The association between polypharmacy and the efficiency of the functional independence measure in an acute-stage hospital: a retrospective cohort study

Abstract Background: Diabetic foot lesions are a major cause of non-traumatic lower limb amputations; they can interfere with daily life, reduce physical function and lower a patient’s quality of life. Physical therapy is necessary to prevent such social disadvantage. Patients at high risk of reamputation may require physical therapy to prevent reamputation. The purpose of this study was to elucidate the factors that influence re-amputation in patients with minor amputations who were treated with physical therapy during their hospitalization.Methods: This was a retrospective cohort study of 245 consecutive hospitalized patients who presented to our Wound Care Center between January 2015 and February 2018 and received physical therapy after a minor amputation. Participants were identified from admission records (to surgical and physical therapy units) stored in the electronic medical records. We examined reamputations that occurred in the ipsilateral lower extremity during the 1-year post-discharge outpatient period. The maximum follow-up period was１year. We used Cox proportional hazards analysis to examine factors affecting the risk of reamputation.Results: Of the 129 patients enrolled, 42 patients (32.5%) underwent reamputations during an average observation period of 6.2 months (range, 2.1 to 10.9 months). The factors associated with reamputation were a requirement for hemodialysis, ankle dorsiflexion angle, and ambulation Functional Independence Measure score.Conclusions: We identified a requirement for hemodialysis, ankle dorsiflexion angle, and functional independence measure (FIM) ambulation as the factors associated with reamputation in patients with diabetes who had undergone minor amputation. In the future, developing a physical therapy program that focuses on these factors could help reduce reamputations.

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Reamputation in patients with diabetes-related minor amputations who underwent physical therapy during their hospitalization. A single-facility retrospective cohort study

10.21203/rs.3.rs-52938/v3 ◽

2020 ◽

Author(s):

Shinsuke Imaoka ◽

Koji Sato ◽

Masahide Furukawa ◽

Minoru Okita ◽

Toshio Higashi

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Physical Therapy ◽

Retrospective Cohort Study ◽

Lower Limb ◽

Retrospective Cohort ◽

Functional Independence Measure ◽

Functional Independence ◽

Amputation Rate ◽

Modifiable Risk Factors

Abstract Background：Diabetes-related foot lesions are a major cause of non-traumatic lower limb amputations and are associated with a high re-amputation rate. Lesions can cause hindrance in activities of daily living, reduce physical function, and lower a patient’s quality of life. Physical therapy is necessary to prevent these limitations. Thus far, there has been limited investigation into the re-amputation rate in patients who have undergone physical therapy. This study aimed to elucidate modifiable risk factors for re-amputation in patients with minor amputations who were treated with physical therapy during their hospitalization.Methods：This was a retrospective cohort study of 245 consecutive hospitalized patients who presented to our Wound Care Center between January 2015 and February 2018 and received physical therapy after a minor amputation. Participants were identified from admission records (to surgical and physical therapy units) stored in the electronic medical records. We examined reamputations that occurred in the ipsilateral lower extremity during the 1-year post-discharge outpatient period. The maximum follow-up period was set at 1 year. We used Cox proportional hazards analysis to examine factors affecting the risk of reamputation.Results: Of the 129 patients enrolled, 42 patients (32.5%) underwent reamputations during an average observation period of 6.2 months (range, 2.1 to 10.9 months). The factors associated with reamputation were a requirement for hemodialysis, ankle dorsiflexion angle, and ambulation Functional Independence Measure score.Conclusions: In diabetes patients with minor amputations, requirement for hemodialysis, ankle dorsiflexion angle, and functional independence measure (FIM) ambulation were shown to be modifiable risk factors for re-amputation. This emphasizes that maintaining vascular endothelial function through lower limb muscle exercises for hemodialysis, improving ankle mobility, and off-loading walking are necessary to reduce the risk of reamputation. Patients with these risk factors should be encouraged to participate in physical therapy.

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The Association Between Antipsychotic Drug Use and Rehabilitation Outcome in Post-Acute Hip Fractured Patients: A Retrospective Cohort Study

Journal of Applied Gerontology ◽

10.1177/0733464820904564 ◽

2020 ◽

pp. 073346482090456

Author(s):

Avital Hershkovitz ◽

Ran Nissan

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Functional Independence Measure ◽

Multiple Linear Regression Model ◽

Functional Independence ◽

Functional Improvement ◽

Rehabilitation Outcome ◽

Rehabilitation Outcomes ◽

Functional Gain

Antipsychotic (AP) use may lead to numerous side effects which may affect rehabilitation outcomes. A retrospective cohort study was carried out on 448 hip fractured patients admitted to a post-acute geriatric rehabilitation center. Functional improvement was measured by the Functional Independence Measure (FIM), motor FIM (mFIM), and mFIM effectiveness. A multiple linear regression model and regression analysis was used to evaluate the level of association between AP use and achievement of favorable functional gain. AP users exhibited lower functional ability on admission and at discharge, achieved a significantly lower functional gain and required longer rehabilitation time compared with nonusers. AP use by post-acute hip fractured patients negatively affects their chances of achieving favorable rehabilitation outcome after adjustment for confounders.

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Characteristics and Outcomes of Hip Fracture Patients Hospitalized in an Orthogeriatric Unit Versus an Orthopedic Department: A Retrospective Cohort Study

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459320986299 ◽

2021 ◽

Vol 12 ◽

pp. 215145932098629 ◽

Cited By ~ 1

Author(s):

Yulia Bugaevsky ◽

Yochai Levy ◽

Avital Hershkovitz ◽

Irena Ocheretny ◽

Adaya Nissenholtz ◽

...

Keyword(s):

Older Adults ◽

Cohort Study ◽

Hip Fracture ◽

Hip Fractures ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Functional Independence ◽

Functional Improvement ◽

Orthopedic Department ◽

Successful Recovery

Introduction: Hip fractures are a significant health risk in older adults and a major cause of morbidity, functional decline and mortality. Our aim was to compare clinical outcomes of older patients hospitalized in an ortho-geriatric (OG) unit to those hospitalized in an orthopedic department (OD) for surgical treatment of a hip fracture. Methods: A retrospective cohort study of hip fractured patients hospitalized between 2015-2016 in a single tertiary university-affiliated medical center. Included were patients aged 65 and older who had undergone hip fracture surgery and were admitted to either a geriatric or orthopedic ward. Results: 441 patients met the inclusion criteria (195 in the OG unit, 246 in the OD); 257 were transferred to an affiliated geriatric center hospital (107 from the OG unit and 127 from the OD) for rehabilitation. Patients in the OG unit were older, more cognitively and functionally impaired and with more comorbidities. The 1-year mortality rate was significantly lower in the OD group (OR 0.32, CI 95% 0.19-0.53, p < 0.001), however, after propensity matching, the 30-day and 1 year mortality rates were similar in both groups. No difference was found in the rehabilitation length of stay between the groups. The functional independence measure improvement was similar in both groups, with a non-significant trend toward better functional improvement among OG unit patients. Conclusions: Despite the higher complexity of patients, worse baseline functional capacity in the OG unit, improvement after rehabilitation was similar in both groups. These results demonstrate the advantages of the OG unit in treating and stabilizing frail older adults, thus maximizing their chances for a successful recovery after hip fractures. Level of Evidence: Level IV

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Risk Factors for Aspiration Pneumonia among Elderly Patients in a Community-Based Integrated Care Unit: A Retrospective Cohort Study

Geriatrics ◽

10.3390/geriatrics6040113 ◽

2021 ◽

Vol 6 (4) ◽

pp. 113

Author(s):

Isao Uno ◽

Takaaki Kubo

Keyword(s):

Cohort Study ◽

Integrated Care ◽

Aspiration Pneumonia ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Functional Independence ◽

Physical Factors ◽

Community Based ◽

Factors Associated ◽

Oral Environment

We aimed to clarify the physical factors associated with the incidence of aspiration pneumonia in a community-based integrated care unit. This retrospective cohort study included 412 patients aged 65 years or older admitted to a community-based integrated care unit. A new diagnosis of aspiration pneumonia made by the attending physician based on physical examination, imaging findings, and blood test data after 48 h of admission was considered as an incidence of aspiration pneumonia. Basic patient information, activities of daily living, swallowing function, nutritional status, cognitive function, oral health-related factors, and energy intake were retrospectively investigated. We classified the patients into a pneumonia group and a non-pneumonia group, and examined the factors associated with the development of aspiration pneumonia. The mean age was 86.9 ± 8.1 years, and the pneumonia group comprised 49 participants. Comparison between the groups showed significant differences in oral environment, denture use, cognitive functional independence measure, and discharge to home. In multivariate logistic regression analysis, oral environment (odds ratio (OR) = 0.229, 95% confidence interval (CI): 0.070–0.753, p = 0.015) and use of dentures (OR = 0.360, 95% CI: 0.172–0.754, p = 0.007) were independently associated with aspiration pneumonia. Oral care and the use of dentures may be effective in preventing aspiration pneumonia.

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Re-amputation in patients with diabetes -related minor amputations who underwent physical therapy during their hospitalization. A single-facility retrospective cohort study

10.21203/rs.3.rs-52938/v4 ◽

2021 ◽

Author(s):

Shinsuke Imaoka ◽

Koji Sato ◽

Masahide Furukawa ◽

Minoru Okita ◽

Toshio Higashi

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Physical Therapy ◽

Retrospective Cohort Study ◽

Lower Limb ◽

Retrospective Cohort ◽

Functional Independence ◽

Ankle Dorsiflexion ◽

Amputation Rate ◽

Modifiable Risk Factors

Abstract Background：Diabetes-related foot lesions are a major cause of non-traumatic lower limb amputations and are associated with a high re-amputation rate. Lesions can cause hindrance in activities of daily living, reduce physical function, and lower a patient’s quality of life. Physical therapy is necessary to prevent these limitations. Thus far, there has been limited investigation into the re-amputation rate in patients who have undergone physical therapy. This study aimed to elucidate modifiable risk factors for re-amputation in patients with minor amputations who were treated with physical therapy during their hospitalization.Methods：This was a retrospective cohort study of 245 consecutive hospitalized patients who presented to our Wound Care Center between January 2015 and February 2018 and received physical therapy after a minor amputation. Participants were identified from admission records to surgical and physical therapy units stored in the electronic medical records. We examined re-amputations that occurred in the ipsilateral lower extremity during the 1-year post-discharge outpatient period. The maximum follow-up period was set at 1 year. We used Cox proportional hazards analysis to examine factors affecting the risk of re-amputation.Results: Of the 129 patients enrolled, 42 patients (32.5%) underwent re-amputations during an average observation period of 6.2 months (range, 2.1 to 10.9 months). The factors associated with re-amputation were a requirement for hemodialysis, ankle dorsiflexion angle, and the Functional Independence Measure (FIM) ambulation score.Conclusions: In diabetes patients with minor amputations, a requirement for hemodialysis, ankle dorsiflexion angle, and the FIM ambulation score were shown to be modifiable risk factors for re-amputation. This emphasizes that maintaining vascular endothelial function through lower limb muscle exercises for hemodialysis, improving ankle mobility, and relieving plantar pressure during walking are necessary to reduce the risk of re-amputation. Patients with these risk factors should be encouraged to participate in physical therapy.

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Weight Change during the Early Phase of Convalescent Rehabilitation after Stroke as a Predictor of Functional Recovery: A Retrospective Cohort Study

Nutrients ◽

10.3390/nu14020264 ◽

2022 ◽

Vol 14 (2) ◽

pp. 264

Author(s):

Hiroshi Kishimoto ◽

Yuka Nemoto ◽

Takayuki Maezawa ◽

Kazushi Takahashi ◽

Kazunori Koseki ◽

...

Keyword(s):

Weight Loss ◽

Cohort Study ◽

Functional Recovery ◽

Retrospective Cohort Study ◽

Early Phase ◽

Retrospective Cohort ◽

Statistical Significance ◽

Weight Maintenance ◽

Functional Independence ◽

Wide Range

It has been reported that weight gain at discharge compared with admission is associated with improved activities of daily living in convalescent rehabilitation (CR) patients with low body mass index. Here, we investigated whether weight maintenance or gain during the early phase of CR after stroke correlates with a better functional recovery in patients with a wide range of BMI values. We conducted this retrospective cohort study in a CR ward of our hospital and included adult stroke patients admitted to the ward from January 2014 to December 2018. After ~1 month of hospitalization, the patients were classified into weight loss and weight maintenance or gain (WMG) groups based on the Global Leadership Initiative on Malnutrition criteria for weight. We adopted the motor functional independence measure (FIM) gain as the primary outcome. The motor FIM gain tended to be greater in the WMG group but without statistical significance. However, multiple regression analysis showed that WMG was significantly and positively associated with motor FIM gain. In conclusion, weight maintenance or gain in patients during the early phase of CR after stroke may be considered as a predictor of their functional recovery, and nutritional management to prevent weight loss immediately after the start of rehabilitation would contribute to this.

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Abstract TP155: Weight Loss and Functional Outcomes After Stroke

Stroke ◽

10.1161/str.48.suppl_1.tp155 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Nnana Amakiri ◽

Michael Reding ◽

Carolin I Dohle

Keyword(s):

Weight Loss ◽

Cohort Study ◽

Weight Change ◽

Retrospective Cohort Study ◽

Stroke Rehabilitation ◽

Retrospective Cohort ◽

Pearson Correlation ◽

Functional Independence ◽

Stroke Severity ◽

Hospital Inpatient

Introduction: It is a well described fact that elderly hospitalized patients lose weight, and this weight loss has been attributed to loss of muscle mass. On our acute Inpatient Stroke Rehabilitation Unit, patients with more severe deficits on admission appear to lose more weight than patients who are fairly functional. With this retrospective cohort study, we examined whether weight loss during stroke rehabilitation was associated with stroke severity as measured with the Functional Independence Measure (FIM) Score, and due to poor nutrition due to dysphagia or otherwise decreased food intake (estimated by Percent of Meal Consumed (PoMC)). Methods: 420 ischemic stroke patients, admitted to the Burke Rehabilitation Hospital Inpatient Stroke Unit between 12/14 and 12/15, were included in this retrospective cohort study. Weight change per admission day, as well as motor, cognitive and total FIM Scores was recorded. Patients who had mechanically altered diet orders or thickened liquid orders were judged to be dysphagic, and nutritional intake was estimated by PoMC. Results: Weight change per day during inpatient stroke rehabilitation was not correlated with gains in motor FIM (Pearson correlation 0.07, p=0.89) or cognitive FIM (Pearson Correlation -0.053, p=0.29) scores. Weight change per day was also not correlated with admission cognitive or motor FIM scores, indicating that stroke severity did not predict weight loss during admission. Of note, weight change per day was also not correlated with dysphagia, indicating that patient with swallowing difficulties were able to meet their nutritional needs through dietary modifications. Conclusion: Weight changes after stroke do not appear to be correlated to stroke severity and stroke outcomes, as measured by the FIM Score. In our cohort, dysphagia was not an independent risk factor for weight loss. Future prospective trials will be required in order to assess which patients are at risk for weight loss, and whether weight loss is correlated with other measures of impairment.

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