Outcomes in total knee arthroplasty patients after inpatient rehabilitation: influence of age and gender

OBJECTIVES: To examine age and gender effects on outcomes after inpatient rehabilitation in primary total knee arthroplasty (TKA) and revision TKA patients. DESIGN: This retrospective, comparative study was conducted in a 50-bed, university-affiliated rehabilitation hospital. Patients included primary TKA patients (n = 286) and revision TKA patients (n = 138) placed into one of three age brackets: <60 yrs, 60-70 yrs, or >70 yrs. Measurements included length of stay (LOS), FIM scores, hospital charges, and discharge disposition location. RESULTS: FIM scores improved from admission to discharge in both primary and revision patients (P = 0.015). LOS was shorter in primary than revision patients (8.3 vs. 10.4 days, P = 0.001), and the LOS was longest in patients >70 yrs compared with those <60 or 60-70 yrs (10.6 vs. 8.7 and 8.8 days, respectively; P = 0.004). FIM efficiency was greater in primary than in revision TKA patients (3.68 vs. 2.77 points/day, P = 0.001), and greater for men than women in each age bracket regardless of TKA type (3.68 vs. 2.78 points/day, P = 0.001). Total hospital charges were lower for men than women for both TKA types ($9,656 +/- 823 vs. $11,544 +/- 1,359; P = 0.015), and were highest in patients >70 yrs of age (P = 0.015). CONCLUSIONS: Primary and revision TKA patients make improvements in functional independence during inpatient rehabilitation. Although FIM gains were similar among age and gender groupings, FIM efficiency is lowest in women. Despite similar daily hospital costs among the groups, slower progress with functional gains (decreased FIM efficiency) increases the LOS and total hospital charges, especially in older women.     

Sex and age effects on outcomes of total hip arthroplasty after inpatient rehabilitation

OBJECTIVE: To retrospectively examine the effects of sex and age on the inpatient rehabilitation outcomes of patients after total hip arthroplasty (THA). DESIGN: Exploratory, retrospective study. SETTING: A university-affiliated rehabilitation hospital. PARTICIPANTS: Male and female THA patients (N=332) were stratified into age brackets (<65y, 65-84y, >or=85y). All patients completed interdisciplinary inpatient rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Length of stay (LOS), FIM instrument scores, FIM efficiency (FIM/LOS), hospital costs, and discharge disposition location were collected by chart review. RESULTS: Regardless of age, women had lower FIM scores at admission and discharge than men (P<.05). FIM efficiency was 22% to 53% lower for women in primary THA and 16% to 85% lower in revision THA than men (P=.001). Women accrued higher total hospital charges than men (13,099 dollars vs 11,141 dollars; P<.05), and were discharged home less frequently than men (84.4% vs 90.9%; P<.05). Admission FIM scores were 10.6% and 8.9% lower and discharge FIM scores were 7.3% and 9.2% lower in patients 85 years or older than those less than 65 or 65 to 84 years (P<.01). FIM efficiency was 25% to 38% higher in patients less than 85 years than those 85 years and older (P=.015), and 37% higher in men than women (P=.001). Patients 85 years and older were discharged less frequently to home than patients less than 85 years (P<.05). CONCLUSIONS: All patients made functional improvement after inpatient rehabilitation, but women and patients 85 years and older had longer LOS and lower FIM efficiency, incurred greater hospital charges, and were less likely to be discharged to home than men and younger counterparts.     

Influence of admission hematocrit on inpatient rehabilitation outcomes after total knee and hip arthroplasty

OBJECTIVE: To examine admission hematocrit (Hct) status on inpatient rehabilitation outcomes after total knee (TKA) and hip arthroplasty (THA). DESIGN: This study was a retrospective, exploratory analysis. Patients (n = 400) were stratified by admission hematocrit levels: normal (Hct >or=36-41%, World Health Organization criteria for normal Hct in women and men), low (Hct between the operational 30% cutoff and 36-41%), and very low (Hct <30%). Functional Independence Measure (FIM) scores and specific lower-body FIM motor scores, FIM efficiency, length of stay (LOS), and total hospital charges were analyzed. RESULTS: Regardless of arthroplasty joint, all improved total FIM score, motor FIM score, and specific lower-body activity FIM scores (walking, wheelchair, dressing, transfers, stairs) by discharge (all P < 0.05). LOS was 28.9-31% longer in the TKA-very low Hct and THA-very low Hct groups than in the normal Hct groups (P = 0.026). Total hospital charges were 32.6-45.6% higher in the TKA-very low Hct and THA-very low Hct groups than in the normal Hct groups (P < 0.05). Hct was a significant contributor to the variance of linear regression models for LOS and total charges (P < 0.05). CONCLUSIONS: Although very low Hct at admission does not impede functional gains, it is related to longer LOS and greater hospital charges. Rehabilitation teams should consider this when preparing plans of care, rehabilitation goals, and plans for discharge.     

Effect of obesity on inpatient rehabilitation outcomes following total knee arthroplasty

OBJECTIVES: To examine obesity effects on outcomes following inpatient rehabilitation in patients following primary total knee arthroplasty or revision total knee arthroplasty. DESIGN: Retrospective, comparative study. SETTING: Fifty-bed, university-affiliated rehabilitation hospital. PATIENTS: Obese (N = 139; body mass index >30 kg/m(2)) and non-obese (N = 146; body mass indexB <30 kg/m(2)) total knee arthroplasty patients. Participants were further stratified based on total knee arthroplasty type, primary and revision for a total of four groups. INTERVENTION: Interdisciplinary inpatient rehabilitation. MAIN MEASURES: Range of motion, length of stay, Functional Independence Measure (FIM) scores, FIM efficiency scores, total and daily hospital charges, and discharge disposition location. RESULTS: Range of motion and FIM scores improved from admission to discharge in both obese and non-obese patients regardless of total knee arthroplasty type. FIM efficiency was lower in revision than primary total knee arthroplasty (2.8 versus 3.6 patients/day; P < 0.005) but not different between obese and non-obese groups. Total hospital charges were lower for the primary than for the revision patients (P < 0.05), but were directly related with body mass index (r = 0.140, P < 0.05). Discharge disposition locations were not different among groups. CONCLUSION: Rehabilitation teams can expect comparable gains between obese and non-obese patients following total knee arthroplasty, but at a greater expense.     

Outcomes after inpatient rehabilitation of primary and revision total hip arthroplasty

OBJECTIVE: To compare the outcomes of patients who have gone to inpatient rehabilitation after primary total hip arthroplasty (THA) and revision THA. DESIGN: Retrospective, comparative study. SETTING: Fifty-bed freestanding, university-affiliated rehabilitation hospital. PARTICIPANTS: Two hundred fifty-five male and female primary THA patients and 147 male and female revision THA patients. INTERVENTION: Interdisciplinary inpatient rehabilitation. MAIN OUTCOME MEASURES: Length of stay (LOS), FIM instrument score and FIM motor score components, hospital charges, and discharge disposition location. RESULTS: FIM scores improved from admission to discharge by 29.7 and 27.9 points for the primary THA and revision THA groups, respectively (P<.05). LOS was shorter for primary THA patients compared with revision THA patients (10.0d vs 11.5d, P<.05). FIM efficiency (DeltaFIM/LOS) was greater for primary THA compared with revision THA (3.4 and 2.7 points/day, P<.05). Total rehabilitation hospital charges were 11,421 US dollars and 13,707 US dollars for the primary and revision THA groups, respectively, with the mechanical and infection revision THAs incurring the greatest charges (14,596 US dollars and 15,386 US dollars, respectively; P<.001). Compared with primary THA, revision THA patients were twice as likely to be discharged to locations other than home. CONCLUSIONS: FIM score improvement was lower and LOS and hospital charges were greater in revision THA than in primary THA after rehabilitation. Infection revision THA patients gained less functional independence and were discharged home less often than mechanical or pain revision THA patients; finally, infection and mechanical revision THA accrued the highest hospital charges.     

Association between body mass index and functional independence measure in patients with deconditioning

OBJECTIVE: To assess the association of body mass index (BMI) with functional independence measure (FIM) score in patients with deconditioning. We also examined whether the association was different for motor and cognitive subscales of the FIM instrument. DESIGN: A retrospective study of 1077 inpatients admitted to the general medicine service for deconditioning at an acute rehabilitation hospital. Patients were classified into underweight (BMI < 18.5), normal range (BMI = 18.5-24.9), overweight (BMI = 25.0-29.9), obese class I (BMI = 30.0-34.9), obese class II (BMI = 35.0-39.9), and obese class III (BMI > or = 40). RESULTS: Median gain in FIM scores from admission to discharge was highest in obese class I patients (27 points), followed by obese class II patients (26 points). The most gain in FIM scores was accounted for by the motor subscale. Adjusting for age, gender, and length of in-hospital stay, obese class I patients had a 5.8-point (95% confidence limits = 1.2, 7.0) higher gain in FIM score compared with patients with BMI in the normal range. CONCLUSIONS: In an acute rehabilitation setting, obese patients had higher gains in FIM scores as compared with normal-range-BMI patients. Most of the improvements in FIM scores were accounted for by the motor subscale, with little or no improvement on the cognitive scale.     

Poster 7: Impact of balance deficits after traumatic brain injury on inpatient rehabilitation functional outcome: a multicenter study

Objective: To evaluate how sitting and standing balance ratings of patients with traumatic brain injury (TBI) on admission to rehabilitation impacts functional outcome, rehabilitation charges, and rehabilitation length of stay (LOS). Design: Multicenter analysis of consecutive admissions to designated Traumatic Brain Injury Model Systems (TBIMS). Setting: TBIMS centers. Participants: 908 adults with TBI were included in the study. Interventions: Not applicable. Main Outcome Measure: FIM™ instrument admission and discharge scores, FIM change and efficiency; rehabilitation LOS and charges; and discharge disposition. Results: Persons with grossly impaired sitting balance on admission to rehabilitation had lower discharge FIM scores and greater rehabilitation charges than those with normal or mildly impaired sitting balance. Persons with mildly impaired sitting balance had lower discharge FIM scores and greater rehabilitation charges than those with normal sitting balance. Subjects with grossly impaired standing balance compared with normal or mildly impaired standing balance had greater rehabilitation charges and LOS and lower discharge FIM scores and FIM efficiency. Subjects with grossly impaired balance on admission to rehabilitation had significantly lower motor FIM items compared with those who had normal or mildly impaired balance. Subjects with grossly impaired sitting balance were discharged from rehabilitation to someplace other than their home more than twice as often as those with normal sitting balance (11.7% vs 23.3%). Subjects with grossly impaired standing balance were discharged from rehabilitation to someplace other than their home more than 3 times as often as subjects with normal standing balance (6.7% vs 21.5%). Conclusion: In patients with TBI, sitting and standing balance ratings on admission to rehabilitation are useful indicators of functional impairment and not returning home at discharge from rehabilitation.     

全髋膝关节置换术后患者急性疼痛比较及影响因素分析

目的比较全髋关节置顶(THA)及全膝关节置换(TKA)术后急性疼痛的程度,探索THA及TKA术后急性疼痛可能的影响因素。方法选取2014年10月-2015年4月在我院行THA及TKA的患者各60例,收集患者的年龄、性别、体质量指数(BMI)、手术侧别及麻醉分级等资料,并在术前24h及术后24h、2d、3d、5d对手术关节静息及行走疼痛进行VAS评分,比较两组患者术后急性疼痛程度并分析其可能的影响因素。结果 THA及TKA组患者的年龄、手术侧别及麻醉分级差异无统计学意义(P0.05),但TKA组女性患者所占比例及BMI均高于THA组(P0.05)。TKA组术后第3天静息VAS评分低于THA组(P0.05),其余时间点两组差异无统计学意义(P0.05)。TKA组各时间点行走VAS评分均高于THA组,差异有统计学意义(P0.05)。不同性别及手术侧别VAS评分差异均无统计学意义。年龄、BMI及ASA分级与静息VAS评分无相关性,年龄与行走VAS评分也无相关性,但BMI与各时间点行走VAS评分呈正相关(P0.05),ASA分级与术后第1天行走VAS评分呈负相关(P0.05)。结论 TKA患者术后急性疼痛程度高于THA患者,BMI与术后急性疼痛程度呈正相关,术前控制体质量对减轻THA、TKA术后急性疼痛有重要意义。     

Absence of combined effects of anemia and bilateral surgical status on inpatient rehabilitation outcomes following total knee arthroplasty

Purpose.?To examine the effects of anemia on inpatient rehabilitation outcomes following unilateral and bilateral total knee arthroplasty (TKA).

Method.?This was a multicenter, retrospective study from 15 inpatient rehabilitation facilities. Patients (N?=?5421) with very low hematocrit (Hct?<30%), low Hct (30–36% women, 30–41% men), or normal Hct (>36% women, 41% men) were included. Inpatient rehabilitation occurred following TKA. Functional independence measure (FIM) scores, length of stay (LOS), itemized hospital charges, discharge destination were main outcomes.

Results.?LOS was 13% longer and hospital charges were 12.5–18.0% higher in the very low Hct than remaining groups (p?=?0.0001). The FIM score and subscores for walking, stair climbing, bathing, transfers, and dressing changes were comparable for all Hct groups for the overall score. Hct?<30% did not correspond to worse outcomes in patients with bilateral surgeries compared with unilateral surgeries; total FIM scores improved 47–53% across all Hct groups, regardless of bilateral surgical status. Discharge to home ranged 92.6–94.7% across all Hct groups (p?>?0.05).

Conclusions.?Rehabilitation teams can expect comparable functional improvements and discharge to home in anemic and non-anemic patients with either unilateral or bilateral surgeries without hematologic correction in the rehabilitation setting, but might need an additional day to accomplish these outcomes.     

Low ejection fraction: effect on the rehabilitation progress and outcome of stroke patients

OBJECTIVE: To determine the effect of low ejection fraction (35%). DESIGN: A retrospective chart review of the 332 stroke patients admitted to the inpatient rehabilitation unit of an acute tertiary general hospital during a 36-mo period. A total of 262 (79%) of these patients (126 men and 136 women) had an ejection fraction study performed and are the subjects of this analysis. They were classified into two groups: low ejection fraction (n = 36) and high ejection fraction (n = 226). The main outcome measures included discharge total FIM score, FIM gain, FIM efficiency, length of stay, and discharge disposition. RESULTS: Patients with low ejection fraction had lower discharge FIM scores (82.9 vs. 89.1, t = 2.09, P < 0.04), lower FIM gain (15.9 vs. 19.3, t = 1.99, P < 0.05), and lower FIM efficiency (1.2 vs. 1.7, t = 232, P < 0.03), and they were less likely to return home (69% vs. 85%, chi 2= 5.25, P < 0.04) as compared with patients with high ejection fraction. Lengths of stay were not significantly different between the two groups. CONCLUSION: Compared with patients in the high ejection fraction cohort, the low ejection fraction subjects had lower discharge FIM scores, FIM gains, and FIM efficiency. However, almost 70% progressed well enough to be discharged to home. Low ejection fraction in stroke patients may well serve as an indicator of a patient population with greater medical and social needs.     

The impact of patient's weight on post-stroke rehabilitation

Purpose To evaluate the influence of patient’s weight on rehabilitation outcomes in first-event stroke patients. Design Retrospective, observational comparative study. 102 first-time stroke male and female patients admitted to the 52-bed neurology rehabilitation department in a rehabilitation hospital were included in the study. Body mass index (BMI), Functional Independence Measure (FIM) on admission and at discharge, as well as the delta-FIM (FIM on admission – FIM at discharge) were evaluated. The Kruskal–Wallis test was used to compare the FIM and the NIHSS scores between BMI groups (normal, overweight, moderate and severe obesity). Results A statistically significant negative correlation (rho?=??0.20, p?=?0.049) was found between FIM change and BMI, that remained significant after adjustments for age, sex and hospitalisation days. No difference was found between groups in FIM or NIHSS change between BMI groups. Conclusions In sub-acute post-stroke patients undergoing rehabilitation in rehabilitation hospital, BMI was negatively associated with the improvement of functional parameters. Patients’ BMI should be taken into consideration when predicting rehabilitation outcome for stroke patients. Further investigations are needed to identify the functional parameters affected by the patients’ BMI.

• Implications for Rehabilitation

• In sub-acute post-stroke patients undergoing rehabilitation in rehabilitation hospital, BMI was negatively associated with the improvement of functional parameters.

• Patients’ BMI should be taken into consideration when predicting rehabilitation outcome for stroke patients.

• New rehabilitation strategies should be designed to improve the functional outcomes of rehabilitation of obese patients.

     

Influence of admission functional status on functional change after stroke rehabilitation

OBJECTIVE: To determine whether the admission functional score influences the functional change after stroke rehabilitation. DESIGN: Two hundred forty-three patients who had received the Functional Independence Measure (FIM) assessment at admission and at discharge were enrolled in the study. The patients were stratified into three groups according to their FIM total scores at admission, i.e., < or =36, 37 to 72, and > or =73. RESULTS: The Scheffé's multiple comparison test showed that patients with FIM total scores of > or =73 at admission were significantly younger (58 +/- 11 [SD] yr) than those who had scores of 37 to 72 (64 +/- 11 yr) or < or =36 (66 +/- 12 yr). Patients with FIM total scores of 37 to 72 at admission showed significantly higher FIM gain (37 +/- 15) compared with those patients who had scores of > or =73 (20 +/- 10) or < or =36 (29 +/- 23). CONCLUSION: The functional levels of affected patients at admission stratified by the FIM scale roughly predict the degree of functional gain after rehabilitation in survivors with a first episode of ischemic stroke. Moderately affected patients will benefit from intensive rehabilitation. These findings may be useful for rehabilitation triage.     

Venous thromboembolism in a rehabilitation setting after major lower-extremity amputation

OBJECTIVE: To determine the prevalence of venous thromboembolic disease (VTED) and impact on functional outcome in patients with major lower-extremity (LE) amputation admitted to an inpatient rehabilitation unit. DESIGN: Retrospective medical records review. SETTING: Acute inpatient rehabilitation unit in a tertiary, urban academic medical center. PARTICIPANTS: Fifty consecutive patients admitted to an acute inpatient rehabilitation unit after a major LE amputation. Participants were screened at rehabilitation admission for LE deep vein thrombosis using duplex ultrasonography. INTERVENTIONS: Not applicable.Main outcome measures VTED incidence, FIM instrument, total rehabilitation charges, and length of stay (LOS). RESULTS: Six of 50 patients (12%) had evidence of VTED. The VTED cohort had significantly lower admission and discharge FIM scores than the no-VTED cohort (admission FIM score, 57.2 vs 76.0; discharge FIM score, 66.0 vs 90.1, respectively; P< or =.02). Subjects with VTED had a longer rehabilitation LOS (22.8d vs 13.9d, respectively; P=.02) and higher total rehabilitation charges (28,314 US dollars vs 17,724 US dollars, respectively; P<.05). CONCLUSIONS: In this study, VTED prevalence after LE amputation in a rehabilitation setting was 12%. Subjects with VTED had lower admission and discharge functional status, longer LOS, and higher hospital charges. The utility of screening duplex ultrasound examinations at rehabilitation admission remains unclear.     

Examination of follow-up therapy in patients with stroke

OBJECTIVE: Examine the patterns and effect of follow-up therapy for persons with stroke. DESIGN: Retrospective analysis of national inpatient medical rehabilitation facilities and follow-up survey data from 1994 to 2001. A total of 45,164 patients received inpatient medical rehabilitation after a stroke. The mean age (+/- standard deviation) was 69.5 (+/-12.8) yrs, 48% were women, and 77% were non-Hispanic white. Average length of stay was 21.9 (+/-14.2) days. RESULTS: The highest gain in FIM instrument ratings for follow-up therapy was associated with a discharge FIM rating of > or =65. Patients with FIM ratings > or =65 at discharge who received follow-up therapy gained an average of 19.4 points between discharge and follow-up assessment compared with a mean gain of 15.1 points for persons who did not receive follow-up therapy. Validity was examined using 100 bootstrap replications. The percentage of persons with FIM instrument scores of > or =65 receiving follow-up therapy increased from 38% in 1994 to 58% in 2001. CONCLUSIONS: The differences in postdischarge FIM gains between patients with and without follow-up therapy were greatest among patients with discharge FIM instrument ratings of > or =65. Compared with patients whose discharge FIM ratings were >65, patients with discharge FIM scores of > or =65 who underwent follow-up therapy demonstrated substantially greater average postdischarge FIM gains than those with FIM ratings of >65.     

Nontraumatic vs. traumatic spinal cord injury: a rehabilitation outcome comparison

OBJECTIVE: Nontraumatic spinal cord injury (SCI) represents a significant proportion of individuals admitted for SCI rehabilitation; however, there is limited literature regarding their outcomes. As our society continues to age and nontraumatic injuries present with greater frequency, further studies in this area will become increasingly relevant. The objective of this study was to compare outcomes of patients with nontraumatic SCI with those with traumatic SCI after inpatient rehabilitation. DESIGN: A longitudinal study with matched block design was used comparing 86 patients with nontraumatic SCI admitted to a SCI rehabilitation unit and 86 patients with traumatic SCI admitted to regional model SCI centers, controlling for age, neurologic level of injury, and American Spinal Injury Association impairment classification. Main outcome measures included acute and rehabilitation hospital length of stay, FIM scores, FIM change, FIM efficiency, rehabilitation charges, and discharge-to-home rates. RESULTS: Results indicate that when compared with traumatic SCI, patients with nontraumatic SCI had a significantly (P < 0.01) shorter rehabilitation length of stay (22.38 vs. 41.35 days) and lower discharge FIM scores (57.3 vs. 65.6), FIM change (18.6 vs. 31.0), and rehabilitation charges ($25,050 vs. $64,570). No statistical differences were found in acute care length of stay, admission FIM scores, FIM efficiency, and community discharge rates. CONCLUSIONS: The findings indicate that patients with nontraumatic SCI can achieve rates of functional gains and community discharge comparable with traumatic SCI. Whereas patients with traumatic SCI achieved greater overall functional improvement, patients with nontraumatic SCI had shorter rehabilitation length of stay and lower rehabilitation charges. These findings have important implications for the interdisciplinary rehabilitation process in the overall management and outcome of individuals with nontraumatic SCI.     

Vitamin D status of patients admitted to a hospital rehabilitation unit: relationship to function and progress

OBJECTIVE: The primary objective was to determine the association between vitamin D status, baseline function, and short-term inpatient rehabilitation progress. DESIGN: This was a prospective convenience sampling of 100 patients in a tertiary general hospital rehabilitation unit (RU). The cohort comprised men and women of mixed race with a variety of diagnoses (mean age 70 yrs). Patient histories and demographic information were obtained by patient interview and chart review. Serum 25-hydroxyvitamin D (25OHD) (nmol/L) was measured on or after the day of admission. The Functional Independence Measurement (FIM) instrument, a validated survey tool, was used to measure function at admission and discharge. RESULTS: Eleven percent of the patients were overtly vitamin D deficient, with serum 25OHD concentrations <20 nmol/L. Ninety-four percent of the patients had serum 25OHD concentrations below the recommended minimum optimal concentration of 80 nmol/L. Using the Spearman rank correlation test, low serum 25OHD was weakly but significantly associated with low total FIM scores: r = 0.25 (P < 0.012) and r = 0.23 (P < 0.021) for admission and discharge total FIM score, respectively. Patients with serum 25OHD concentrations greater than the median value of 41.3 nmol/L had significantly higher FIM efficiency scores (discharge total FIM score - admission total FIM score/length of stay [LOS]) than the subgroup of patients below the median (2.0 +/- 1.1 vs. 1.6 +/- 0.9, respectively; P < or = 0.026). Serum 25OHD was not significantly correlated with FIM efficiency or the unadjusted change in total FIM score (discharge total FIM score - admission total FIM score), but it was significantly correlated with LOS (the lower the serum 25OHD concentration, the longer the LOS, and vice versa; r = -0.235, P < 0.018). Thus, the difference in FIM efficiency between patients with serum 25OHD above and below the median was the result of the significant inverse correlation between serum 25OHD and LOS; as a group, patients with serum 25OHD above the median had a 19% shorter LOS than the group with serum 25OHD below the median value (11.4 +/- 4.9 vs. 14.1 +/- 5.6 days, respectively; P = 0.005). CONCLUSIONS: Most patients in a hospital RU had a suboptimal serum 25OHD concentration, reflecting what has previously been observed in hospitalized patients in general and also the population at large. Although no specific physical deficits or attributes could be directly attributed to low serum 25OHD, the baseline functional status of RU patients, LOS, and progress attributable to inpatient rehabilitation (FIM efficiency) were favorably affected by higher serum 25OHD concentrations.     

Fugl—Meyer运动功能评分的敏感性及实用性

目的　本文旨在通过对偏瘫患者康复前后运动能力与Fugl-Meyer运动积分(FMA)相关性研究判断其对治疗效果评定的敏感性及实用价值。方法　选择住院的偏瘫患者21例,于入院前后分别进行FMA下肢运动积分、实际运动能力Rivermead运动指数(RMI)和功能独立性评定(FIM,选用转移与行进积分)。康复方法以下肢物理治疗、步行和日常生活活动训练为中心。统计采用配对t检验与相关分析。结果　住院治疗前后比较FMA,P＞0.05;RMI与FIM,均P＜0.05。三者治疗前后均存在显著相关关系(P＜0.001)。治疗前后差值相关性分别为FMA-RMIr=0.48(P＜0.05);FMA-FIMr=0.08(P＞0.05);RMI-FIMr=0.58(P＜0.01)。结论　FMA可反映下肢运动能力,但对治疗前后评定敏感性差,与RMI和FIM比较不能直观反映患者实际移动能力,其实用性较低。     

Effect of Body Mass Index on Stroke Rehabilitation

Objective

To investigate the association between body mass index (BMI) and the functional progress of patients with stroke, admitted to a rehabilitation hospital.

Design

A retrospective cohort study.

Setting

A freestanding university rehabilitation hospital stroke unit.

Participants

All patients (N=819) admitted to the stroke unit of a rehabilitation hospital during the study.

Interventions

Not applicable.

Main Outcome Measures

The primary study outcome measure was the FIM efficiency of patients by BMI category.

Results

For the 819 patients admitted during the observation period, BMI was compared with FIM score changes per day (FIM efficiency). After adjusting for age and sex, the FIM efficiency differed by BMI. The underweight group had the lowest FIM efficiency, followed by the obese and normal-weight subgroups. The overweight group had the highest FIM efficiency (P=.05) when compared with the obese subgroup.

Conclusions

Among patients admitted to an acute rehabilitation hospital for stroke rehabilitation, overweight patients had better functional progress than did patients in the other weight categories.     

Analysis of FIM instrument scores for patients admitted to an inpatient cardiac rehabilitation program

OBJECTIVE: To evaluate in an inpatient cardiac rehabilitation program (a phase IB) whether length of stay (LOS), discharge to home, and improvement in physical function differed between patients with lower and higher degrees of functional independence on admission. DESIGN: A retrospective study. SETTING: A public acute long-term care hospital. PATIENTS: All cardiac rehabilitation patients (N = 143) admitted to the hospital from January 1998 through June 1999. Patients were divided into a higher- and a lower-functioning group by using the admission FIM instrument scores above and below the midpoint of 72. Comparisons in LOS, discharge disposition, and functional gains between these 2 groups were then performed. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FIM scores, FIM change, FIM gains per week, LOS, and discharge disposition. RESULTS: Total FIM scores at discharge were significantly higher than those on admission (25%, P <.0001). The median value of total FIM gains per week was 7.78 with a stay of 17 days and a home discharge rate of 76%. The higher-functioning group (n = 106) differed from the lower group (n = 37) with shorter stay (15 vs 23d, P <.0001), greater FIM gains per week (8.6 vs 4.8, P =.002), and greater likelihood of discharge to home or community (84% vs 54%, P <.001). The average incremental FIM change in each group was the same. In multivariate analysis, both admission (P =.001) and discharge (P <.001) FIM scores were the best predictors of patients' discharge disposition to home. CONCLUSIONS: Admission FIM scores are important predictors for the clinical course and discharge outcomes of cardiac rehabilitation patients, with those with higher admission FIM scores having a shorter LOS and greater likelihood of discharge to home. The admission FIM scores can help to establish realistic goals.