-up at 4–8 weeks, 6 months, and 1 year. K means cluster modeling for longitudinal data (kml3d) was used to identify distinct, homogeneous clusters of functional outcome trajectories. Patients with at least 3 assessments were included in the trajectory analyses (N = 129). The Scale for the Assessment of Negative Symptoms (SANS), Scale for the Assessment of Positive Symptoms (SAPS), and Neurological examination abnormalities (NEA) were used as predictors against Global Assessment of Functioning Scale (GAF). ResultsIn each of the three predictor models, four distinct functional outcome trajectories emerged: “Poor”, “Intermediate”, High” and “Catch-up”. Individuals with male gender; ethnic minority status; low premorbid adjustment; low executive function/IQ, low SES, personality disorder, substance use history may be risk factors for poor recovery. ConclusionsFunctioning recovery in individuals with FEP is heterogeneous, although distinct recovery profiles are apparent. Data-driven trajectory analysis can facilitate better characterization of individual longitudinal patterns of functioning recovery.

DEPRESSIVE SYMPTOM SUBTYPES IN OLDER ADULTS AFTER HIP FRACTURE

Depressive symptoms after hip fracture are common, and psychosocial impairment impedes recovery. However, depression is clinically heterogenous; thus, the aim was to identify and describe depressive symptom subtypes in the year following hip fracture. Men (n=149) and women (n=155) 65 years or older from the Baltimore Hip Studies 7th Cohort with depressive symptoms measured at baseline (within 22 days post-admission) or 2, 6, or 12 months follow-up using the 20-item Center for Epidemiological Studies Depression (CES-D) scale were included (n=304). Longitudinal latent class analysis was applied to participant’s CES-D symptoms to identify subtypes with similar patterns of depressive symptoms during the yearlong hip fracture recovery period. Item-response probabilities were used to evaluate the symptomatic profiles for each subtype. Posterior probability estimates were used to assign time-specific subtype membership and describe changes in prevalence. Four depression subtypes were identified: “No Symptoms” (49.3%), “Moderate-Melancholic” (31.3%), “Severe-Melancholic” (12.0%), and “Severe-Anhedonic” (7.4%). “No Symptoms” had low item-response probabilities across all symptoms and increased in prevalence during recovery. “Moderate-Melancholic” and “Severe-Melancholic” were differentiated by higher item-response probabilities for symptoms of anhedonia, somatic criterion, and psychomotor agitation but prevalence for both groups decreased over time. “Severe-Anhedonic” had greater item-response probabilities for the inability to experience pleasure and prevalence remained constant. Findings revealed four distinct depressive symptom subtypes in older adults after hip fracture, which differ in prevalence and clinical presentation, and severe subtypes may be risk factors for poor recovery and require specific intervention.

Abstract TMP37: Social Network Size at Stroke Onset is Associated With 3 and 6-Month Stroke Outcomes

Introduction: Social mechanisms involved in stroke recovery are important and underutilized. For at least three decades, research has shown that social factors such as living alone negatively influence outcomes after stroke. Prior studies relied on social support measures without study of the network social structure. Our study uses higher-resolution social network analysis to examine structure (e.g., size and connectivity) and composition (e.g., proportion kin) in relation to stroke outcomes at 3 and 6 months. Hypothesis: Social network structural traits, size and connectivity, at stroke onset is related to the Patient Recovery Outcome Measurement Information System (PROMIS) physical function score at 3 and 6 months. Methods: In a cohort study, 160 patients with a first-time ischemic stroke were enrolled at stroke hospitalization. Social network characteristics were assessed using a bedside survey interview. The PROMIS physical function score was assessed on the phone at 3 and 6 months after stroke. Unadjusted and adjusted analyses were completed using Spearman Correlation and multivariate linear regression. Results: 144 patients (90%) at 3 months and 120 patients (75%) at 6 months completed the study. The mean age was 62, and NIH stroke scale was 3. Social network size at stroke onset was positively associated with 3- (spearman correlation=0.22, p&lt;0.01) and 6-month (spearman correlation=0.21, p=0.02) PROMIS physical function score. Connectivity measures and the proportion of kin in the network were not associated with the outcome. After control of age, stroke severity, and depression, network size remained strongly associated to physical function at 3 and 6-months, beta=0.74 [0.51,0.97], p&lt;0.01. Conclusions: Of social network traits, network size at stroke onset is independently associated with physical function after stroke. Small networks are an important risk factor for poor recovery, likely equivalent to traditional risk factors.

"Linking boundary crossing from work to nonwork to work-related rumination across time: A variable- and person-oriented approach": Correction to Kinnunen et al. (2016).

Reports an error in "Linking Boundary Crossing from Work to Nonwork to Work-Related Rumination across Time: A Variable- and Person-Oriented Approach" by Ulla Kinnunen, Taru Feldt, Jessica de Bloom, Marjaana Sianoja, Kalevi Korpela and Sabine Geurts (Journal of Occupational Health Psychology, Advanced Online Publication, Apr 28, 2016, np). There were errors in two separate sections of the article. The final sentence preceding Hypothesis 4 in "The Present Study" section should read, "We did not hypothesize that the specific forms of work-related thoughts (i.e., affective rumination, problem-solving pondering, or lack of psychological detachment) would be differently associated with stability or changes in boundary crossing behavior." The fifth sentence in the second paragraph of the "Identifying Subgroups of Boundary Crossing Behavior Across Time" subsection of the "Results" section should read, "Group 5 (n = 162, 19%), characterized by stable low boundary crossing behavior across time (M = 1.37 for Time 1 and M = 1.34 for Time 2), and Group 6 (n = 154, 18%), characterized by stable high boundary crossing behavior (M = 4.54 for Time 1 and M = 4.60 for Time 2), were almost equally large in size." (The following abstract of the original article appeared in record 2016-20812-001.) This 1-year follow-up study (N = 841) investigated the relationship between boundary crossing behavior from work to nonwork and work-related rumination (i.e., affective rumination, problem-solving pondering, and lack of psychological detachment from work during off-job time). This relationship is important to examine as work-related rumination is a risk factor for poor recovery and ill-health over time. The aims were twofold: first, to examine these relationships in terms of temporal ordering, and, second, to show how individual differences regarding stability and change of boundaries from work to nonwork are reflected in work-related rumination across time. The structural equation modeling analyses lent support to the hypothesized normal causation model compared with the reversed causation and reciprocal models. However, only the cross-lagged relationship between high boundary crossing behavior at T1 and lack of psychological detachment at T2 was significant. Through latent profile analysis, 6 subgroups of boundary crossing behavior across time were identified. Over 70% of the employees belonged to the stable (low, moderate, high) and about one-third to the changing (mostly increasing) boundary crossing subgroups. Employees in the 2 stable (high and moderate) boundary crossing subgroups reported less psychological detachment and more problem-solving pondering during off-job time than did those in the low boundary crossing subgroup. Employees in the change groups reported simultaneous expected changes, especially in their problem-solving pondering. No effects on affective rumination were found. Thus frequent boundary crossing behavior from work to nonwork plays a different role regarding the various forms of work-related rumination during nonwork. (PsycINFO Database Record

Risk Factors for Prolonged Treatment of Whiplash-Associated Disorders.

ObjectivesWhiplash-associated disorders (WAD) are the most common injuries that are associated with car collisions in Japan and many Western countries. However, there is no clear evidence regarding the potential risk factors for poor recovery from WAD. Therefore, we used an online survey of the Japanese population to examine the association between potential risk factors and the persistence of symptoms in individuals with WAD.Materials and MethodsAn online survey was completed by 127,956 participants, including 4,164 participants who had been involved in a traffic collision. A random sample of the collision participants (n = 1,698) were provided with a secondary questionnaire. From among the 974 (57.4%) respondents to the secondary questionnaire, we selected 183 cases (intractable neck pain that was treated over a period of 6 months) and 333 controls (minor neck pain that was treated within 3 months). Multivariable logistic regression analysis was used to evaluate the potential risk factors for prolonged treatment of WAD.ResultsFemale sex, the severity of the collision, poor expectations of recovery, victim mentality, dizziness, numbness or pain in the arms, and lower back pain were associated with a poor recovery from WAD.ConclusionsIn the present study, the baseline symptoms (dizziness, numbness or pain in the arms, and lower back pain) had the strongest associations with prolonged treatment for WAD, although the psychological and behavioral factors were also important. These risk factors should be considered when evaluating patients who may have the potential for poor outcomes.