Functional measures of first-stroke rehabilitation inpatients: Usefulness of the functional independence measure total score with a clinical rationale

Introduction: Having a therapist observe patients engaged in Robotic Upper Limb Therapy (RULT) is considered inefficient use of a therapist’s time and skill. We therefore assessed the feasibility of (RULT) administered by a trained volunteer. Methods: The Volunteer had two 30-minute training sessions by an Occupational Therapist (OT) rehearsing the MIT-Manus Planar Upper Limb Robotic software applications, proper positioning of the patient, and device shut-off and safety considerations. Initial patient sessions were supervised by the patient’s OT until the Volunteer demonstrated satisfactory performance. Inpatients on a Stroke Rehabilitation Unit were referred by their OT for RULT if they could initiate horizontal gravity-eliminated movement of the forearm and could follow one step commands. They were enrolled in 25 minute (RULT) sessions based upon the Volunteer’s availability from one to three half-days per week. Functional Independence Measures and Fugl-Meyer Scores were recorded at the time of Stroke Unit Admission by the OT unaware of (RULT) score results. Statistical analyses were performed using SPSS version 11.5 and significance was attributed if p<0.05 using 2-tailed analyses. Results: A total of 28 patients were enrolled in (RULT) but 2 were unable to participate due to pain in the affected upper limb. Participants had a mean of 3 ± 1.5 SD treatments each. Both the patients and volunteer considered their involvement in the program as worthwhile and meaningful. Admission MIT-Manus Adaptive-3 treatment software data showed that the Normalized Jerk+Line+Target (Norm JLT) Score [defined as (Jerk Score/237)+(Deviation from a Straight Line/13)+(Target Distance Error/14)] demonstrated a significant Spearman-rho Correlation with admission Functional Independence Measure (FIM) upper dressing r = -0.56 p=.003; and FIM grooming subscores r = -0.415, p=.035. The Norm JLT score also predicted change in Fugl-Meyer Upper Limb scores from admission to discharge r = - .788, p = 0.000. Conclusions: Robotic Upper Limb Therapy by a trained Volunteer on an inpatient Stroke Rehabilitation Unit is easily administered, is viewed by the patients and volunteer as rewarding, and provides objective measures useful for assessing upper limb function and outcome.

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Determining Stroke Rehabilitation Inpatients' Level of Nursing Care

Clinical Nursing Research ◽

10.1177/c10n1r5 ◽

2001 ◽

Vol 10 (1) ◽

pp. 40-51 ◽

Cited By ~ 3

Author(s):

Jan Coleman Gross ◽

Stacey W. Goodrich ◽

Mary E. Kain ◽

Elizabeth A. Faulkner

Keyword(s):

Nursing Care ◽

Stroke Rehabilitation ◽

Functional Independence Measure ◽

Inpatient Rehabilitation ◽

Functional Independence ◽

Rehabilitation Program ◽

Two Factors ◽

Staffing Needs ◽

Care Index ◽

Strong Inverse Relationship

The purpose of this study was to evaluate the feasibility of using the Functional Independence Measure (FIM) to predict staffing needs of stroke patients in an acute inpatient rehabilitation program. The Patient Care Index (PCI) was concurrently administered with the FIM on all stroke admissions to a stroke rehabilitation unit over a 3-month period. One hundred fourteen patients 18 years of age or older admitted to the unit with a medical diagnosis of stroke were included in the sample. Total FIM score had a strong inverse relationship to the level of care indicated by the PCI at Days 1, 5, 7, 10, 15, and 20 of rehabilitation (rs = —.76 to —.87). Total FIM score and the need for staff supervision for safety were the two factors predictive of the level of nursing care. The FIM has potential to guide nurse-staffing decisions.

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The Current State of Stroke Rehabilitation in Japan

Neurorehabilitation and Neural Repair ◽

10.1177/154596839901300403 ◽

1999 ◽

Vol 13 (4) ◽

pp. 219-223

Author(s):

Yoshihisa Masakado ◽

Naoichi Chino

Keyword(s):

Regression Analysis ◽

Chronic Conditions ◽

Stroke Rehabilitation ◽

Functional Independence Measure ◽

Functional Independence ◽

Rehabilitation Program ◽

Stroke Outcome ◽

Stroke Patients ◽

Current State ◽

Rehabilitation System

This paper presents the current state of stroke rehabilitation in Japan. The Japanese rehabilitation system is much different from those in other countries, mainly because of the Japanese insurance system, which covers from acute to chronic conditions. In this situation, a Japanese inpatient stroke rehabilitation program treats patients until they reach a plateau in impairment and disability. Thus we can evaluate the true func tional prognosis because of longer periods of observation for assessing the recovery pat tern of impairment and disability. As a result, we can predict stroke outcome much more precisely. We recently developed a new evaluation methods for stroke patients called the Stroke Impairment Assessment Set (SIAS) based on work from the Sym posium on Methodologic Issues in Stroke Outcome Research in 1989. Using the SIAS and the Functional Independence Measure, we have successfully predicted stroke out come using regression analysis.

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Abstract T P127: Look Past the NIHSS! Rehabilitation Metrics that Predict Home Discharge in Ischemic Stroke Patients

Stroke ◽

10.1161/str.46.suppl_1.tp127 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Nneka Ifejika ◽

Linda Aramburo-Maldonado ◽

Chunyan Cai ◽

Melvin R Sline ◽

Elizabeth A Noser ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Care ◽

Assisted Living ◽

Stroke Rehabilitation ◽

Functional Independence Measure ◽

Functional Independence ◽

Advanced Age ◽

Nursing Facilities ◽

Stroke Patients ◽

Home Discharge

Introduction: The goals of stroke rehabilitation are to restore functional ability and to return patients' home with a good quality of life. There is a paucity of data on stroke rehabilitation tools that both track improvements and help predict the likelihood of home discharge. Hypothesis: Improvement in functional independence measure (FIM) score increases home discharge rates, decreases acute care readmissions and decreases placement in skilled nursing facilities (SNF). Advanced age and infections such as symptomatic UTI (SUTI) negate FIM score improvement. Methods: We merged the prospectively collected Stroke and Neurorehabilitation Registries at our comprehensive stroke center, identifying ischemic stroke patients admitted between January 2011 and November 2013 (n=367). Demographics, rehabilitation metrics and NIHSS were collected. Age, SUTI, discharge FIM and rehabilitation length of stay (LOS Rehab) were included in the multivariate regression. Results: Of 367 ischemic stroke patients, 273 went home, 47 to a SNF, 25 to acute care and 22 to another facility (i.e.,assisted living, board and care). All patients tolerated 3 hours of daily therapy (PT, OT, SLP). Despite median NIHSS values of 9 in both groups (P=0.356), patients with SUTI had lower FIM scores on admission (49.2 ± 13.9 vs. 56.8±15.2; P<0.0001) and discharge (68.5 ± 16.9 vs. 76.3 ± 17.0; P<0.0001). For a one year age increase, there was a 5% increase in SNF admit (OR 1.05, 95%CI 1.02-1.08; P<0.001) compared to home. For a one unit increase in FIM, there was a 4% decrease in another facility admit (OR 0.96, 95% CI 0.93 to 0.99; P<0.01), a 6% decrease in SNF admit (OR 0.94, 95%CI 0.92-0.96; P<0.001) and a 10% decrease in acute care readmit (OR 0.90, 95% CI 0.88-0.94; P<0.0001) compared to home. For a one day increase in LOS Rehab, there was a 19% decrease in acute care readmit (OR 0.81, 95% CI 0.73-0.89; P<0.0001) compared to home, and a 7% increase in home discharge compared to another facility (OR 1.07, 95% CI 1.02 to 1.12; P<0.001). Conclusions: Improved FIM score and increased LOS Rehab were the primary criteria for home discharge after stroke rehabilitation. Advanced age increased the likelihood of SNF placement. SUTI impacted rehabilitation progress, but did not affect discharge to home.

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Inpatient Rehabilitation Outcomes in Patients With Stroke Aged 85 Years or Older

Physical Therapy ◽

10.2522/ptj.20150364 ◽

2016 ◽

Vol 96 (9) ◽

pp. 1381-1388 ◽

Cited By ~ 5

Author(s):

Suzanne R. O'Brien ◽

Ying Xue

Keyword(s):

Outcome Measures ◽

Stroke Rehabilitation ◽

Functional Independence Measure ◽

Inpatient Rehabilitation ◽

The United States ◽

Functional Independence ◽

Assessment Instrument ◽

Age Group ◽

Cross Sectional ◽

Discharge Outcomes

Abstract Background In the United States, people 85 years of age or older have a growing number of strokes each year, and this age group is most at risk for disability. Inpatient rehabilitation facilities (IRFs) adhere closest to post-acute stroke rehabilitation guidelines and have the most desirable outcomes compared with skilled nursing facilities. As stroke is one of the leading causes of disability, knowledge of postrehabilitation outcomes is needed for this age group, although at present such information is limited. Objective The purpose of this study was to describe functional and discharge outcomes after IRF rehabilitation in people with stroke aged 85 years or older. Design A serial, cross-sectional design was used. Methods Inpatient Rehabilitation Facility–Patient Assessment Instrument data were analyzed beginning in 2002 for the first 5.5 years after implementation of the prospective payment system and included 71,652 cases. Discharge function, measured using the Functional Independence Measure (FIM), and community discharge were the discharge outcome measures. Sample description used frequencies and means. Generalized estimating equations (GEEs) with post hoc testing were used to analyze the annual trends for discharge FIM and community discharge by age group (85–89, 90–94, 95–99, and ≥100 years). Risk-adjusted linear and logistic GEE models, with control for cluster, were used to analyze the association between both outcome measures and age group. Results Over 5.5 years, mean discharge FIM scores decreased by 3.6 points, and mean achievement of community discharge decreased 5.5%. Approximately 54% of the sample achieved community discharge. Continuous and logistic GEEs revealed factors associated with discharge outcomes. Limitations Results obtained using an observational design should not be viewed as indicating causation. The lack of control for a caregiver may have altered results. Conclusions The very elderly people admitted to IRF stroke rehabilitation made functional gains, and most were able to return to the community.

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Validity of the pulses profile compared with the functional independence measure for measuring disability in a stroke rehabilitation setting

Archives of Physical Medicine and Rehabilitation ◽

10.1016/s0003-9993(99)90224-1 ◽

1999 ◽

Vol 80 (7) ◽

pp. 760-765 ◽

Cited By ~ 9

Author(s):

Shawn C. Marshall ◽

Brian Heisel ◽

Diana Grinnell

Keyword(s):

Stroke Rehabilitation ◽

Functional Independence Measure ◽

Functional Independence

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Metacognitive Strategy Training Is Feasible for People With Aphasia

OTJR Occupation Participation and Health ◽

10.1177/15394492211023196 ◽

2021 ◽

pp. 153944922110231

Author(s):

Jessica Kersey ◽

William S. Evans ◽

Katie Mullen ◽

Annette Askren ◽

Robert Cavanaugh ◽

...

Keyword(s):

Stroke Rehabilitation ◽

Functional Independence Measure ◽

Functional Independence ◽

Strategy Training ◽

Metacognitive Strategy ◽

Intervention Delivery ◽

Participant Engagement ◽

Measure Change ◽

Metacognitive Strategy Training ◽

Training Protocol

Metacognitive strategy training shows promise for reducing disability following stroke, but previous trials have excluded people with aphasia. Considering the high incidence of poststroke aphasia, it is important to determine whether people with aphasia can benefit from strategy training. The purpose of this study was to determine the feasibility of an adapted strategy training protocol for people with aphasia. We recruited 16 adults with mild-moderate aphasia from inpatient stroke rehabilitation. We examined recruitment and retention, intervention delivery and fidelity, participant engagement and communication, participant strategy mastery, and change in disability. Therapists demonstrated good fidelity to intervention elements. Participants demonstrated good engagement and fair communication. The sample achieved a mean Functional Independence Measure change of 21.8 ( SD = 16.2, Cohen’s d = .95), similar to matched controls without aphasia from previous trials. An adapted strategy training protocol appears feasible for people with aphasia in inpatient stroke rehabilitation. Future studies should examine the efficacy of this approach in larger samples.

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Polypharmacy and Potentially Inappropriate Medications in Stroke Rehabilitation: Prevalence and Impact

10.21203/rs.3.rs-1012014/v1 ◽

2021 ◽

Author(s):

Ayaka Matsumoto ◽

Yoshihiro Yoshimura ◽

Fumihiko Nagano ◽

Takahiro Bise ◽

Yoshifumi Kido ◽

...

Keyword(s):

Energy Intake ◽

Stroke Rehabilitation ◽

Functional Independence Measure ◽

Length Of Hospital Stay ◽

Functional Independence ◽

Potentially Inappropriate Medications ◽

Negatively Associated ◽

Home Discharge ◽

The Impact ◽

Inappropriate Medications

Abstract BackgroundEvidence is scarce regarding the polypharmacy and potentially inappropriate medications (PIMs) in rehabilitation medicine.AimTo investigate the prevalence and impact on outcomes of polypharmacy and PIMs in stroke rehabilitation.MethodsA retrospective cohort study was conducted with 849 older inpatients after stroke.Polypharmacy was defined as six or more medications, and PIMs were defined based on Beers criteria 2019. Study outcomes included Functional Independence Measure (FIM)-motor, FIM-cognitive, energy intake, dysphagia, length of hospital stay and the rate of home discharge. To consider the impact of pharmacotherapy during rehabilitation, multivariate analyses were used to determine whether the presence of polypharmacy or PIMs at discharge was associated with outcomes.ResultsAfter enrollment, 361 patients (mean age 78.3 ± 7.7 years; 49.3% male) were analyzed. Polypharmacy was observed in 43.8% and 62.9% of patients, and any PIMs were observed 64.8% and 65.4% of patients at admission and discharge, respectively. The most frequently prescribed PIMs included antipsychotics, benzodiazepines, and proton pump inhibitors. Polypharmacy was negatively associated with FIM-motor score (β = -0.072, P = 0.017), FIM-cognitive score (β = -0.077, P = 0.011), energy intake (β = -0.147, P = 0.004), and home discharge (OR: 0.499; 95% CI: 0.280, 0.802; P = 0.015). PIMs were negatively associated with energy intake (β = -0.066, P = 0.042) and home discharge (OR: 0.452; 95% CI: 0.215, 0.756; P = 0.005).ConclusionsPolypharmacy and PIMs are commonly found among older patients undergoing stroke rehabilitation. Moreover, polypharmacy and PIMs are negatively associated with outcomes.

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