151
|
|
152
|
Wang CY, Graham JE, Karmarkar AM, Reistetter TA, Protas EJ, Ottenbacher KJ. FIM motor scores for classifying community discharge after inpatient rehabilitation for hip fracture. PM R 2013; 6:493-7. [PMID: 24389348 DOI: 10.1016/j.pmrj.2013.12.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 12/10/2013] [Accepted: 12/18/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the utility of functional status in classifying patients by discharge setting after inpatient rehabilitation for hip fracture. DESIGN Retrospective cohort study. SETTING A total of 1257 inpatient rehabilitation facilities in the United States. PATIENTS Medicare beneficiaries (N = 117,168) receiving inpatient rehabilitation for hip fracture from 2007 to 2009. METHODS Receiver operating characteristic curve analyses to assess the overall discriminatory ability of functional status scores (Functional Independence Measure [FIM] total, FIM cognition, and FIM motor) and to identify the functioning threshold that best differentiates patients by discharge setting. MAIN OUTCOME MEASUREMENTS Discharge setting (community versus institutional). RESULTS Approximately 68% of patients were discharged to the community after inpatient rehabilitation for hip fracture. Receiver operating characteristic curve analyses indicate that discharge FIM motor ratings (area under the curve: 0.84) alone are as effective as a multivariable model (area under the curve: 0.85), including sociodemographic and clinical factors, in discriminating patients discharged to the community from those discharged to an institution. A discharge FIM motor rating of 58 yielded the best balance in sensitivity and specificity for classifying patients by discharge setting. CONCLUSIONS Discharge FIM motor ratings demonstrated good discriminatory ability for classifying discharge setting. An FIM motor rating of 58 may serve as a clinical tool to guide treatment plans and/or as additional information in complex discharge planning decisions for patients with hip fracture.
Collapse
Affiliation(s)
- Ching-Yi Wang
- School of Physical Therapy and Center for Education and Research on Geriatrics and Gerontology, Chung Shan Medical University, Taichung, Taiwan(∗)
| | - James E Graham
- Division of Rehabilitation Sciences, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-1137(†).
| | - Amol M Karmarkar
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX(‡)
| | - Timothy A Reistetter
- Department of Occupational Therapy, University of Texas Medical Branch, Galveston, TX(§)
| | - Elizabeth J Protas
- School of Health Professions, University of Texas Medical Branch, Galveston, TX(‖)
| | - Kenneth J Ottenbacher
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX(¶)
| |
Collapse
|
153
|
Abstract
PURPOSE This manuscript seeks to explain why applications of item response theory (IRT) and factor analytic methods provide evidence of validity, and why for the same reasons that they provide evidence of validity, they can advance substantive knowledge. METHODS A narrative review of the psychometrics literature and disability literature is presented explaining the rationale for the use of quantitative validation methods. RESULTS Both the field of psychometrics and the application of psychometric methods in rehabilitation science are expanding rapidly. Logistic IRT models and factor analytic methods are the most commonly used validation tools in rehabilitation. CONCLUSIONS Many of the available psychometric tools provide evidence of validity, because they are powerful tests of formally specified hypotheses regarding how specific observable traits relate to underlying latent construct. Thus, while the methods for studying psychometric validity have largely been focused on the question of whether or not rehabilitation outcome measures can be used with legitimacy, they also offer a potential research tool for explaining the mechanisms of disability within the framework of the International Classification of Functioning, Disability, and Health. IMPLICATIONS FOR REHABILITATION Quantitative validation of a functional status instrument using latent trait modeling techniques (i.e. IRT and CFA) study the measurement value of an instrument and help to ensure that the instrument provides meaningful information to clinical providers. Latent trait modeling has demonstrated that consistent with the ICF, participation restrictions in those with chronic knee osteoarthritis is driven by activity limitations caused by the knee impairments rather than directly by the knee impairments themselves.
Collapse
Affiliation(s)
- Paul Gerrard
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital , Wellesley, MA , USA
| |
Collapse
|
154
|
Tanaka N, Nakatsuka M, Ishii H, Nakayama R, Hosaka R, Meguro K. Clinical utility of the functional independence measure for assessment of patients with Alzheimer's disease and vascular dementia. Psychogeriatrics 2013; 13:199-205. [PMID: 24289460 DOI: 10.1111/psyg.12012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 07/08/2012] [Accepted: 03/14/2013] [Indexed: 12/01/2022]
Abstract
AIM The aim of this study was to investigate the clinical utility of the Functional Independence Measure (FIM), and especially FIM-Cognition (FIM-C) scores, in patients with Alzheimer's disease (AD) and vascular dementia (VaD), and to determine the influence of behavioural and psychological symptoms of dementia (BPSD) on FIM-C scores. METHODS This was a cross-sectional survey of 37 AD and 40 VaD patients. Cognitive function was assessed with the Cognitive Abilities Screening Instrument. Activities of daily living were evaluated with the FIM and the Barthel Index. BPSD were assessed with the Behavioural Pathology in Alzheimer's Disease Frequency Weighted Severity Scale. RESULTS For both groups, Spearman's correlations were found between FIM-Motor and Barthel Index scores and between FIM-C and Mini Mental State Examination scores. Each FIM-C subscore was correlated with Cognitive Abilities Screening Instrument scores in both groups, except for the FIM-C Social interaction subscore in VaD. VaD patients showing Activity Disturbance and Aggressiveness on the Behavioural Pathology in Alzheimer's Disease Frequency Weighted Severity Scale had significantly lower FIM-C Memory and Social interaction subscores than those without BPSD. CONCLUSION The results suggest that the FIM-Motor and FIM-C scales are useful measures of physical and cognitive disabilities in patients with AD and VaD. The FIM-C profile of AD may reflect global cognitive function, while that of VaD may be more influenced by BPSD.
Collapse
Affiliation(s)
- Naofumi Tanaka
- Department of Geriatric Behavioral Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Rehabilitation Medicine and Neurology, Kawasaki Kokoro Hospital, Kawasaki, Japan
| | | | | | | | | | | |
Collapse
|
155
|
Kim JH, Lee LK, Lee JU, Kim MY, Yang SM, Jeon HJ, Lee WD, Noh JW, Kim JH, Kim JH, Lee TH, Kim J. A pilot study on the effect of functional electrical stimulation of stroke patients in a sitting position on balance and activities of daily living. J Phys Ther Sci 2013; 25:1097-101. [PMID: 24259923 PMCID: PMC3818750 DOI: 10.1589/jpts.25.1097] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 04/19/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study investigated the effect of functional electrical stimulation (FES)
of stroke patients in a sitting position on balance and activities of daily living.
[Methods] FES was applied to stroke patients (six male, three female) while in a sitting
and supine position. FES was applied six times for 30 minutes each for a total of six
weeks. [Results] The timed up and go (TUG) values at weeks 2, 4, and 6 after FES treatment
in a sitting position were noticeably decreased in a time-dependent manner, compared with
controls. In the sitting, the functional reach test (FRT) values were significantly
increased in a time-dependent manner. The same values in the supine position weakly showed
a similar pattern to those in the sitting position. Furthermore, the functional
independent measurement (FIM) values in the sitting position were markedly increased in a
time-dependent manner. In the sitting position, the intensity of FES was markedly
decreased in a time-dependent manner. The same values in the supine position weakly showed
a similar pattern to those in the sitting position. [Conclusion] These results suggest
that the conditions of stroke patients in both the sitting and supine positions after FES
treatment were improved and that FES had a greater effect in the sitting position.
Collapse
Affiliation(s)
- Ju-Hyun Kim
- Laboratory of Health Science and Nanophysiotherapy, Department of Physical Therapy, Graduate School, Yongin University
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
156
|
Accelerated care versus standard care among patients with hip fracture: the HIP ATTACK pilot trial. CMAJ 2013; 186:E52-60. [PMID: 24246589 DOI: 10.1503/cmaj.130901] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A hip fracture causes bleeding, pain and immobility, and initiates inflammatory, hypercoagulable, catabolic and stress states. Accelerated surgery may improve outcomes by reducing the duration of these states and immobility. We undertook a pilot trial to determine the feasibility of a trial comparing accelerated care (i.e., rapid medical clearance and surgery) and standard care among patients with a hip fracture. METHODS Patients aged 45 years or older who, during weekday, daytime working hours, received a diagnosis of a hip fracture requiring surgery were randomly assigned to receive accelerated or standard care. Our feasibility outcomes included the proportion of eligible patients randomly assigned, completeness of follow-up and timelines of accelerated surgery. The main clinical outcome, assessed by data collectors and adjudicators who were unaware of study group allocations, was a major perioperative complication (i.e., a composite of death, preoperative myocardial infarction, myocardial injury after noncardiac surgery, pulmonary embolism, pneumonia, stroke, and life-threatening or major bleeding) within 30 days of randomization. RESULTS Of patients eligible for inclusion, 80% consented and were randomly assigned to groups (30 to accelerated care and 30 to standard care) at 2 centres in Canada and 1 centre in India. All patients completed 30-day follow-up. The median time from diagnosis to surgery was 6.0 hours in the accelerated care group and 24.2 hours in the standard care group (p < 0.001). A major perioperative complication occurred in 9 (30%) of the patients in the accelerated care group and 14 (47%) of the patients in the standard care group (hazard ratio 0.60, 95% confidence interval 0.26-1.39). INTERPRETATION These results show the feasibility of a trial comparing accelerated and standard care among patients with hip fracture and support a definitive trial. TRIAL REGISTRATION ClinicalTrials.gov, no. NCT01344343.
Collapse
|
157
|
Uchikawa K, Inaba M, Kagami H, Ichimura S, Fujiwara T, Tsuji T, Otaka Y, Liu M. Executive dysfunction is related with decreased frontal lobe blood flow in patients with subarachnoid haemorrhage. Brain Inj 2013; 28:15-9. [DOI: 10.3109/02699052.2013.847209] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
158
|
Hawkins AT, Henry AJ, Crandell DM, Nguyen LL. A systematic review of functional and quality of life assessment after major lower extremity amputation. Ann Vasc Surg 2013; 28:763-80. [PMID: 24495325 DOI: 10.1016/j.avsg.2013.07.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 07/17/2013] [Accepted: 07/18/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND When judging the success or failure of major lower extremity (MLE) amputation, the assessment of appropriate functional and quality of life (QOL) outcomes is paramount. The heterogeneity of the scales and tests in the current literature is confusing and makes it difficult to compare results. We provide a primer for outcome assessment after amputation and assess the need for the additional development of novel instruments. METHODS MEDLINE, EMBASE, and Google Scholar were searched for all studies using functional and QOL instruments after MLE amputation. Assessment instruments were divided into functional and QOL categories. Within each category, they were subdivided into global and amputation-specific instruments. An overall assessment of instrument quality was obtained. RESULTS The initial search revealed 746 potential studies. After a review of abstracts, 102 were selected for full review, and 40 studies were then included in this review. From the studies, 21 different assessment instruments were used 63 times. There were 14 (67%) functional measures and 7 (33%) QOL measures identified. Five (36%) of the functional instruments and 3 (43%) of the QOL measures were specific for MLE amputees. Sixteen instruments were used >1 time, but only 5 instruments were used >3 times. An additional 5 instruments were included that were deemed important by expert opinion. The 26 assessment instruments were rated. Fourteen of the best-rated instruments were then described. CONCLUSIONS The heterogeneity of instruments used to measure both functional and QOL outcomes make it difficult to compare MLE amputation outcome studies. Future researchers should seek to use high-quality instruments. Clinical and research societies should endorse the best validated instruments for future use in order to strengthen overall research in the field.
Collapse
Affiliation(s)
- Alexander T Hawkins
- Center for Surgery and Public Health, Boston, Massachusetts; Brigham & Women's Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts
| | | | - David M Crandell
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Louis L Nguyen
- Center for Surgery and Public Health, Boston, Massachusetts; Brigham & Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
159
|
Hoffman JE, Paschal KA. Functional outcomes of adult patients with West Nile virus admitted to a rehabilitation hospital. J Geriatr Phys Ther 2013; 36:55-62. [PMID: 22785181 DOI: 10.1519/jpt.0b013e318258bcba] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE The clinical manifestation of West Nile Virus (WNV) varies in individuals from mild flu-like symptoms to acute flaccid paralysis. Advanced age is the most significant risk factor for developing severe neurological disease and for death. The broad range of neurologic symptoms associated with WNV infection leads to varied body structure and function limitations and participation restrictions that may require rehabilitation. The purpose of this study is to describe the functional impairments upon admission and the functional outcomes at discharge of 48 adult patients admitted with WNV to a rehabilitation facility in the Midwest from 2002 to 2009. METHODS A retrospective chart review was completed on 48 patients (29 male, 19 female) with mean age 67.8 (SD = 16.6, range = 24-91) years and median age 72.5 years, admitted to inpatient rehabilitation with a diagnosis of WNV after January 1, 2002, and discharged prior to December 31, 2009. General information (sex, age, social history, employment, and living environment), past medical history, and information specific to the current hospitalization (medical conditions, functional status and activity level on admission and discharge as measured by the Functional Independence Measure [FIM], lengths of stay [LOSs] in the acute care and rehabilitation hospital, physical therapy care, discharge destination, and follow-up care provisions) were gathered. The standardized response mean (SRM) was calculated for total, motor, and cognitive FIM scores to provide insight into the effect size and the responsiveness of the FIM for the patients with WNV in this study. RESULTS All patients were admitted to the rehabilitation hospital from acute care hospitals following LOSs ranging from 1 to 62 days. The rehabilitation hospital LOS ranged from 2 to 304 days. These patients had significant comorbidities including hypertension (43.75%), diabetes mellitus (41.67%), acute respiratory failure (37.5%), ventilator dependency/tracheostomy (33.33%), and pneumonia (29.17%). Their admission FIM scores ranged from 13 to 116 (mean = 45.8 ± 28.2) and discharge FIM scores ranged from 18 to 121 (mean = 75.1 ± 34.2). The change in FIM during inpatient rehabilitation was statistically significant (P < .001). The calculated SRM for the total (1.06) and motor (1.12) FIM indicate a large effect size, whereas the SRM for the cognitive FIM (0.79) indicates a moderate effect. The majority of patients were discharged home or to a nursing facility (46%), skilled or extended care (38%) with a need for continued rehabilitation services. DISCUSSION AND CONCLUSIONS The manifestation of the WNV and functional outcomes after comprehensive rehabilitation vary from patient to patient. Higher numbers of comorbid conditions lead to more complex presentation and challenge rehabilitation professionals to design individualized plans of care to enable these patients to achieve the highest functional outcomes. Most patients require follow-up physical therapy care after discharge from rehabilitation.
Collapse
Affiliation(s)
- Julie E Hoffman
- Department of Physical Therapy, Creighton University, Omaha, NE 68178, USA.
| | | |
Collapse
|
160
|
Williams G, Hill B, Kahn M. The concurrent validity and responsiveness of the high-level mobility assessment tool for mobility limitations in people with multitrauma orthopedic injuries. PM R 2013; 6:235-40. [PMID: 24056162 DOI: 10.1016/j.pmrj.2013.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 09/05/2013] [Accepted: 09/11/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the concurrent validity, responsiveness, and ceiling effect of the revised High-Level Mobility Assessment Tool (HiMAT) in persons after orthopedic multitrauma. DESIGN Cross-sectional sample of convenience. SETTING A large tertiary rehabilitation hospital. PARTICIPANTS Forty-three participants with orthopedic multitrauma lower limb injuries that resulted from motor vehicle accidents. METHODS This study compared the concurrent validity, responsiveness, and ceiling effects of the revised HiMAT, motor subsection of the Functional Independence Measure (FIM) instrument. Performances for all participants were concurrently scored on the motor FIM, revised HiMAT, and the Lower Extremity Functional Scale (LEFS) at initial testing, and 6 and 12 weeks after the decision to fully bear weight. MAIN OUTCOME MEASUREMENTS Revised HiMAT, motor FIM, and LEFS. RESULTS The correlation between the revised HiMAT and the motor FIM was moderate (r = 0.49; P <.001) and partly induced by a ceiling effect in the motor FIM. After 12 weeks of full weight bearing, 51.2% of participants achieved the maximum score on the motor FIM. The correlation between the revised HiMAT and LEFS was weak (r = 0.39; P = .012), which indicated a weak relationship between self-reported mobility problems and actual performance. The revised HiMAT was more responsive than the motor FIM and the LEFS, based on the proportion of persons who exceeded the minimal detectable change score over a period of 6 and 12 weeks. CONCLUSION The revised HiMAT is more responsive to change than the LEFS and motor FIM, and less susceptible to a ceiling effect than the motor FIM for persons with orthopedic multitrauma. It has poor-to-moderate concurrent validity with the LEFS and motor FIM, which suggests that it may be measuring a different aspect of mobility.
Collapse
Affiliation(s)
- Gavin Williams
- Physiotherapy Department, Epworth Hospital, 89 Bridge Rd, Richmond, 3121, Victoria, Australia; School of Physiotherapy, The University of Melbourne, Melbourne, Australia; School of Physiotherapy, La Trobe University, Melbourne, Australia(∗).
| | - Bridget Hill
- Physiotherapy Department, Epworth Hospital, Victoria, Australia(†)
| | - Michelle Kahn
- Physiotherapy Department, Epworth Hospital, Victoria, Australia(‡)
| |
Collapse
|
161
|
Initial Physical Grades and Cognitive Stages After Acute Stroke: Who Receives Comprehensive Rehabilitation Services? PM R 2013; 5:1007-18. [DOI: 10.1016/j.pmrj.2013.08.598] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 06/07/2013] [Accepted: 08/10/2013] [Indexed: 11/21/2022]
|
162
|
Enderby P. Introducing the therapy outcome measure for AAC services in the context of a review of other measures. Disabil Rehabil Assist Technol 2013; 9:33-40. [PMID: 23924388 DOI: 10.3109/17483107.2013.823576] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This article discusses the importance of outcome measures in improving Augmentative and Alternative Communication (AAC) services, reviews existing methods and introduces a new approach. METHOD Three methods were used in this study. 1. A literature review identifying outcome measures used in AAC research. 2. A questionnaire to AAC services in the UK which aimed to identify the objectives of their services and the outcome measures commonly used. 3. A working group of AAC experts provided additional information and interpretation. Central properties and conceptual framework were considered. RESULTS The literature review and questionnaire identified 23 outcome measures none of which cover the conceptual frameworks associated with all of the overall objectives of AAC provision. The review has informed the further development of a particular outcome measure the AAC Therapy Outcome Measure (AAC TOM) ensuring that basic principles of the International Classification of Functioning (ICF-WHO) are retained and the measure can be used in benchmarking. CONCLUSION An outcome measure needs to reflect change associated with service delivery. AAC services endeavour to impact on all of the domains of the ICF. A new measure is required in order to reflect the nature of these services. This article introduces an outcome measure which is in the process of being trialled by some services in the UK.
Collapse
Affiliation(s)
- Pam Enderby
- The Innovation Centre, University of Sheffield , Sheffield , UK
| |
Collapse
|
163
|
Rabadi MH, Rabadi FM, Hallford G, Aston CE. Efficacy and safety of short-term use of COX-2 inhibitors in patients after an acute stroke with musculoskeletal pain. Ann Indian Acad Neurol 2013; 16:47-52. [PMID: 23661962 PMCID: PMC3644781 DOI: 10.4103/0972-2327.107699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Revised: 03/04/2012] [Accepted: 07/21/2012] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Musculoskeletal pain commonly occurs in the elderly, many of whom are also prone to suffer from strokes. We studied whether short-term use (≤ 4 weeks) of cyclooxygenase-2 (COX-2) inhibitors for musculoskeletal pain in stroke patients helped them to participate in their therapies and was safe and efficacious. MATERIALS AND METHODS Three hundred and three patients admitted consecutively with first ischemic stroke were studied. Two cohorts were defined, based on whether patients with acute stroke had sufficient musculoskeletal pain that warranted oral COX-2 inhibitors (COX-2 group) or not (case-matched controls). Primary efficacy measures were change in Fugl-Meyer (F-M) pain score and change in total functional independence measure (TFIM) scores on discharge from hospital. Safety was judged by the incidence of vascular episodes during the study period. RESULTS From the original 303 patients, 64 patients in the COX-2 group were matched with 64 patients in the non-COX-2 group. The groups were matched for age (±5 years), gender, and admission TFIM score (± 5 points). Baseline characteristics between the 2 groups were similar. The primary and secondary outcome measures were similar between the 2 groups, except for ambulation endurance, which favored the non-COX-2 group (P < 0.03). Greater change in the pain score (less pain) was found in the COX-2 group; this effect was strongest in patients who were independent prior to their stroke (on post hoc analysis). There were too few adverse events in either group of any significance. CONCLUSIONS The short-term use of COX-2 inhibitors reduced musculoskeletal pain in acute stroke patients, improved functional motor outcome, and were found to be safe.
Collapse
Affiliation(s)
- Meheroz H Rabadi
- Weill Medical College of Cornell University at Burke Rehabilitation Hospital, White Plains, NY, USA
| | | | | | | |
Collapse
|
164
|
Rabadi MH, Vincent AS. Comparison of the Kurtkze Expanded Disability Status Scale and the Functional Independence Measure: measures of multiple sclerosis-related disability. Disabil Rehabil 2013; 35:1877-84. [DOI: 10.3109/09638288.2013.766269] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
165
|
The surgical management of upper tract stone disease among spinal cord-injured patients. Spinal Cord 2013; 51:457-60. [DOI: 10.1038/sc.2013.15] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
166
|
The Uniform Data System for Medical Rehabilitation: report of patients with debility discharged from inpatient rehabilitation programs in 2000-2010. Am J Phys Med Rehabil 2013; 92:14-27. [PMID: 23117268 DOI: 10.1097/phm.0b013e31827441bc] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Benchmark data are provided for a national sample of patients who received inpatient rehabilitation for debility. DESIGN Patients with debility from 830 inpatient rehabilitation facilities in the United States contributing to the Uniform Data System for Medical Rehabilitation from 2000 to 2010 were examined. Demographic information (age, marital status, sex, race/ethnicity, prehospital living setting, and discharge setting), hospital information (length of stay, program interruptions, payer, and codes for admitting diagnosis), and functional status (Functional Independence Measure [FIM] instrument ratings at admission and discharge, FIM change, and FIM efficiency) were analyzed. RESULTS Data from 2000 to 2010 (N = 260,373) revealed a decrease in mean (SD) FIM total admission ratings from 73.9 (16.2) to 62.5 (15.8). The FIM total discharge ratings decreased from 95.0 (19.7) to 88.2 (19.8). Mean (SD) length of stay decreased from 14.3 (9.1) to 12.1 (6.2) days. The FIM efficiency (change/day) increased from 1.9 (1.7) to 2.4 (1.9). Discharge to community decreased from 80% to 75%. Acute care discharges accounted for 12% of the cases. Policy changes affecting classification, reimbursement, and/or documentation processes may have influenced the results. CONCLUSIONS National data indicate that the number of debility cases is increasing with diverse composition of etiologic diagnoses. A high proportion of these patients is discharged to acute care compared with other impairment groups.
Collapse
|
167
|
Validity and reliability of the FIM instrument in the inpatient burn rehabilitation population. Arch Phys Med Rehabil 2013; 94:1521-1526.e4. [PMID: 23473701 DOI: 10.1016/j.apmr.2013.02.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 02/13/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To provide evidence of construct validity for the FIM instrument in the inpatient rehabilitation burn population. DESIGN Confirmatory factor analysis and item response theory were used to assess construct validity. Confirmatory factor analysis was performed on a 2-factor model of the FIM instrument and on a 6-subfactor model. Mokken scale analysis, a nonparametric item response theory, was performed on each of the FIM instrument's 2 major factors, motor and cognitive domains. Internal consistency using Cronbach alpha and Molenaar and Sijtsma's statistic was also examined. SETTING Inpatient rehabilitation facilities. PARTICIPANTS Data from the Uniform Data System for Medical Rehabilitation for patients with an impairment code of burn injury from the years 2002 to 2011 were used for this analysis. A total of 7569 subjects were included in the study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Comparative fit index results for the confirmatory factor analyses and adherence to assumptions of the Mokken scale model. RESULTS Confirmatory factor analysis provided a comparative fit index of .862 for the 2-factor model and .941 for the 6-subfactor model. Mokken scale analysis showed scalability coefficients of .681 and .891 for the motor and cognitive domains, respectively. Measures of internal consistency statistic gave values of >.95 for each major domain of the FIM instrument. CONCLUSIONS The FIM instrument has evidence of validity and reliability as an outcome measure for patients with burn injuries in the inpatient rehabilitation setting. The 6-subfactor model provides a better fit than the 2-factor model by confirmatory factor analysis. There is evidence that the motor and cognitive domains each form valid unidimensional metrics based on nonparametric item response theory.
Collapse
|
168
|
Schaber P, Klein T, Hanrahan E, Vencil P, Afatika K, Burns T. Using cognitive-functional assessment to predict self-care performance of memory care tenants. Am J Alzheimers Dis Other Demen 2013; 28:171-8. [PMID: 23293251 PMCID: PMC10852974 DOI: 10.1177/1533317512470206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A challenge in admitting individuals with Alzheimer's disease and related dementias into memory care residential facilities is determining the appropriate level of service based on abilities and care needs. At intake, the incoming tenant's functional performance capacity is obtained through family or proxy report corroborated with screening results of global cognitive function. Based on this information, the agency determines the level of service needs; if misjudged, inadequate placement can be stressful for the individual and family and costly for the facility. This study examined the predictive validity of a clinically administered assessment of cognitive-functional performance, Cognitive Performance Test (CPT), in gauging service needs in 4 activities of daily living (ADL; dressing, eating/feeding, showering, and toothbrushing) with 57 tenants residing in a memory care-assisted living facility. Linear regression results revealed a significant relationship between CPT scores and ADL performance in all areas (P < .001) with CPT scores accounting for 51% to 62% of the variability in performance.
Collapse
Affiliation(s)
- Patricia Schaber
- Program in Occupational Therapy, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, USA.
| | | | | | | | | | | |
Collapse
|
169
|
Hutzler Y, Chacham-Guber A, Reiter S. Psychosocial effects of reverse-integrated basketball activity compared to separate and no physical activity in young people with physical disability. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:579-587. [PMID: 23123871 DOI: 10.1016/j.ridd.2012.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 09/13/2012] [Accepted: 09/14/2012] [Indexed: 06/01/2023]
Abstract
The purpose of this study was to examine the impact of participation in different sport modalities on quality of life (QOL) and perceived social competence (PSC) in young people with physical disability. Ninety participants (33 females and 57 males) were monitored across four conditions: competitive separate physical activity (COSPA), recreational separate physical activity (RESPA), reverse-integrated basketball activity (RIBA), and no physical activity (NOPA). QOL and PSC questionnaires were administered at the beginning and the end of the study's duration of six months. ANCOVA corrected for functional independence and gender revealed significant group effects for pre to post change values of QOL and PSC, with greater positive change in the RIBA compared to all other groups. In addition, one-way ANOVA on pre to post change values with LSD post hoc revealed significant differences. RIBA change values for QOL with 8.77%, and for PSC with 9.98% change were significantly higher (p<.001) than in all other groups (ranges -0.18 through 1.36% for QOL, and -2.31 through 2.34% for PSC). These outcomes demonstrate a favorable outcome of the RIBA on participants. Low functional ability did not constrain the effects of sport participation.
Collapse
|
170
|
Hordacre BG, Stevermuer T, Simmonds F, Crotty M, Eagar K. Lower-limb amputee rehabilitation in Australia: analysis of a national data set 2004 - 10. AUST HEALTH REV 2013; 37:41-7. [DOI: 10.1071/ah11138] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 05/13/2012] [Indexed: 11/23/2022]
Abstract
Objective.
Examine demographics, clinical characteristics and rehabilitation outcomes of lower-limb amputees, using the Australasian Rehabilitation Outcomes Centre (AROC) database.
Methods.
Lower-limb amputee rehabilitation separations between 2004 and 2010 were identified using AROC impairment codes 5.3–5.7.1 Analysis was conducted by year, impairment code, Australian National Sub-acute and Non-Acute Patient (AN-SNAP) classification (S2–224, Functional Independence Measure (FIM) motor(Mot) score 72–91; S2–225, FIM (Mot) score 14–71) and states of Australia.
Results.
Mean length of stay (LOS) for all lower-limb amputee episodes was 36.1 days (95% confidence interval (CI): 35.4–36.9). Majority of episodes were unilateral below knee (63.6%), males (71.8%) with a mean age of 67.9 years (95% CI: 67.6–68.3). Year-on-year analysis revealed a trend for increasing LOS and decreasing age. Analysis by impairment code demonstrated no significant difference in rehabilitation outcomes. Analysis by AN-SNAP found that LOS was 16.2 days longer for S2–225 than for S2–224 (95% CI: 14.7–17.8, P < 0.001), and FIM (Mot) change was 12.0 points higher for S2–225 than for S2–224 (95% CI: 11.5–12.6, P < 0.001). Analysis by states revealed significant variation in LOS, FIM (Mot) change and FIM (Mot) efficiency which may be associated with variations in organisation of rehabilitation services across states.
Conclusion.
Although amputees represented a comparatively small proportion of all rehabilitation episodes in Australia, their LOS was significant. Unlike many other rehabilitation conditions, there was no evidence of decreasing LOS over time. AN-SNAP classes were effective in distinguishing rehabilitation outcomes, and could potentially be used more effectively in planning rehabilitation programs.
What is known about the topic?
Literature reporting on the rehabilitation outcomes of cohorts of lower-limb amputees in Australia is limited to individual sites. No previous literature was identified that reported national data.
What does this paper add?
This study investigates amputee rehabilitation at a national level over a 7-year observation period (2004–10) and comprises 6588 episodes. It reports the national demographics, clinical characteristics and rehabilitation outcomes, with the aim of identifying findings that have implications for practitioners.
What are the implications for practitioners?
Although only a small proportion of all episodes in the AROC database, this subset of lower-limb amputee episodes has provided a useful snapshot of the current state of amputee rehabilitation in Australia. We believe these findings have significant implications for practitioners in delivery of amputee rehabilitation services across Australia. Practitioners may benefit from adjusting service delivery based upon the decreasing age of lower limb amputees. Findings from this study also indicate that AN-SNAP classifications are effective in discriminating amputee rehabilitation outcomes and may be used to streamline rehabilitation services and provide a more efficient and effective rehabilitation service to prevent further increases in LOS.
Collapse
|
171
|
Campo M, Shiyko MP, Margulis H, Darragh AR. Effect of a Safe Patient Handling Program on Rehabilitation Outcomes. Arch Phys Med Rehabil 2013; 94:17-22. [DOI: 10.1016/j.apmr.2012.08.213] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 08/24/2012] [Accepted: 08/28/2012] [Indexed: 11/28/2022]
|
172
|
Corrigan JD, Cuthbert JP, Whiteneck GG, Dijkers MP, Coronado V, Heinemann AW, Harrison-Felix C, Graham JE. Representativeness of the Traumatic Brain Injury Model Systems National Database. J Head Trauma Rehabil 2012; 27:391-403. [PMID: 21897288 PMCID: PMC3410043 DOI: 10.1097/htr.0b013e3182238cdd] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether the Traumatic Brain Injury Model Systems National Database (TBIMS-NDB) is representative of individuals aged 16 years and older admitted for acute, inpatient rehabilitation in the United States with a primary diagnosis of traumatic brain injury (TBI). DESIGN Secondary analysis of existing data sets. SETTING Acute inpatient rehabilitation facilities. PARTICIPANTS Patients aged 16 years and older with a primary rehabilitation diagnosis of TBI. MAIN OUTCOME MEASURES Demographic characteristics, functional status, and hospital length of stay. RESULTS Patients included in the TBIMS-NDB from October 2001 through December 2007 were largely representative of all individuals 16 years and older admitted for rehabilitation in the United States with a primary diagnosis of TBI. The major difference in distribution was age-the TBIMS-NDB cohort did not include as large a proportion of patients older than 65 years as were admitted for rehabilitation with a primary diagnosis of TBI in the United States. Distributional differences for age-related characteristics were observed; however, groups of patients partitioned at aged 65 years differed minimally, especially within the younger than 65 years subset. Regardless of age, the proportion of patients with a rehabilitation stay of 1 to 9 days was larger nationwide. Nationwide admissions showed an age distribution similar to patients discharged alive from acute care with moderate, severe or penetrating TBI. The proportion of patients aged 70 years and older admitted for TBI rehabilitation in the United States increased every year, a trend that was not evident in the general population, TBIMS-NDB or among TBI patients in acute care. CONCLUSIONS These results provide substantial empirical evidence that the TBIMS-NDB is representative of patients receiving inpatient rehabilitation for TBI in the United States. Researchers utilizing the TBIMS-NDB may want to adjust statistically for the lower percentage of patients older than 65 years or those with stays less than 10 days.
Collapse
Affiliation(s)
- John D Corrigan
- Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH 43210, USA.
| | | | | | | | | | | | | | | |
Collapse
|
173
|
Berges IM, Kuo YF, Ottenbacher KJ, Seale GS, Ostir GV. Recovery of functional status after stroke in a tri-ethnic population. PM R 2012; 4:290-5. [PMID: 22541375 DOI: 10.1016/j.pmrj.2012.01.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 01/12/2012] [Accepted: 01/24/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine recovery of functional status for white, black, and Hispanic patients who have had a stroke from the time of admission to inpatient medical rehabilitation to 12 months after discharge. DESIGN A longitudinal study that used information from the Stroke Recovery in Underserved Population database, a prospective observational study of persons with stroke who received inpatient medical rehabilitation services during 2005-2006. SETTING Eleven inpatient rehabilitation facilities located across diverse regions of the United States, including California, Florida, Iowa, Illinois, Kentucky, New Jersey, New York (2), Texas (2), and Washington, DC. PARTICIPANTS A total of 990 adults aged 55 years or older who had a stroke and were admitted to 1 of 11 inpatient medical rehabilitation facilities in the United States were interviewed at 4 time points, including admission to and discharge from an inpatient medical rehabilitation facility and 3 and 12 months after discharge. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Functional status as measured by the Functional Independence Measure (FIM). RESULTS For the total sample, FIM ratings increased from admission to discharge and from discharge to 3-month follow-up, with little recovery occurring between 3 and 12 months. In random effects mixed models, at 3-month follow-up, both black and Hispanic patients had lower FIM ratings than did white patients. At 12-month follow-up, black and white patients were similar; however, Hispanic patients continued to have lower FIM ratings compare with white patients. Racial/ethnic group, age, length of stay, and medical comorbidities were significant predictors of total FIM ratings over the 4 time points. CONCLUSIONS Persons 55 years and older who have had a stroke, regardless of race/ethnicity, appear to benefit from inpatient medical rehabilitation. Most functional status gains occur during inpatient medical rehabilitation and continue in the first few months after discharge, with little change afterward.
Collapse
Affiliation(s)
- Ivonne-M Berges
- University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-0460, USA.
| | | | | | | | | |
Collapse
|
174
|
White DK, Wilson JC, Keysor JJ. Measures of adult general functional status: SF-36 Physical Functioning Subscale (PF-10), Health Assessment Questionnaire (HAQ), Modified Health Assessment Questionnaire (MHAQ), Katz Index of Independence in activities of daily living, Functional Independence Measure (FIM), and Osteoarthritis-Function-Computer Adaptive Test (OA-Function-CAT). Arthritis Care Res (Hoboken) 2012; 63 Suppl 11:S297-307. [PMID: 22588752 DOI: 10.1002/acr.20638] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
175
|
Grauwmeijer E, Heijenbrok-Kal MH, Haitsma IK, Ribbers GM. A Prospective Study on Employment Outcome 3 Years After Moderate to Severe Traumatic Brain Injury. Arch Phys Med Rehabil 2012; 93:993-9. [DOI: 10.1016/j.apmr.2012.01.018] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Revised: 01/06/2012] [Accepted: 01/25/2012] [Indexed: 10/28/2022]
|
176
|
“Time is brain”: Only in the acute phase of stroke? NEUROLOGÍA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.nrleng.2011.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
177
|
Berges IM, Seale GS, Ostir GV. The role of positive affect on social participation following stroke. Disabil Rehabil 2012; 34:2119-23. [DOI: 10.3109/09638288.2012.673684] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
178
|
Glenny C, Stolee P, Thompson M, Husted J, Berg K. Underestimating physical function gains: comparing FIM motor subscale and interRAI post acute care activities of daily living scale. Arch Phys Med Rehabil 2012; 93:1000-8. [PMID: 22497989 DOI: 10.1016/j.apmr.2011.12.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 09/21/2011] [Accepted: 12/16/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To investigate the construct validity of the activities of daily living (ADLs) sections of 2 major systems developed to measure functional ability in rehabilitation settings. Health assessment systems can inform care planning as well as policy decision-making on service effectiveness. Frailty, comorbidity, and heterogeneity make it difficult to accurately measure health outcomes for older adults. Objective investigation of the value of geriatric rehabilitation services requires assessment systems that are comprehensive, reliable, valid, and sensitive to clinically relevant changes in older patients. DESIGN Trained health care workers assessed patients with both tools at admission and discharge. We used Rasch analysis to compare the instruments' dimensionality, item difficulty, item fit, differential item function, and number of response options. SETTING Musculoskeletal and geriatric rehabilitation units in 2 Ontario hospitals. PARTICIPANTS Older adults receiving rehabilitation (N=209; mean age ± SD, 78.5±9.3; 67% women). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES FIM and the interRAI Post Acute Care Assessment (interRAI PAC). RESULTS For both the FIM motor and the interRAI PAC ADLs items, the difficulty level of the items was much lower than the participant's level of ability, resulting in a large ceiling effect. Also, on both scales, less actual change in functional ability was required to move between the midlevel response options. CONCLUSIONS Both scales have limited ability to discriminate between subjects with higher functional ability, which indicates that they may underestimate the effectiveness of inpatient rehabilitation for this group of patients when used alone.
Collapse
Affiliation(s)
- Christine Glenny
- Department of Health Studies and Gerontology, University of Waterloo, Waterloo, ON, Canada
| | | | | | | | | |
Collapse
|
179
|
Adunsky A, Arad M, Koren-Morag N, Fleissig Y, Mizrahi EH. Atrial fibrillation is not associated with rehabilitation outcomes of elderly hip fracture patients. Geriatr Gerontol Int 2012; 12:688-94. [DOI: 10.1111/j.1447-0594.2012.00845.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
180
|
Sánchez AI, Krafty RT, Weiss HB, Rubiano AM, Peitzman AB, Puyana JC. Trends in survival and early functional outcomes from hospitalized severe adult traumatic brain injuries, pennsylvania, 1998 to 2007. J Head Trauma Rehabil 2012; 27:159-69. [PMID: 21386713 PMCID: PMC3143237 DOI: 10.1097/htr.0b013e3182074c41] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE : To determine trends for in-hospital survival and functional outcomes at acute care hospital discharge for patients with severe adult traumatic brain injury (SATBI) in Pennsylvania, during 1998 to 2007. METHODS : Secondary analysis of the Pennsylvania trauma outcome study database. MAIN OUTCOME MEASURES : Survival and functional status scores of 5 domains (feeding, locomotion, expression, transfer mobility, and social interaction) fitted into logistic regression models adjusted for age, sex, race, comorbidities, injury mechanism, extracranial injuries, severity scores, hospital stay, trauma center, and hospital level. Sensitivity analyses for functional outcomes were performed. RESULTS : There were 26 234 SATBI patients. Annual numbers of SATBI increased from 1757 to 3808 during 1998 to 2007. Falls accounted for 47.7% of all SATBI. Survival increased significantly from 72.5% to 82.7% (odds ratio [OR] = 1.10, 95% CI: 1.08-1.11, P < .001). In sensitivity analyses, trends of complete independence in functional outcomes increased significantly for expression (OR = 1.01, 95% CI: 1.00-1.02, P = .011) and social interaction (OR = 1.01, 95% CI: 1.00-1.03, P = .002). There were no significant variations over time for feeding, locomotion, and transfer mobility. CONCLUSIONS : Trends for SATBI served by Pennsylvania's established trauma system showed increases in rates but substantial reductions in mortality and significant improvements in functional outcomes at discharge for expression and social interaction.
Collapse
Affiliation(s)
- Alvaro I Sánchez
- Departments of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
| | | | | | | | | | | |
Collapse
|
181
|
Padwal RS, Wang X, Sharma AM, Dyer D. The impact of severe obesity on post-acute rehabilitation efficiency, length of stay, and hospital costs. J Obes 2012; 2012:972365. [PMID: 22523669 PMCID: PMC3317131 DOI: 10.1155/2012/972365] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 12/17/2011] [Indexed: 01/24/2023] Open
Abstract
Background and Objective. The purpose of this retrospective observational study was to examine the influence of severe obesity on length of stay (LOS), rehabilitation efficiency, and hospital costs post-acute rehabilitation in a population-based, tertiary care, publicly-funded regional rehabilitation center. Participants. 42 severely obese subjects (mean age 53 y; mean BMI 50.9 kg/m(2)) and 42 nonobese controls (mean age 59 y; mean BMI 23.0 kg/m(2)) matched by sex and admitting diagnosis. Main Outcome Measures. Total LOS, rehab LOS, waiting for transfer LOS, Fuctional Independence Measure (FIM) efficiency, and hospital costs. Results. Compared to controls, severely obese subjects experienced longer total LOS (98.4 vs. 37.4 days; P = 0.03), rehabilitation LOS (55.8 vs. 37.4 days; P = 0.04), and waiting for transfer LOS (42.6 vs. 0 days; P = 0.006); increased hospital costs ($115,822 vs. $43,969; P = 0.03); and similar FIM efficiency (0.58 vs. 0.67; P = 0.27). Severe obesity was an independent predictor of total LOS (beta-coefficient 0.51; P = 0.03), rehab LOS (0.46; P = 0.02) but not FIM efficiency (-0.63; P = 0.06). Conclusion. Severe obesity adversely affects rehabilitation LOS and expenditures. Targeted interventions in severely obese individuals to optimize post-acute rehabilitation care delivery are needed.
Collapse
Affiliation(s)
- Raj S. Padwal
- Department of Medicine, University of Alberta, Edmonton, AB, Canada T6G 2B7
- *Raj S. Padwal:
| | - Xiaoming Wang
- Department of Medicine, University of Alberta, Edmonton, AB, Canada T6G 2B7
| | - Arya M. Sharma
- Department of Medicine, University of Alberta, Edmonton, AB, Canada T6G 2B7
| | - David Dyer
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, AB, Canada T5G 0B7
| |
Collapse
|
182
|
Dubuc N, Dubois MF, Raîche M, Gueye NR, Hébert R. Meeting the home-care needs of disabled older persons living in the community: does integrated services delivery make a difference? BMC Geriatr 2011; 11:67. [PMID: 22029878 PMCID: PMC3271235 DOI: 10.1186/1471-2318-11-67] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 10/26/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The PRISMA Model is an innovative coordination-type integrated-service-delivery (ISD) network designed to manage and better match resources to the complex and evolving needs of elders. The goal of this study was to examine the impact of this ISD network on unmet needs among disabled older persons living in the community. METHODS Using data from the PRISMA study, we compared unmet needs of elders living in the community in areas with or without an ISD network. Disabilities and unmet needs were assessed with the Functional Autonomy Measurement System (SMAF). We used growth-curve analysis to examine changes in unmet needs over time and the variables associated with initial status and change. Sociodemographic characteristics, level of disability, self-perceived health status, cognitive functioning, level of empowerment, and the hours of care received were investigated as covariates. Lastly, we report the prevalence of needs and unmet needs for 29 activities in both areas at the end of the study. RESULTS On average, participants were 83 years old; 62% were women. They had a moderate level of disability and mild cognitive problems. On average, they received 2.07 hours/day (SD = 1.08) of disability-related care, mostly provided by family. The findings from growth-curve analysis suggest that elders living in the area where ISD was implemented and those with higher levels of disability experience better fulfillment of their needs over time. Besides the area, being a woman, living alone, having a higher level of disability, more cognitive impairments, and a lower level of empowerment were linked to initial unmet needs (r2 = 0.25; p < 0.001). At the end of the study, 35% (95% CI: 31% to 40%) of elders with needs living in the ISD area had at least one unmet need, compared to 67% (95% CI: 62% to 71%) in the other area. In general, unmet needs were highest for bathing, grooming, urinary incontinence, walking outside, seeing, hearing, preparing meals, and taking medications. CONCLUSIONS In spite of more than 30 years of home-care services in the province of Quebec, disabled older adults living in the community still have unmet needs. ISD networks such as the PRISMA Model, however, appear to offer an effective response to the long-term-care needs of the elderly.
Collapse
Affiliation(s)
- Nicole Dubuc
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, Quebec, J1H 5N4, Canada
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, 1036 Belvedere South, Sherbrooke, Quebec, J1H 4C4, Canada
| | - Marie-France Dubois
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, Quebec, J1H 5N4, Canada
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, 1036 Belvedere South, Sherbrooke, Quebec, J1H 4C4, Canada
| | - Michel Raîche
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, 1036 Belvedere South, Sherbrooke, Quebec, J1H 4C4, Canada
| | - N'Deye Rokhaya Gueye
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, 1036 Belvedere South, Sherbrooke, Quebec, J1H 4C4, Canada
- Faculty of Arts & Faculty of Sciences, Université de Saint-Boniface, 200, Avenue de la Cathédrale, Winnipeg, MB, R2H 0H7, Canada
| | - Réjean Hébert
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, Quebec, J1H 5N4, Canada
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, 1036 Belvedere South, Sherbrooke, Quebec, J1H 4C4, Canada
| |
Collapse
|
183
|
Herbold JA, Bonistall K, Walsh MB. Rehabilitation Following Total Knee Replacement, Total Hip Replacement, and Hip Fracture. J Geriatr Phys Ther 2011; 34:155-60. [DOI: 10.1519/jpt.0b013e318216db81] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
184
|
["Time is brain": only in the acute phase of stroke?]. Neurologia 2011; 27:197-201. [PMID: 21890240 DOI: 10.1016/j.nrl.2011.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 06/29/2011] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE In Spain, stroke is the leading cause of death in women as well as the leading cause of disability in adults. This translates into a huge human and economic cost. In recent years there have been significant advances both in the treatment of acute stroke and in the neuro-rehabilitation process; however, it is still unclear when the best time is to initiate neurorehabilitation and what the consequences of delaying treatment are. To test the effect of a single day delay in the onset of neurorehabilitation on functional improvement achieved, and the influence of that delay in the rate of institutionalisation at discharge. METHODS A retrospective study of patients admitted to Parkwood Hospital's Stroke Neurorehabilitation Unit (UNRHI) (University of Western Ontario, Canada) between April 2005 and September 2008 was performed. We recorded age, Functional Independence Measurement (FIM) score at admission and discharge, the number of days between the onset of stroke and admission to the Neurorehabilitation Unit and discharge destination. RESULTS After adjustment for age and admission FIM, we found a significant association between patient functional improvement (FIM gain) and delay in starting rehabilitation. We also observed a significant correlation between delay in initiating therapy and the level of institutionalisation at discharge. CONCLUSIONS A single day delay in starting neurorehabilitation affects the functional prognosis of patients at discharge. This delay is also associated with increased rates of institutionalisation at discharge.
Collapse
|
185
|
Mortenson WB, Miller WC, Backman CL, Oliffe JL. Predictors of mobility among wheelchair using residents in long-term care. Arch Phys Med Rehabil 2011; 92:1587-93. [PMID: 21840499 DOI: 10.1016/j.apmr.2011.03.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 01/05/2011] [Accepted: 03/30/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify predictors of mobility among long-term care residents who use wheelchairs as their main means of mobility. Based on the Matching Person to Technology Model, we hypothesized that wheelchair-related, personal, and environmental factors would be independent predictors of mobility. DESIGN Cross-sectional study. SETTING Eleven long-term residential care facilities in the lower mainland of British Columbia, Canada. PARTICIPANTS Residents (N=268): self-responding residents (n=149) and residents who required proxy respondents (n=119). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Mobility was measured using the Nursing Home Life-Space Diameter. Standardized measures of personal, wheelchair-related, and environmental factors were administered and sociodemographic data were collected as independent variables. RESULTS Independent mobility decreased as the distance from the resident's room increased: 63% of participants were independently mobile on their units, 40% were independently mobile off their units within the facilities, and 20% were independently mobile outdoors. For the total sample, the significant predictors of mobility, in descending order of importance, were: wheelchair skills (including the capacity to engage brakes and maneuver), functional independence in activities of daily living, having 4 or more visits per week from friends or family, and use of a power wheelchair. This regression model accounted for 48% of variance in mobility scores. CONCLUSIONS Limited independent mobility is a common problem among facility residents. Residents may benefit from interventions such as wheelchair skills training or provision of powered mobility, but the effectiveness of these interventions needs to be evaluated.
Collapse
Affiliation(s)
- W Ben Mortenson
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada.
| | | | | | | |
Collapse
|
186
|
Berges IM, Seale G, Ostir GV. Positive affect and pain ratings in persons with stroke. Rehabil Psychol 2011; 56:52-7. [PMID: 21401286 DOI: 10.1037/a0022683] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine the association between positive affect at discharge from inpatient medical rehabilitation and pain ratings 3 months postdischarge in persons with stroke aged 50 or older. DESIGN A longitudinal study using information from the Stroke Recovery in Underserved Population (SRUP) data base. A 4-item positive affect scale and an 11-point visual analog pain scale were collected at discharge and at 3 months postdischarge. PARTICIPANTS The study included 917 adults aged 50 and older with first-time stroke admitted to one of eleven inpatient medical rehabilitation facilities across the United States. RESULTS The mean age of the sample was 71 years, 51.0% were women, and 51.6% were married. One third of the sample reported pain and the mean positive affect score was 9.2 (range 0-12). Cumulative logit models showed higher positive affect scores at discharge were significantly associated with lower pain ratings (OR: 0.87, 95% CI 0.81, 0.92) at 3-month follow-up after adjusting for discharge pain ratings, negative affect, and demographic and clinical characteristics. CONCLUSION High positive affect at discharge from inpatient medical rehabilitation was associated with lower pain ratings 3 months post discharge after controlling for pain and negative affect at discharge and clinical and demographic characteristics. The identification of links between positive affect and pain may contribute to a better understanding of functional recovery processes poststroke and the planning of therapeutic programs directed at the positive psychological strengths in elderly persons with stroke.
Collapse
Affiliation(s)
- Ivonne-Marie Berges
- Sealy Center on Aging and Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX 77555, USA.
| | | | | |
Collapse
|
187
|
Influence of Age on Rehabilitation Outcomes and Survival in Post-Acute Inpatient Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2011; 31:230-8. [DOI: 10.1097/hcr.0b013e318207d314] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
188
|
Skidmore ER, Holm MB, Whyte EM, Dew MA, Dawson D, Becker JT. The feasibility of meta-cognitive strategy training in acute inpatient stroke rehabilitation: case report. Neuropsychol Rehabil 2011; 21:208-23. [PMID: 21391121 DOI: 10.1080/09602011.2011.552559] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Meta-cognitive strategy training may be used to augment inpatient rehabilitation to promote active engagement and subsequent benefit for individuals with cognitive impairments after stroke. We examined the feasibility of administering a form of meta-cognitive strategy training, Cognitive Orientation to daily Occupational Performance (CO-OP), during inpatient rehabilitation. We trained an individual with cognitive impairments after right hemisphere stroke to identify performance problems, set self-selected goals, develop plans to address goals, and evaluate performance improvements. To assess feasibility, we examined the number of meta-cognitive training sessions attended, the number of self-selected goals, and changes in goal-related performance. We also examined changes in rehabilitation engagement and disability. The participant used the meta-cognitive strategy to set eight goals addressing physically oriented, instrumental, and work-related activities. Mean improvement in Canadian Occupational Performance Measure Performance Scale scores was 6.1. Pittsburgh Rehabilitation Participation Scale scores (measuring rehabilitation engagement) improved from 3.2 at admission to 4.9 at discharge. Functional Independence Measure scores (measuring disability) improved from 68 at admission, to 97 at discharge. Performance Assessment of Self-Care Skills scores improved from 1.1 at admission to 2.9 at discharge. The results indicate that meta-cognitive strategy training was feasible during inpatient rehabilitation and warrants further evaluation to determine its effectiveness.
Collapse
Affiliation(s)
- Elizabeth R Skidmore
- Department of Occupational Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA 15260, USA.
| | | | | | | | | | | |
Collapse
|
189
|
Ma Y, Liu Y, Fu HM, Wang XM, Wu BH, Wang SX, Peng GG. Evaluation of admission characteristics, hospital length of stay and costs for cerebral infarction in a medium-sized city in China. Eur J Neurol 2011; 17:1270-6. [PMID: 20402751 DOI: 10.1111/j.1468-1331.2010.03007.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Stroke is a heavy economic and health burden for the patients and society. This study aimed to evaluate hospital length of stay (LOS) by admission characteristics and costs correlated with medical insurance status for cerebral infarction in a medium-sized city in China. METHODS A total of 557 consecutive patients with principal diagnosis of cerebral infarction were enrolled. Admission characteristics, LOS, and costs were retrospectively analyzed. RESULTS The mean LOS was 18.5 days (median, 16 days). Our analysis demonstrated that medical insurance status, stroke severity (National Institutes of Health Stroke Scale score, Functional Independence Measure cognitive and motor score, Glasgow coma scale), Oxfordshire Community Stroke Project (OCSP) classification, some comorbidities (coronary heart disease, chronic obstructive pulmonary disease, and hyperlipemia), and raised leukocytes were the main explanatory factors for LOS by stepwise multiple regression model. The mean per patient costs were US $983.0, and mean daily costs US $67.0. Drugs were the most expensive cost subtype, all subtypes costs except non-medical care were significantly higher in patients with state medicine than in those with new cooperative medical scheme (NCMS) (P < 0.001). CONCLUSION Stroke severity, OCSP classification, raised leukocytes on admission, some comorbidities, and medical insurance status may help to predict LOS for patients with cerebral infarction. Healthcare expenditures were heavy burdens to inhabitants. State medicine patients could shorten unnecessary LOS to improve the resources allocation and cost-efficiency.
Collapse
Affiliation(s)
- Y Ma
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong Department of Forensic Medicine, North Sichuan Medical College, Nanchong, P. R. China
| | | | | | | | | | | | | |
Collapse
|
190
|
Reistetter TA, Graham JE, Deutsch A, Markello SJ, Granger CV, Ottenbacher KJ. Diabetes comorbidity and age influence rehabilitation outcomes after hip fracture. Diabetes Care 2011; 34:1375-7. [PMID: 21562326 PMCID: PMC3114361 DOI: 10.2337/dc10-2220] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the influence of diabetes on length of stay (LOS), functional status, and discharge setting in individuals with hip fracture. RESEARCH DESIGN AND METHODS This work included secondary analyses of 79,526 individuals from 915 rehabilitation facilities in the U.S. Patients were classified into three groups using the Centers for Medicare and Medicaid Services comorbidity structure: individuals without diabetes (77.0%), individuals with non-tier diabetes (18.3%), and individuals with tier diabetes (4.7%). RESULTS Mean age was 79.4 years (SD 9.6), and mean LOS was 13.3 days (SD 5.3). Tier diabetes was associated with longer LOS, lower functional status ratings, and reduced odds of discharge home when compared with individuals with no diabetes and non-tier diabetes. Statistically significant interactions (P < 0.05) were found between age and diabetes classification for LOS, functional status, and discharge setting. CONCLUSIONS The impact of diabetes on recovery after hip fracture is moderated by age.
Collapse
Affiliation(s)
- Timothy A Reistetter
- Department of Occupational Therapy, University of Texas Medical Branch, Galveston, Texas, USA
| | | | | | | | | | | |
Collapse
|
191
|
The impact of sacral sensory sparing in motor complete spinal cord injury. Arch Phys Med Rehabil 2011; 92:376-83. [PMID: 21353822 DOI: 10.1016/j.apmr.2010.07.242] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 06/09/2010] [Accepted: 07/20/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the effect of sensory sparing in motor complete persons with spinal cord injury (SCI) on completion of rehabilitation on neurologic, functional, and social outcomes reported at 1 year. DESIGN Secondary analysis of longitudinal data collected by using prospective survey-based methods. SETTING Data submitted to the National SCI Statistical Center Database. PARTICIPANTS Of persons (N=4106) enrolled in the model system with a motor complete injury (American Spinal Injury Association Impairment Scale [AIS] grade A or B) at the time of discharge between 1997 and 2007, a total of 2331 (56.8%) completed a 1-year follow-up interview (Form II) and 1284 (31.3%) had complete data for neurologic (eg, AIS grade, injury level) variables at 1 year. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES AIS grade (A vs B) at 1 year, bladder management, hospitalizations, perceived health status, motor FIM items, Satisfaction With Life Scale, depressive symptoms, and social participation. RESULTS Compared with persons with AIS grade A at discharge, persons with AIS grade B were less likely to require indwelling catheterization and be hospitalized and more likely to perceive better health, report greater functional independence (ie, self-care, sphincter control, mobility, locomotion), and report social participation in the first year postinjury. A greater portion of individuals with AIS grade B at discharge had improved neurologic recovery at 1 year postinjury than those with AIS grade A. Significant AIS group differences in 1-year outcomes related to physical health were maintained after excluding persons who improved to motor incomplete status for only bladder management and change in perceived health status. This recognition of differences between persons with motor complete injuries (AIS grade A vs B) has important ramifications for the field of SCI rehabilitation and research.
Collapse
|
192
|
Deutsch A, Almagor O, Rowles D, Pucci D, Chen D. Characteristics and Outcomes of Aged Medicare Beneficiaries with a Traumatic Spinal Cord Injury: 2002-2005. Top Spinal Cord Inj Rehabil 2011. [DOI: 10.1310/sci1604-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
193
|
Adams HP. Clinical Scales to Assess Patients with Stroke. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10021-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
194
|
Wilde EA, Whiteneck GG, Bogner J, Bushnik T, Cifu DX, Dikmen S, French L, Giacino JT, Hart T, Malec JF, Millis SR, Novack TA, Sherer M, Tulsky DS, Vanderploeg RD, von Steinbuechel N. Recommendations for the use of common outcome measures in traumatic brain injury research. Arch Phys Med Rehabil 2010; 91:1650-1660.e17. [PMID: 21044708 DOI: 10.1016/j.apmr.2010.06.033] [Citation(s) in RCA: 319] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 06/09/2010] [Accepted: 06/11/2010] [Indexed: 11/28/2022]
Abstract
This article summarizes the selection of outcome measures by the interagency Traumatic Brain Injury (TBI) Outcomes Workgroup to address primary clinical research objectives, including documentation of the natural course of recovery from TBI, prediction of later outcome, measurement of treatment effects, and comparison of outcomes across studies. Consistent with other Common Data Elements Workgroups, the TBI Outcomes Workgroup adopted the standard 3-tier system in its selection of measures. In the first tier, core measures included valid, robust, and widely applicable outcome measures with proven utility in TBI from each identified domain, including global level of function, neuropsychological impairment, psychological status, TBI-related symptoms, executive functions, cognitive and physical activity limitations, social role participation, and perceived health-related quality of life. In the second tier, supplemental measures were recommended for consideration in TBI research focusing on specific topics or populations. In the third tier, emerging measures included important instruments currently under development, in the process of validation, or nearing the point of published findings that have significant potential to be superior to some older ("legacy") measures in the core and supplemental lists and may eventually replace them as evidence for their utility emerges.
Collapse
Affiliation(s)
- Elisabeth A Wilde
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
195
|
Cullen NK, Weisz K. Cognitive correlates with functional outcomes after anoxic brain injury: a case-controlled comparison with traumatic brain injury. Brain Inj 2010; 25:35-43. [PMID: 21121706 DOI: 10.3109/02699052.2010.531691] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To assess the effectiveness of inpatient rehabilitation in adults who have sustained an anoxic brain injury (AnBI). Secondly, to identify areas of cognition that predict functional outcomes at discharge. DESIGN Retrospective, matched case-controlled study. METHODS Ten patients with moderate-to-severe AnBI and 10 patients with traumatic brain injury (TBI), treated in an inpatient neurorehabilitation programme, were matched on age, acute care length of stay and admission Functional Independence Measure (FIM). Functional outcome was assessed using the FIM and Disability Rating Scale (DRS). RESULTS Patients with AnBI performed worse on all measures of functional outcome relative to patients with TBI. Patients with AnBI achieved significantly lower FIM motor and cognitive gain compared with patients with TBI (11.5, SD 13.6 vs. 31.0, SD 19.7 and 2.4, SD 3.9 vs. 7.5, SD 4.2, respectively (p < 0.02)). DRS data showed similar trends of functional improvement between the groups. Several neuropsychometric tests correlated with functional outcome (p < 0.01). CONCLUSIONS Patients with AnBI had worse functional outcomes following rehabilitation than patients with TBI, confirming the results of previous reports. Poor cognitive function predicted poor functional outcomes on the FIM and somewhat on the DRS. Research is needed to assess why these differences occur and to improve or develop new effective rehabilitation treatments for AnBI.
Collapse
Affiliation(s)
- Nora K Cullen
- Toronto Rehabilitation Institute, Toronto, ON, Canada.
| | | |
Collapse
|
196
|
Raju RS, Sarma PS, Pandian JD. Psychosocial Problems, Quality of Life, and Functional Independence Among Indian Stroke Survivors. Stroke 2010; 41:2932-7. [DOI: 10.1161/strokeaha.110.596817] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rinu Susan Raju
- From the Stroke Unit (R.S.R., J.P.), Christian Medical College, Ludhiana, Punjab, India; Achutha Menon Centre for Health Science Studies (P.S.S.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Prabhakaran S. Sarma
- From the Stroke Unit (R.S.R., J.P.), Christian Medical College, Ludhiana, Punjab, India; Achutha Menon Centre for Health Science Studies (P.S.S.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Jeyaraj D. Pandian
- From the Stroke Unit (R.S.R., J.P.), Christian Medical College, Ludhiana, Punjab, India; Achutha Menon Centre for Health Science Studies (P.S.S.), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| |
Collapse
|
197
|
Schiess MC, Oh IJ, Stimming EF, Lucke J, Acosta F, Fisher S, Simpson RK. Prospective 12-month study of intrathecal baclofen therapy for poststroke spastic upper and lower extremity motor control and functional improvement. Neuromodulation 2010; 14:38-45; discussion 45. [PMID: 21992161 DOI: 10.1111/j.1525-1403.2010.00308.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the effects of intrathecal baclofen (ITB) therapy for the treatment of poststroke spastic hemiparesis on quality of life, functional independence, and upper, lower extremity (UE, LE) motor functions. MATERIALS AND METHODS Prospective observational study of adult men and women with a minimum 6-month stroke-related spastic hemiparesis graded as ≥2 in UE and LE on Modified Ashworth Scale (MAS). Patients served as their own controls with measures compared pre-implant with 12 months post ITB including: MAS, manual muscle test (MMT), gait distance/velocity, Functional Independence Measures (FIM), stroke-specific quality of life scale (SSQL), and upper extremity manual activity log. RESULTS After 12-month ITB therapy, 26 patients (poststroke=6.4±9 years) demonstrated 1) reduced MAS/increased MMT for most LE muscle groups (p≤0.0001); 2) reduced MAS/increased MMT most UE muscle groups (p≤0.01); 3) FIM scores improved (p≤0.05) except bed mobility and lower body dressing; 4) gait distance and velocity improved (p≤0.05); 5) SSQL domains of family roles, mobility, personality, self-care, social roles, thinking, UE function, and work/productivity improved (p≤0.05); 6) amount of use and quality of movement of the spastic UE in performing common activities of daily living increased (p<0.0001). CONCLUSIONS Regardless of duration of spastic hemiparesis, a reduction in tone with ITB therapy facilitates motor strength improvement and is associated with clinically significant improvements in functional independence and quality of life.
Collapse
Affiliation(s)
- Mya C Schiess
- Department of Neurology, University of Texas Houston Medical School, Houston, TX 77030, USA.
| | | | | | | | | | | | | |
Collapse
|
198
|
Stadhouder A, Buckens CFM, Holtslag HR, Öner FC. Are existing outcome instruments suitable for assessment of spinal trauma patients? J Neurosurg Spine 2010; 13:638-47. [DOI: 10.3171/2010.5.spine09128] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Valid outcome assessment tools specific for spinal trauma patients are necessary to establish the efficacy of different treatment options. So far, no validated specific outcome measures are available for this patient population. The purpose of this study was to assess the current state of outcome measurement in spinal trauma patients and to address the question of whether this group is adequately served by current disease-specific and generic health-related quality-of-life instruments.
Methods
A number of widely used outcome measures deemed most appropriate were reviewed, and their applicability to spinal trauma outcome discussed. An overview of recent movements in the theoretical foundations of outcome assessment, as it pertains to spinal trauma patients has been attempted, along with a discussion of domains important for spinal trauma.
Commonly used outcome measures that are recommended for use in trauma patients were reviewed from the perspective of spinal trauma. The authors further sought to select a number of spine trauma–relevant domains from the WHO's comprehensive International Classification of Functioning, Disability and Health (ICF) as a benchmark for assessing the content coverage of the commonly used outcome measurements reviewed.
Results
The study showed that there are no psychometrically validated outcome measurements for the spinal trauma population and there are no commonly used outcome measures that provide adequate content coverage for spinal trauma domains.
Conclusions
Spinal trauma patients are currently followed either as a subset of the polytrauma population in the acute and early postacute setting or as a subset of neurological injury in the long-term revalidation medicine setting.
Collapse
Affiliation(s)
| | | | - Herman R. Holtslag
- 2Rehabilitation & Sports Medicine, University Medical Center Utrecht, The Netherlands
| | | |
Collapse
|
199
|
Yeung SMT, Davis AM, Soric R. Factors influencing inpatient rehabilitation length of stay following revision hip replacements: a retrospective study. BMC Musculoskelet Disord 2010; 11:252. [PMID: 20979662 PMCID: PMC2987976 DOI: 10.1186/1471-2474-11-252] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 10/28/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The annual incidence of revision hip replacements has increased in both Canada and United States, particularly in younger adults. Patients following revision hip replacements often require longer hospital length of stay (LOS) but little is known about predictors of inpatient rehabilitation LOS in this group of patients. The purpose of this study was to evaluate the socio-demographic, pre-surgery, surgery and post-surgery related factors that might influence rehabilitation LOS of inpatients following revision hip replacements. METHODS This study included inpatients discharged from a musculoskeletal ward between 2002 and 2006 following rehabilitation revision hip replacement. Data sources included the National Reporting System, a standardized, provincial administrative database and augmented by chart abstraction. The collected elements included the outcome LOS and the following independent variables: age, sex, support at home, environmental barriers, language barrier, number of revision surgeries on the affected hip, comorbidity, previous orthopaedic surgeries in the lower extremities (L/ES), the hip component(s) revised, weight-bearing status, hemoglobin level, complications, days lapsed from surgery to rehabilitation admission and admission scores on the Functional Independence Measure (FIM). Simple linear regression was used to take forward any predictors significant at p < .10 level. Variables that satisfied the significance level were grouped in blocks and entered for regression analyses. RESULTS The 275 patients in this sample had a mean age of 69 years; 62% were female and the mean LOS was 29.6 days. Statistically significant predictors of longer LOS were low admission FIM score, female sex, revision of only the femoral component, 2 or more prior surgeries in the L/Es and 2 or more hip revisions (redo revision). The final model explained 28% of variance in inpatient LOS. CONCLUSIONS A score of 9-14 points lower in admission FIM, female sex, revision of only the femoral component, prior surgeries in the L/Es and redo hip revision are all independent factors associated with 4-6 days longer LOS. These results may facilitate an understanding of bed flow. Additionally, patients with one or a combination of the above characteristics may benefit from enhanced care plans that facilitate achievement of rehabilitation goals for discharge home.
Collapse
Affiliation(s)
- So-Mei Teresa Yeung
- Musculoskeletal Service, West Park Healthcare Centre, 82 Buttonwood Ave, Toronto, ON, M6M 2J5, Canada.
| | | | | |
Collapse
|
200
|
Rigby P, Ryan SE, Campbell KA. Electronic aids to daily living and quality of life for persons with tetraplegia. Disabil Rehabil Assist Technol 2010; 6:260-7. [DOI: 10.3109/17483107.2010.522678] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|