Functional outcomes by age after inpatient stroke rehabilitation in Saudi Arabia.

BACKGROUND: Among various risk factors, age has been identified as a nonmodifiable risk factor for stroke that influences functional outcomes after inpatient stroke rehabilitation in the developed world as well as in Saudi Arabia (SA). The demand for inpatient stroke rehabilitation services increases with population aging and stroke incidence; however, these services are limited in SA. OBJECTIVE: To examine functional outcomes by age after inpatient stroke rehabilitation in SA. PATIENTS AND METHODS: Data from 418 patients with stroke who underwent inpatient stroke rehabilitation at the King Fahad Medical City-Rehabilitation Hospital, Riyadh, SA, between November 2008 and December 2014 were collected from electronic medical records. According to the patients' age, we classified participants into two groups: adults, aged <65 years (n=255), and older adults, aged ≥65 years (n=163). All patients' functional statuses at admission and discharge from inpatient stroke rehabilitation were assessed using the functional independence measure (FIM) scale. RESULTS: The mean age was 59.9 years (SD =9.4). Older adults had significantly smaller changes in functional outcome from admission to discharge on both the total FIM (23 [SD =15.9]) and the motor FIM (21 [SD =15.4]), and they were significantly less independent (36%) compared to adults. In the adjusted models, older adults had significantly lower scores than adults, by 11 points (p<0.0001) for the total FIM score and by 10 points (p<0.0001) for the motor FIM subscale score. There was no significant change with age in the cognitive FIM subscale score. CONCLUSION: After inpatient stroke rehabilitation, older adults had limited functional outcomes or were less independent than adults. However, the clinical relevance of this finding is questionable, so there is currently no justification to deny patients access to intensive stroke rehabilitation solely because of advanced age. Future large-scale research is needed to confirm rehabilitation outcomes by including confounders such as social support, socioeconomics, comorbidities, and the patient's opinion after rehabilitation.

Association Between Lower Extremity Performance and Health-Related Quality of Life in Elderly Mexican Americans.

OBJECTIVE: To examine the longitudinal association between levels of lower extremity performance (LEP) and health-related quality of life (HRQoL) in older Mexican Americans aged 72 years or older participating in the Hispanic Established Population for the Epidemiological Study of the Elderly (2000-2006). METHOD: LEP was measured in 621 non-institutionalized participants with the Short Physical Performance Battery (SPPB). Participants were divided into high (SPPB score 10-12), intermediate (SPPB score 7-9), and low (SPPB score 0-6) groups based on LEP. HRQoL was assessed using the Medical Outcomes Study Short Form (SF-36), which includes a Physical Composite Scale (PCS) and a Mental Composite Scale (MCS). RESULTS: Participants in the high LEP group had slower rates of decline in the PCS, and those in the intermediate LEP group had slower rates of decline in the MCS score over time. DISCUSSION: Increased LEP was associated with slower rates of decline in physical and mental HRQoL in older Mexican Americans.

Trajectories in functional recovery for patients receiving inpatient rehabilitation for unilateral hip or knee replacement.

The purpose of this study was to explore trajectories of recovery in patients with lower extremity joint replacements receiving post-acute rehabilitation. A retrospective cohort design was used to examine data from the Uniform Data System for Medical Rehabilitation (UDSMR®) for 7434 patients with total knee replacement (TKR) and 4765 patients with total hip replacement (THR) who received rehabilitation from 2008 to 2010. Functional Independence Measure (FIM)™ instrument ratings were obtained at admission, discharge, and 80-180 days after discharge. Random coefficient regression analyses using linear mixed models were used to estimate mean ratings for items within the four motor subscales (self-care, sphincter control, transfers, and locomotion) and the cognitive domain of the FIM instrument. Mean improvements at discharge for motor items ranged from 1.16 (95% confidence interval [CI]: 1.14, 1.19) to 2.69 (95% CI: 2.66, 2.71) points for sphincter control and locomotion, respectively. At follow-up mean motor improvements ranged from 2.17 (95% CI: 2.15, 2.20) to 4.06 (95% CI: 4.03, 4.06) points for sphincter control and locomotion, respectively. FIM cognition yielded smaller improvements: discharge=0.47 (95% CI: 0.46, 0.48); follow-up=0.83 (95% CI: 0.81, 0.84). Persons who were younger, female, non-Hispanic white, unmarried, with fewer comorbid conditions, and who received a TKR demonstrated slightly higher functional motor ratings. Overall, patients with unilateral knee or hip replacement experienced substantial improvement in motor functioning both during and up to six months following inpatient rehabilitation.

Are physical therapy interns competent in patient management skills? Assessment of the views of clinical and academic physical therapists.

[Purpose] This study aimed at evaluating PT interns' performance from the perspectives of clinical and academic physical therapists (PTs). [Methods] An online questionnaire based on a modified version of the Clinical Internship Evaluation Tool (CIET) was used to evaluate PT interns' performance in patient management skills. Assessors comprised clinical and academic PTs from Saudi Arabia. The survey aimed at assessing the competency of interns in 25 patient management skills comprising four major domains: clinical examination, patient evaluation, diagnosis and prognosis, and intervention. Assessors were also asked to rank the importance of possessing each skill and evaluating the internship programs at their facilities. A multivariate logistic regression analysis assessed whether the demographic variables between the two groups influenced their views. [Results] A total of 148 participants (112 clinical PTs and 36 academic PTs) responded to the survey. The majority of the participants agreed that interns were competent in all 25 skills. Differences between the two groups of assessors were observed for five out of the 25 skills. Interestingly, skills with the highest means were perceived as the most important skills by both groups of assessors. There was no association between sociodemographic variables and evaluation scores. [Conclusion] There were no differences observed between clinical and academic PTs in their evaluation of PT interns in 20 of the 25 clinical skills. There were indications of a need for further improvement in certain competencies and skills such as clinical examination, evaluation, diagnosis and prognosis, and intervention.