Comparison of the responsiveness of the Utrecht Scale for Evaluation of Rehabilitation (USER) and the Barthel Index in stroke patients

2019 ◽  
Vol 33 (10) ◽  
pp. 1672-1681 ◽  
Author(s):  
Winke van Meijeren-Pont ◽  
Gerard Volker ◽  
Thea Vliet Vlieland ◽  
Paulien Goossens
Keyword(s):  
Observational Study ◽  
Effect Size ◽  
Barthel Index ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Stroke Patients ◽  
Discharge Data ◽  
Rehabilitation Facility ◽  
Inpatient Rehabilitation Facility ◽  
The Mean

Objective: To compare the responsiveness of the Utrecht Scale for Evaluation of Rehabilitation (USER) to the responsiveness of the Barthel Index in stroke patients in an inpatient rehabilitation facility. Design: Observational study. Setting: Inpatient rehabilitation facility. Subjects: Consecutive stroke patients admitted for clinical rehabilitation. Interventions: Not applicable. Main measures: The USER and the Barthel Index were administered by a nurse at admission and discharge. The Effect Size and Standardized Response Mean (SRM) were calculated as measures of responsiveness. Results: From 198 (78%) of the 254 patients who were included in the study period, both admission and discharge data were available. At admission the mean score of the USER subscale Functional independence was 43.1 ( SD = 18.9) and at discharge the mean score was 59.3 ( SD = 13.8). The mean score of the Barthel Index at admission was 13.3 ( SD = 5.4) and at discharge 18.4 ( SD = 3.3). The Effect Size of the USER subscales Mobility, Self-care, Cognitive functioning, Pain, Fatigue and Mood were 0.85, 0.77, 0.48, 0.19, 0.40 and 0.28, respectively, and of the Barthel Index 0.94. The results for the SRM were in the same range. Conclusion: In inpatient rehabilitation after stroke, the USER was less responsive than the Barthel Index.

Abstract TMP47: Impact of Medicare Reform on Inpatient Rehabilitation Facility Access for Hemorrhagic Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Nneka L Ifejika ◽  
Farhaan Vahidy ◽  
Mathew Reeves ◽  
Xian Ying ◽  
Roland Matsouaka ◽  
...  
Keyword(s):  
Skilled Nursing Facility ◽  
Inpatient Rehabilitation ◽  
Prospective Payment System ◽  
Sensitivity Analyses ◽  
Teaching Hospitals ◽  
Admission Criteria ◽  
Stroke Patients ◽  
Rehabilitation Facility ◽  
Inpatient Rehabilitation Facility ◽  
The Impact

Introduction: There is growing evidence that ICH patients make larger & faster recovery gains compared to ischemic stroke patients. Inpatient rehabilitation facility (IRF) care can significantly facilitate improvement. In 2010, changes to IRF admission criteria potentially restricted access. We hypothesize the Centers for Medicare and Medicaid Services (CMS) 2010 IRF Prospective Payment System Rule decreased IRF access & increased skilled nursing facility (SNF) utilization in ICH patients. Methods: The proportion of ICH survivors discharged to IRF, SNF or home was estimated using GWTG-Stroke data between 1/1/2008 & 12/31/2015 (n=265,444). Two binary hierarchical models determined the association between the 1/1/2010 CMS admission criteria change for IRFs and discharge setting, adjusting for patient & hospital characteristics. Subgroup analyses evaluated the effects of age, region & hospital type. Sensitivity analyses used complete NIHSS data (≈49%). Results: The prevalence of the 3 discharge destinations changed significantly over time (CMH row-mean-score P<0.0001; Figure 1). IRF rehab odds decreased and SNF rehab odds increased for ICH patients compared to home after the CMS 2010 IRF PPS Rule (Figure 2a & 2b). Decreased IRF rehab odds were found in patients age<65, Western US location or at non-teaching hospitals (Figure 2a). Increased SNF rehab odds were found in patients age≥65, Midwest location or at teaching hospitals (Figure 2b). Conclusions: IRF Rehab odds decreased and SNF rehab odds increased during the time period after CMS 2010 IRF PPS Rule implementation in ICH patients. The impact of such legislative changes on patient outcomes warrants further study.

scholarly journals Safety, Feasibility, and Outcomes of Frequent, Long-Duration Rehabilitation in an Inpatient Rehabilitation Facility after Prolonged Hospitalization for Severe COVID-19: An Observational Study

2021 ◽  
Author(s):  
Frank Vickory ◽  
Kyle Ridgeway ◽  
Jason Falvey ◽  
Beth Houwer ◽  
Jennifer Gunlikson ◽  
...  
Keyword(s):  
Critical Care ◽  
Critical Illness ◽  
Observational Study ◽  
Functional Limitations ◽  
Inpatient Rehabilitation ◽  
Functional Impairments ◽  
Rehabilitation Facility ◽  
Long Duration ◽  
Rehabilitation Facilities ◽  
Inpatient Rehabilitation Facility

Abstract Objectives The objective of this study was to evaluate safety, feasibility, and outcomes of 30 patients within an inpatient rehabilitation facility following hospitalization for severe COVID-19 infection. Methods This was an Observational Study of 30 patients (ages 26–80) within a large, metropolitan academic hospital following hospitalization for complications from severe COVID-19. Ninety percent of the participants required critical care and 83% required mechanical ventilation during their hospitalization. Within an inpatient rehabilitation facility and model of care, frequent, long duration rehabilitation was provided by occupational therapists, physical therapists, and speech language pathologists. Results The average inpatient rehabilitation facility length of stay was 11 days (ranging from 4–22 days). Patients averaged 165 minutes per day (ranging from 140–205 minutes) total of physical therapy, occupational therapy, and speech therapy. Twenty eight of the 30 patients (93%) discharged to the community. One patient required readmission from the inpatient rehabilitation facility to the acute hospital. All 30 patients improved their functional status with inpatient rehabilitation. Conclusion In this cohort of 30 patients, inpatient rehabilitation after severe COVID-19 was safe and feasible. Patients were able to participate in frequent, long duration rehabilitation with nearly all patients discharging to the community. Clinically, inpatient rehabilitation should be considered for patients with functional limitations following severe COVID-19. Given 90% of our cohort required critical care, future studies should investigate the efficacy and effectiveness of inpatient rehabilitation following hospitalization for critical illness. Frequent, long duration rehabilitation shows promising potential to address functional impairments following hospitalization for severe COVID-19. Impact Statement Inpatient rehabilitation facilities should be considered as a discharge location for hospitalized survivors of COVID-19, especially severe COVID-19, with functional limitations precluding community discharge. Clinicians and administrators should consider inpatient rehabilitation and inpatient rehabilitation facilities to address the rehabilitation needs of COVID-19 and critical illness survivors.

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