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

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.

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

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.

Clinically Relevant Behaviors in Elderly Hip Fracture Inpatients

2002 ◽  
Vol 32 (3) ◽  
pp. 249-259 ◽  
Author(s):  
Helen H. Dorra ◽  
Eric J. Lenze ◽  
Yookyung Kim ◽  
Benoit H. Mulsant ◽  
Michael C. Munin ◽  
...  
Keyword(s):  
Mental Health ◽  
Hip Fracture ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Elderly Persons ◽  
Depression And Anxiety ◽  
Rehabilitation Outcome ◽  
Rehabilitation Hospital ◽  
Outcome Behaviors

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.

scholarly journals Impact of COVID-19 Pandemic on Inpatient Rehabilitation and the Original Infection Control Measures for Rehabilitation Team

2021 ◽  
Author(s):  
Yukimasa Igawa ◽  
Takahiro Sugimoto ◽  
Hiromasa Horimoto ◽  
Yusuke Moriya ◽  
Masaki Okada ◽  
...  
Keyword(s):  
Infection Control ◽  
Functional Independence Measure ◽  
Qualitative Evaluation ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Control Measures ◽  
Rehabilitation Team ◽  
Training Time ◽  
Infection Control Measures ◽  
The Impact

AbstractObjectiveThis study aimed to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on inpatient rehabilitation, and to determine the effectiveness of the original infection control measures implemented for the rehabilitation team.MethodsIn this single-center, retrospective, observational study, we calculated multiple rehabilitation indices of patients discharged from our rehabilitation ward between February 28 and May 25, 2020 when Hokkaido was initially affected by COVID-19, and compared them with those calculated during the same period in 2019. Fisher’s exact test and the Mann-Whitney U test were used for statistical analysis. We also verified the impact of implementing the original infection control measures for the rehabilitation team on preventing nosocomial infections.ResultsA total of 93 patients (47 of 2020 group, 46 of 2019 group) were included. The median age was 87 and 88 years, respectively, with no differences in age, sex, and main disease between the groups. Training time per day in the ward in 2020 was significantly lower than that in 2019 (p = 0.013). No significant differences were found in the qualitative evaluation indices of Functional Independence Measure (FIM) score at admission, FIM gain, length of ward stay, FIM efficiency, and rate of discharge to home. None of the patients or staff members had confirmed COVID-19 during the study period.ConclusionsEarly COVID-19 pandemic in Hokkaido affected the quantitative index for inpatient rehabilitation but not the qualitative indices. No symptomatic nosocomial COVID-19 infections were observed with our infection control measures.

scholarly journals Inpatient Rehabilitation Care in Alberta: How Much Does Stroke Severity and Timing Matter?

2019 ◽  
Vol 46 (6) ◽  
pp. 691-701
Author(s):  
Eric Tanlaka ◽  
Kathryn King-Shier ◽  
Theresa Green ◽  
Cydnee Seneviratne ◽  
Sean Dukelow
Keyword(s):  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Stroke Severity ◽  
Discharge Destination ◽  
Severe Stroke ◽  
Rehabilitation Care ◽  
Mild Stroke ◽  
The Impact ◽  
Functional Gains

ABSTRACT:Background:We examined the impact of stroke severity and timing to inpatient rehabilitation admission on length of stay (LOS), functional gains, and discharge destination.Methods:Alberta inpatient stroke rehabilitation data between April 2013 and March 2017 were analyzed. We evaluated the impact of stroke severity, as measured by the Functional Independence Measure (FIM), on timing to inpatient rehabilitation, functional gains, LOS, and discharge destination. Further, we examined whether timing to inpatient rehabilitation impacted the latter three factors.Results:The 2404 adults were subcategorized as mild (1237), moderate (1031), or severe (136) based on FIM at inpatient rehabilitation admission. Length of time to rehabilitation admission was not significantly (p = 0.232) different between stroke severities. Mean length of time (days) to rehabilitation admission was 19.79 (20.3 SD) for mild, 27.7 (35.7 SD) for moderate, and 37.70 (56.8 SD) for severe stroke. Mean FIM change for mild (M = 16.3, 9.9 SD) differed significantly (p = 5.1 × 10–9) from moderate (M = 30.4, 16.4 SD) and severe (M = 31.0, 25.7 SD) stroke. The mean LOS for mild stroke (M = 41.3, 31.9 SD) was significantly (p = 5.1 × 10–9) different from moderate stroke (M = 86.8, 76.4 SD) and severe stroke (M = 126.1, 104.2 SD). Time to inpatient rehabilitation admission showed a small, significant impact on FIM change (p = 1.4 × 10–9, partial η2 0.022) and LOS (p = 1.1 × 10–19, partial η2 0.042). Shorter times to rehabilitation admission and mild stroke were associated with discharging home without needing homecare.Conclusion:Stroke severity has a significant impact on the conduct of inpatient rehabilitation. Yet, despite suggestions shortening timing to rehabilitation should improve outcomes, the impact on functional gains and rehabilitation LOS was small.

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

2020 ◽  
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.

scholarly journals Impact of timing of ventriculoperitoneal shunt placement on outcome in posttraumatic hydrocephalus

2019 ◽  
Vol 130 (2) ◽  
pp. 406-417 ◽  
Author(s):  
Robert G. Kowalski ◽  
Alan H. Weintraub ◽  
Benjamin A. Rubin ◽  
Donald J. Gerber ◽  
Andrew J. Olsen
Keyword(s):  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Csf Shunt ◽  
Vp Shunt ◽  
Shunt Placement ◽  
Point Reduction ◽  
Evans Index ◽  
Ct Brain ◽  
The Impact

OBJECTIVEPosttraumatic hydrocephalus (PTH) is a frequent sequela of traumatic brain injury (TBI) and complication of related cranial surgery. The roles of PTH and the timing of cerebrospinal fluid (CSF) shunt placement in TBI outcome have not been well described. The goal of this study was to assess the impact of hydrocephalus and timing of ventriculoperitoneal (VP) shunt placement on outcome during inpatient rehabilitation after TBI.METHODSIn this cohort study, all TBI patients admitted to Craig Hospital between 2009 and 2013 were evaluated for PTH, defined as ventriculomegaly, and hydrocephalus symptoms, delayed or deteriorating recovery, or elevated opening pressure on lumbar puncture. Extent of ventriculomegaly was quantified by the Evans index from CT scans. Outcome measures were emergence from and duration of posttraumatic amnesia (PTA) and functional status as assessed by means of the Functional Independence Measure (FIM). Findings in this group were compared to findings in a group of TBI patients without PTH (controls) who were admitted for inpatient rehabilitation during the same study period and met specific criteria for inclusion.RESULTSA total of 701 patients were admitted with TBI during the study period. Of these patients, 59 (8%) were diagnosed with PTH and were included in this study as the PTH group, and 204 who were admitted for rehabilitation and met the criteria for inclusion as controls constituted the comparison group (no-PTH group). PTH was associated with initial postinjury failure to follow commands, midline shift or cistern compression, subcortical contusion, and craniotomy or craniectomy. In multivariable analyses, independent predictors of longer PTA duration and lower FIM score at rehabilitation discharge were PTH, emergency department Glasgow Coma Scale motor score < 6, and longer time from injury to rehabilitation admission. PTH accounted for a 51-day increase in PTA duration and a 29-point reduction in discharge FIM score. In 40% of PTH patients with preshunt CT brain imaging analyzed, ventriculomegaly (Evans index > 0.3) was observed 3 or more days before VP shunt placement (median 10 days, range 3–102 days). Among PTH patients who received a VP shunt, earlier placement was associated with better outcome by all measures assessed and independently predicted better FIM total score and shorter PTA duration.CONCLUSIONSPosttraumatic hydrocephalus predicts worse outcome during inpatient rehabilitation, with poorer functional outcomes and longer duration of PTA. In shunt-treated PTH patients, earlier CSF shunting predicted improved recovery. These results suggest that clinical vigilance for PTH onset and additional studies on timing of CSF diversion are warranted.

scholarly journals Sex Differences in Stroke Rehabilitation Care in Alberta

2020 ◽  
Vol 47 (4) ◽  
pp. 494-503
Author(s):  
Eric Tanlaka ◽  
Kathryn King-Shier ◽  
Theresa Green ◽  
Cydnee Seneviratne ◽  
Sean Dukelow
Keyword(s):  
Stroke Rehabilitation ◽  
Living Arrangement ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Stroke Severity ◽  
Discharge Destination ◽  
Stroke Patients ◽  
Rehabilitation Care ◽  
The Impact

ABSTRACT:Background:Female stroke patients may experience poorer functional outcomes than males following inpatient rehabilitation.Methods:Data from Alberta inpatient stroke rehabilitation units were examined to determine: (1) the impact of sex on time to inpatient rehabilitation, functional gains (using the Functional Independence Measure (FIM)), length of stay (LOS), and discharge destination; (2) if sex was related to age at the time of stroke, stroke severity, and living arrangement at discharge from rehabilitation; and (3) whether patients’ age and preadmission living arrangement had an influence on LOS in rehabilitation or discharge destination.Results:Two thousand two hundred sixty-six adult stroke patients (1283 males and 983 females) were subcategorized as mild (FIM >80; n = 1155), moderate (FIM 40–80; n = 994), or severe (FIM <40; n = 117). Fifty-five percent of males (45.7% females) had mild stroke; 39.5% of males (49.5% females) had moderate stroke; and 5.5% of males (4.8% females) had severe stroke. Females were significantly older than males (p = 2.4 × 10−4). No sex difference existed in time from acute care to rehabilitation admission (p = 0.73) or in mean FIM change (p = 0.294). Mean LOS was longer for females than males (p=0.018). Males were more likely than females to be discharged home (p = 1.8 × 10−13). Further, male patients (p = 6.4 × 10−7) and those < 65 years (p = 1.4 × 10−23) were more likely to be discharged home without homecare.Conclusion:There are significant sex and age differences in LOS in rehabilitation and discharge destination of stroke patients. These differences may suggest that sex and age of the patient need to be considered in care planning.

scholarly journals The impact of COVID-19 infection on hip fracture 30-day mortality

Trauma ◽  
2021 ◽  
pp. 146040862094972
Author(s):  
Ahmed Fadulelmola ◽  
Rob Gregory ◽  
Gavin Gordon ◽  
Fiona Smith ◽  
Andrew Jennings
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Hospital Admissions ◽  
The Elderly ◽  
Primary Outcome Measure ◽  
Time To Death ◽  
Significant Difference ◽  
The Mean ◽  
The Impact ◽  
Mean Time

Introduction: A novel virus, SARS-CoV-2, has caused a fatal global pandemic which particularly affects the elderly and those with comorbidities. Hip fractures affect elderly populations, necessitate hospital admissions and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality. Method: Data related to 75 adult hip fractures admitted to two units during March and April 2020 were reviewed. The mean age was 83.5 years (range 65–98 years), and most (53, 70.7%) were women. The primary outcome measure was 30-day mortality associated with COVID-19 infection. Results: The COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in the COVID-19-positive group (10/20, 50%) compared to the COVID-19-negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval: 17.0–22.5). The mean time from admission to surgery was 43.1 h and 38.3 h, in COVID-19-positive and COVID-19-negative groups, respectively. All COVID-19-positive patients had shown symptoms of fever and cough, and all 10 cases who died were hypoxic. Seven (35%) cases had radiological lung findings consistent of viral pneumonitis which resulted in mortality (70% of mortality). 30% ( n = 6) contracted the COVID-19 infection in the community, and 70% ( n = 14) developed symptoms after hospital admission. Conclusion: Hip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest X-ray for patients presenting with hip fractures help in early planning of high-risk surgeries and allow counselling of the patients and family using realistic prognosis.

scholarly journals Impact of Rehabilitation Dose on Nutritional Status at Discharge from a Convalescent Rehabilitation Ward in Malnourished Patients with Hip Fracture

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 722
Author(s):  
Yusuke Ito ◽  
Hidetaka Wakabayashi ◽  
Shinta Nishioka ◽  
Shin Nomura ◽  
Ryo Momosaki
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Hip Fracture ◽  
Nutritional Status ◽  
Logistic Regression Analysis ◽  
Short Form ◽  
Mini Nutritional Assessment ◽  
Functional Independence ◽  
Rehabilitation Ward ◽  
The Impact

The object of this study is to determine the impact of the rehabilitation dose on the nutritional status at discharge from a convalescent rehabilitation ward in malnourished patients with hip fracture. This retrospective case-control study involved malnourished patients with hip fracture aged 65 years or older who had been admitted to a convalescent rehabilitation ward and whose data were registered in the Japan Rehabilitation Nutrition Database. The primary outcome was nutritional status at discharge. Patients were classified according to whether nutritional status was improved or not at discharge, according to the Mini Nutritional Assessment-Short Form® (MNA-SF) score. The association between improved nutritional status and rehabilitation dose was assessed by a logistic regression analysis. Data were available for 145 patients (27 men, 118 women; mean age 85.1 ± 7.9 years). Daily rehabilitation dose was 109.5 (median 94.6–116.2) min and the MNA-SF score at admission was 5 (median 4–6). Nutritional status was improved in 97 patients and not improved in 48. Logistic regression analysis showed the following factors to be independently associated with nutritional status at discharge: Functional Independence Measure score (OR 1.042, 95% CI 1.016–1.068), energy intake (OR 1.002 CI 1.000–1.004), daily rehabilitation dose (OR 1.023, 95% CI 1.002–1.045), and length of hospital stay (OR 1.026, 95% CI 1.003–1.049). The daily rehabilitation dose in malnourished patients with hip fracture may positively impact nutritional status at discharge.

scholarly journals Factors Related to Greater Functional Recovery after Suffering a Stroke

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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