Poster 99: Patient Characteristics and Inpatient Rehabilitation Outcomes After Hip Fractures

Inpatient rehabilitation has been shown to be an effective intervention for sensorimotor performance in multiple sclerosis (MS) patients. So far, predictions of the rehabilitation outcomes are limited. The objective was to predict inpatient rehabilitation outcomes by changes in the Watzmann Severity Scale (WSS), a statistical estimation of the EDSS by sensorimotor capacity. Sensorimotor performance and physical activity during rehabilitation (by actigraphy) were assessed in a sample of 28 MS patients at a facility for neurorehabilitation. Daily changes in the WSS were predicted by a model of multiple linear regression. The resulting model had an R2adjusted of 0.48 (p < 0.01) and revealed five impacting factors (a reduction in the WSS represents an improvement): the number of steps (β-weight = 0.52, p < 0.01), the duration of nocturnal rest time (β-weight = 0.46, p = 0.01), the EDSS at entry (β-weight = 0.38, p = 0.03), a relapsing-remitting MS (β-weight = 0.37, p = 0.03), and the performance in a visuomotor pursuit task with time pressure (β-weight = −0.35, p = 0.04). One standard deviation improvement was predicted when the patient at admission yielded 6600 fewer steps per day, 94 min less rest per night, −2.7 points in the EDSS at entry, a relapsing-remitting MS, and a pursuit task performance that decreased by 2.2 standard deviations. Overall, the patients improved by −0.22 ± 0.51 WSS points during 19.3 ± 4.5 d of inpatient rehabilitation. Different potential explanations of the findings are discussed, one of which proposes that the results reflect an unhealthy lifestyle which, in addition to MS, would explain the higher predicted improvements by rehabilitation tackling both MS and the patients’ lifestyle.

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Atrial Fibrillation and Mortality in the Oldest Old after Surgery for Hip Fractures

Gerontology ◽

10.1159/000513450 ◽

2021 ◽

pp. 1-7

Author(s):

Amit Frenkel ◽

Vladimir Zeldetz ◽

Roni Gat ◽

Yair Binyamin ◽

Asaf Acker ◽

...

Keyword(s):

Atrial Fibrillation ◽

Risk Factor ◽

Hip Fractures ◽

Retrospective Cohort ◽

Primary Outcome ◽

Oldest Old ◽

Postoperative Mortality ◽

Patient Characteristics ◽

One Year

Introduction: One-year mortality following hip fractures increases steeply with age, from 2% in the 60- to 69-year-old population up to 28% in the oldest old (older than 90 years). Of the various factors that contribute to hip fractures, atrial fibrillation (AF) is an independent risk factor at any age. Objective: The objective of this study was to assess the association of AF with mortality among the oldest old with hip fractures. Method: This is a retrospective cohort study of 701 persons above age 90 years who underwent orthopedic repair for a hip fracture during 2000–2018. Of them, 218 (31%) had AF at hospital admission. The primary outcome was survival following surgery. We compared patient characteristics and 30-day, 180-day, 1-year, and 3-year survival between patients with and without AF. Results: The adjusted odds ratio for 30-day postoperative mortality for those with AF versus without AF group was 1.03 (95% confidence interval [CI] 0.63–1.66). Survival estimates were higher among those without AF than with AF at 180 days postoperative: 0.85 (95% CI 0.82–0.89) versus 0.68 (95% CI 0.61–0.74), p < 0.001; at 1 year postoperative: 0.68 (95% CI 0.63–0.72) versus 0.48 (95% CI 0.42–0.55), p < 0.001; and at 3 years postoperative: 0.47 (95% CI 0.42–0.52) versus 0.28 (95% CI 0.27–0.34), p < 0.001. Conclusions: Among individuals aged >90 years, operated for hip fractures, mortality was similar for those with and without AF at 30 days postoperative. However, the survival curves diverged sharply after 180 days. Our findings suggest that AF is not an immediate surgical risk factor, but rather confers increased long-term risk in this population.

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Racial Differences in Post-Acute Transition After Hip Fracture in Medicare Patients With ADRD

Innovation in Aging ◽

10.1093/geroni/igaa057.2307 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 666-667

Author(s):

Indrakshi Roy ◽

Amol Karmarkar ◽

Amit Kumar ◽

Meghan Warren ◽

Patricia Pohl ◽

...

Keyword(s):

Hip Fracture ◽

Racial Differences ◽

Home Health Care ◽

Multinomial Logistic Regression ◽

Skilled Nursing Facility ◽

Ethnic Disparities ◽

Inpatient Rehabilitation ◽

Patient Characteristics ◽

Nursing Facility ◽

Skilled Nursing

Abstract The incidence of hip fractures in patients with Alzheimer’s disease and related dementias (ADRD) is 2.7 times higher than it is in those without ADRD. However, there are no standardized post-acute transition models for patients with ADRD after hip fracture. Additionally, there is a lack of knowledge on how post-acute transitions vary by race/ethnicity. Using 100% Medicare data (2016-2017) for 120,179 older adults with ADRD, we conduct multinomial logistic regression, to examine the association between race and post-acute discharge locations (proportion discharged to skilled nursing facility [SNF], inpatient rehabilitation facility [IRF], and Home with Home Health Care [HHC]), after accounting for patient characteristics. Compared to non-Hispanic Whites, Hispanics have a significantly lower odds ratio for discharge to HHC 0.62 (95%CI=0.53-0.73), IRF 0.44 (CI=0.39-0.51), and SNF 0.26 (CI=0.23-0.30). Improving care in patients with ADRD and reducing racial and ethnic disparities in quality of care and health outcomes will be discussed.

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Relationship of physical therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: The SCIRehab project

Journal of Spinal Cord Medicine ◽

10.1179/2045772312y.0000000058 ◽

2012 ◽

Vol 35 (6) ◽

pp. 503-526 ◽

Cited By ~ 43

Author(s):

Laura Teeter ◽

Julie Gassaway ◽

Sally Taylor ◽

Jacqueline LaBarbera ◽

Shari McDowell ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Physical Therapy ◽

Inpatient Rehabilitation ◽

Patient Characteristics ◽

Cord Injury ◽

Relationship Of

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Poster 262: A Multicenter Analysis of Age and Sex Effects on Inpatient Rehabilitation Outcomes Following Total Joint Arthroplasty

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2007.06.676 ◽

2007 ◽

Vol 88 (9) ◽

pp. E86

Author(s):

Kevin R. Vincent ◽

Heather K. Vincent

Keyword(s):

Total Joint Arthroplasty ◽

Inpatient Rehabilitation ◽

Joint Arthroplasty ◽

Sex Effects ◽

Rehabilitation Outcomes ◽

Multicenter Analysis ◽

Age And Sex

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Poster 105 The Impact of Comorbidities and Complications on Burn Injury Inpatient Rehabilitation Outcomes

PM&R ◽

10.1016/j.pmrj.2012.09.730 ◽

2012 ◽

Vol 4 ◽

pp. S225-S226

Author(s):

Paul Gerrard ◽

Margaret A. DiVita ◽

Richard Goldstein ◽

Karen J. Kowalske ◽

Paulette Niewczyk ◽

...

Keyword(s):

Burn Injury ◽

Inpatient Rehabilitation ◽

Rehabilitation Outcomes ◽

The Impact

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Abstract 145: Transferred Ischemic Stroke Patients Have Worse Outcomes After Endovascular Therapy

Stroke ◽

10.1161/str.45.suppl_1.145 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Malik M Adil ◽

Shyam Prabhakaran

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Hospital Mortality ◽

Endovascular Treatment ◽

Endovascular Therapy ◽

Systems Of Care ◽

Inpatient Rehabilitation ◽

Patient Characteristics ◽

Transferred Patients ◽

Stroke Systems Of Care

Background and Objective: Ischemic stroke (IS) patients may require inter-facility transfer for higher level of care. Endovascular treatment is the main indication for transfer. We aimed to compare patient characteristics and clinical outcomes amongst transferred vs. non-transferred IS patients who undergo endovascular therapy. Methods: Patients admitted to US hospitals between 2008 and 2011 with a primary discharge diagnosis of IS were identified by ICD-9 codes (433, 434, 436 and 437.1). Mechanical embolectomy (ME) was identified using the ICD-9 procedure code 39.74 or DRG 543 and cerebral angiography (CA) day 0-1 by 88.41. Using logistic regression, we estimated the odds ratio (OR) and 95% confidence intervals (CI) for intracerebral hemorrhage (ICH), in-hospital mortality, and good outcomes (discharge home or inpatient rehabilitation) among transfer vs. non-transfers, adjusting for potential confounders. Results: Of 116,382 patients with IS treated with ME or CA (7.0% of all patients with IS), 10.1% were performed in transferred patients. Atrial fibrillation and hyperlipidemia was significantly higher in IS transfers. In-hospital mortality was higher among IS transfers (9.0% vs. 3.7%; p<0.001) and discharge to home or inpatient rehabilitation was less likely among transferred IS patients (70.2% vs. 80.6%; p<0.001). ICH was higher among IS transfers (4.6% vs. 1.7%; p<0.001). After adjusting for age, gender, race, presence of hypertension, dyslipidemia, atrial fibrillation, renal failure, alcohol abuse, insurance status, and hospital teaching status, transferred patients had higher odds of ICH (OR 2.0, 95% CI 1.5-2.8, p<0.001)] and death (OR 2.0, 95% CI 1.6-2.4, p<0.001) and lower odds of discharge to home/rehabilitation (OR 0.5, 95% CI 0.4-0.7, p<0.001) . Conclusion: Endovascular treatment for acute ischemic stroke may be associated with worse outcomes among inter-hospital transfer patients compared to non-transfers. Organized stroke systems of care may need to consider pre-hospital strategies to increase direct referrals to comprehensive stroke centers and inter-hospital strategies to reduce delays to treatment.

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Factors Associated With Rehabilitation Outcomes in Patients With Unilateral Vestibular Hypofunction: A Prospective Cohort Study

Physical Therapy ◽

10.1093/ptj/pzaa138 ◽

2020 ◽

Vol 100 (11) ◽

pp. 2009-2022

Author(s):

Susan J Herdman ◽

Courtney D Hall ◽

Lisa Heusel-Gillig

Keyword(s):

Gait Speed ◽

Outcome Measure ◽

Patient Characteristics ◽

Meaningful Change ◽

Balance Confidence ◽

Factors Associated ◽

Rehabilitation Outcomes ◽

Vestibular Hypofunction ◽

Dynamic Gait Index ◽

Dynamic Gait

Abstract Objective The purpose of this study was to determine factors associated with rehabilitation outcomes following vestibular rehabilitation (VR). Methods In this prospective cohort study, 116 patients who completed at least 2 supervised sessions participated. Patient characteristics and comorbidities were recorded. Initial and discharge measures included symptom intensity, balance confidence, quality of life, percent of time symptoms interfere with life, perceived benefits of VR, gait speed, fall risk, visual acuity during head movement, and anxiety/depression. Intention-to-treat analyses were performed to determine outcomes at discharge. Bivariate correlations between independent (group characteristics and baseline measures) and dependent (discharge measures) variables were determined. Logistic regressions were performed to identify factors associated with whether a patient would have a normal score or meaningful change at discharge. Results There was a large effect of VR with significant improvement for the group as a whole on each outcome measure. For each outcome measure, most patients improved. Based on preliminary logistic regression, 2 patient characteristics were associated with outcome: number of therapy visits predicted meaningful improvement in gait speed, and falls after the onset of the unilateral vestibular hypofunction (UVH) predicted meaningful change in the percent of time symptoms interfered with life. Initial Activities-Specific Balance Confidence Scale (ABC) and Dynamic Gait Index scores predicted normal ABC scores at discharge, and initial ABC scores predicted recovery of Dynamic Gait Index scores. Preliminary prediction models were generated for balance confidence, impact of dizziness on life, dynamic visual acuity, gait speed, and fall risk. Conclusions Therapists may use these findings for patient education or to determine the need for adjunct therapy, such as counseling. Impact Not all people with UVH improve following VR, but there is little research examining why. This study looked at multiple factors and identified number of visits and falls after onset of UVH as patient characteristics associated with outcomes following VR; these findings will help therapists create better predictive models.

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