Outcome trends post discharge from inpatient rehabilitation to the community.

PURPOSE: This study provides evidence of the outcome trends following inpatient rehabilitation services. METHODS: The methodology of this study design uses descriptive statistical analysis, paired t-tests, and analysis of variance (ANOVA) to examine multiple variables. This quantitative, non-experimental study describes the research population and the data collection instrument, the inpatient rehabilitation facility patient assessment instrument (IRF PAI), including the Functional Independence Measure (FIM). FINDINGS: Identified trends provide evidence that functional gains of the disabled population were maintained post discharge from an inpatient rehabilitation facility. Demographics, medical information, and discharge information were studied to describe relationships between the discharge information (discharge living setting, discharge with home health services, discharge to the person living with) and maintained functional performance. CONCLUSIONS: This evidence provides essential information for healthcare providers, including nurses, policy makers, and governments regarding functional gains following inpatient rehabilitation, and community discharge trends of people receiving inpatient rehabilitation services. CLINICAL RELEVANCE: The evidence in this study supports that inpatient rehabilitation services should be provided to all persons with disabilities to increase functioning to the greatest level of independence possible. Further evidence-based knowledge regarding the proposed 75% Rule of the Prospective Payment System (PPS) is needed and required, affecting the access and delivery of rehabilitation services. All patients have a right to quality, cost-effective care without restrictions to certain populations to encourage return to community dwelling.

A retrospective study of Cerebrolysin in patients with moderate to severe traumatic brain injury: Cognitive and functional outcomes.

In this retrospective study, we aimed to evaluate the effects of the neurotrophic compound Cerebrolysin on executive, cognitive, and functional performance in patients with traumatic brain injury (TBI) with a highly severe disability level. A total of 44 patients were included in the study, with 33 patients in the control group and 11 patients in the interventional group who received intravenous infusions of 30 mL Cerebrolysin. Both groups received standard rehabilitation therapy following the rehabilitation protocol for patients with TBI at Hospital Clínico Mutual de Seguridad. Functional and cognitive scales were evaluated at baseline, at four months, and at the endpoint of the intervention therapy at seven months (on average). The results revealed a significant improvement in the Cerebrolysin-treated group compared to the control group. Specifically, patients who received Cerebrolysin showed a moderate residual disability and a significant reduction in the need for care. Concerning the promising results and considering the limitations of the retrospective study design, we suggest that randomized controlled studies be initiated to corroborate the positive findings for Cerebrolysin in patients with moderate to severe brain trauma.

Casa Colina Fall Risk Assessment Scale-Revised: Predicting Falls in Inpatient Rehabilitation Facilities.

Objective: To revise the Casa Colina Fall risk assessment scale (CCFRAS) using the new Medicare standards required functional ability quality measures and to assess the sensitivity and specificity of this revised fall risk assessment tool. Design: The Casa Colina Fall risk assessment scale-revised (CCFRAS-R) was assessed both retrospectively and prospectively on consecutive patients at 3 inpatient rehabilitation facilities (IRFs) to determine the sensitivity and specificity of this tool in predicting fall risk. Setting: Three IRFs. Participants: A total of 6253 adult patients (N=6253) admitted to 1 of 3 IRF settings including those with stroke, brain injury, spinal cord injury, and other conditions requiring medical rehabilitation, with mean age of 66 years; 50% were female and 50% were male. Interventions: Not applicable. Main Outcomes: Each IRF quantified the number of falls detected for the patient population under evaluation and determined the site-specific sensitivity and specificity of the CCFRAS-R. Results: Quality measures were analyzed for predicting fall risk using logistic regression analyses and found that impaired toileting hygiene, impaired toilet transfer, impaired chair/bed transfer, and difficulty walking 3 meters were the most significant predictors for falls. The area under the curve was used to determine the cut-off score and new scoring for the revised falls scale. A second data set was used to validate the tool showing a sensitivity and specificity of 0.6 and 0.62, respectively (P=.001). The degree of "agreeability" between the original scale and the revised scale was 0.72. Conclusion: This multi-site data set predicted quality measures for the risk of falling resulting in a revised fall risk assessment scale for IRFs. Evaluation of this revised assessment tool indicates that the CCFRAS-R is effective and broadly generalizable for predicting patients at high risk for falling although the sensitivity and specificity of the tool may vary slightly based on environmental differences and patient acuity.

Clinical characteristics and effects of enzyme replacement therapy with elosulfase alfa in Korean patients with mucopolysaccharidosis type IVA.

Mucopolysaccharidosis type IVA (MPS IVA) is a rare autosomal recessive disorder caused by a deficiency in N-acetylgalactosamine-6-sulfatase, which results in skeletal and connective tissue abnormalities, as well as various non-skeletal manifestations. Although enzyme replacement therapy (ERT) is recommended as the first-line treatment, the outcomes of ERT on bone pathology remain controversial. We report clinical characteristics and outcomes of ERT in 9 patients with MPS IVA (6 males and 3 females) from 7 unrelated families. During ERT, results from pulmonary function tests, echocardiography, the 6-min walk test, and the Functional Independence Measure were monitored biannually. Anthropometric data were compared with previously reported growth charts of subjects with MPS IVA. Among the 9 patients (5 severe, and 4 slowly progressive form), 7 patients (5 severe, 2 slowly progressive) commenced ERT at a median age of 3.8 years (range: 0.8-13.7 years) and were treated for a median duration of 1.9 years (range: 1.2-5.7 years). Mean height standard deviation scores using MPS IVA growth charts were + 0.4 (+0.0 in severe phenotypes) at initiation and + 0.7 (+0.2 in severe phenotypes) at the last follow-up. Four patients with severe phenotypes underwent surgery for cervical myelopathy and 1 patient with a slowly progressive phenotype underwent a bilateral pelvic osteotomy for hip pain during ERT. The parameters of pulmonary and heart function, endurance, and Functional Independence Measure scores were maintained or increased after ERT. Overall, ERT was well tolerated without deterioration of cardiorespiratory and functional outcomes during treatment, although skeletal outcomes, including growth, were limited.

Statistical analysis plan: Early mobilization by head-up tilt with stepping versus standard care after severe traumatic brain injury.

BACKGROUND: Early mobilization on a tilt table with stepping versus standard care may be beneficial for patients with severe brain injury, but data from randomized clinical trials are lacking. This detailed statistical analysis plan describes the analyses of data collected in a randomized clinical feasibility trial for early mobilization by head-up tilt with stepping versus standard care after severe traumatic brain injury. METHODS: Primary feasibility outcomes are the proportion of included participants who were randomized out of all screened patients; the proportion of participants allocated to the experimental intervention who received at least 60% of the planned exercise sessions; and safety outcomes such as adverse events and reactions and serious adverse events and reactions. Exploratory clinical outcomes are suspected unexpected serious adverse reactions; and functional outcomes as assessed by the Coma Recovery Scale-Revised at four weeks; Early Functional Ability Scale and Functional Independence Measure at three months. The description includes the statistical analysis plan, including the use of multiple imputations and Trial Sequential Analysis.

The Serum BDNF Level Offers Minimum Predictive Value for Motor Function Recovery After Stroke.

Brain-derived neurotrophic factor (BDNF) plays an important role in neuroplasticity and neurogenesis following ischemic and non-ischemic brain injury. The predictive value of BDNF for short-term outcome after stroke is controversial. The objective of this study was to investigate the relationship among serum BDNF level, fractional anisotropy (FA), and functional outcome during post-acute stroke rehabilitation. Serum BDNF levels were measured on admission to an acute inpatient rehabilitation hospital. The primary functional outcome was functional independence measure (FIM) motor subscore at discharge. The secondary outcome measures were FIM total score at discharge, FIM motor subscore on admission, length of stay in the hospital, and discharge destination. We investigated the relationship among the level of serum BDNF and FA as well as functional outcome measures. Three hundred forty-eight consecutive stroke subjects were included in the analysis. Serum BDNF levels on admission were statistically but not clinically correlated with FIM motor subscore at discharge (r = 0.173, P = 0.001) and FIM total score at discharge (r = 0.155, P = 0.004). Receiver operating characteristic (ROC) analysis of BDNF as a predictor for FIM motor subscore improvement showed low accuracy of prediction with an area under the curve (AUC) of 0.581 (P = 0.026). Serum BDNF significantly correlated with FA in the high FIM motor group (n = 10, r = 0.609, P = 0.031) but not in the low FIM motor group (n = 11, r = - 0.132, P = 0.349). The serum BDNF level alone offers minimum predictive value for recovery of motor function during post-acute rehabilitation. Our findings suggest that serum BDNF level may be correlated with FA.

Rupture of a non-traumatic anterior communicating artery aneurysm: Does location of aneurysm associate with functional independence following post-acute in-patient neurorehabilitation?

OBJECTIVE: Patients with non-traumatic rupture of an aneurysm located at the anterior communicating artery (ACoA) often experience cognitive disabilities. It is unknown whether location of aneurysm also affects the possibility for improvement in functional independence compared to patients with an aneurysmal subarachnoid hemorrhage (a-SAH) located elsewhere. The aim was to explore the association between location of aneurysm (ACoA versus other) and level of functional independence, measured by Functional Independence Measure (FIM), at discharge from rehabilitation. Additionally, age and FIM at admission were explored. METHOD: Historical cohort study among 107 patients with a-SAH based on data from a clinical database and a population-based register. Data were analyzed using multivariable logistic regression. RESULTS: Patients with ACoA were admitted with poorer cognitive FIM (median 6 (IQR 5-14) compared to patients with aneurysms located elsewhere (median 12 (IQR 6-23) (p = 0.0129); no difference at discharge. No association between aneurysm location and functional independence was observed. Higher age was associated with poorer outcome in bowel management OR 0.54 (95% CI 0.31-0.92), bladder management OR 0.59 (95% CI 0.35-0.98), comprehension OR 0.53 (95% CI 0.30-0.94), and memory OR 0.48 (95% CI 0.25-0.93). Overall, FIM at admission was associated with functional independence at discharge with the exception of stair walking and bladder management which did not reach statistical significance. CONCLUSION: ACoA was not associated with poorer level of functional independence compared to patients with a-SAH located elsewhere. Higher age was associated with poorer outcome in continence, comprehension, and memory, whereas higher FIM was associated with better functional independence across items at discharge.