Clinically Relevant Behaviors in Elderly Hip Fracture Inpatients

Objective: To examine the range of behaviors documented by inpatient rehabilitation staff and the association of these behaviors with functional outcome, in elderly persons undergoing rehabilitation after hip fracture. Method: Subjects were 137 patients, aged 60 and older, admitted to a rehabilitation hospital after a hip fracture, defined as having either a good or poor rehabilitation outcome based on change in Functional Independence Measure motor subscale scores during the course of their admission. Their charts were systematically reviewed for nursing and therapy staff documentation of behaviors. Prevalence of behaviors was compared between good and poor rehabilitation outcome groups. Results: Disturbances in cognition and rehabilitation participation were common and were associated with poorer rehabilitation outcome. Behaviors reflective of depression and anxiety were relatively uncommon and not associated with rehabilitation outcome. Conclusions: Rehabilitation staff frequently detect and document disturbances in cognition and participation that are associated with poorer rehabilitation outcome. It is recommended that staff observations be routinely added to mental health evaluations. Additionally, routine mental health screening and required staff documentation of behaviors would improve case detection rate.

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Use of the Frailty Tools Fi Mds and Fi Rockwood to Predict Outcomes of Inpatient Rehabilitation after Proximal Hip Fracture

Journal of Clinical Research and Reports ◽

10.31579/2693-4779/049 ◽

2021 ◽

Vol 8 (3) ◽

pp. 01-06

Author(s):

Jochanan Naschitz

Keyword(s):

Hip Fracture ◽

Clinical Decision Making ◽

Frailty Index ◽

Functional Independence Measure ◽

Inpatient Rehabilitation ◽

Functional Independence ◽

Elderly Persons ◽

Clinical Frailty Scale ◽

The Mean ◽

The Impact

Background Among factors which affect the outcome of rehabilitation after hip fracture, the role of pre-fracture frailty has not been defined. Objective To assess the impact of frailty on rehabilitation outcome in elderly persons with proximal hip fracture. Setting Geriatric rehabilitation center. Design Retrospective observational study. Subjects Forty consecutive patients with proximal hip fracture. Methods The following parameters were calculated: FI-MDS frailty index, Rockwood Clinical Frailty Scale (FI Rockwood), Functional Independence Measure (FIM) on discharge, absolute functional gain (ΔFIM), length of stay (LOS), and FIM gain per day (ΔFIM/LOS). FIM discharge ≥90 and motor FIM discharge >58 indicated success in rehabilitation. Results There were 31 women and 9 men, mean age 80 years. The mean pre-fracture FI MDS was 10 points (SD 5.8) out of 58 possible, the mean FI Rockwood score was 3 (SD 1.7) out of 7 possible. The mean admission FIM was 76.6 (SD 16), the mean discharge FIM was 92.7 (SD 19.3), mean LOS 22.5 days (SD 9.7), mean ΔFIM/LOS 0.8 (SD 0.6). Pre-fracture frailty was associated with worse outcome of rehabilitation: FI MDS predicted discharge FIM ≥90 with OR 0.86, p 0.012; FI Rockwood predicted discharge FIM ≥90 with OR 0.68, p 0.027; FI MDS predicted discharge motor FIM >58 with OR 0.91, p 0.07; FI Rockwood predicted discharge motor FIM >58 with OR 0.71, p 0.027. Conclusions Though pre-fracture frailty correlated with FIM on discharge, neither frailty tool was specific enough to predict success in rehabilitation and the necessary length of rehabilitation. Translating frailty scores in tools adequate for clinical decision making remains an aim for future studies.

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Inpatient Rehabilitation after Hip Fracture: Predicting Success in Rehabilitation based on Preliminary FIM

Journal of Clinical Research and Reports ◽

10.31579/2690-1919/170 ◽

2021 ◽

Vol 8 (1) ◽

pp. 01-05

Author(s):

Jochanan Naschitz

Keyword(s):

Hip Fracture ◽

Multidisciplinary Team ◽

Comprehensive Evaluation ◽

Functional Independence Measure ◽

Inpatient Rehabilitation ◽

Functional Independence ◽

Rehabilitation Center ◽

Predicting Success ◽

The Mean ◽

Surrogate Measure

Background: Predicting success of inpatient rehabilitation after hip fracture is an unmet challenge Objective: To assess whether a first impression Functional Independence Measure (FIM) before comprehensive evaluation may be useful to predict success in rehabilitation Setting: Geriatric rehabilitation center. Design: Retrospective observational study Subjects: 42 consecutive elderly patients with proximal hip fracture. Methods: The Functional Independence Measure (FIM) was assessed on the day of admission by a nurse (PreFIM), on day 3-5 by a multidisciplinary team (FimAdm) and on the day before discharge by the same multidisciplinary team (FIMDis). The potential of motor PreFIM to predict rehabilitation success, corresponding to motor FIMDis >58, was assessed, along with the length of stay in rehabilitation (LOS). Results: The mean motor PreFIM was 43.3 (SD 11.4), motor FIMAdm 48.9 (SD 13.7), motor FIMDis 63.8 (SD 16.7), LOS 22.5 days (SD 9.7). Motor PreFIM predicted motor FIM discharge >58, the surrogate measure for success of rehabilitation, with 76.7% sensitivity and 83.3% specificity. Motor PreFIM relation to LOS was statistically insignificant. Conclusions: In a population of disabled elderlies, the motor PreFIM on admission-day was helpful to predict success in rehabilitation after hip fracture, but not the necessary duration of rehabilitation. Large prospective studies are needed to validate this data.

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COMORBIDITY AND NON-PROSTHETIC INPATIENT REHABILITATION OUTCOMES AFTER DYSVASCULAR LOWER EXTREMITY AMPUTATION

Canadian Prosthetics & Orthotics Journal ◽

10.33137/cpoj.v3i1.33916 ◽

2020 ◽

Vol 3 (1) ◽

Author(s):

Michelle G. Marquez ◽

Matthew Kowgier ◽

W. Shane Journeay

Keyword(s):

Length Of Stay ◽

Lower Extremity ◽

Functional Outcomes ◽

Functional Independence Measure ◽

Inpatient Rehabilitation ◽

Functional Independence ◽

Limb Loss ◽

Medical Conditions ◽

Amputation Level ◽

Rehabilitation Hospital

BACKGROUND: Dysvascular amputations arising from peripheral vascular disease and/or diabetes are common. Patients who undergo amputation often have additional comorbidities that may impact their recovery after surgery. Many individuals undergo post-operative inpatient rehabilitation to improve their non-prosthetic functional independence. Thus far, our characterization of comorbidity in this population and how it is associated with non-prosthetic inpatient functional recovery remains relatively unexplored. OBJECTIVE: The objective of this study was to describe comorbidities, using the Charlson Comorbidity Index (CCI), and to examine associations between comorbidity and functional outcomes in a cohort of patients with dysvascular limb loss undergoing non-prosthetic inpatient rehabilitation. METHODOLOGY: A retrospective cohort design was used to analyze a group of 143 patients with unilateral, dysvascular limb loss who were admitted to inpatient rehabilitation. Age, sex, amputation level, amputation side, length of stay (LOS), time since surgery, Functional Independence Measure (FIM) scores (Total and Motor at admission and discharge), and CCI scores were collected. FINDINGS: The data showed that neither total or specific comorbidities were associated with functional outcomes or LOS in this cohort and rehabilitation model. Multivariate analysis demonstrated an inverse relationship with age and FIM scores, where increased age was associated with lower Total and Motor FIM at admission and discharge. Comorbidities were not associated with functional outcomes. Dementia was negatively associated with FIM scores, however this requires more study given the low number of patients with dementia in this cohort. CONCLUSION: These data suggest that regardless of burden of comorbidity or specific comorbidities that patients with dysvascular limb loss may derive similar functional benefit from post-operative non-prosthetic inpatient rehabilitation. Layman’s Abstract: Lower extremity limb loss arising from peripheral vascular disease and/or diabetes is common. Patients who require amputation often have multiple medical conditions that may impact their recovery after surgery. Moreover, many individuals undergo inpatient rehabilitation after surgery to improve self-care and mobility before discharge from hospital. We understand very little about how multiple medical conditions in patients with recent limb loss who are admitted to rehabilitation hospitals are impacted. Specifically, whether individuals with multiple medical conditions have negative functional consequences and do they stay in a rehabilitation hospital for a longer period of time. The objective of this study was to describe the types of medical conditions that patients with recent limb loss have and to examine the relationship between these conditions with functional outcomes and length of stay in hospital while undergoing inpatient rehabilitation. 143 patients with unilateral, dysvascular limb loss who were admitted to an inpatient rehabilitation hospital were included in the analysis. Age, gender, amputation level, amputation side, length of stay, time since surgery, Functional Independence Measure scores (measure of a patient’s function) and Charlson Comorbidity Index (measure of multiple medical conditions) scores were collected. This study suggests that regardless of the burden of multiple medical conditions or specific medical problems, that patients with recent limb loss may derive similar benefit after surgery at an inpatient rehabilitation hospital prior to consideration for a prosthesis. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/33916/26327 How To Cite: Marquez M.G., Kowgier M., Journeay W.S. Comorbidity and non-prosthetic inpatient rehabilitation outcomes after dysvascular lower extremity amputation. Canadian Prosthetics & Orthotics Journal. 2020;Volume3, Issue1, No.1. https://doi.org/ 10.33137/cpoj.v3i1.33916 Corresponding Author: Dr. W. Shane Journeay, PhD, MD, MPH, FRCPC, BC-Occ MedProvidence Healthcare – Unity Health Toronto, 3276 St Clair Avenue East, Toronto ON M1L 1W1E-mail: [email protected]: https://orcid.org/0000-0001-6075-3176

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Impact of place of residence, frailty and other factors on rehabilitation outcomes post hip fracture

Age and Ageing ◽

10.1093/ageing/afaa131 ◽

2020 ◽

Cited By ~ 1

Author(s):

Stephanie Low ◽

Edmund Wee ◽

Michael Dorevitch

Keyword(s):

Hip Fracture ◽

Residential Care ◽

Functional Independence Measure ◽

Inpatient Rehabilitation ◽

Functional Independence ◽

Community Dwelling ◽

Hip Fracture Surgery ◽

Rehabilitation Outcomes ◽

Poor Outcomes ◽

Fracture Surgery

Abstract Background Following hip fracture surgery, patients from residential care are frequently excluded from inpatient rehabilitation. We aimed to assess the impact of place of residence and other factors such as frailty on rehabilitation outcomes after hip fracture surgery. Methods Retrospective cohort study. Outcome measures included Functional Independence Measure efficiency, discharge destination and recovery of pre-fracture mobility. Univariable and multivariable linear or logistic regression analyses were performed. Setting One general rehabilitation and two geriatric evaluation and management wards in a large public tertiary teaching hospital. Participants A total of 844 patients who underwent inpatient rehabilitation after hip fracture surgery from 2010 to 2018. Results There were 139 (16%) patients from residential care. Being from residential care was not an independent predictor of poor outcomes. Premorbid frailty (Clinical Frailty Scale) was the strongest independent predictor of poorer Functional Independence Measure efficiency, inability to recover pre-fracture mobility and return to community dwelling. Dementia and delirium were also independently predictive of poor outcomes across all measures. Age > 90 years was independently predictive of inability to recover pre-fracture mobility and return to community dwelling. Conclusion Being from residential care is not independently associated with poor outcomes following inpatient rehabilitation after hip fracture surgery and should not be the basis for excluding these patients from rehabilitation. Major predictors of poorer outcomes include premorbid frailty, dementia, delirium and age > 90 years. If able and motivated, those with potentially reversible functional limitations should be given the opportunity to participate in inpatient rehabilitation as even small gains can have a significant impact on quality of life.

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Factors Related to Greater Functional Recovery after Suffering a Stroke

Brain Sciences ◽

10.3390/brainsci11060802 ◽

2021 ◽

Vol 11 (6) ◽

pp. 802

Author(s):

María Vázquez-Guimaraens ◽

José L. Caamaño-Ponte ◽

Teresa Seoane-Pillado ◽

Javier Cudeiro

Keyword(s):

Functional Status ◽

Hospital Discharge ◽

Functional Independence Measure ◽

Inpatient Rehabilitation ◽

Functional Independence ◽

Primary Diagnosis ◽

Rehabilitation Service ◽

Bivariate Analysis ◽

Linear Regression Models ◽

Functional Assessments

Background: In a stroke, the importance of initial functional status is fundamental for prognosis. The aim of the current study was to investigate functional status, assessed by the Functional Independence Measure (FIM) scale, and possible predictors of functional outcome at discharge from inpatient rehabilitation. Methods: This is a retrospective study that was carried out at the Physical Medicine and Rehabilitation Service in A Coruña (Spain). A total of 365 consecutive patients with primary diagnosis of stroke were enrolled. The functional assessments of all patients were performed through the FIM. A descriptive and a bivariate analysis of the variables included in the study was made and a succession of linear regression models was used to determine which variables were associated with the total FIM at discharge. Results: Prior to having the stroke, 76.7% were totally independent in activities of daily living. The FIM scale score was 52.5 ± 25.5 points at admission and 83.4 ± 26.3 at hospital discharge. The multivariate analysis showed that FIM scores on admission were the most important predictors of FIM outcomes. Conclusions: Our study indicates that the degree of independence prior to admission after suffering a stroke is the factor that will determine the functionality of patients at hospital discharge.

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Evaluation of Functional Recovery by Motor Functional Independence Measure Test of Elderly After Hip Fracture in Serbia

Acta Médica Portuguesa ◽

10.20344/amp.4267 ◽

2014 ◽

Vol 27 (1) ◽

pp. 88 ◽

Cited By ~ 1

Author(s):

Natasa Radosavljevic ◽

Dejan Nikolic ◽

Milica Lazovic ◽

Zoran Radosavljevic ◽

Aleksandar Jeremic

Keyword(s):

Hip Fracture ◽

Functional Recovery ◽

Age Groups ◽

Functional Independence Measure ◽

Severity Index ◽

Functional Independence ◽

Post Discharge ◽

Third Age ◽

Period 2 ◽

Group 2

Introduction: The aim of the study was to evaluate motor functional status measured by motor Functional Independence Measure (mFIM) test in population above 65 years of age after the hip fracture. Material and Methods: We evaluated 203 patients after hip fracture by mFIM test on 3 occasions: at admission (Period-1), at discharge (Period-2) and 3 months after discharge (Period-3); 3 age groups: Group65-74, Group75-84 and Group85-up and 2 groups concerning Severity Index (SI): group 0-1.99 (SI1) and group ≥ 2 (SI2). Results: In same SI group there is significant increase in mFIM values for Period-2 and Period-3 for both genders and in first two age groups, while for those above 85 years of age with higher SI we found non-significant change in mFIM values between discharge and 3 months post discharge period. Discussion: The most significant improvement is obtained for women in first and third age groups and with higher SI. Conclusion: Gender is not significant predictor for motor functional recovery measured by mFIM test in patients with hip fracture, although the admittance mFIM is a good indicator for mFIM capacity recovery in women of certain age groups (first and third age groups).

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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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Abstract P104: Impact Of Orthostatic Hypotension In Inpatient Rehabilitation

Hypertension ◽

10.1161/hyp.76.suppl_1.p104 ◽

2020 ◽

Vol 76 (Suppl_1) ◽

Author(s):

Luis E. Okamoto ◽

Purnima Sharma ◽

Lauren Massey ◽

Italo Biaggioni ◽

Jeff Johns

Keyword(s):

Spinal Cord ◽

Orthostatic Hypotension ◽

Significant Proportion ◽

Functional Independence Measure ◽

Inpatient Rehabilitation ◽

Functional Independence ◽

Admission Diagnosis ◽

Neurological Conditions ◽

The Difference ◽

Spinal Cord Dysfunction

Inpatient rehabilitation is crucial in the management of patients after injuries, surgery, or those with debilitating or neurological conditions. Orthostatic hypotension (OH) is commonly associated with these conditions, and therefore, the inability to stand and participate in rehabilitation therapy can negatively impact their recovery. To test this hypothesis, we study a cohort of 8352 patients who underwent rehabilitation at Vanderbilt Stallworth Rehabilitation Hospital between 2014-2019 to assess the prevalence of OH and its impact on the length of stay (LOS), functional independence measure (FIM) change (discharge FIM-admission FIM), and FIM efficiency (FIM change/LOS), compared to patients without OH admitted during the same period. We found that the prevalence of OH was 3.8% (n = 314; 60±18 yrs; 227 men). OH was commonly associated with patients admitted for neurological conditions (29%, n = 91), spinal cord dysfunction (22%, n = 71), orthopedic disorders (13%, n = 13), and stroke (10%, n = 33). On admission, patients with OH had a longer predicted LOS compared to those without OH (18±6 vs. 16±5 days, respectively, p = 0.001), reflecting greater medical complexity. Moreover, the actual LOS at discharge was significantly longer in OH patients compared to those without OH (19±12 vs. 13±9 days; p = 0.001) as was the difference between actual-predicted LOC (1±11 vs. 2±8; p = 0.001). The change in FIM was similar in both patients with and without OH (30±26 vs. 33±20, respectively; p = 0.52) but FIM efficiency was lower in OH patients (2±2.2 vs. 3±2.2 without OH; p = 0.001). OH prolonged LOS regardless of the admission diagnosis (stroke, other neurological conditions, spinal cord dysfunction and orthopedic disorders). In conclusion, OH is present in a significant proportion of patients undergoing acute rehabilitation and adversely impacts the recovery of these patients as measured by lower FIM efficacy and a prolonged rehabilitation period to achieve the same functional gain as patients without OH.

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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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