The Importance of Measuring Functional Independence for Rehabilitation Therapy in Older Trauma Patients

Abstract Prior retrospective studies suggest that physical medicine and rehabilitation (PM&R) acute care consultation improves outcome and reduces acute care length of stay (ACLOS) in trauma patients. There have not been prospective studies to evaluate this impact in burn patients. This cohort study compared outcomes before and after the introduction of a PM&R consultation service to the acute burn program, and the inpatient rehabilitation program, at a large academic hospital. The primary outcome measures were length of stay (LOS) in acute care and during subsequent inpatient rehabilitation. For the acute care phase, there were 194 patients in the preconsultation group and 114 who received a consultation. There was no difference in age, Baux score, or LOS in these patients. For the rehabilitation phase, there were 109 patients in the prephysiatrist group and 104 who received PM&R care. The LOS was significantly shorter in the latter group (24 days vs 30 days, P = .002). Functional independence measure (FIM) change, unexpected readmission, and discharge destination were not significantly different. The addition of a burn physiatrist did not influence ACLOS. However, there was a significant reduction in inpatient rehabilitation LOS.

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Preinjury Functional Independence is not Associated with Discharge Location in Older Trauma Patients

Journal of Surgical Research ◽

10.1016/j.jss.2021.04.029 ◽

2021 ◽

Vol 266 ◽

pp. 413-420

Author(s):

Emma Holler ◽

Ashley D Meagher ◽

Damaris Ortiz ◽

Sanjay Mohanty ◽

America Newnum ◽

...

Keyword(s):

Functional Independence ◽

Trauma Patients ◽

Discharge Location

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Effect of Hospital Length of Stay on Functional Independence Measure Score in Trauma Patients

American Journal of Physical Medicine & Rehabilitation ◽

10.1097/phm.0000000000000453 ◽

2016 ◽

Vol 95 (8) ◽

pp. 597-607 ◽

Cited By ~ 3

Author(s):

Farid F. Muakkassa ◽

Robert A. Marley ◽

Katherine L. Billue ◽

Mackenzie Marley ◽

Sophia Horattas ◽

...

Keyword(s):

Length Of Stay ◽

Functional Independence Measure ◽

Functional Independence ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Functional Independence Measure Score

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Effects of Rehabilitation Therapy on Parkinsonians' Disability and Functional Independence

Neurorehabilitation and Neural Repair ◽

10.1177/154596839601000402 ◽

1996 ◽

Vol 10 (4) ◽

pp. 223-231 ◽

Cited By ~ 6

Author(s):

F. Patti ◽

A. Reggio ◽

F. Nicoletti ◽

T. Sellaroli ◽

G. Deinite ◽

...

Keyword(s):

Functional Independence ◽

Rehabilitation Therapy

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Abstract TP120: Complement Activation Contributes to Malignant Transformation of Stroke and Limits Cognitive Recovery After Reperfusion Therapy

Stroke ◽

10.1161/str.51.suppl_1.tp120 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Ali M Alawieh ◽

Wuwei Feng ◽

Alejandro M Spiotta ◽

Stephen Tomlinson

Keyword(s):

Malignant Transformation ◽

Complement Activation ◽

Reperfusion Therapy ◽

Functional Independence ◽

Cognitive Outcomes ◽

Cognitive Recovery ◽

Complement Inhibition ◽

Rehabilitation Therapy ◽

Risk Of Hemorrhage ◽

Treatment Window

Introduction: Ischemic stroke involves an ischemic event followed by post-ischemic neuroinflammation, leading to acute mortality, neuronal loss, and impaired recovery. Standard of care reperfusion therapy (thrombolysis or thrombectomy) has a limited treatment window due to risk of hemorrhage, and leads to functional independence in only a subset of patients. We studied the role of complement and neuroinflammation in the pathophysiology behind the major clinical challenges of reperfusion therapy; the risk of hemorrhage and limited cognitive recovery. Methods: We used 3 stroke models, namely transient middle cerebral artery occlusion (MCAO), permanent MCAO and microembolic models, to investigate the effects of t-PA, mechanical reperfusion, rehabilitation therapy, and complement inhibition in mice. We used B4-Crry, a site-targeted inhibitor of C3 activation that specifically localizes to neoepitopes expressed in the post-ischemic brain following its intravenous administration. A retrospective analysis was also performed for cognitive and motor recovery in human patients following reperfusion therapy. Results: Complement inhibition with B4-Crry improved the safety, efficacy and treatment window of reperfusion therapy, decreased hemorrhagic transformation, and improved cognitive recovery. Despite reperfusion with t-PA, there was ongoing complement-dependent microglial activation and phagocytosis of hippocampal synapses for at least 30 days leading to pronounced long-term cognitive deficits. Administration of B4Crry, alone or in combination with thrombolytic therapy, limited complement deposition in the perilesional brain, and reduced microgliosis and synaptic uptake. Reperfusion therapy alone did not improve cognitive outcomes, even when combined with rehabilitation therapy. Reperfusion therapy did not improve cognitive outcomes in stroke patients. Conclusions: Although post-stroke reperfusion therapy limits the size of injury and improves motor deficits, post-reperfusion complement activation and neuroinflammation contribute to the malignant transformation of stroke acutely and seeds a chronic neurodegenerative inflammatory response. Complement modulation may be a promising adjuvant to reperfusion therapy.

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Measurement of mobility and physical function in hospitalised trauma patients: A systematic review of instruments and their measurement properties

Trauma ◽

10.1177/1460408619879326 ◽

2019 ◽

Vol 22 (1) ◽

pp. 7-17

Author(s):

Sara Calthorpe ◽

Lara A Kimmel ◽

Melissa J Webb ◽

Belinda J Gabbe ◽

Anne E Holland

Keyword(s):

Systematic Review ◽

Trauma Patient ◽

Physical Function ◽

Hospital Setting ◽

Functional Independence Measure ◽

Functional Independence ◽

Acute Hospital ◽

Trauma Patients ◽

Acute Hospital Setting ◽

Care Index

Introduction It is well recognised that organised trauma systems reduce trauma patient mortality. As established systems mature, there is an increasing need to better understand the patient recovery trajectory. Mobility and physical function are key aspects of recovery, but the optimal instruments for measurement in the acute hospital setting remain unclear. Methods A systematic review was undertaken to identify and describe mobility and physical function instruments scored by direct patient assessment, in adult trauma patients in an acute hospital setting. Databases were searched with no date restrictions. Instruments that were specific to subgroups or related to individual conditions, diseases or joints were excluded. The consensus-based standards for the selection of health measurement instruments checklist was used to assess risk of bias where relevant. Clinimetric properties were reported where possible, including reliability, validity and responsiveness. Results Fourteen thousand one hundred and fourteen articles were identified with 37 eligible for final review, including six instruments. None had been specifically designed for use in a heterogeneous range of trauma patients. The Functional Independence Measure was the most commonly cited (n = 10 studies), with evidence of construct validity, responsiveness and minimal floor/ceiling effects (<3%). The Acute Care Index of Function (n = 1 study) was found to be valid and responsive whilst the modified Iowa Level of Assistance (n = 2 studies) was reliable and responsive, but ceiling effects ranged from 26% to 37%. Little clinimetric data were available for other measures. Conclusion Evidence from a few studies show promise for the use of the Functional Independence Measure, Acute Care Index of Function and modified Iowa Level of Assistance to measure mobility and physical function in trauma patients, however comprehensive clinimetric data are lacking. Future research should test these scores in specifically designed clinimetric property studies in defined trauma patient populations. This would enable the identification of a gold standard measure for evaluating treatment effectiveness, enabling benchmarking between centres, allow prediction of recovery pathways and optimise trauma patient outcomes.

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Inception of an Australian Spine Trauma Registry: the Minimum Dataset

Global Spine Journal ◽

10.1055/s-0032-1319772 ◽

2012 ◽

Vol 2 (2) ◽

pp. 071-078 ◽

Cited By ~ 9

Author(s):

J. W. Tee ◽

C. H. P. Chan ◽

R. L. Gruen ◽

M. C. B. Fitzgerald ◽

S. M. Liew ◽

...

Keyword(s):

Data Analysis ◽

Pilot Study ◽

Trauma Registry ◽

Significant Proportion ◽

Functional Independence ◽

Trauma Patients ◽

Spine Trauma ◽

Trauma Outcomes ◽

Patient Reported ◽

Minimum Dataset

Background The establishment of a spine trauma registry collecting both spine column and spinal cord data should improve the evidential basis for clinical decisions. This is a report on the pilot of a spine trauma registry including development of a minimum dataset. Methods A minimum dataset consisting of 56 data items was created using the modified Delphi technique. A pilot study was performed on 104 consecutive spine trauma patients recruited by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). Data analysis and collection methodology were reviewed to determine its feasibility. Results Minimum dataset collection aided by a dataset dictionary was uncomplicated (average of 5 minutes per patient). Data analysis revealed three significant findings: (1) a peak in the 40 to 60 years age group; (2) premorbid functional independence in the majority of patients; and (3) significant proportion being on antiplatelet or anticoagulation medications. Of the 141 traumatic spine fractures, the thoracolumbar segment was the most frequent site of injury. Most were neurologically intact (89%). Our study group had satisfactory 6-month patient-reported outcomes. Conclusion The minimum dataset had high completion rates, was practical and feasible to collect. This pilot study is the basis for the development of a spine trauma registry at the Level 1 trauma center.

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