Early Mobilization of Mild-Moderate Intracerebral Hemorrhage Patients in a Stroke Center: A Randomized Controlled Trial

Background. Few studies have addressed early out-of-bed mobilization specifically in acute intracerebral hemorrhage (ICH) patients. Patient benefit in such cases is unclear, with early intervention timing and duration identical to those in standard care. Objective. We investigated the efficacy of an early mobilization (EM) protocol, administered within 24 to 72 hours of stroke onset, for early functional independence in mild-moderate ICH patients. Methods. Sixty patients admitted to a stroke center within 24 hours of ICH were randomly assigned to early mobilization (EM) or standard early rehabilitation (SER). The EM group underwent an early out-of-bed mobilization protocol, while the SER group underwent a standard protocol focusing on in-bed training in the stroke center. Intervention in both groups lasted 30 minutes per session, once a day, 5 days a week. Motor subscales of the Functional Independence Measure (FIM-motor; primary outcome), Postural Assessment Scale for Stroke Patients, and Functional Ambulation Category (FAC) were evaluated (assessor-blinded) at baseline, and at 2 weeks, 4 weeks, and 3 months after stroke. Length of stay in the stroke center was also recorded. Results. The EM group showed significant improvement in FIM-motor score at all evaluated time points ( P = .004) and in FAC outcomes at 2 weeks ( P = .033) and 4 weeks ( P = .011) after stroke. Length of stay in the stroke center was significantly shorter for the EM group ( P = .004). Conclusion. Early out-of-bed mobilization via rehabilitation in a stroke center, within 24 to 72 hours of ICH, may improve early functional independence compared with standard early rehabilitation. Clinical Trial Registration: NCT03292211.

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Sensorimotor vs. Motor Upper Limb Therapy for Patients With Motor and Somatosensory Deficits: A Randomized Controlled Trial in the Early Rehabilitation Phase After Stroke

Frontiers in Neurology ◽

10.3389/fneur.2020.597666 ◽

2020 ◽

Vol 11 ◽

Author(s):

Nele De Bruyn ◽

Leen Saenen ◽

Liselot Thijs ◽

Annick Van Gils ◽

Eva Ceulemans ◽

...

Keyword(s):

Upper Limb ◽

Controlled Trial ◽

Motor Impairment ◽

Early Rehabilitation ◽

Stroke Patients ◽

Post Intervention ◽

Clinical Trial Registration ◽

Additional Therapy ◽

Somatosensory Function

Background: Somatosensory function plays an important role in motor learning. More than half of the stroke patients have somatosensory impairments in the upper limb, which could hamper recovery.Question: Is sensorimotor upper limb (UL) therapy of more benefit for motor and somatosensory outcome than motor therapy?Design: Randomized assessor- blinded multicenter controlled trial with block randomization stratified for neglect, severity of motor impairment, and type of stroke.Participants: 40 first-ever stroke patients with UL sensorimotor impairments admitted to the rehabilitation center.Intervention: Both groups received 16 h of additional therapy over 4 weeks consisting of sensorimotor (N = 22) or motor (N = 18) UL therapy.Outcome measures: Action Research Arm test (ARAT) as primary outcome, and other motor and somatosensory measures were assessed at baseline, post-intervention and after 4 weeks follow-up.Results: No significant between-group differences were found for change scores in ARAT or any somatosensory measure between the three time points. For UL impairment (Fugl-Meyer assessment), a significant greater improvement was found for the motor group compared to the sensorimotor group from baseline to post-intervention [mean (SD) improvement 14.65 (2.19) vs. 5.99 (2.06); p = 0.01] and from baseline to follow-up [17.38 (2.37) vs. 6.75 (2.29); p = 0.003].Conclusion: UL motor therapy may improve motor impairment more than UL sensorimotor therapy in patients with sensorimotor impairments in the early rehabilitation phase post stroke. For these patients, integrated sensorimotor therapy may not improve somatosensory function and may be less effective for motor recovery.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03236376.

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The effect on subjective quality of life of occupational therapy based on adjusting the challenge–skill balance: a randomized controlled trial

Clinical Rehabilitation ◽

10.1177/0269215519858713 ◽

2019 ◽

Vol 33 (11) ◽

pp. 1732-1746

Author(s):

Ippei Yoshida ◽

Kazuki Hirao ◽

Ryuji Kobayashi

Keyword(s):

Quality Of Life ◽

Occupational Therapy ◽

Controlled Trial ◽

Functional Independence Measure ◽

Functional Independence ◽

Subjective Quality ◽

Subjective Quality Of Life ◽

Rehabilitation Process ◽

And Control

Objective: To verify the effect of adjusting the challenge–skill balance with respect to rehabilitation process. Design: A single-blind, two-arm, parallel-group, randomized controlled trial. Setting: Recovery rehabilitation unit of Harue Hospital, Japan. Subjects: The trial included 72 clients (mean (SD): age, 74.64 (9.51) years; Functional Independence Measure score, 98.26 (15.27)) with cerebral or spinal disease or musculoskeletal disease. Interventions: Clients were randomly divided into two groups: the experimental group, who received occupational therapy with adjustment of the challenge–skill balance, and the control group who received conventional occupational therapy. Time from admission to discharge was considered the implementation period; the final evaluation was conducted at three months after discharge. Main measures: The primary outcome was subjective quality of life (Ikigai-9). Secondary outcomes were the health-related quality of life (EuroQol–5 Dimensions, Five Levels (EQ-5D-5L)), the Flow State Scale for Occupational Tasks, and the Functional Independence Measure. A cost-effectiveness analysis was conducted using total cost and quality-adjusted life-year based on the EQ-5D-5L. Results: Significant differences were observed between the experimental and control groups with respect to the Ikigai-9 score ( P = 0.008) and EQ-5D-5L ( P = 0.038), and the effect sizes were 0.76 (95% confidence interval [CI]: 0.27–1.24) and 0.62 (95% CI: 0.14–1.10), respectively. No significant between-group differences in other outcomes were observed, for example, the Functional Independence Measure score improved in both experimental and control groups (119.80 (5.50) and 118.84 (6.97), respectively. The incremental cost-effectiveness ratio was US$5518.38. Conclusions: Adjusting the challenge–skill balance may be a useful approach to improve the participant’s subjective quality of life in the rehabilitation process.

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Length of Stay in In-Patient Rehabilitation after Stroke in Qatar

The Scientific World JOURNAL ◽

10.1100/tsw.2008.81 ◽

2008 ◽

Vol 8 ◽

pp. 547-555

Author(s):

Loganathan Venkatachalm ◽

Ana Bobinac Georgievski ◽

Wafaa Al Yazeedi ◽

Rajvir Singh ◽

Hilda Uribazo Garrido

Keyword(s):

Length Of Stay ◽

Hemorrhagic Stroke ◽

Functional Independence Measure ◽

Inpatient Rehabilitation ◽

Significant Negative Correlation ◽

Multivariate Regression Analysis ◽

Functional Independence ◽

Medical Rehabilitation ◽

Rehabilitation Unit ◽

Disability Scale

The objective of this study was to analyze the factors predicting length of stay in a stroke patient rehabilitation unit at Hamad Medical Corporation (HMC) in Qatar. The medical rehabilitation data of 100 stroke patients discharged from a 15-bed inpatient rehabilitation unit (IPRU) were collected retrospectively from medical records during the period from September 2004 to April 2007. A questionnaire was developed, and variables included in the study were age of the patient, length of stay in acute care (LOSa), length of stay in rehabilitation (LOSr), functional independence measure on admission and discharge (FIMa and FIMd), modified disability scale, and modified mobility scale. Patients were grouped by impairments defined by cause as ischemic or hemorrhagic stroke, and right or left body side deficit. A significant negative correlation was observed between LOSr and FIMa (r= −0.44,p= 0.00), and positive correlation between LOSr and LOSa (r= 0.37,p= 0.00). There was no correlation between LOSr and FIMd (r= −0.03,p= 0.76). We observed that low admission FIMa and FIMd were related to extended LOS in both acute and IPRU. Multivariate regression analysis was performed by taking age, LOSa, cause of hemorrhage or ischemia, and FIMa as independent variables, and LOSr as dependent variable. The model could explain only 26% variation for LOSr. This study supports the hypothesis of an association between LOSr, LOSa, and FIMa. Further research is needed to confirm the results of this and other similar studies.

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Early Mobilization in Ischemic Stroke: A Pilot Randomized Trial of Safety and Feasibility in a Public Hospital in Brazil

Cerebrovascular Diseases Extra ◽

10.1159/000381417 ◽

2015 ◽

Vol 5 (1) ◽

pp. 31-40 ◽

Cited By ~ 10

Author(s):

Simone Rosa Poletto ◽

Letícia Costa Rebello ◽

Maria Júlia Monteiro Valença ◽

Daniele Rossato ◽

Andrea Garcia Almeida ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Public Hospital ◽

Controlled Trial ◽

Pilot Trial ◽

Intervention Group ◽

Total Duration ◽

Early Mobilization ◽

Functional Independence ◽

Control Group

Background: The effect of early mobilization after acute stroke is still unclear, although some studies have suggested improvement in outcomes. We conducted a randomized, single-blind, controlled trial seeking to evaluate the feasibility, safety, and benefit of early mobilization for patients with acute ischemic stroke treated in a public teaching hospital in Southern Brazil. This report presents the feasibility and safety findings for the pilot phase of this trial. Methods: The primary outcomes were time to first mobilization, total duration of mobilization, complications during early mobilization, falls within 3 months, mortality within 3 months, and medical complications of immobility. We included adult patients with CT- or MRI-confirmed ischemic stroke within 48 h of symptom onset who were admitted from March to November 2012 to the acute vascular unit or general emergency unit of a large urban emergency department (ED) at the Hospital de Clínicas de Porto Alegre. The severity of the neurological deficit on admission was assessed by the National Institutes of Health Stroke Scale (NIHSS). The NIHSS and modified Rankin Scale (mRS, functional outcome) scores were assessed on day 14 or at discharge as well as at 3 months. Activities of daily living (ADL) were measured with the modified Barthel Index (mBI) at 3 months. Results: Thirty-seven patients (mean age 65 years, mean NIHSS score 11) were randomly allocated to an intervention group (IG) or a control group (CG). The IG received earlier (p = 0.001) and more frequent (p < 0.0001) mobilization than the CG. Of the 19 patients in the CG, only 5 (26%) underwent a physical therapy program during hospitalization. No complications (symptomatic hypotension or worsening of neurological symptoms) were observed in association with early mobilization. The rates of complications of immobility (pneumonia, pulmonary embolism, and deep vein thrombosis) and mortality were similar in the two groups. No statistically significant differences in functional independence, disability, or ADL (mBI ≥85) were observed between the groups at the 3-month follow-up. Conclusions: This pilot trial conducted at a public hospital in Brazil suggests that early mobilization after acute ischemic stroke is safe and feasible. Despite some challenges and limitations, early mobilization was successfully implemented, even in the setting of a large, complex ED, and without complications. Patients from the IG were mobilized much earlier than controls receiving the standard care provided in most Brazilian hospitals.

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Effect of hyponatremia on cancer patients' in-patient rehabilitation length of stay.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e20626 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e20626-e20626

Author(s):

Megan Nelson ◽

J. Lynn Palmer ◽

Jack Brian Fu ◽

Janet L. Williams ◽

Rajesh R. Yadav ◽

...

Keyword(s):

Length Of Stay ◽

Cancer Patients ◽

Functional Independence Measure ◽

Inpatient Rehabilitation ◽

Functional Independence ◽

Cancer Rehabilitation ◽

Cancer Center ◽

Rehabilitation Unit ◽

Increased Risk ◽

Patient Groups

e20626 Background: The incidence of hyponatremia in cancer patients has been reported as high as 47%. Hyponatremia is associated with gait and attention impairments, increased falls, increased risk of fractures, and osteoporosis. Our aim is to determine if hyponatremia impact cancer patients’ rehabilitation length of stay, functional outcome, and survival. Methods: Retrospective study was conducted in a tertiary cancer center on two hundreds and ninty-five patients who underwent inpatient cancer rehabilitation between January 27, 2009 through July, 31, 2010. Hyponatremia incidence, rehabilitation length of stay (LOS), functional independence measure (FIM) for ambulation and transfers, and survival information were collected. Results: The incidence of hyponatremia in cancer patients admitted to our inpatient rehabilitation unit was 41.4%. Median rehabilitation LOS for patients with mild (Na 130-134 mEq/L) and moderate-severe (Na<130 mEq/L) hyponatremia was 11 and 15 days, respectively, which was significantly longer than patients with eunatremia (10 days; P = .03). FIM change for ambulation and transfers during inpatient rehabilitation stay was not significantly different, nor was survival significantly different, between different patient groups. Conclusions: A high percentage of patients have hyponatremia upon admission to our inpatient cancer rehabilitation unit, and this is associated with a prolonged rehabilitation LOS.

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A Single-center Comparison Using Exoskeleton Rehabilitation for Cerebrovascular Accidents and Traumatic Brain Injury in a Cohort of Hispanic Patients

10.21203/rs.3.rs-42275/v1 ◽

2020 ◽

Author(s):

Lisa R Treviño ◽

Kristina Vatcheva ◽

Michael E Auer ◽

Angela Morales ◽

Lama M Abdurrahman ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Length Of Stay ◽

Functional Independence Measure ◽

Retrospective Chart Review ◽

The United States ◽

Functional Independence ◽

Similar Amount ◽

Federal Drug Administration ◽

Robotic Exoskeleton

Abstract Background Traumatic brain injury (TBI) is one of the leading causes of disability in the United States. The EKSO GT Bionics® (EKSO®) is a robotic exoskeleton approved by the Federal Drug Administration (FDA) for rehabilitation following a cerebrovascular accident (CVA or stroke) and recently received approval for use in patients with TBI. The aim of the study was to examine if the use of exoskeleton rehabilitation in patients with TBI will produce beneficial outcomes. Methods This retrospective chart-review reports the use of the (EKSO®) robotic device in the rehabilitation of patients with TBI compared to patients with CVA. We utilized data from a single, private rehabilitation hospital for patients that received post-CVA or post-TBI robotic exoskeleton intervention. All patients that used the exoskeleton were discharged from the hospital between 01/01/2017 to 04/30/2020. Ninety-four percent of patients in the CVA groups and 100% of patients in the TBI group were of Hispanic or Latino ethnicity. Gains in total Functional Independence Measure (FIM), walking and cognition, and length of stay in the rehabilitation facility were measured. Results Patients in the TBI group (n = 11) were significantly younger than the patients in the CVA group (n = 66; p < 0.05). Both groups spent a similar amount of time active, number of steps taken, and the number of sessions in the exoskeleton. Both groups also started with similar admission FIM scores. The FIM gain in the TBI group was similar to that of the CVA group (37.5 and 32.0 respectively). The length of stay between groups was not different either. Conclusions The use of exoskeleton rehabilitation in patients with TBI appear to produce similar outcomes as for patients with CVA, prompting further attention of this intervention for this type of injury. Trial registration: Retrospectively registered on 07/09/2020 in clinicaltrials.gov number NCT4465019.

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Multidisciplinary versus physiotherapy-only weekend rehabilitation: A prospective cohort study

10.21203/rs.3.rs-428190/v1 ◽

2021 ◽

Author(s):

Erin Caruana ◽

David Rowell ◽

Suzanne Kuys ◽

Sandra G. Brauer

Keyword(s):

Cohort Study ◽

Length Of Stay ◽

Prospective Cohort ◽

Functional Independence Measure ◽

Cost Savings ◽

Functional Independence ◽

Historical Control Group ◽

Historical Control ◽

Control Group ◽

Rehabilitation Unit

Abstract Background This study aims to investigate the impact of multidisciplinary Saturday rehabilitation (MSR) on length of stay, functional independence, gait and balance when compared to a 6-day physiotherapy-only service in a pragmatic setting. An economic evaluation of the intervention conducted from the perspective of the healthcare provider is included.Methods A prospective cohort study with a historical control was conducted in an Australian private mixed rehabilitation unit to compare a multidisciplinary and physiotherapy-only 6-day rehabilitation service. Clinical outcomes included the Functional Independence Measure (Motor, Cognitive, Total), gait speed (10 Meter Walk test) and five balance measures (Timed Up and Go test, Step test, Functional Reach, Feet Together Eyes Closed and the Balance Outcome Measure of Elder Rehabilitation). Economic outcomes were rehabilitation unit length of stay and additional treatment costs.Results A total of 366 patients were admitted to the rehabilitation unit over two 20-week periods. The prospective cohort (MSR) had 192 participants and the historical control group (physiotherapy Saturday rehabilitation) had 174 participants). Participants in the historical control group had lower total and cognitive Functional Independence Measure scores (p < 0.078), and generally performed at a lower level on admission gait and balance measures compared to the prospective cohort. More participants in the prospective cohort attended weekend therapy, attending more sessions and spending more time in therapy compared to those in the historical control group (p < 0.012). After controlling for differences in admission Functional Independence Measure scores, length of stay was reduced by 1.39 ± 0.77 days. The economic evaluation estimated cost savings of $1,536 per patient. The largest savings were attributed to neurological patients $4,854. Traumatic and elective orthopaedic patients realised cost savings per admission of $2,668 and $2,180, respectively.Conclusions Implementation of MSR results in a more efficient service, enabling a greater amount of therapy to be provided over a shorter length of stay. The provision of a multi-disciplinary Saturday rehabilitation is potentially cost reducing for the treating hospital.Trial registration not applicable.

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Reinforced Feedback in Virtual Environment for Rehabilitation of Upper Extremity Dysfunction after Stroke: Preliminary Data from a Randomized Controlled Trial

BioMed Research International ◽

10.1155/2014/752128 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 45

Author(s):

Paweł Kiper ◽

Michela Agostini ◽

Carlos Luque-Moreno ◽

Paolo Tonin ◽

Andrea Turolla

Keyword(s):

Randomized Controlled Trial ◽

Virtual Environment ◽

Upper Extremity ◽

Motor Function ◽

Upper Limb ◽

Controlled Trial ◽

Functional Independence Measure ◽

Functional Independence ◽

Stroke Etiology ◽

Randomized Controlled

Objectives. To study whether the reinforced feedback in virtual environment (RFVE) is more effective than traditional rehabilitation (TR) for the treatment of upper limb motor function after stroke, regardless of stroke etiology (i.e., ischemic, hemorrhagic).Design. Randomized controlled trial.Participants. Forty-four patients affected by stroke.Intervention. The patients were randomized into two groups: RFVE (N=23) and TR (N=21), and stratified according to stroke etiology. The RFVE treatment consisted of multidirectional exercises providing augmented feedback provided by virtual reality, while in the TR treatment the same exercises were provided without augmented feedbacks.Outcome Measures. Fugl-Meyer upper extremity scale (F-M UE), Functional Independence Measure scale (FIM), and kinematics parameters (speed, time, and peak).Results. The F-M UE (P=0.030), FIM (P=0.021), time (P=0.008), and peak (P=0.018), were significantly higher in the RFVE group after treatment, but not speed (P=0.140). The patients affected by hemorrhagic stroke significantly improved FIM (P=0.031), time (P=0.011), and peak (P=0.020) after treatment, whereas the patients affected by ischemic stroke improved significantly only speed (P=0.005) when treated by RFVE.Conclusion. These results indicated that some poststroke patients may benefit from RFVE program for the recovery of upper limb motor function. This trial is registered withNCT01955291.

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