Examination of the dependency and complexity of patients admitted to in-patient rehabilitation in Australia

2020 ◽  
Vol 44 (1) ◽  
pp. 143 ◽  
Author(s):  
Duncan McKechnie ◽  
Julie Pryor ◽  
Murray J. Fisher ◽  
Tara Alexander
Keyword(s):  
Descriptive Analysis ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Systematic Investigation ◽  
Health Condition ◽  
Active Management ◽  
Rehabilitation Service ◽  
Rehabilitation Outcomes ◽  
Patient Dependency ◽  
Cohort Study Design

Objective The aim of this study was to determine whether there has been a measurable change in the dependency and complexity of patients admitted to in-patient rehabilitation in Australia between 2007 and 2016. Methods A retrospective cohort study design was used to examine in-patient rehabilitation data held in the Australasian Rehabilitation Outcomes Centre Registry Database for the period 2007–16. Epidemiological descriptive analysis was used to examine datasets for difference between four discrete years (2007, 2010, 2013 and 2016). Datasets included patient demographics, length of stay (LOS), comorbidities, complications and the Functional Independence Measure (FIM™). Results Between 2007 and 2016, rehabilitation in-patients as a whole: (1) had a mean decrease in total admission FIM score; (2) became more complex, as evidenced by the increased proportion of particular comorbidities impacting on rehabilitation, namely cardiac and respiratory disease, dementia, diabetes and morbid obesity; and (3) had a mean decrease in total discharge FIM score. However, there was an increase in the proportion of patients discharged home from rehabilitation (from 86.5% to 92%) and decreases in onset and rehabilitation LOS of 2.2 and 2.5 days respectively. Conclusion The dependency and complexity of patients admitted to in-patient rehabilitation in Australia has increased between 2007 and 2016. What is known about the topic? Anecdotal reports suggest that rehabilitation patients in Australia have become more complex, necessitating increased active management of their presenting health condition and comorbid health conditions. However, to date, no systematic investigation has been undertaken to examine trends in rehabilitation in-patient dependency and complexity over time. What does this paper add? This study provides measurable evidence of increased dependency and complexity in patients admitted to rehabilitation in Australia. Further, compared with 2007, rehabilitation in-patients as a whole had an increased burden of care on discharge from rehabilitation in 2016. What are the implications for practitioners? The changes in patient dependency and complexity reported in this study have implications for rehabilitation service delivery. This is because the increased need for illness or injury and comorbidity management may result in increased potential for acute complications and health deterioration, and compensatory care for patients during rehabilitation. Clinicians may need to widen their skill set to include more acute and chronic illness management.

Adipokines as Potential Biomarkers in the Neurorehabilitation of Obese Stroke Patients

2020 ◽  
Vol 17 (4) ◽  
pp. 437-445
Author(s):  
Irene Ciancarelli ◽  
Giovanni Morone ◽  
Marco Iosa ◽  
Stefano Paolucci ◽  
Loris Pignolo ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Functional Recovery ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Enzyme Linked Immunosorbent Assay ◽  
Stroke Patients ◽  
Rehabilitation Outcomes ◽  
Before And After ◽  
Forward Stepwise ◽  
Clinical Measures

Background: Limited studies concern the influence of obesity-induced dysregulation of adipokines in functional recovery after stroke neurorehabilitation. Objective: To investigate the relationship between serum leptin, resistin, and adiponectin and functional recovery before and after neurorehabilitation of obese stroke patients. The adipokine potential significance as prognostic markers of rehabilitation outcomes was also verified. Methods: Twenty obese post-acute stroke patients before and after neurorehabilitation and thirteen obese volunteers without-stroke, as controls, were examined. Adipokines were determined by commercially available enzyme-linked immunosorbent assay (ELISA) kits. Functional deficits were assessed before and after neurorehabilitation with the Barthel Index (BI), modified Rankin Scale (mRS), and Functional Independence Measure (FIM). Results: Compared to controls, higher leptin and resistin values and lower adiponectin values were observed in stroke patients before neurorehabilitation and no correlations were found between adipokines and clinical outcome measures. Neurorehabilitation was associated with improved scores of BI, mRS, and FIM. After neurorehabilitation, decreased values of Body Mass Index (BMI) and resistin together increased adiponectin were detected in stroke patients, while leptin decreased but not statistically. Comparing adipokine values assessed before neurorehabilitation with the outcome measures after neurorehabilitation, correlations were observed for leptin with BI-score, mRS-score, and FIM-score. No other adipokine levels nor BMI assessed before neurorehabilitation correlated with the clinical measures after neurorehabilitation. The forward stepwise regression analysis identified leptin as prognostic factor for BI, mRS, and FIM. Conclusions: Our data show the effectiveness of neurorehabilitation in modulating adipokines levels and suggest that leptin could assume the significance of biomarker of functional recovery.

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.

Validité de la Mesure de l'Indépendance Fonctionnelle (MIF) pour les personnes âgées suivies en réadapation

1997 ◽  
Vol 16 (4) ◽  
pp. 626-646
Author(s):  
Louise Demers ◽  
Francine Giroux
Keyword(s):  
Internal Consistency ◽  
Cognitive Skills ◽  
Functional Independence Measure ◽  
The Elderly ◽  
Functional Independence ◽  
Factorial Structure ◽  
Burden Of Care ◽  
Discharge Data ◽  
Rehabilitation Outcomes ◽  
Components Analysis

ABSTRACTThe Functional Independence Measure (FIM) was developed to assess the burden of care of persons receiving rehabilitation services in regard to self-care activities and social and cognitive skills. Until now, no study has evaluated the validity of the FIM with the elderly without distinction of diagnosis. The purpose of this study was to examine the MIF's factorial structure using a principal components analysis. As a secondary goal, the predictive validity and the internal consistency of the instrument were also examined. Data collected from 120 subjects generated a solution consisting of three factors accounting for 67.6 per cent of the total variance. The first factor (46.6%) represents the handicap concept, the second factor (14.7%) measures disability and the third factor (6.3%) represents disability with a major component of physical involvement of lower extremities. The results of this analysis confirm the multidimensional structure of the FIM and reveal the possibility of a third factor for the elderly. With this population, internal consistency of the instrument, obtained from admission and discharge data, is estimated at 0.92 and 0.96 with Cronbach's alpha. Total FIM score at discharge as well as items related to the handicap factor as measured on admission allow us to correctly predict place of discharge in a proportion of 72.9 per cent of the cases. These results indicate that the FIM bears an interesting potential for measuring rehabilitation outcomes for the elderly.

Retraining selective trunk muscle activity: A key to more successful rehabilitation outcomes for hemiparetic stroke patients

2021 ◽  
pp. 1-8
Author(s):  
Matteo Bigoni ◽  
Veronica Cimolin ◽  
Luca Vismara ◽  
Andrea G. Tarantino ◽  
Silvia Baudo ◽  
...  
Keyword(s):  
Treatment Cycle ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Berg Balance Scale ◽  
Rehabilitation Program ◽  
Trunk Muscles ◽  
Single Subject ◽  
Rehabilitation Outcomes ◽  
Additional Improvement ◽  
Hemiparetic Stroke

BACKGROUND: Hemiparetic patients lose the ability to move their trunk selectively, abdominals are affected and neither voluntary nor reflex activity is present. OBJECTIVE: To investigate if the inclusion of specific exercises for the trunk muscles in a rehabilitation program for chronic hemiparetic patients could lead to an additional improvement. METHODS: A multiple-participant single-subject design was replicated in patients with hemiplegia. The study was conducted in two cycles: for the first cycle (A), patients received conventional rehabilitation program, then for the second cycle (B), six months later, the same subjects received conventional rehabilitation therapy plus an additional specific selective trunk muscles training. Trunk Impairment Scale (TIS), Berg Balance Scale (BBS), 10 meters distance walk test (10 MWT), Functional Independence Measure (FIM) and instrumental gait analysis were performed before and after both treatment cycles. RESULTS: Significant changes were observed in TIS and 10 MWT after the two treatment cycles. However, after treatment cycle B, BBS and FIM score showed an additional improvement. Whereas, after treatment cycle A gate analysis did not relevantly changed, but after cycle B a significant improvement was registered in velocity, cadence and percentage of stance in the gait cycle. CONCLUSIONS: In our patients, the training for selective activation of the trunk muscles had led to a consistent improvement of gate analysis parameters, and hemiparesis-related disability in stance and activities of daily living.

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..

Abstract P200: Orthostatic Hypotension Is An Independent Predictor Of Delayed Rehabilitation Recovery

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Luis E Okamoto ◽  
Jin-Woo Park ◽  
Purnima Sharma ◽  
Andre Diedrich ◽  
Lauren Massey ◽  
...  
Keyword(s):  
Orthostatic Hypotension ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Electrolyte Imbalance ◽  
Factors Affecting ◽  
Rehabilitation Outcomes ◽  
Organ Systems ◽  
Negative Effect ◽  
Potential Factors

Inpatient acute 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 can negatively impact their recovery. We found an incidence of OH of 4% in a cohort of 8350 patients at Vanderbilt Stallworth Rehabilitation Hospital (60±17yr, 72% men vs. non-OH 60±18 yr, 57% men). On admission, OH patients had a longer predicted length of rehabilitation hospitalization stay (LOS; 18±6 vs. non-OH 16±5 days; P<0.01) and lower Functional Independence Measure (FIM, 49±19 vs. non-OH 55±19; P<0.01), reflecting greater medical complexity. Actual LOS was even longer than predicted in OH (actual-predicted LOS [ΔLOS], 1±11 vs. non-OH -2±8 days; P<0.01) and FIM efficiency was lower ([discharge-admission FIM]/LOS, 2.5±1.6 vs. non-OH 3.1±1.9; P<0.01), suggesting that OH may be an independent factor for worse rehabilitation outcomes. To test this hypothesis, we conducted univariate and multivariate regression analyses in the adult patients (n=8146) of this cohort to include other potential factors affecting ΔLOS and FIM efficiency (age, sex, diagnosis of admission and comorbidities grouped into 22 categories by organ systems). We found that OH was independently associated with a longer than predicted LOS (i.e. greater ΔLOS) and lower FIM efficiency (regression coefficient 2.2±0.5 and -0.4±0.1, respectively; P<0.01). These associations remained significant after adjusting for predicted LOS and FIM on admission, suggesting that the effects of OH were not accounted for in these metrics. Other factors significantly associated with greater ΔLOS and lower FIM efficiency were comorbidities associated with the urinary tract, gastrointestinal and peripheral nervous systems, infections, electrolyte imbalance and pressure ulcers. In conclusion, OH has a major independent negative effect on rehabilitation outcomes, and is associated with longer than predicted inpatient rehabilitation LOS and lower functional gain. We suggest that the presence of OH should be considered when setting up the rehabilitation plan, to include management of OH.

scholarly journals Evidence supporting the use of a subjective staff evaluation to assess the benefit of rehabilitation in hemodialysis patients undergoing inpatient rehabilitation

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Takahiro Shimoda ◽  
Helen Alston ◽  
Angelique Chai ◽  
Sarbjit V. Jassal
Keyword(s):  
Subjective Evaluation ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Subjective Assessment ◽  
Functional Independence ◽  
Patient Specific ◽  
Rehabilitation Service ◽  
Patient Reported ◽  
Time Of Admission ◽  
Partial Success

Abstract Background We questioned whether the introduction of a subjective evaluation of patient-specific goals, could be used as a valid method to assess the effectiveness of inpatient rehabilitation. Methods In this prospective cohort study, all admissions to the UHN hemodialysis rehabilitation service between April 2013 and August 2016 were included. We introduced a system of subjective assessment, performed by the team at the time of admission and discharge. We evaluated Functional Independence Measure (FIM®) score and KDQoL for objective measures of physical function and patient-reported quality of life. Results A total of 201 patients were included. The median FIM score at discharge correlated well with the subjective staff evaluation. FIM score changes for those with evaluations for Success, Partial success, and Not Successful were 28 [interquartile range (IQR) 20–34], 24 [IQR18–31], 16 [IQR 11–34] respectively. The median PCS at discharge for those deemed to have Success was 37.4 [IQR31.0, 44.7], and for those with Partial success & Not Successful 28.8 [IQR 22.4, 39.2]. There was no correlation with MCS scores (55.2 [IQR 51.2, 60.2], 58.4 [IQR 50.1, 63.1] respectively). Conclusions These results suggest the subjective staff evaluation is a brief but valid assessment of patient outcome for dialysis patients undergoing inpatient rehabilitation.

scholarly journals Caída y factores demográficos y clínicos en adultos mayores: estudio de seguimiento

2021 ◽  
Vol 20 (1) ◽  
pp. 139-171
Author(s):  
Jack Roberto Silva Fhon ◽  
Rosalina Aparecida Partezani Rodrigues
Keyword(s):  
Older Adults ◽  
Older Adult ◽  
Mixed Model ◽  
Descriptive Analysis ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Wilcoxon Test ◽  
Clinical Factors ◽  
Chi Squared ◽  
State Examination

Objetivo: Analizar los factores demográficos y clínicos relacionados a las caídas en el adulto mayor que viven en el domicilio en un seguimiento de cinco años Método: Estudio cuantitativo y longitudinal retrospectivo realizado entre 2007/2008 y 2013 con 262 participantes brasileños con edad superior a 65 años. Se utilizaron los instrumentos de perfil demográfico, Mini Examen del Estado Mental, enfermedades autorreferidas, caídas y sus características, Escala de Fragilidad de Edmonton, Escala de Lawton y Brody y Medida de Independencia Funcional. Se realizaron análisis descriptivo, Chi cuadrado, prueba de Wilcoxon y prueba de modelos mixtos. Estudio aprobado por el comité de ética.Resultados: La mayoría era del sexo femenino, con edad entre 65 a 79 años, escolaridad entre 1 a 4 años y jubilados. La prevalencia de caídas fue de 21,8% y 37,8% en ambas evaluaciones. Se verificó que para cada enfermedad más que el adulto mayor tiene, aumenta la chance de sufrir una nueva caída. Además, para cada punto más en la escala de fragilidad, el adulto mayor tiene mayor chance de caer. Por otro lado, para cada medicamento a menos que el adulto mayor utiliza, presenta 10% menos chance de caer.Conclusión: La caída estuvo asociado a factores clínicos en el adulto mayor siendo necesario que el profesional de salud realice evaluaciones constantes para identificar este evento y sus desencadenantes. Objective: To analyze the demographic and clinical factors related to falls of older adults living at home in a five-year follow-up Materials and methods: Retrospective quantitative and longitudinal study conducted between 2007/2008 and 2013 with 262 Brazilians participants over 65 years old. We used the demographic profile, Mini-Mental State Examination, self-reported diseases, falls and their characteristics, Edmonton Frail Scale, Lawton and Brody Scale, Functional Independence Measure instruments. We performed descriptive analysis, Chi-squared, Wilcoxon test and mixed model test.Results: Most participants were women, aged between 65 to 79 years, schooling between 1 to 4 years and retired. The prevalence of falls was 21.8% and 37.8% in both evaluations. We verified that the chance of suffering a new fall increases for each additional disease of the older adult. In addition, for each point to more on the frail scale, the older adult has a greater chance of falling. On the other hand, for each medication withdrawn, the chance of falling decreases 10%.Conclusion: The fall was associated with clinical factors in older adults, therefore constant evaluations must be carried out to identify this event and its triggers. Objetivo: Analisar os fatores demográficos e clínicos relacionados à queda no idoso que vive no domicílio em um seguimento de cinco anos. Método: Estudo quantitativo e longitudinal retrospectivo realizado entre 2007/2008 e 2013 com 262 participantes brasileiros com idade superior de 65 anos. Foram utilizados os instrumentos de perfil demográfico, Mini Exame do Estado Mental, doenças autorreferidas, quedas e suas características, Escala de Fragilidade de Edmonton, Escala de Lawton y Brody y Medida de Independência Funcional. Realizaram-se análise descritivo, Qui quadrado, Teste de Wilcoxon e prova de modelos mistos. Estudo aprovado pelo comitê de ética.Resultados: A maioria era do sexo feminino, com idade entre 65 e 79 anos, escolaridade entre 1 a 4 anos e aposentados. A prevalência da queda foi de 21,8% e 37,8% em ambas as avaliações. Verificou-se que para cada doença a mais que o idoso sofre, aumenta a chance de sofrer uma nova queda. Ademais, para cada ponto a mais na escala de fragilidade, o idoso apresenta uma maior chance de cair. Por outro lado, para cada medicamento a menos que o idoso utiliza, presenta chance 10% menor de cair.Conclusão: A queda esteve associada a fatores clínicos no idoso sendo necessário que o profissional de saúde realize avaliações constantes com a finalidade de identificar esse evento e seus desencadeantes.

scholarly journals Efficacy of pulmonary rehabilitation in severe and critical-ill COVID-19 patients: a controlled study

2020 ◽  
Author(s):  
Gilbert Büsching ◽  
Zhongxing Zhang ◽  
Jean Paul Schmid ◽  
Thomas Sigrist ◽  
Ramin Khatami
Keyword(s):  
Pulmonary Rehabilitation ◽  
Rating Scale ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Controlled Study ◽  
Control Group ◽  
P Value ◽  
Fisher Exact Test ◽  
Rehabilitation Outcomes ◽  
Critical Ill

AbstractSevere and critical ill COVID-19 patients frequently need acute care hospitalization including mechanical ventilation at ICU due to acute respiratory distress. A high proportion of these patients will develop ICU-acquired weakness and a need for rehabilitation. However data on rehabilitation outcomes in these patients are scarce and the efficacy of rehabilitation remains essentially unclear. We therefore compared the rehabilitation outcomes between COVID-19 patients with pneumonia and other patients with common pneumonia to assess their rehabilitation efficacies.We retrospectively compared the performances of six-min walk test (6MWT), chronic respiratory questionnaire (CRQ), and functional independence measure (FIM) at the discharge from pulmonary rehabilitation between 51 Covid-19 patients and 51 patients with common pneumonia using linear regression controlled for baseline values at entrance, age, sex and cumulative Illness rating scale. Fisher exact test was applied to test whether the odd ratios (ORs) of non-improvement/improvement in 6MWT (>30-m) and CRQ (>10-point) at discharge were different between the two groups.Covid-19 patients had similar performances at discharge in 6MWT (P-value=0.14), CRQ (P-value=0.55), and 4.2-point higher (P-value=0.004) in FIM compared to the control group. No differences in the outcomes were found between severe and critical COVID-19 patients. The OR of non-improvement/improvement in 6MWT was 0.30 (P-value=0.13) between COVID-19 and control groups; but the odd of non-improvement in CRQ tended to be 3.02 times higher (P-value =0.075) in COVID-19 group.In-house rehabilitation is effective and suitable for COVID-19 patients irrespective from disease severity. The discrepancy of high physical improvement and relatively low gains of disease related quality of life compared to control patients with common pneumonia is however remarkable. Further studies need to evaluate whether this discrepancy is an indicator of chronic disease development.

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