The association between hand grip strength and rehabilitation outcome in post-acute hip fractured patients.

PURPOSE: Various factors have been shown to affect the rehabilitation outcome of hip fractured patients. Considering the decrease in muscle mass with aging and its impact on mobility, we hypothesized that a relationship exists between hand grip strength and rehabilitation outcome. METHODS: We retrospectively studied 373 post-hip fracture patients, admitted for rehabilitation. Muscle strength was measured by hand grip dynamometer. MAIN OUTCOME MEASURES: functional independence measure motor functional independence measure, motor functional independence measure effectiveness and length of stay). A favorable functional gain was defined as a motor Functional Independence Measure effectiveness score > 0.5. The Spearman correlation assessed the associations between hand grip strength and outcome measures. A multiple linear regression model tested whether hand grip strength was an independent predictor of discharge motor Functional Independence Measure scores and length of stay RESULTS: Significant correlations were found between hand grip strength and functional outcomes. A significant independent association was found between hand grip strength and discharge motor Functional Independence Measure score after adjustment for confounding demographic and clinical variables. High hand grip strength on admission was significantly associated with a greater chance of achieving a favorable functional gain (OR 1.064, 95% CI, 1.01-1.13; p = 0.032). Hand grip strength was not found to be associated with length of stay. CONCLUSION: Hand grip strength is independently associated with rehabilitation outcome in post-acute frail hip fractured patients. Initial screening for hand grip strength on admission may help identify patients who require an intensive resistance exercise program.

Measuring rehabilitation outcome in post-acute hip fractured patients.

PURPOSE: To present our experience in measuring rehabilitation achievements of post-acute hip fractured patients with the FIM instrument; assess its appropriateness as to the patients' various disability levels and describe our experience with other measuring tools in patients less sensitive to changes in the FIM instrument. METHODS: A retrospective study performed in a post-acute geriatric rehabilitation center. Three hundred and eighty-seven hip fractured patients admitted from January 2010 to May 2012 were included in this study. Patients were evaluated by the Functional Independence Measure (FIM), the Timed Get Up and Go (TUG) test and "bed to chair" transfer FIM parameter. The study population was divided into three disability groups according to their admission disability level: high (admission FIM score <40), moderate (FIM 40-79) and low (FIM ≥ 80). The Mann-Whitney U, ANOVA and Chi square tests analyzed the data. RESULTS: The FIM instrument was found most sensitive in identifying functional change in patients with moderate disability. Low disability patients received more physio- and occupational-therapy treatment time, yet achieved a lower mean FIM score change compared to moderately disabled patients. The smallest real difference (SRD = 13) for the FIM score was achieved by 60% of patients with moderate disability. When assessed by the TUG test, most patients (94%) improved their score. The SRD% of 31% was achieved by 71.7% of the patients. Nineteen patients (35.9%) achieved a discharge score of <20 s. The high disability group achieved the lowest mean FIM score change. On admission, 52/64 (81%) patients required considerable help in transferring from bed to chair (FIM 1-2), however, upon discharge, the majority (69.2%) improved to the level of a one man transfer (FIM ≥ 3). Forty-one (64.1%) patients were discharged home. CONCLUSION: Post-acute hip fracture patients exhibit variable functional ability. Assessing rehabilitation achievements with a disability measure is limited; therefore, it is advisable to use an instrument most suitable to the patients' disability level.

Motor imagery practice for improving sit to stand and reaching to grasp in individuals with poststroke hemiparesis.

BACKGROUND: Motor imagery practice refers to the mental rehearsal of motor acts in the absence of actual movement production. PURPOSE: To evaluate the effect of motor imagery practice on the performance of sit to stand (STS) and reaching to grasp in subjects with post stroke chronic hemiparesis. METHOD: The study was designed as a crossover intervention. Participants were 13 individuals (mean age, 68.9 [±4.9] years) with chronic hemiparesis enrolled in a day center at the Bet-Rivka Rehabilitation Hospital in Petach Tikvah, Israel. Following 1 week of baseline measurements of the performance of STS and reaching to grasp, these functions were mentally practiced for 15 minutes 3 times a week for 4 weeks. Half of the subjects mentally practiced STS, while the other half practiced the reaching imagery protocol. Subsequently, the participants in each group crossed over to practice the second function for the next 4 weeks. All practice sessions were performed according to a pre-established protocol under supervision. Measurements of real performance took place twice before and twice immediately following each practice session. For STS, the Tetrax Balance System was used to measure the speed of performance and weight distribution between the legs. Reaching to grasp was appraised via a "kinematic" glove and included speed variables of the hand. RESULTS: A significant decrease was found in the values of STS duration. Weight distribution between the legs was not affected by the intervention. For reaching to grasp, a significant improvement was found in the mean and the maximum reaching velocity. CONCLUSIONS: In individuals with chronic hemiparesis, the imagery practice of meaningful motor tasks can positively affect real performance.

Use of a device to support standing during a physical activity program to improve function of individuals with disabilities who reside in a nursing home.

PURPOSE: To demonstrate the feasibility of an innovative program of physical activity using a standing-support device targeted towards adult residents of a nursing home who are unable to transfer or stand independently. METHOD: Intervention study. PARTICIPANTS: Thirteen residents, age 82 +/- 11 years, at the Beit Bayer Nursing Home, Jerusalem, Israel, who were unable to transfer or stand independently. INTERVENTION: Eight-week observational period followed by 12-week physical activity performed while standing in a Standing-Support Device. MEASUREMENTS: Manual Muscle Testing, joint range of motion, forward and lateral reach, time to stand independently, distance walked with a walker, Functional Independence Measure. RESULTS: Compared to the observational period, significant post-intervention improvements were noted particularly in lower extremity muscle strength. Improvements in the Functional Independence Measure were noted in sphincter control, locomotion, mobility, motor score, and total score. Over 60% of those previously requiring assistance in standing became able to stand for an average of 1 min unassisted and walk an average of 14 m with a walker. CONCLUSION: A pilot program of physical activity using a Standing-Support Device is feasible in selected stance-disabled older adult nursing home residents. Participants showed evidence of muscle strength and functional improvement. Future studies of the device with a concurrent examination of healthcare costs, functional improvement, and staff burden, are recommended.