Specialized Rehabilitation Unit Research Articles

Competing discourses as barriers to change in rehabilitation nursing: a discourse analysis.

The power of action research to create change by anchoring research results in practice was challenged in an action research project at a specialized rehabilitation unit for persons with acquired spinal cord injury. Despite the co-researchers' new insights, approaches, and actions supporting patient participation, it was not possible to change the basic conditions for the practicing of nursing. We aimed to raise awareness of the mechanisms that govern barriers by exploring these barriers as experienced by nurses in their effort to change their practice to improve patient participation. We used Fairclough's critical discourse analysis drawing on Foucault's practical systems; ethics (identity, relation to oneself), power (action, relation to others), and knowledge (representation, aspects of the world), which he combines with discourse-analytical concepts. Our discourse analysis of the empirical data at micro-level uncovers the nature of barriers to change in practice. In addition, our analysis at macro-level unveils how these practices are embedded in larger historical, societal, and institutional discourses. This identified two current discourses: a biomedical discourse and a biopsychosocial discourse. In the light of these two discourses, the nurses at micro-level saw themselves as strong agents for the best rehabilitation by acting in accordance with the biopsychosocial discourse. But they were unable to find the time and space to do so due to tasks, structures, and practices specified by an organization dominated by the biomedical discourse.

P91: Symptoms of Anxiety and Depression after stroke – a follow up study in outpatients followed in a rehabilitation recovery unit

Background:Depression and anxiety persist in a large number of patients after stroke. Anxiety affects around one third of patients during the first year. Nowadays, this phenomenon receives significantly less attention compared to other psychological problems, and poor psychological services after the onset of the disease were reported in previous studies. Some patients have access to specialized rehabilitation units (“Integrated Continuing Care Unit, UCCI”) that can ameliorate anxiety and significantly improve health-related quality-of-life (QoL), avoiding depression and improve patients' functional disability.Objective:To analyze the associations between anxiety/depression symptoms and QoL in patients with chronic stroke, during and after discharge from UCCI.Methods:An observational, longitudinal and descriptive study was carried out with patients with a clinical history of stroke discharged from hospitals in Portuguese central area, aged ≥65 years, without dementia diagnosis. Patients were observed at admission at the rehabilitation unit, discharge, and 6 and 12 months after discharge, and data were collected through a protocol composed of several self- completion instruments, namely the Hospital Anxiety and Depression Scale (HADS) and Stroke Specific Quality-of-Life Scale (SS-QoL). Data on clinical and demographic variables were collected and analyses performed to describe associations with HADS scores. Data were collected from August/2020 to July/2022 and analyzed using SPSS®,V.26.0.Results:A cohort of 154 stroke patients was assessed (M/F ratio=1.8, age 75±9 years). Anxiety scores were 6.8(4.8) (6 months) and 5.8(4.1) (12 months). Depression scores were 8.7(5.3) (6 months) and 8.1(4.7); (12 months). Anxiety total score at 6 months was significantly related (p<0.05) with 3 domains of SS- QoL (Personality, Social Role and Work/Productivity). However, no differences were found at 12 months. Depression was significantly related with all domains of SS-QoL except Vision (p<0.05).Conclusion:HADS score for anxiety were normal (0-7) at 6 and 12 months; however, depression remain in the Borderline abnormal classification (8-10), 6 and 12 months after stroke, which appear to have a negative impact in almost all SS-QoL domains of patients with chronic stroke. The current study highlights the need to prevent depression symptoms after stroke as this can negatively affect the functional recovery of the entire ongoing rehabilitation process.

The effect of comprehensive rehabilitation on post-COVID-19 syndrome

BackgroundThe present study aimed to investigate the efficacy of a comprehensive rehabilitation program on quality of life, anxiety, fatigue, and functional status in post-COVID-19 patients admitted to a specialized rehabilitation unit. The secondary objective of the study was to compare the differences between vaccinated and unvaccinated patients.ResultsThe single-center prospective study was conducted. Demographics, comorbidities, vaccination, clinical signs and symptoms, and oxygen saturation were assessed. The rehabilitative protocol was created considering the condition of patients, age, the direct impact of COVID-19 on the systems, sequelae, severity of disease, and comorbidities. The comprehensive rehabilitation program through a multidisciplinary team is applied in a stepwise graded manner. The Nottingham Health Profile (NHP), Fatigue Severity Scale (FSS) The Functional Ambulation Categories (FAC), the modified Medical Research Council (mMRC), the Modified Borg Scale, post-COVID-19 Functional Status (PCFS) scale, Hospital Anxiety and Depression Scale (HADS), and the Barthel Index (BI) were used. In total, 39 patients (61.5% men, age 59.7.0 ± 15.6 years) participated in the study. They were discharged home after 37.5 ± 17.6 days stay in the hospital. The most frequently reported persistent symptoms were dyspnea (76.9%), fatigue (69.2%), and myalgia (64.1%). There was a statistically significant improvement in baseline outcomes including BI, HADS, PCFS, FSS, MMRC, Modified Borg Scale, FAC, O2 support, and NHP after the comprehensive rehabilitation program (p < 0.001). The vaccinated patients had older age, high BMI, and shorter duration of rehabilitation (p = 0.003, p = 0.040, p = 0.022, respectively), while unvaccinated patients had higher BI, FSS, PCFS, and FAC.ConclusionThe comprehensive rehabilitation program improves quality of life, reduces fatigue, anxiety, and depression, and regains function in patients with post-COVID-19 syndrome. In addition, vaccinated patients had older ages and shorter duration of rehabilitation, while unvaccinated patients achieved higher functional status and had significantly higher levels of fatigue at discharge.

Medical rehabilitation technology for patients after high-tech joint and spine surgeries

Approximately 6 thousand endoprosthesis surgeries of hip, knee and spine stabilization are annually performed in older patients in the Irkutsk region. Patients require a second stage of medical rehabilitation — in a specialized rehabilitation unit. The article presents the technology of medical rehabilitation, which is used for this group of patients, including assessment of rehabilitation prognosis, application of physical rehabilitation methods, correction of somatic pathology and psychological status. Aim: to improve the immediate and long-term results of hip and knee endoprosthetics, spine stabilization surgeries by developing a system of rehabilitation measures based on individual patient parameters and aimed at optimal restoration of function. Materials and Methods. The focus of the investigation was on the patients from the Medical Rehabilitation Department, Clinical Hospital of the ISC SB of the RAS. Patients affected with coxarthrosis, gonarthritis, osteochondrosis of the spine, who had undergone joint replacement or stabilizing spinal surgery in the Medical Rehabilitation Department of Irkutsk Scientific Center of Surgery and Traumatology, 5–7 days before transfer to the Medical Rehabilitation Department of Clinical Hospital of the ISC SB of the RAS. The subjects also underwent clinical, paraclinical, locomotive, physical examination and laboratory test; physical activity assessment and estimation of indicators of the integral rehabilitation scale, the medical rehabilitation scale and the physical activity scale were performed as well. In the course of medical rehabilitation, patients received physiotherapeutic appointments, physiotherapy exercises, correction of somatic pathology, and correction of psychological status. Results. In 2020–2021, 240 older patients were treated in the Medical Rehabilitation Department after large joints arthroplasty and spinal reconstructive surgeries. The technology of medical rehabilitation was used for these patients. As a result, pain syndrome was eliminated, contracture of the operated joint was stopped, locomotor function improved, patients' physical activity and self-care ability were optimized, and somatic disorders were corrected. In addition, our own scales have been developed and improved: the Integral Rehabilitation Orthopedic Scale, the Individual Physical Activity Scale. Conclusion. Implementation of this rehabilitation technology has significantly optimized the outcomes of large joints arthroplasty or spinal reconstructive surgeries.

Role of weight lost in breast cancer-related lymph

ObjectiveAnalysis of data collected in routine clinical practice of the combined impact of both physical activity and decrease in body mass index (BMI) on a minor prevalence of lymphedema in post-breast cancer patients. MethodsAnalysis of data obtained by the specialized rehabilitation unit, from 99 female patients for 18 months, after a specific diet, sports program and complete decongestive therapy (CDT) was indicated. Personal data, affected organ volume, weight, physical activity level and Functional Assessment of Cancer Therapy Questionnaire for Breast Cancer (FACT-B+4) were collected in follow-up visits. ResultsAlthough the average of body-mass index showed no change during the assessment period, about 13% of patients in the second follow-up visit and 30% in the third one had lost weight. Women experiencing weight-loss in the third follow-up visit presented a reduced volume of the affected organ [−50 (−248 to 141) ml vs. 130 (−148 to 355) ml, p<0.05] as compared to weight-gaining patients. No relationship was established between physical activity and lymphedema volume changes. ConclusionsApart from the conventional treatment with orthotics and manual lymph drainage, BCRL prevention and treatment needs to focus – right from the start – on weight management or weight-loss in obese patients.

248 BENEFITS OF POST-OPERATIVE SPECIALIST GERIATRIC CARE FOR OLDER PATIENTS UNDERGOING ELECTIVE ORTHOPAEDIC SURGERY

Abstract Background The Covid-19 pandemic changed work practices across many different healthcare institutions. The difficulties with cross-site transfers created an opportunity in our institution to provide on-site post-operative rehabilitation for older patients undergoing elective orthopaedic surgery. The aim of this study is to assess the impact of post-operative specialist geriatric care on older patients. Methods This is a single-centre, retrospective study that received approval from the local hospital ethics committee. Data were collected on all patients admitted to the on-site specialist rehabilitation unit post-elective orthopaedic surgery between 1st May 2020 and 31st December 2021. Two patients in this group were excluded as they had not attended a pre-operative assessment clinic. Data were collected from hospital Information Technology platform, Bluespiers. Results 76 patients, 18 males and 58 females, were included in this study. The median age was 80 years. In the specialist rehabilitation unit, evidence of cognitive impairment was established in 40.79% of cases, there were 3 cases of newly diagnosed dementia, a history of falls was identified in 32.89% of patients and 13.16% of patients were found to have sarcopaenia. The median length of stay in the rehabilitation unit was 25 days. 51.32% of patients were discharged home independently, 23.68% of patients went home with a new Home-Care Package (HCP), 15.79% of patients were discharged home with an existing HCP, 6.58% of patients were transferred for further treatment and 2.63% patients were discharged to residential care units. Conclusion This data demonstrates a clear role for specialist geriatric care in elective rehabilitation, with a significant proportion of patients being discharged home independently. The benefits of a comprehensive geriatric assessment in the peri-operative setting include increased identification of cognitive impairment allowing appropriate implementation of brain health as well as identification of a history of falls, enabling falls risk assessment and management including bone health assessment.

164 OLDER PATIENTS AT THE PREOPERATIVE ASSESSMENT CLINIC: CHANGING THE FOCUS FROM FIT FOR SURGERY TO OPTIMISATION FOR SURGERY

Abstract Background The Pre-operative Assessment Clinic (PAC) is run by the Anaesthetic Department and assesses older patients undergoing elective orthopaedic surgery. The aim of this study was to examine how PAC currently assesses older patients and how effective it is in assessing for likelihood of postoperative complications and requirement for rehabilitation. Methods A single-centre, retrospective study that received approval from the local ethics committee. Data were collected on all patients post elective orthopaedic surgery admitted to the on-site specialist rehabilitation unit for older persons, between 1st May 2020 and 31st December 2021. Data were collected from hospital Information Technology platform, Bluespiers. Results Seventy-six patients (58 female; median age: 80 years) were included. Median time from PAC to surgery was 95 days. Functional assessment was completed in 63.16% of cases, formal cognitive assessment was done in 13% of cases. Number of falls in the preceding year was recorded in 31% of patients. Baseline mobility was recorded in 93% of cases. Whilst smoking and alcohol history was recorded in 96% of cases, number of units was not calculated. 45% (n=34) of patients were correctly identified as likely to require post-operative inpatient rehabilitation. PAC did not record sarcopaenia, polypharmacy or delirium risk factors. From our dataset, at least 13% had sarcopaenia, 80% had polypharmacy and 23% required opiate medications. Post-operatively, 16% of patients developed a delirium and 12% had an acute kidney injury. Conclusion In its current format, PAC fails to optimally risk stratify frail, older patients. Attention concentrates on fitness for surgery rather than optimisation of patients. Failure to record frailty, sarcopenia, cognitive impairment and risk factors for delirium is leading to missed opportunities in terms of delirium prevention, and peri-operative optimisation of older patients as well as discharge planning before surgery. Collaboration with specialist geriatric services at PAC should improve patient outcomes.

Prediction of emergence from prolonged disorders of consciousness from measures within the UK rehabilitation outcomes collaborative database: a multicentre analysis using machine learning

Purpose Predicting emergence from prolonged disorders of consciousness (PDOC) is important for planning care and treatment. We used machine learning to examine which variables from routine clinical data on admission to specialist rehabilitation units best predict emergence by discharge. Materials and methods A multicentre national cohort analysis of prospectively collected clinical data from the UK Rehabilitation Outcomes (UKROC) database 2010–2018. Patients (n = 1170) were operationally defined as “still in PDOC” or “emerged” by their total UK Functional Assessment Measure (FIM + FAM) discharge score. Variables included: Age, aetiology, length of stay, time since onset, and all items of the Neurological Impairment Scale, Rehabilitation Complexity Scale, Northwick Park Dependency Scale, and the Patient Categorisation Tool. After filtering, prediction of emergence was explored using four techniques: binary logistic regression, linear discriminant analysis, artificial neural networks, and rule induction. Results Triangulation through these techniques consistently identified characteristics associated with emergence from PDOC. More severe motor impairment, complex disability, medical and behavioural instability, and anoxic aetiology were predictive of non-emergence, whereas those with less severe motor impairment, agitated behaviour and complex disability were predictive of emergence. Conclusions This initial exploration demonstrates the potential opportunities to enhance prediction of outcome using machine learning techniques to explore routinely collected clinical data. Implications for rehabilitation Predicting emergence from prolonged disorders of consciousness is important for planning care and treatment. Few evidence-based criteria exist for aiding clinical decision-making and existing criteria are mostly based upon acute admission data. Whilst acknowledging the limitations of using proxy data for diagnosis of emergence, this study suggests that key items from the UKROC dataset, routinely collected on admission to specialist rehabilitation some months post injury, may help to predict those patients who are more (or less) likely to regain consciousness. Machine learning can help to enhance our understanding of the best predictors of outcome and thus assist with clinical decision-making in PDOC.

Implementation of early rehabilitation for critically ill children in China: A survey and narrative review of the literature.

IntroductionThe focus of this survey was to understand the current status of implementation of early rehabilitation for critically ill children in China. We also reviewed the available literature on this topic for further insights to inform its future development.Materials and methodsWe used a cross-sectional study design to survey tertiary hospitals nationwide. Questionnaires were distributed via the social media platform “WeChat Questionnaire Star” within the framework of the Rehabilitation Group of the Pediatrics Branch of the Chinese Medical Association. A narrative literature review on the implementation of the early rehabilitation for critically ill pediatric and/or adult patients was carried out.ResultsA total of 202 valid questionnaires were received. About half (n = 105, 52.0%) of respondent hospitals reported that they implement early rehabilitation for critically ill children. Among these 105 hospitals, 28 implemented a continuous chain of early rehabilitation. A total of 24 hospitals had set up permanent specialized centralized early rehabilitation units for critically ill children.Implications and future directionsEarly rehabilitation for critically ill children is not widely available in China and only a minority of hospitals implement a continuous chain of early rehabilitation. To improve this undesirable situation, we suggest creating a two-level integrated system comprising centralized early rehabilitation units and surrounding early rehabilitation networks within a region.

Prevalence of Long-Term Opioid Therapy in a Chronic Non-Cancer Pain Population Attending a University-Based Tertiary Pain Clinic in Sweden: A Cross-Sectional Study.

BackgroundOpioid therapy is a common treatment for chronic pain, despite accumulating evidence regarding harm and a lack of data to support the efficacy of long-term treatment.The prevalence of opioid therapy in Swedish patients with chronic non-cancer pain is unknown. The aim of this study was to assess a short-term period prevalence of prescribed opioid-use and long-term opioid therapy in a population with complex chronic non-cancer pain.MethodsThe study population comprised 1,613 patients with chronic non-cancer pain referred to a university-based tertiary pain clinic in Sweden during 2015–17. Data from a 360-day period prior to consultation were extracted from the Swedish Quality Registry for Pain Rehabilitation (SQRP) and Swedish Prescribed Drug Register (SPDR). Milligram morphine equivalents per day (MME/day) for dispensed opioids were analysed for a 90-day period preceding consultation, and long-term opioid therapy was determined for the entire 360-day period.ResultsThe 90-day prevalence was 38% (95% confidence interval (95% CI) 36.0–40.8%) and 360-day prevalence was 22.3% (n=360, 95% CI 20.4–24.4%).ConclusionPrescribing rates of opioids in a Swedish population with complex non-cancer chronic pain were high; 2 in 5 patients were dispensed an opioid within a 90-day period prior to consultation.LAY ABSTRACTOpioid therapy is a common treatment for chronic pain, despite accumulating evidence regarding harm and a lack of data to support the efficacy of long-term treatment. The use of opioid treatments in Swedish patients with chronic non-cancer pain is unknown. Hence, the current study aimed to assess the frequency of opioid use in a population with complex chronic non-cancer pain. The study population comprised 1,613 patients referred to a Swedish specialized pain rehabilitation unit during 2015–17. Data for 1 year prior to assessment were extracted from the Swedish Quality Registry for Pain Rehabilitation and Swedish Prescribed Drug Register. Milligram morphine equivalents per day for dispensed opioids were analysed for short-term prevalence and long-term opioid therapy. In conclusion, the prescribing rates of opioids in a Swedish population with complex non-cancer chronic pain were high; 2 in 5 patients were dispensed an opioid within a 90-day period prior to consultation.

Prolonged disorders of consciousness: identification using the UK FIM + FAM and cohort analysis of outcomes from a UK national clinical database

Purpose 1: To determine whether Total UK FIM + FAM scores can identify patients in VS/MCS. 2: Using the identified cut-off points, to examine outcomes from specialist rehabilitation. Methods Part 1: Retrospective analysis of a consecutive clinical cohort (n = 388) presenting to a single specialist PDOC evaluation programme 2007–2021. FIM + FAM scores were analysed by PDOC diagnosis to define cut-off points for vegetative (VS) and minimally conscious states (MCS). Part 2: Multicentre cohort analysis of prospectively-collected clinical outcomes data from the UK Rehabilitation Outcomes Collaborative database of adults in PDOC registered 2011–2020 (n = 2384 in 68 centres). Results Cut-off points of ≤31 and 32–35 in FIM + FAM total scores respectively identified patients in VS/MCS-Minus and MCS-Plus. Approximately 365 PDOC patients are admitted to specialist rehabilitation units in England each year. By discharge, 43% have emerged into consciousness and demonstrate a wide range of disability. A few reached full independence, but the majority remained severely dependent. Nevertheless, those who emerged generated mean net life-time savings of over £436,000 (£400 million for this cohort). Conclusion In absence of a dedicated PDOC registry, FIM + FAM scores can identify patients in VS/MCS at population level. Identifying those who emerge and providing timely rehabilitation generates cost-savings well-exceeding the cost of the evaluation/rehabilitation programme. Implications for rehabilitation The UK National Health Service currently collects no systematic data to identify patients in PDOC, so we have no accurate information on how many patients there are, where they are managed or what their outcomes are. In the absence of more direct data, total FIM + FAM scores of < =31 and 32–35 respectively can be used to identify patients in vegetative and minimally conscious states. Of the 365 or so patients admitted to specialist rehabilitation units per year, 43% emerge into consciousness leaving about 150 patients per year in PDOC states that are likely to be permanent. Identifying those who emerge and providing timely rehabilitation generates cost-savings that pay for the entire PDOC evaluation/rehabilitation programme many times over.

Use and cost of Medicare Benefits Schedule and Pharmaceutical Benefits Scheme services following inpatient rehabilitation for acquired disability in Australia.

Objectives This study explored publicly funded health system and patient expenditure in the post-acute phase following discharge from inpatient acquired brain injury (ABI) or spinal cord injury (SCI) rehabilitation. The secondary aim was to explore sociodemographic and injury characteristics associated with high costs. Methods This was a prospective cohort study. 153 patients (ABI: n = 85; SCI: n = 68) who consented to the use of their Medicare data were recruited between March 2017 and March 2018, at the point of discharge from ABI or SCI specialist rehabilitation units. The main outcome measure involved linkage of the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) data for the 12 months following discharge from rehabilitation. Bayesian penalised regression was used to determine characteristics associated with high costs. Results The median number of MBS items used in the 12 months after discharge was 33 (IQR: 21-52). General practitioners and allied health services were accessed by 100% and 41% of the cohort, respectively. The median MBS system cost (in Australian dollars) was $2006 (IQR: $162-$3090). Almost half (46%) of the participants had no MBS patient expenditure. The median PBS system cost was $541 (IQR: $62-$1574). For people with ABI, having a traumatic injury or one comorbidity was associated with lower PBS system costs by on average $119 and $134, respectively. We also found that hospitalisation in ABI was associated with higher PBS system costs, by on average $669. Conclusion There was evidence of high and variable MBS and PBS costs, raising concerns about financial hardship. Future research should focus on identifying any unmet service and prescription needs in the post-acute rehabilitation phase for these populations.

Reflecting on experiences of care: an exploratory qualitative descriptive study of the perspectives of stroke survivors, families and staff

ObjectiveThe aim of this study was to identify barriers and enablers from the perspectives of stroke survivors, carers and staff to understand the experiences of care.DesignThe study used a qualitative...

Functional outcomes and cost-efficiency of specialist in-patient rehabilitation following spinal cord injury: a multi-centre national cohort analysis from the UK Rehabilitation Outcomes Collaborative (UKROC)

Purpose: To evaluate functional outcomes, care needs and cost-efficiency of specialist rehabilitation for a multi-centre cohort of inpatients with spinal cord injury (SCI)-comparison based on age and aetiology. Methods and materials: Retrospective analysis of prospectively collected data from the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database from 2012-2019. Adults with SCI admitted for a rehabilitation programme in levels 1 and 2 specialist rehabilitation Units in England, were included if they had valid UK Functional Assessment Measure (UK FIM + FAM) and Northwick Park Dependency Scale (NPDS) scores recorded on admission and discharge (n = 2506 of 3321 admissions). Results: Approximately 425 patients were admitted yearly. 1344(56%) patients were under 65. 736(29%) had traumatic aetiology. Older and Traumatic SCI patients were more likely to have cervical cord damage (X 2, p < 0.001). There was a significant improvement in all parameters of functional independence (UK FIM + FAM) (p < 0.001), with the reduction in dependency and care costs (NPDS/NPCNA) (p < 0.001). 1817(72.5%) patients were discharged home. Mean care-costs savings were £25 500/year per patient. Year-on-year trends showed admissions with increasing age, higher complexity and dependency with corresponding increasing episode costs (ANOVA p < 0.001). However, the time taken to offset the cost of rehabilitation did not change significantly (ANOVA p = 0.57). Conclusions: Specialist rehabilitation services provide effective and cost-efficient rehabilitation for patients with spinal cord injury. Implications for Rehabilitation Approximately a third of patients who access specialist inpatient rehabilitation following spinal cord injury (SCI) in England are managed in the Specialist Level 1 and 2 neuro-rehabilitation units, rather than in the eight designated national SCI Centres. Despite admitting progressively more complex and dependent patients over eight years, these specialist rehabilitation units continue to provide highly cost-efficient care. The mean annual savings amount to £25,500 per patient. With a mean admission rate of 425 patients, this would generate total savings in excess of £10 million per year for the cohort. Specialist rehabilitation services play an important, but under-recognised, role in the spinal cord injury care pathway.

From open to locked doors - From dependent to independent: Patient narratives of participation in their rehabilitation processes.

The present study aimed to explore patients' experiences of participating in their rehabilitation process in the context of specialised rehabilitation in Norway. The rights of patients to participate in their care and treatment is an ideology that underlines newer international and Norwegian public documents. However, there is a gap between policy statements and clinical practice, and a discrepancy between patients' and professionals' statements about patient participation in rehabilitation. A qualitative approach with a narrative design. Eleven patients were individually interviewed to tell their stories about the rehabilitation processes. We utilised narrative analysis with a three-dimensional space narrative structure including temporality, sociality and spatiality. This study followed the COREQ checklist. The analysis identified two throughout plots: 'person-centred culture' and 'time', and three plots which constructed how the patients participate in change through the rehabilitation process: (a) dependent-'open doors'; (b) motivation from within; and (c) independence-'locked doors'. Patient participation in rehabilitation was dependent on person-centred cultures in the unit and on different aspects of time. The dialogue and the power balance between the patients and the health personnel changed as the rehabilitation progressed. Motivation for rehabilitation had to come from within patients. The paternalistic ideology did not seem to dominate the specialised rehabilitation unit in the present study. This study gives new insight into how patients participate in change in the rehabilitation process. This can be valuable for healthcare professionals and governments. Insight into how the lack of person-centred focus can harm the rehabilitation process, and a deeper understanding of the meaning of time in the rehabilitation process is essential. These results may provide a stimulus for discussions on how patients might participate in their rehabilitation process.

POS-348 Predicting difficulties with direct home discharge following hip fracture for patients living with CKD: Insights from a 6-year prospective study

Patients with chronic kidney disease (CKD) are at higher risk of falls and sustaining hip fractures compared to those without CKD. Worse clinical outcomes are observed in CKD groups, exacerbated by frailty, sarcopenia and other co-morbidities. Arranging discharge to own home following hip fracture is often difficult for older patients living with CKD. Patients with CKD usually have markedly deteriorated functional status following acute trauma and basic rehabilitation requirements cannot be holistically supported within a home environment. The most useful clinical assessment tool to predict for non-home discharge in patients with CKD following hospitalization with hip fracture remains unknown. Patients with CKD G3b-5 admitted from home to a tertiary hospital in North West UK with hip fracture between Jun 2013 and Dec 2019 were included. Parameters assessed on hospital admission for each patient included Clinical Frailty Scale (CFS), Charlson’s Co-morbidity Index (CCI), Chronic Kidney Disease Frailty Index Laboratory Score (CKD FI-LAB), Karnofsky Performance Status Scale, Sernbo Score, Nottingham Hip Fracture Score, Estimated VO2 Peak, ASA Physical Status Classification System Score and Abbreviated Mental Test Score. Patients who did not directly return home after hospitalization following hip fracture were discharged to a residential home, nursing home, specialist rehabilitation unit in the region or another district general hospital for ongoing rehabilitation needs. Receiver Operating Characteristic (ROC) curve analyses were performed to evaluate the ability of individual scoring tools to predict non-home discharge following hip fracture in patients with CKD admitted from home. A total of 225 patients met study inclusion criteria. The mean age was 81.6±10.1 yrs and the female:male ratio was 1.7:1. 33 patients (14.7%) were on long-term dialysis. 30-day in-hospital mortality was 5.9%. Following hip fracture hospitalization, 117 patients (52.0%) directly returned home on discharge. 13 patients (5.8%) were discharged to residential home, 51 patients (22.7%) to nursing home, 22 patients (9.8%) to a specialist rehabilitation unit in the region and 12 patients (5.3%) were repatriated to a district general hospital closer to the patient’s pre-admission residence. Difference in 1-year mortality rate between the non-home discharge cohort and those directly discharged home from hospital was +16.2% (p<0.001). Area under a curve (AUC) values from ROC analyses are shown in the table. Tabled 1PredictorAUC Value95% CIClinical Frailty Scale0.950.88-1.00Charlson's Co-morbidity Index0.920.85-0.99Chronic Kidney Disease Frailty Index Laboratory Score0.890.82-0.96Karnofsky Performance Status Scale0.850.78-0.92Sernbo Score0.840.77-0.91Nottingham Hip Fracture Score0.790.72-0.85Estimated VO2 Peak0.780.71-0.84ASA Physical Status Classification System Score0.690.62-0.75Abbreviated Mental Test Score0.660.59-0.73 Open table in a new tab Frailty and co-morbidity assessment tools (CFS, CCI and CKD FI-LAB) displayed the best predictive ability for non-home discharge following hip fracture in patients with CKD. Difficulty with direct home discharge is associated with significant mortality over the short term. Future research should explore holistic, multi-modal and multi-disciplinary interventions that aim to improve outcomes of patients with CKD at risk of extensive post-trauma rehabilitation needs.

Do Patients With COVID-19 Benefit from Rehabilitation? Functional Outcomes of the First 100 Patients in a COVID-19 Rehabilitation Unit

ObjectiveTo determine the benefits associated with brief inpatient rehabilitation for coronavirus 2019 (COVID-19) patients. DesignRetrospective chart review. SettingA newly created specialized rehabilitation unit in a tertiary care medical center. ParticipantsConsecutive sample of patients (N=100) with COVID-19 infection admitted to rehabilitation. InterventionInpatient rehabilitation for postacute care COVID-19 patients. Main Outcome MeasuresMeasurements at admission and discharge comprised a Barthel Activities of Daily Living Index (including baseline value before COVID-19 infection), time to perform 10 sit-to-stands with associated cardiorespiratory changes, and grip strength (dynamometry). Correlations between these outcomes and the time spent in the intensive care unit (ICU) were explored. ResultsUpon admission to rehabilitation, 66% of the patients were men, the age was 66±22 years, mean delay from symptom onset was 20.4±10.0 days, body mass index was 26.0±5.4 kg/m2, 49% had hypertension, 29% had diabetes, and 26% had more than 50% pulmonary damage on computed tomographic scans. The mean length of rehabilitation stay was 9.8±5.6 days. From admission to discharge, the Barthel index increased from 77.3±26.7 to 88.8±24.5 (P<.001), without recovering baseline values (94.5±16.2; P<.001). There was a 37% improvement in sit-to-stand frequency (0.27±0.16 to 0.37±0.16 Hz; P<.001), a 13% decrease in post-test respiratory rate (30.7±12.6 to 26.6±6.1; P=.03), and a 15% increase in grip strength (18.1±9.2 to 20.9±8.9 kg; P<.001). At both admission and discharge, Barthel score correlated with grip strength (ρ=0.39-0.66; P<.01), which negatively correlated with time spent in the ICU (ρ=–0.57 to –0.49; P<.05). ConclusionsInpatient rehabilitation for COVID-19 patients was associated with substantial motor, respiratory, and functional improvement, especially in severe cases, although there remained mild persistent autonomy loss upon discharge. After acute stages, COVID-19, primarily a respiratory disease, might convert into a motor impairment correlated with the time spent in intensive care.

Práticas integrativas e complementares: percepções de praticantes de Chi Kung

Esta é uma pesquisa qualitativa e descritiva realizada em um município mineiro no primeiro semestre de 2016, com o objetivo de compreender a condição e percepção de saúde, bem como a corporeidade após a prática de Chi Kung em usuários de unidade especializada em reabilitação. Utilizou-se entrevista individual e grupo focal de forma audiogravada. Participaram nove usuários, das quais, a maioria era do sexo feminino, na faixa etária de 19 a 59 anos, se autodeclarou parda, em união estável e com ensino fundamental incompleto. Na análise de conteúdo emergiram duas categorias: Caminhar na rede SUS e Percepções de saúde e corporeidade. A adesão ao Chi Kung relacionou-se a: melhorias na condição de saúde; experiências anteriores de cuidado e vínculo com a profissional. O desenvolvimento do autocuidado, a desmedicalização e a ampliação das percepções de saúde e corporeidade foram destacados como contribuições da prática. A possibilidade de implantação dos grupos na atenção primária foi reconhecida pelos participantes. A institucionalização das práticas integrativas e complementares no município é fundamental para a expansão das iniciativas e do acesso.

The Applicability of the Patient-Specific Functional Scale (PSFS) in Rehabilitation for Patients with Acquired Brain Injury (ABI) - A Cohort Study.

AimThe primary aim of this study was to investigate the applicability of the Patient-Specific Functional Scale (PSFS) in patients with acquired brain injury (ABI) admitted to a specialized rehabilitation unit in a regional hospital. A secondary aim was to identify patient characteristics and functioning that predicted changes in the PSFS.Patients and MethodsIn a cohort study, 59 patients with ABI were assessed for the ability to complete the PSFS. A trained multidisciplinary team applied the PSFS as part of a collaborative development of rehabilitation goals. The modified Rankin Scale (mRS), the Functional Ambulation Categories (FAC), the Rivermead Behavioural Memory Test (RBMT), the Norwegian Basic Aphasia Assessment (NBAA) and the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) were used to identify characteristics of the sample. Multivariate regression analyses were performed to investigate associations between changes in the PSFS score from admission to discharge and a selected set of participant baseline characteristics and functioning.ResultsFifty-four patients (92%) of the patients with ABI were able to complete the PSFS. The five (8%) who were unable to complete the PSFS had severe cognitive or language impairment. The PSFS score improved by a mean of 2.6 (SD 2.0) points from admission to discharge. The LOTCA score made the strongest unique contribution to explain the change in the PSFS score (beta = 0.477, p= 0.020).ConclusionIn the present study, most patients with ABI (92%) were able to complete the PSFS. Cognitive function on admission was a predictor of improved functioning on the PSFS.

Lockdown in a specialised rehabilitation unit: the best of times.

Specialised rehabilitation units offer inpatient multi-disciplinary rehabilitation for individuals with severe and enduring mental illness. A cornerstone of therapy is the work in the community through further education and community organisations. However, coronavirus restrictions have meant that such external supports are no longer available for the duration of the crisis. This has led to opportunities for developing new ways of offering rehabilitation within hospital environments. This article describes some of the new initiatives developed. The benefits of the lockdown for service users are also discussed. Many found the cessation of visits from family members with whom they had an ambivalent relationship helpful. The lockdown improved relationships between patients on the unit and encouraged a greater feeling of community. The lockdown has also emphasised the importance of team self-awareness and an awareness of the nature of the treatments offered.