scholarly journals The Association Between Sarcopenia and Functional Improvement in Older and Younger Patients Who Completed Inpatient Rehabilitation: A Prospective Cohort Study

2021 ◽  
Vol 2 ◽  
Author(s):  
Irina Churilov ◽  
Leonid Churilov ◽  
Kim Brock ◽  
David Murphy ◽  
Richard J. MacIsaac ◽  
...  
Keyword(s):  
Cohort Study ◽  
Goal Attainment ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Rehabilitation Program ◽  
Functional Improvement ◽  
Goal Attainment Scaling ◽  
Standard Error Estimation ◽  
Measure Change

Objective: To investigate the association between sarcopenia and functional improvement in patients older and younger than 65 years upon completion of an inpatient rehabilitation program.Design: Prospective cohort study.Participants: Adult consecutive patients who completed the inpatient rehabilitation program at a metropolitan tertiary referral hospital general inpatient rehabilitation unit.Methods: Sarcopenia status was determined using the European Working Group on Sarcopenia in Older People 2 algorithm, using muscle mass measured by BioImpedance Analysis and grip strength. Progress in rehabilitation was measured using change in the Functional Independence Measure and Goal Attainment Scaling score. To investigate the age group by sarcopenia status interaction we used quantile regression models with bootstrapped standard error estimation for functional improvement and linear regression model with robust standard error estimation for GAS score.Results: 257 participants [128 (50%) male, median age 63 years (IQR: 52–72)], 33(13%) with sarcopenia, completed inpatient rehabilitation [median length of stay 16 days (IQR: 11–27.5)]. Participants' median Functional Independence Measure change was 24 (IQR 15–33.5) and mean total Goal Attainment Scaling score was 57.6 (SD 10.2). Adjusting for admission Functional Independence Measure score, the median difference in Functional Independence Measure change between participants with and without sarcopenia was: −4.3 (95% CI: −10.6, 1.9); p = 0.17 in participants 65 years and younger, and 4.6 (95% CI: 1.0, 8.2); p = 0.01 in participants older than 65; age-by-sarcopenia interaction p = 0.02.Conclusions: Unlike younger people, older people with sarcopenia have greater functional improvement in inpatient rehabilitation than those without sarcopenia.

Determining Stroke Rehabilitation Inpatients' Level of Nursing Care

2001 ◽  
Vol 10 (1) ◽  
pp. 40-51 ◽  
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.

scholarly journals Rehabilitation for cerebral palsy: Analysis of the Australian rehabilitation outcome dataset

2011 ◽  
Vol 02 (01) ◽  
pp. 043-049
Author(s):  
Bhasker Amatya ◽  
Fary Khan
Keyword(s):  
Cerebral Palsy ◽  
Information Needs ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Hospital Length Of Stay ◽  
Functional Improvement ◽  
Specific Information ◽  
Hospital System ◽  
Rehabilitation Outcomes

ABSTRACT Objective: To examine the outcome of inpatient rehabilitation for cerebral palsy (CP), using the Australian Rehabilitation Outcomes Center (AROC) database. Materials and Methods: De-identified data from the AROC database was analyzed for all rehabilitation admissions during 2003 – 2008, using four classes for the functional level. The outcomes included: Functional Independence Measure (FIM) scores, FIM efficiency, hospital length of stay (LOS), and discharge destination. Results: Of 141 case episodes 56.7% were female, mean age 48.5 years, 87.2% were discharged to the community and 64.5% (n = 91) were in the lowest functional classes (217, 218, and 219). The majority of CP patients were treated in the public hospital system (66.7% versus 33.3%), and had a slightly longer LOS compared with those treated in private facilities (22.6 versus 17.9 days, mean difference - 4.7 days, 95% CI - 9.2 to - 0.2, P = 0.041). The FIM for all classes (216 – 218) showed significant functional improvement during the admission (P = 0.001). As expected those in the most functionally impaired classes showed most change (FIM change: 16.6 in class 217, 15.3 in class 218). FIM efficiency was the highest in classes 217 compared to the other classes. The year-to-year trend demonstrated a mixed pattern for hospital LOS and was not significant (P = 0.492). Conclusion: The AROC dataset is a valuable research tool for describing rehabilitation outcomes. However, more specific information needs to be collected alongside the core AROC data, to allow a more meaningful evaluation of outcomes for CP rehabilitation..

Effectiveness of an Inpatient Multidisciplinary Rehabilitation Program for People With Parkinson Disease

2008 ◽  
Vol 88 (7) ◽  
pp. 812-819 ◽  
Author(s):  
Terry Ellis ◽  
Douglas I Katz ◽  
Daniel K White ◽  
T Joy DePiero ◽  
Anna D Hohler ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Speech Therapy ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Change Score ◽  
Rehabilitation Program ◽  
Primary Diagnosis ◽  
Outpatient Setting ◽  
Total Change

Background and PurposeIn the outpatient setting, it can be difficult to effectively manage the complex medical and rehabilitation needs of people with Parkinson disease (PD). A multidisciplinary approach in the inpatient rehabilitation environment may be a viable alternative. The purposes of this study were: (1) to investigate the effectiveness of an inpatient rehabilitation program for people with a primary diagnosis of PD, (2) to determine whether gains made were clinically meaningful, and (3) to identify predictors of rehabilitation outcome.SubjectsSixty-eight subjects with a diagnosis of PD were admitted to an inpatient rehabilitation hospital with a multidisciplinary movement disorders program.MethodsSubjects participated in a rehabilitation program consisting of a combination of physical therapy, occupational therapy, and speech therapy for a total of 3 hours per day, 5 to 7 days per week, in addition to pharmacological adjustments based on data collected daily. A pretest-posttest design was implemented. The differences between admission and discharge scores on the Functional Independence Measure (FIM) (total, motor, and cognitive scores), Timed “Up & Go” Test, 2-Minute Walk Test, and Finger Tapping Test were analyzed.ResultsAn analysis of data obtained for the 68 subjects admitted with a diagnosis of PD revealed significant improvements across all outcome measures from admission to discharge. Subjects with PD whose medications were not adjusted during their admission (rehabilitation only) (n=10) showed significant improvements in FIM total, motor, and cognitive scores. Improvements exceeded the minimal clinically important difference in 71% of the subjects. Prior level of function at admission accounted for 20% of the variance in the FIM total change score.Discussion and ConclusionThe results suggest that subjects with a diagnosis of PD as a primary condition benefited from an inpatient rehabilitation program designed to improve functional status.

scholarly journals Locomotor Training Within an Inpatient Rehabilitation Program After Pediatric Incomplete Spinal Cord Injury

2007 ◽  
Vol 87 (9) ◽  
pp. 1224-1232 ◽  
Author(s):  
Laura A Prosser
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Pediatric Population ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Rehabilitation Program ◽  
Locomotor Training ◽  
Incomplete Spinal Cord Injury ◽  
Cord Injury

Background and Purpose: The outcomes of intense locomotor training after incomplete spinal cord injury (SCI) have been described in adults with acute and chronic injuries and with various levels of ambulatory function. This case report describes a comprehensive inpatient rehabilitation program with a locomotor training component in a child with a severe incomplete SCI.Case Description: A 5-year-old girl injured at C4 participated in locomotor training for 5 months during inpatient rehabilitation.Outcomes: The patient's Functional Independence Measure for Children II (WeeFIM II) mobility score increased from 5/35 to 21/35. Her Walking Index for Spinal Cord Injury II (WISCI II) score improved from 0 to 12. The patient returned to walking in the community with assistive devices.Discussion: It is feasible to include an intense locomotor training program in the clinical rehabilitation setting for a child with a severe SCI, and the outcomes were consistent with results in adults. Further investigation with experimental designs and more participants will determine the extent to which this intervention benefits the pediatric population with SCI.

scholarly journals Evaluation of sensorimotor reactions during early rehabilitation for patients after cerebral stroke

Medicina ◽  
2007 ◽  
Vol 43 (12) ◽  
pp. 942
Author(s):  
Daiva Petruševičienė ◽  
Raimondas Savickas ◽  
Aleksandras Kriščiūnas
Keyword(s):  
Early Stage ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Early Rehabilitation ◽  
Point Of View ◽  
Functional Improvement ◽  
Cerebral Stroke ◽  
Stroke Patients ◽  
Functional Changes

Early inpatient rehabilitation is extremely important in functional improvement of patients suffering from cerebral stroke. From our point of view, in rehabilitation of patients after cerebral stroke, the estimation of sensorimotor reactions that enables the evaluation of sensorimotor functional changes is highly relevant. The article describes the comparison of sensorimotor reactions in two subgroups – stroke patients and healthy individuals – by applying Sensoneck system. The evaluation was performed before early stage of rehabilitation and thereafter (following early rehabilitation). In order to estimate the correlation between changes in functional independence and sensorimotor reactions, Functional Independence Measure was used. The study revealed that stroke patients had sensorimotor dysfunctions. During early rehabilitation, the quality of motion performance improved slightly, and sensorimotor reactions improved statistically significantly (P<0.05). The relationship between Functional Independence Measure and Sensoneck scores was not significant (P>0.05).

The Association Between Antipsychotic Drug Use and Rehabilitation Outcome in Post-Acute Hip Fractured Patients: A Retrospective Cohort Study

2020 ◽  
pp. 073346482090456
Author(s):  
Avital Hershkovitz ◽  
Ran Nissan
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Functional Independence Measure ◽  
Multiple Linear Regression Model ◽  
Functional Independence ◽  
Functional Improvement ◽  
Rehabilitation Outcome ◽  
Rehabilitation Outcomes ◽  
Functional Gain

Antipsychotic (AP) use may lead to numerous side effects which may affect rehabilitation outcomes. A retrospective cohort study was carried out on 448 hip fractured patients admitted to a post-acute geriatric rehabilitation center. Functional improvement was measured by the Functional Independence Measure (FIM), motor FIM (mFIM), and mFIM effectiveness. A multiple linear regression model and regression analysis was used to evaluate the level of association between AP use and achievement of favorable functional gain. AP users exhibited lower functional ability on admission and at discharge, achieved a significantly lower functional gain and required longer rehabilitation time compared with nonusers. AP use by post-acute hip fractured patients negatively affects their chances of achieving favorable rehabilitation outcome after adjustment for confounders.

scholarly journals Efficacy of a Training on Executive Functions in Potentiating Rehabilitation Effects in Stroke Patients

2021 ◽  
Vol 11 (8) ◽  
pp. 1002
Author(s):  
Vincenza Tarantino ◽  
Francesca Burgio ◽  
Roberta Toffano ◽  
Elena Rigon ◽  
Francesca Meneghello ◽  
...  
Keyword(s):  
Executive Functions ◽  
Functional Independence Measure ◽  
Training Group ◽  
Functional Independence ◽  
Rehabilitation Program ◽  
Functional Improvement ◽  
Control Group ◽  
Stroke Patients ◽  
Treatment As Usual ◽  
Wide Range

Cognitive impairment after a stroke has a direct impact on patients’ disability. In particular, impairment of Executive Functions (EFs) interferes with re-adaptation to daily life. The aim of this study was to explore whether adding a computer-based training on EFs to an ordinary rehabilitation program, regardless of the specific brain damage and clinical impairment (motor, language, or cognitive), could improve rehabilitation outcomes in patients with stroke. An EF training was designed to have minimal motor and expressive language demands and to be applied to a wide range of clinical conditions. A total of 37 stroke patients were randomly assigned to two groups: a training group, which performed the EF training in addition to the ordinary rehabilitation program (treatment as usual), and a control group, which performed the ordinary rehabilitation exclusively. Both groups were assessed before and after the rehabilitation program on neuropsychological tests covering multiple cognitive domains, and on functional scales (Barthel index, Functional Independence Measure). The results showed that only patients who received the training improved their scores on the Attentional Matrices and Phonemic Fluency tests after the rehabilitation program. Moreover, they showed a greater functional improvement in the Barthel scale as well. These results suggest that combining an EF training with an ordinary rehabilitation program potentiates beneficial effects of the latter, especially in promoting independence in activities of daily living.

scholarly journals Characteristics and Outcomes of Hip Fracture Patients Hospitalized in an Orthogeriatric Unit Versus an Orthopedic Department: A Retrospective Cohort Study

2021 ◽  
Vol 12 ◽  
pp. 215145932098629 ◽  
Author(s):  
Yulia Bugaevsky ◽  
Yochai Levy ◽  
Avital Hershkovitz ◽  
Irena Ocheretny ◽  
Adaya Nissenholtz ◽  
...  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Functional Independence ◽  
Functional Improvement ◽  
Orthopedic Department ◽  
Successful Recovery

Introduction: Hip fractures are a significant health risk in older adults and a major cause of morbidity, functional decline and mortality. Our aim was to compare clinical outcomes of older patients hospitalized in an ortho-geriatric (OG) unit to those hospitalized in an orthopedic department (OD) for surgical treatment of a hip fracture. Methods: A retrospective cohort study of hip fractured patients hospitalized between 2015-2016 in a single tertiary university-affiliated medical center. Included were patients aged 65 and older who had undergone hip fracture surgery and were admitted to either a geriatric or orthopedic ward. Results: 441 patients met the inclusion criteria (195 in the OG unit, 246 in the OD); 257 were transferred to an affiliated geriatric center hospital (107 from the OG unit and 127 from the OD) for rehabilitation. Patients in the OG unit were older, more cognitively and functionally impaired and with more comorbidities. The 1-year mortality rate was significantly lower in the OD group (OR 0.32, CI 95% 0.19-0.53, p < 0.001), however, after propensity matching, the 30-day and 1 year mortality rates were similar in both groups. No difference was found in the rehabilitation length of stay between the groups. The functional independence measure improvement was similar in both groups, with a non-significant trend toward better functional improvement among OG unit patients. Conclusions: Despite the higher complexity of patients, worse baseline functional capacity in the OG unit, improvement after rehabilitation was similar in both groups. These results demonstrate the advantages of the OG unit in treating and stabilizing frail older adults, thus maximizing their chances for a successful recovery after hip fractures. Level of Evidence: Level IV

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.

Abstract P104: Impact Of Orthostatic Hypotension In Inpatient Rehabilitation

Hypertension ◽  
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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