Using EFA and FIM rating scales could provide a more complete assessment of patients with acquired brain injury

Abstract

Purpose: In some hospitals, patients exhibit significant heterogeneity of function at admission and discharge. The current study aims to assess if concurrent usage of the Early Functional Assessment (EFA) and Functional Independence Measure (FIM®) is warranted and practical in rehabilitation centers with diverse patient groups and outcomes. Methods: This retrospective study examined a data set of all patients with concurrent EFA and FIM scores admitted to a single rehabilitation center (4076 scores from 1251 patients). The patients had acquired brain injury of multiple etiologies and a range of severities. Results: The EFA scale was more able to characterize the function of lower functioning patients according to the FIM while the FIM scale was more able to characterize the function of higher functioning patients according to the EFA. This was highlighted by 21% of assessments with the lowest FIM score (18) having corresponding EFA scores of 22–76 and 27% of assessments with the highest EFA score (>90) having corresponding FIM scores of 38–126. Conclusions: In rehabilitation centers with diverse patient groups and outcomes, the FIM and EFA scale could be used to characterize the heterogeneity of function in patients with acquired brain injury. The EFA/FIM scale could be used concurrently in certain patients providing a more complete view of patients throughout the rehabilitation process.

• Implications for Rehabilitation

• Rehabilitation scales can be administered on multiple occasions to track the progress of a patient throughout the rehabilitation process; however, a lot of popular scales (such as the FIM®) are limited containing ceiling and floor effects for higher and lower functioning patients, respectively.

• In rehabilitation centers with diverse patient groups and outcomes, the FIM and EFA scale could be used to characterize the heterogeneity of function in patients with acquired brain injury.

• Concurrent usage of the scales could be indicated for some patients and each scale could provide information that the other scale does not provide however the FIM and EFA scales should be administered solely for EFA scores >90 (FIM administered solely) and the lowest FIM scores (EFA administered solely).

     

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.

     

Characteristics and functional outcomes of brain injury caused by physical assault in Canada: a population-based study from an inpatient rehabilitation setting

Abstract

Purpose: To investigate the characteristics and inpatient rehabilitation outcomes of persons who sustained a traumatic brain injury (TBI) resulting from physical assault – a form of intentional TBI – and compare these outcomes to those of persons with TBI resulting from other aetiologies. Method: A prospective population-based cohort study using inpatient rehabilitation data from Canadian population-based administrative databases for the fiscal years 2001–2006. Outcome measures were measures of functional independence (motor and cognitive), as measured by the FIM? Instrument, and discharge destinations. Results: Characteristics associated with intentional TBI were being male, younger in age and unemployed; living alone and having a greater likelihood of alcohol/drug abuse prior to admission. The intentional TBI group showed poorer total functional gains at discharge from inpatient rehabilitation. Multivariate regression analyses showed that persons with intentional injury were less likely to be discharged home. Conclusions: Persons with TBI from physical assault are a distinct clinical group in Canadian inpatient rehabilitation settings. These findings can support clinicians in determining proper assessment, management, discharge planning and post-rehabilitation care that target specific needs of persons with TBI resulting from physical assault.

• Implications for Rehabilitation

• Clinicians should have appropriate training to properly assess the mental health status of this patient group.

• Inpatient rehabilitation facilities should be prepared to provide services targeting psychosocial, substance abuse and interpersonal relationship issues to persons with a TBI from physical assault while patients are still within a hospital setting.

• Follow-up clinical care and community support services are warranted for those with intentional TBIs, including provision of occupational rehabilitation services, such as vocational rehabilitation.

• The discharge team should be responsible for ensuring appropriate discharge to community in the absence of family or other advocates on behalf of the patient.

     

Predicting goal achievement during stroke rehabilitation for Medicare beneficiaries

Abstract

Purpose: Few studies have investigated the ability of treatment teams to predict functional improvement and whether an association between predicted goals and discharge function in patients with stroke exists. This study investigated goal prediction during stroke rehabilitation delivered in inpatient rehabilitation facilities (IRF) and the factors associated with goal prediction. Methods: A serial, cross-sectional design analyzing the Medicare IRF Patient Assessment Instrument dataset. The sample included 179?479 admissions for stroke aged over 65 years in 968 IRFs. Generalized estimating equations (GEE) controlled for facility cluster effects were used for analysis of time trends for length of stay (LOS), predicted Functional Independence Measure (FIM) scores, discharge FIM scores and predicted-discharge difference FIM scores (goal FIM scores minus discharge FIM scores). GEE models were employed to determine the correlation between predicted FIM and discharge FIM scores and factors associated with goal achievement. Results: Mean LOS, predicted FIM scores and discharge FIM scores decreased 1.8?d, 2.2 points and 3.6 points, respectively, while predicted-discharge difference FIM scores increased 1.3 points. Discharge goals were not met 78.9% of the time. After controlling for patient characteristics, each predicted FIM point was associated with 0.6 discharge FIM points (p?<?0.0001). Factors associated with not meeting or exceeding goals were: age (odds ratio; OR?=?0.997), African Americans (OR?=?0.905), number of comorbidities (OR?=?0.970), number of complications (OR?=?0.932) and right brain stroke (OR?=?0.869). Factors associated with meeting or exceeding goals were: LOS (OR?=?1.03), admission FIM score (OR?=?1.02) and females (OR?=?1.05). Conclusions: Trends for lower goals and lower discharge function occurred over time. A correlation existed between predicted FIM scores and discharge FIM scores. Patient factors were associated with goal achievement.

• Implications for Rehabilitation

• Using the Functional Independence Measure, rehabilitation teams set lower goals for stroke rehabilitation in inpatient rehabilitation facilities during first 5.5 years of the IRF-PAI dataset.

• Discharge FIM scores also trended lower and fell at faster rate than goal FIM scores.

• Teams’ goal FIM scores averaged nearly 12 points higher than discharge FIM scores, and over 75% of patients did not reach goals for the rehabilitation stay.

• Factors associated with meeting or exceeding goals were: length of stay, admission FIM scores and being a female. Factors associated with not meeting or exceeding goals were: age, number of comorbidities and complications, having a right-brain stroke and being African American.

     

Equating activities of daily living outcome measures: the Functional Independence Measure and the Korean version of Modified Barthel Index

Purpose: To create a crosswalk between the Functional Independence Measure (FIM) motor items and the Korean version of the Modified Barthel Index (K-MBI).

Method: Korean community-dwelling adult patients (n?=?276) completed the FIM and K-MBI on the same day in outpatient rehabilitation hospitals. We used a single group design with the Rasch common person equating and conducted a factor analysis of the co-calibrated item pool using the two measures. Rasch analysis was used to investigate the psychometrics of the equated test items in the identified factor structure(s). The correlation between FIM raw scores and converted K-MBI scores was examined.

Results: Three measurement constructs were identified: self-care, mobility, involuntary movement. The equated test items in the three constructs demonstrated good person separation reliability (r?=?0.94–0.96) and good internal consistency (Cronbach’s alpha =0.93–0.97). The three crosswalks between the FIM raw scores and converted K-MBI scores demonstrated good correlations (r?=?0.91–0.93, all p?Conclusions: The Rasch equating method successfully created three crosswalks between the FIM motor items and K-MBI, with the equated test items demonstrating good psychometrics. The crosswalks would address the incomparable scoring systems between the FIM motor items and K-MBI.

• Implications for Rehabilitation

• The three crosswalk tables (scoring tables) would allow clinicians to compare or translate a patient’s motor scores between the FIM and K-MBI.

• The crosswalk tables would allow health-care administrators to track patients’ functional status across various rehabilitation facilities that exclusively use the FIM or K-MBI.

     

Inpatient rehabilitation following stroke: amount of therapy received and associations with functional recovery

Purpose: Canada’s Best Practice Recommendations for Stroke Care state that a minimum of one hour per day of each of the relevant core therapies be provided to patients admitted for inpatient rehabilitation. We examined whether this standard was met on a single, specialized stroke rehabilitation unit and if amount of therapy was an independent contributor to functional improvement. Methods: One-hundred and twenty-three, consecutive patients admitted to a 30-bed stroke rehabilitation program over a 6-month period with the confirmed diagnosis of stroke, were included. Workload measurement data were used to estimate the amount of therapy that patients received from core therapists during their inpatient stay. A multivariable model to predict Functional Independence Measure (FIM) gains achieved was also developed using variables that were significantly correlated with functional gain on univariate analysis. Results: On average, patients received 37 min of active therapy from both physiotherapists (PT) and occupational therapists (OT) and 13 min from speech-language pathologists per day. Admission FIM, length of stay, total OT and PT therapy time (hrs) were significantly correlated with FIM gain. In the final model, which explained 35% of the variance, admission FIM score and total amount of occupational therapy (OT) emerged as significant predictors of FIM gain. Conclusions: Patients admitted to a specialized rehabilitation unit received an average of 37 min a day engaged in therapeutic activities with both occupational and physical therapists. Although this value did not reach the standard of one hour, total amount of OT time contributed significantly to gains in FIM points during hospital stay.

Implications for Rehabilitation

• Patients on an inpatient stroke rehabilitation unit received less than the standard of one hour of physiotherapy and occupational therapy per day.

• Total amount of occupational therapy contributed significantly to gains in Functional Independence Measure points during hospital stay.

     

Motor imagery during action observation increases eccentric hamstring force: an acute non-physical intervention

Purpose: Rehabilitation professionals typically use motor imagery (MI) or action observation (AO) to increase physical strength for injury prevention and recovery. Here we compared hamstring force gains for MI during AO (AO?+?MI) against two pure MI training groups.

Materials and methods: Over a 3-week intervention physically fit adults imagined Nordic hamstring exercises in both legs and synchronized this with a demonstration of the same action (AO?+?MI), or they purely imagined this action (pure MI), or imagined upper-limb actions (pure MI-control). Eccentric hamstring strength gains were assessed using ANOVAs, and magnitude-based inference (MBI) analyses determined the likelihood of clinical/practical benefits for the interventions.

Results: Hamstring strength only increased significantly following AO?+?MI training. This effect was lateralized to the right leg, potentially reflecting a left-hemispheric dominance in motor simulation. MBIs: The right leg within-group treatment effect size for AO?+?MI was moderate and likely beneficial (d?=?0.36), and only small and possibly beneficial for pure MI (0.23). Relative to pure MI-control, effects were possibly beneficial and moderate for AO?+?MI (0.72), although small for pure MI (0.39).

Conclusions: Since hamstring strength predicts injury prevalence, our findings point to the advantage of combined AO?+?MI interventions, over and above pure MI, for injury prevention and rehabilitation.

• Implications for rehabilitation

• While hamstring strains are the most common injury across the many sports involving sprinting and jumping, Nordic hamstring exercises are among the most effective methods for building eccentric hamstring strength, for injury prevention and rehabilitation.

• In the acute injury phase it is crucial not to overload damaged soft tissues, and so non-physical rehabilitation techniques are well suited to this phase.

• Rehabilitation professionals typically use either motor imagery or action observation techniques to safely improve physical strength, but our study shows that motor imagery during observation of Nordic hamstring exercises offers a safe, affordable and more effective way to facilitate eccentric hamstring strength gains, compared with pure motor imagery.

• Despite using bilateral imagery and observation training conditions in the present study, strength gains were restricted to the right leg, potentially due to a left hemispheric dominance in motor simulation.

     

Measuring rehabilitation outcome in post-acute hip fractured patients

Abstract

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.

• Implication for Rehabilitation

• Post-acute hip fracture patients exhibit variable functional ability.

• Assessing rehabilitation achievements with a disability measure is limited.

• It is advisable to use an instrument most suitable to the patients’ disability level.

     

Applicability,validation and reproducibility of the Spinal Cord Independence Measure version III (SCIM III) in patients with non-traumatic spinal cord lesions

Purpose: To verify the applicability, reproducibility and validity of the SCIM III patients with non-traumatic spinal cord injury.

Method: The cross-sectional study included 30 patients (66% females; 41.5?±?14.7 yo) with non-traumatic spinal cord injury of any etiology. Subjects were subjected by computerized gait analysis and answered the Brazilian versions of SCIM III (0–100 points) and FIM? (18–126 points) by two raters (A and B) at the same day and 1 week later (A).

Results: The intraclass correlation coefficient for the use of SCIM III indicated appropriated intra- and inter-evaluator reproducibility (ICC?=?0.9). Correlation between the SCIM III and the motor FIM? was appropriate (r?=?0.6; p?=?0.0). SCIM III subscales and FIM? domains correlated strongly for self-care (r?=?0.8; p?≤?0.001), moderately for transfers (r?=?0.6; p?=?0.0005) and locomotion (r?=?0.6; p?=?0.0006). SCIM III mobility subscale positively correlated with the cadence (r?=?0.8; p?≤?0.01), gait speed (r?=?0.7; p?≤?0.01) and step length (r?=?0.6; p?≤?0.01).

Conclusions: SCIM III is a reproducible functional assessment instrument and capable of evaluating the level of independence of the individual with non-traumatic spinal cord injury. The SCIM III is more sensitive than the MIF? for non-traumatic spastic paraplegic patients with higher levels of independence, particularly if they can walk independently. Linear gait parameters correlated with its mobility subscale.

• Implications for Rehabilitation

• Applicability, validation and reproducibility of the Spinal Cord Independence Measure version III (SCIM III) in patients with non-traumatic spinal cord lesions.

• There are not many studies focused on patients with non-traumatic spinal cord lesion.

• Disability varies in severity, but frequently contributes to limitations in the activities of daily living (ADL) and participation.

• We do not find in the literature studies that assess the functionality of these individuals as comprehensive as ours.

     

Predicting length of stay in specialist neurological rehabilitation

Aims: A retrospective case series was performed to determine which measures of complexity, dependency and function most accurately predict inpatient neurorehabilitation length of stay for individuals with post-acute neurological disorders.

Methods: Sociodemographic, medical and functional variables were extracted from data submitted to the UK Rehabilitation Outcomes Collaborative. Length of stay was calculated as the total number of inpatient days, functional status was measured using Barthel Index, rehabilitation complexity was measured using Extended Rehabilitation Complexity Scale, and nursing dependency was measured using the Northwick Park Dependency Scale.

Results: The mean rehabilitation length of stay was 70.9 days, with length of stay being 35.1 days higher in inpatients with acquired brain injury than inpatients with spinal cord injury. Diagnostic category, Barthel Index scores, Extended Rehabilitation Complexity Scale scores and Northwick Park Dependency Scale scores at admission independently predicted length of stay. Multiple regressions including diagnostic group, Barthel Index, Extended Rehabilitation Complexity Scale and Northwick Park Dependency Scale statistically significantly predicted 37.9% of the variability in length of stay (p?Conclusions: In conclusion, inpatient length of stay is predicted by diagnostic category, Extended Rehabilitation Complexity Scale, Northwick Park Dependency Scale and Barthel Index. The most influential predictor of rehabilitation length of stay was Northwick Park Dependency Scale score at admission. These results may help facilitate rehabilitation resource planning and implementation of effective commissioning plans.

• Implications for Rehabilitation

• The most accurate predicting variable for length of stay in inpatient neurological rehabilitation was nursing need as measured by the Northwick Park Dependency Scale score on admission.

• Service users and commissioners can be provided with more realistic predictions of length of stay derived from admission variables that can be used in planning inpatient rehabilitation.

• Age and gender do not seem to have an effect on the total length of stay in rehabilitation.

     

The role of patient demographics and clinical presentation in predicting discharge placement after inpatient stroke rehabilitation: analysis of a large,US data base

Purpose: To determine whether functional ability at admission and demographics predict discharge placement after inpatient rehabilitation for older adults recovering from stroke. Method: In this retrospective study, we examined records of 31,910 adults 65 years of age and older who were admitted for inpatient rehabilitation post-stroke. Binary logistic regression was used with the outcome of placement and potential predictors of the admission Functional Independence Measure (FIM) score, age, sex and marital status. Results: The average admission FIM was 60.0 out of 126; the average FIM at discharge was 84.8. The mean age was 77.7?±?7.3 years, 57% were female and 52.5% were not married. More than three quarters of the patients were discharged to home. Odds ratios (ORs) with 95% confidence intervals (CIs) showed that patients with a FIM score below the mean of our sample (OR = 5.8, CI = 5.5–6.2), older than the mean age of our sample (OR = 1.6, CI = 1.5–1.7), and who were not married (OR = 1.9, CI = 1.8–2.0) (p-values <0.001) were more likely to be discharged to residential care. Sex was not predictive of placement. Conclusion: The admission FIM was an important predictor of discharge placement after rehabilitation in older adults. Age and marital status were also significant predictors of discharge placement. Sex was not a significant predictor.

Implications for Rehabilitation

• Functional ability, age and marital status are significant predictors of discharge placement after stroke rehabilitation.

• Those who have lower admission Functional Independence Measure scores, are older, and are not married are more likely to be discharged to residential care than their counterparts who return home.

• Sex is not a significant predictor of discharge placement after stroke rehabilitation.

• To anticipate discharge placement after inpatient rehabilitation, the clinician should consider the age and marital support system of the patient, as well as the functional presentation at admission.

     

Patient perspectives on navigating the field of traumatic brain injury rehabilitation: a qualitative thematic analysis

Purpose: This study aimed to provide an understanding of the lived experience of rehabilitation in adults with traumatic brain injury (TBI) from hospital discharge up to four years post-injury.

Materials and methods: We used a qualitative explorative design with semi-structured in-depth interviews. Twenty participants with TBI were included from a level I Trauma Center in Denmark at 1–4 years post-injury. Qualitative thematic analysis was applied for data analysis.

Results: Three main themes emerged during analysis: A new life, Family involvement, and Rehabilitation impediments. These themes and their sub-themes described the patient perspective of TBI and rehabilitation post hospitalization. Participants reassessed their values and found a new life after TBI. Family caregivers negotiated rehabilitation services and helped the participant to overcome barriers to rehabilitation. Although participants were entitled to TBI rehabilitation, they had to fight for the services they were entitled to.

Conclusion: Individuals with TBI found ways of coping after injury and created a meaningful life. Barriers to TBI rehabilitation were overcome with help from family caregivers rather than health care professionals. Future studies need to find ways to ease the burden on family caregivers and pave the way for more accessible rehabilitation in this vulnerable group of patients.

• Implications for rehabilitation

• TBI rehabilitation might benefit from:

• ??Increased transparency in rehabilitation options

• ??More systematic follow-up programs

• ??Age-appropriate rehabilitation facilities

• ??Inclusion of patient and family in the planning of long-term rehabilitation

     

Transitional rehabilitation goals for people with spinal cord injury: looking beyond the hospital walls

Abstract

Purpose: This study aimed to identify, describe and classify the transitional rehabilitation goals of people with spinal cord injury (SCI) and map these goals to the International Classification of Functioning, Disability and Health (ICF). Method: The five most important rehabilitation goals as rated by clients were extracted from records for 220 clients of a transitional rehabilitation service for people with SCI in Australia over a 5-year period. These goals were thematically classified into domains and then mapped to the ICF framework. Goals were compared across age, gender, length of hospital stay, compensation status, level and completeness of injury. Results: A total of 1100 goals were classified into 18 different goal domains, representing most aspects of the ICF framework. Age was negatively related to vocational goals. Length of hospital stay was positively related to personal care goals but negatively related to community access and vocational goals. Goals did not differ across gender or compensation status but did differ across level and completeness of injury. Conclusions: People with SCI have a range of transitional rehabilitation goals that represent most aspects of the ICF framework. Client-centred community rehabilitation during this transition period offers continuity of care to support the realisation of these rehabilitation goals.

• Implications for Rehabilitation

• Transitional rehabilitation is a relatively new community service model in the rehabilitation literature, especially for people with spinal cord injury.

• Client-centred goal setting is integral to these types of community rehabilitation models.

• Rehabilitation goals in transitional rehabilitation are varied and map well to the International Classification of Functioning, Disability and Health (ICF) with a focus on environmental goals.

• A typology of rehabilitation goals in this setting will assist in service planning and evaluation of hospital and community rehabilitation services.

     

Effect of early and intensive rehabilitation in acute stroke patients: retrospective pre-/post-comparison in Japanese hospital

Purpose: There is little high-quality or large-scale clinical research focusing on the effect of early and intensive rehabilitation in Eastern countries. This study aimed to determine whether an early and intensive rehabilitation program in a Japanese hospital affects functional outcomes of acute stroke patients.

Methods: In total, 1588 stroke patients were investigated. A maintained database of all hospitalized acute stroke patients admitted to our facility over two consecutive 2-year periods was reviewed. We relaunched of a new rehabilitation program to be earlier and more intensive at the midpoint of this two periods. The functional outcomes of the patients in the first 2-year period and the subsequent 2-year period were compared.

Results: The total time of rehabilitation exercises per day was significantly increased from the first period to the second period. The number of patients who started rehabilitation within 24?h after admission was significantly increased in the patients admitted during the second period compared with those admitted during the first period. The Functional Independence Measure (FIM) efficiency was significantly higher in the patients admitted during the second period than in those admitted during the first period.

Conclusions: An early and intensive rehabilitation program in a Japanese hospital affects functional outcomes of acute stroke patients.

• Implications for Rehabilitation

• Early and intensive rehabilitation for the stroke patients is an effective means of improving FIM score.

• Early and intensive rehabilitation affects the improvement of FIM efficiency without increasing adverse events.

     

Place orientation and visual construction subdomains of the Mini Mental State Examination test as predictors of rehabilitation outcome of post-acute hip-fractured patients

Purpose: The study aimed at assessing the relationship between various Mini Mental State Examination (MMSE) subdomains and rehabilitation achievements in post-acute hip-fractured patients.

Method: Six hundred and five hip-fractured patients admitted during 2010–2013 to a post-acute geriatric rehabilitation center were included in the study. Main outcome measures were the Functional Independence Measure (FIM) instrument, the motor FIM (mFIM), the Montebello Rehabilitation Factor Score (MRFS) on the mFIM and length of stay (LOS). A logistic regression analysis tested the predictive value of MMSE subdomains for achieving a satisfactory functional gain (mFIM MRFS >30%) on operated patients admitted from community.

Results: Of all the six MMSE subdomains, place orientation and visual construction demonstrated significant predictive values for rehabilitation outcome. Patients who did not err on place orientation and visual construction MMSE domains had better probabilities [(OR 1.28, 95%CI, 1.05–1.58; p?=?0.017); (OR 2.15, 95%CI, 1.28–3.59; p?=?0.004), respectively] of achieving better rehabilitation achievements. Similar results were obtained for cognitively impaired patient groups [(OR 1.40 95%CI, 1.11–1.77; p?=?0.005); (OR 2.47, 95%CI, 1.15–5.30; p?=?0.021), respectively]. For the cognitively intact patient group, the variables with significant predictive value were time orientation and visual construction MMSE subdomains [(OR 2.26, 95%CI, 1.18–4.33; p?=?0.014); (OR 2.87, 95%CI, 1.16–7.09; p?=?0.022), respectively].

Conclusions: Post-acute hip-fractured patients scoring normally on place orientation and visual construction MMSE subdomains have a better chance of achieving favorable rehabilitation outcome.

• Implications for Rehabilitation

• Post-acute hip-fractured patients have a better chance to achieve a favorable rehabilitation outcome when scoring normally on place orientation and visual construction MMSE subdomains.

• Patients having difficulties in orientation and visual construction may need more rehabilitation time as they lack planning and organizational capacity to follow instructions.

• Assessing MMSE subdomains may reveal subtle cognitive impairment in patients scored within the normal range on the MMSE test.

• Identifying subtle cognitive impairment may assist in coordinating the patients and their caregivers' expectations, efficiently allocating resources and help in advanced care planning.

     

Reference system of competence and engagement in adapted physical activities of people with recent spinal cord injury

Abstract

Purpose: This study tested whether persons with Recent Spinal Cord Injury (RSCI) who practice adapted physical activities (APA) and those who do not differ with regard to achievement goals, physical self-perceptions, and global self-esteem. Method: Adults with RSCI in rehabilitation centers voluntarily completed questionnaires of achievement goals and self-esteem. Then, based on whether they engaged or not in APA programs, they were considered participants or non-participants in APA. Results: Compared to participants in APA, non-participants were more oriented toward mastery-avoidance goals and had lower scores of physical self-worth and global self-esteem. No differences were found for other achievement goals and for low-level dimensions of physical self. Conclusions: These findings suggest that mastery-avoidance goals are associated with a maladaptive motivational pattern when intrapersonal comparison conveys a threat for the self. Practical implications for rehabilitation programs for persons with RSCI are offered.

• Implications for Rehabilitation

• Adapted Physical Activities (APA) programs are supervised physical activity programs in which the choice of the activity as well as the frequency, the duration, and the intensity of practice are adapted to the inpatients’ capabilities.

• Attempts to master physical activities can be seen as threatening experiences to be avoided by persons with Recent Spinal Cord Injury (RSCI) in rehabilitation centers.

• Comparing one’s capabilities in physical activities with those of other persons with RSCI is not motivationally detrimental with respect to the practice of these activities.

• Upon persons with RSCI’ arrival in rehabilitation centers, physical educators should promote a friendly competitive climate in the practice of APA to help inpatients recover healthy levels of physical self-perceptions and global self-esteem as well as motivation to exercise.

     

Does English proficiency impact on health outcomes for inpatients undergoing stroke rehabilitation?

Purpose: To determine whether English proficiency and/or the frequency of interpreter use impacts on health outcomes for inpatient stroke rehabilitation. Method: Study design: Retrospective case–control study. Participants: People admitted for inpatient stroke rehabilitation. A high English proficiency group comprised people with native or near native English proficiency (n?=?80), and a low English proficiency group comprised people who preferred a language other than English (n?=?80). Outcome measures: Length of stay (LOS), discharge destination and Functional Independence Measure (FIM). Results: The low English proficiency group showed a greater improvement in FIM from admission to discharge (p?=?0.04). No significant differences were found between groups in LOS, discharge destination and number of encounters with allied health professionals. Increased interpreter usage improved FIM efficiency but did not significantly alter other outcomes. Conclusion: English proficiency does not appear to impact on health outcomes in inpatient rehabilitation with a primarily in-house professional interpreter service. However, there is a need for a larger powered study to confirm these findings.

• Implications for rehabilitation

• People with low English proficiency undergoing inpatient stroke rehabilitation in a setting with a primarily in-house professional interpreter service, achieved similar outcomes to those with high English proficiency irrespective of frequency of interpreter usage.

• A non-significant increase of 4 days length of stay was observed in the low English proficiency group compared to the high English proficiency group.

• For patients with low English proficiency, greater change in Functional Independence Measure efficiency scores was observed for those with higher levels of interpreter use relative to those with low interpreter use. Clinicians should optimise use of interpreters with patients with low English proficiency when possible.

     

Go baby go café: a case study on an immersive rehabilitation environment to improve functional outcomes and quality of life

Purpose: To determine the effectiveness of involving traumatic brain injury survivors in a novel “enriched rehabilitation environment” in which physical, cognitive, social and speech impairments are simultaneously addressed during training within a functioning business.

Method: Participant was a 34-year old with a history of a severe head injury 17?years ago due to a motor vehicle accident. A novel intervention was provided within the Go Baby Go Café at the University of Delaware during her two hour shifts, three times a week for 2?months.

Results: The participant showed improvement in hand function, dynamic mobility, gait speed and cognitive ability. Additionally, changes were also noted across different domains like social activities, feeling of well-being, gross motor function and quality of life.

Conclusions: The Café may be a viable environment for comprehensive intervention. Participation in the Café was associated with wide spread gains in scores on a variety of physical, cognitive, quality-of-life outcomes.

• Implications for rehabilitation

• Long-term impairments after traumatic brain injury often impairs activities of daily living, community integration and return to work.

• The Go Baby Go Café, installed with an overhead harness system serves as an “Immersive Environment” to address various impairments all at once in a real-world setting.

• Individuals with impairments can benefit from this rehabilitation technique, which is structured to improve changes across the International Classification of Functioning Disability and Health spectrum.

     

Boredom in patients with acquired brain injuries during inpatient rehabilitation: a scoping review

Abstract

Purpose: Boredom may impede engagement in inpatient rehabilitation following an acquired brain injury. This review aimed to: (1) describe the experience and (2) quantify the incidence of boredom; (3) identify measurement tools used to quantify boredom; (4) summarize factors contributing to boredom, and (5) outline evidence-based interventions shown to reduce boredom during inpatient rehabilitation.

Methods: Two researchers independently screened publications retrieved from electronic database searches. Publications presenting patient, carer or staff data relating to boredom in inpatients with acquired brain injuries were included.

Results: Two thousand four hundred and ninety-nine references were retrieved, 88 full texts were reviewed, with 24 studies included. The majority of studies reported qualitative data indicating boredom to be a common experience of patients with acquired brain injuries (n?=?14 studies +1 review). The incidence of boredom post acquired brain injury is unknown. Personal and organizational factors and the physical environment may contribute to boredom (n?=?11 studies +2 reviews). Qualitative work (n?=?9 studies) indicates that use of the creative-arts or exposure to environmental enrichment may help alleviate boredom in patients with acquired brain injuries during inpatient rehabilitation.

Conclusion: Further mixed-methods research is required to establish the incidence of and contributing factors to boredom in patients with acquired brain injuries undergoing rehabilitation. Understanding this will help inform future research aimed at improving patient engagement in inpatient rehabilitation.

• Implications for rehabilitation

• Boredom is commonly reported by hospitalised patients with ABI to negatively affect their rehabilitation yet the scope of the problem has not been measured.

• Boredom is a complex phenomenon, likely influenced by a number of personal and environmental factors that are not fully understood in this population.

• Through a better understanding of boredom, interventions may be developed to improve patient engagement in inpatient rehabilitation programs.