scholarly journals Length of Stay in In-Patient Rehabilitation after Stroke in Qatar

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.

Effect of hyponatremia on cancer patients' in-patient rehabilitation length of stay.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20626-e20626
Author(s):  
Megan Nelson ◽  
J. Lynn Palmer ◽  
Jack Brian Fu ◽  
Janet L. Williams ◽  
Rajesh R. Yadav ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Cancer Patients ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Cancer Rehabilitation ◽  
Cancer Center ◽  
Rehabilitation Unit ◽  
Increased Risk ◽  
Patient Groups

e20626 Background: The incidence of hyponatremia in cancer patients has been reported as high as 47%. Hyponatremia is associated with gait and attention impairments, increased falls, increased risk of fractures, and osteoporosis. Our aim is to determine if hyponatremia impact cancer patients’ rehabilitation length of stay, functional outcome, and survival. Methods: Retrospective study was conducted in a tertiary cancer center on two hundreds and ninty-five patients who underwent inpatient cancer rehabilitation between January 27, 2009 through July, 31, 2010. Hyponatremia incidence, rehabilitation length of stay (LOS), functional independence measure (FIM) for ambulation and transfers, and survival information were collected. Results: The incidence of hyponatremia in cancer patients admitted to our inpatient rehabilitation unit was 41.4%. Median rehabilitation LOS for patients with mild (Na 130-134 mEq/L) and moderate-severe (Na<130 mEq/L) hyponatremia was 11 and 15 days, respectively, which was significantly longer than patients with eunatremia (10 days; P = .03). FIM change for ambulation and transfers during inpatient rehabilitation stay was not significantly different, nor was survival significantly different, between different patient groups. Conclusions: A high percentage of patients have hyponatremia upon admission to our inpatient cancer rehabilitation unit, and this is associated with a prolonged rehabilitation LOS.

Severe Disability After Stroke: Outcome After Inpatient Rehabilitation

1999 ◽  
Vol 13 (3) ◽  
pp. 199-203 ◽  
Author(s):  
John G. Schmidt ◽  
Jessie Drew-Cates ◽  
Mary L. Dombovy
Keyword(s):  
Functional Outcome ◽  
Hemorrhagic Stroke ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Efficiency Score ◽  
Poor Functional Outcome ◽  
Rehabilitation Unit ◽  
Home Setting ◽  
Severe Stroke ◽  
Acute Rehabilitation

Objective: To determine the functional outcome following acute rehabilitation of patients with severe and very severe stroke using the Functional Independence Mea sure (FIM). Background: Most patients with severe and very severe stroke are reported in the literature to have a poor functional outcome. However, there are few studies that specifically address severity and their conclusions are confounding. Methods: We retrospectively reviewed charts of 41 consecutive patients with the primary diag nosis of ischemic or hemorrhagic stroke admitted to an inpatient rehabilitation unit with a admission FIM score of <60. Outcome measures included discharge residence, length of stay, and FIM score. Results: Over 63 percent (26 patients) were discharged to home. Discharge mean FIM scores (61.24) were significantly improved over the admission mean FIM (34.12) for self-care, mobility, communication, and social cog nition. The FIM Efficiency score was 0.356/day (mean[FIMdis-FIMadm]/mean LOS) as compared with previous reports of FIM Efficiency of 0.97/day for all stroke. Con clusion: Patients with severe stroke can experience improvement during inpatient rehabilitation and be discharged to a home setting, although the rate of improvement is less than that of more moderate stroke.

scholarly journals Multidisciplinary versus physiotherapy-only weekend rehabilitation: A prospective cohort study

2021 ◽  
Author(s):  
Erin Caruana ◽  
David Rowell ◽  
Suzanne Kuys ◽  
Sandra G. Brauer
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Prospective Cohort ◽  
Functional Independence Measure ◽  
Cost Savings ◽  
Functional Independence ◽  
Historical Control Group ◽  
Historical Control ◽  
Control Group ◽  
Rehabilitation Unit

Abstract Background This study aims to investigate the impact of multidisciplinary Saturday rehabilitation (MSR) on length of stay, functional independence, gait and balance when compared to a 6-day physiotherapy-only service in a pragmatic setting. An economic evaluation of the intervention conducted from the perspective of the healthcare provider is included.Methods A prospective cohort study with a historical control was conducted in an Australian private mixed rehabilitation unit to compare a multidisciplinary and physiotherapy-only 6-day rehabilitation service. Clinical outcomes included the Functional Independence Measure (Motor, Cognitive, Total), gait speed (10 Meter Walk test) and five balance measures (Timed Up and Go test, Step test, Functional Reach, Feet Together Eyes Closed and the Balance Outcome Measure of Elder Rehabilitation). Economic outcomes were rehabilitation unit length of stay and additional treatment costs.Results A total of 366 patients were admitted to the rehabilitation unit over two 20-week periods. The prospective cohort (MSR) had 192 participants and the historical control group (physiotherapy Saturday rehabilitation) had 174 participants). Participants in the historical control group had lower total and cognitive Functional Independence Measure scores (p < 0.078), and generally performed at a lower level on admission gait and balance measures compared to the prospective cohort. More participants in the prospective cohort attended weekend therapy, attending more sessions and spending more time in therapy compared to those in the historical control group (p < 0.012). After controlling for differences in admission Functional Independence Measure scores, length of stay was reduced by 1.39 ± 0.77 days. The economic evaluation estimated cost savings of $1,536 per patient. The largest savings were attributed to neurological patients $4,854. Traumatic and elective orthopaedic patients realised cost savings per admission of $2,668 and $2,180, respectively.Conclusions Implementation of MSR results in a more efficient service, enabling a greater amount of therapy to be provided over a shorter length of stay. The provision of a multi-disciplinary Saturday rehabilitation is potentially cost reducing for the treating hospital.Trial registration not applicable.

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

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

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.

Impact of Nosocomial Infection on Length of Stay and Functional Improvement Among Patients Admitted to an Acute Rehabilitation Unit

2001 ◽  
Vol 22 (02) ◽  
pp. 83-87 ◽  
Author(s):  
Joseph M. Mylotte ◽  
Robin Graham ◽  
Lucinda Kahler ◽  
B. Lauren Young ◽  
Susan Goodnough
Keyword(s):  
Length Of Stay ◽  
Nosocomial Infection ◽  
Functional Status ◽  
Functional Independence ◽  
Functional Improvement ◽  
Multivariate Linear Regression Analysis ◽  
Rehabilitation Unit ◽  
Cord Injury ◽  
Acute Rehabilitation ◽  
First Time

AbstractObjective:To identify factors predictive of length of stay (LOS) and the level of functional improvement achieved among patients admitted to an acute rehabilitation unit for the first time, with special reference to the role of nosocomial infection.Setting:A 40-bed acute rehabilitation unit within a 300-bed, tertiary-care, public, university-affiliated hospital.Study Population:All patients admitted to the unit between January 1997 and July 1998.Design:Prospective cohort study in which demographic and clinical data, including occurrence of nosocomial infection, were collected during the entire unit admission of each patient. Multivariate linear regression analysis was used to identify factors predictive of unit LOS or improvement in functional status as measured by the change in the Functional Independence Measure (FIM) score between admission and discharge (ΔFIM).Results:There were 423 admissions to the rehabilitation unit during the study period, of which 91 (21.5%) had spinal cord injury (SCI) as a principal diagnosis. One hundred seven nosocomial infections occurred during 84 (19.9%) of the 423 admissions. The most common infections were urinary tract (31.8% of all infections), surgical-site (18.5%), andClostridium difficilediarrhea (15%). Only one patient died of infection. After controlling for severity of illness on admission, functional status on admission, age, and other clinical factors, the significant positive predictors of unit LOS were as follows: SCI (P&lt;.001), pressure ulcer (.002), and nosocomial infection (&lt;.001). Significant negative predictors of ΔFIM were age (P&lt;.001), FIM score on admission (&lt;.001), prior hospital LOS (.002), and nosocomial infection (.007).Conclusions:Several variables were identified as contributing to a longer LOS or to a smaller improvement in functional status among patients admitted for the first time to an acute rehabilitation unit Of these variables, only nosocomial infection has the potential for modification. Studies of new approaches to prevent infections among patients undergoing acute rehabilitation should be pursued.

Abstract TP137: Robotic Upper Limb Therapy by a Trained Volunteer on an Inpatient Stroke Rehabilitation Unit

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Lisa Spinelli ◽  
Christine Trudell ◽  
Lisa Edelstein ◽  
Mike Reding
Keyword(s):  
Upper Limb ◽  
Stroke Rehabilitation ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Rehabilitation Unit ◽  
Software Applications ◽  
Upper Limb Function ◽  
Straight Line ◽  
One Step ◽  
Safety Considerations

Introduction: Having a therapist observe patients engaged in Robotic Upper Limb Therapy (RULT) is considered inefficient use of a therapist’s time and skill. We therefore assessed the feasibility of (RULT) administered by a trained volunteer. Methods: The Volunteer had two 30-minute training sessions by an Occupational Therapist (OT) rehearsing the MIT-Manus Planar Upper Limb Robotic software applications, proper positioning of the patient, and device shut-off and safety considerations. Initial patient sessions were supervised by the patient’s OT until the Volunteer demonstrated satisfactory performance. Inpatients on a Stroke Rehabilitation Unit were referred by their OT for RULT if they could initiate horizontal gravity-eliminated movement of the forearm and could follow one step commands. They were enrolled in 25 minute (RULT) sessions based upon the Volunteer’s availability from one to three half-days per week. Functional Independence Measures and Fugl-Meyer Scores were recorded at the time of Stroke Unit Admission by the OT unaware of (RULT) score results. Statistical analyses were performed using SPSS version 11.5 and significance was attributed if p<0.05 using 2-tailed analyses. Results: A total of 28 patients were enrolled in (RULT) but 2 were unable to participate due to pain in the affected upper limb. Participants had a mean of 3 ± 1.5 SD treatments each. Both the patients and volunteer considered their involvement in the program as worthwhile and meaningful. Admission MIT-Manus Adaptive-3 treatment software data showed that the Normalized Jerk+Line+Target (Norm JLT) Score [defined as (Jerk Score/237)+(Deviation from a Straight Line/13)+(Target Distance Error/14)] demonstrated a significant Spearman-rho Correlation with admission Functional Independence Measure (FIM) upper dressing r = -0.56 p=.003; and FIM grooming subscores r = -0.415, p=.035. The Norm JLT score also predicted change in Fugl-Meyer Upper Limb scores from admission to discharge r = - .788, p = 0.000. Conclusions: Robotic Upper Limb Therapy by a trained Volunteer on an inpatient Stroke Rehabilitation Unit is easily administered, is viewed by the patients and volunteer as rewarding, and provides objective measures useful for assessing upper limb function and outcome.

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.

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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