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.

     

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.

     

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.

     

Implementing an inpatient rehabilitation Saturday service is associated with improved patient outcomes and facilitates patient flow across the health care continuum

Abstract

Purpose: To evaluate the effectiveness of the introduction of a Saturday inpatient rehabilitation service in improving patient outcomes and facilitating hospital access and flow. Methods: A quasi-experimental study with a historical comparison group is presented. Data were evaluated for the 477 patients admitted and discharged in the 6 months following the implementation (October 2012–March 2013) of the service and 499 patients in the historical control group (April 2012–September 2012). Results: Prior to the introduction of the service median number of patients admitted on a Saturday was 0 (range 0–3), post-implementation the median number of patients admitted on a Saturday increased to 2 (range 0–5), this difference was statistically significant (Z?=??3.61, p?<?0.001). Median regression modelling demonstrated that, after adjusting for admission Functional Independence (FIM) score, gender, length of stay (LOS) and age, there was a small but significant increase in discharge FIM scores (median increase 2.28, p?=?0.027) for those patients admitted in the post-implementation phase. There was no such effect of the service on LOS. Conclusions: The implementation of the Saturday inpatient rehabilitation service was associated with improved patient outcomes and supported an increase in patient flow throughout the organization as evidenced by an increased number of Saturday patient admissions.

• Implications for Rehabilitation

• Inpatient rehabilitation services do not operate in isolation; they are a critical link in the healthcare continuum.

• There is a mounting body of evidence that the introduction of weekend rehabilitation services has a positive impact on patient outcomes.

• To maximize health outcomes, access to critical services and patient flow, organizations and staff need to move away from the long-standing 5-day/week inpatient rehabilitation model and start transitioning to a model that incorporates weekend therapy services.

     

Caregiver availability for severe stroke results in improved functional ability at discharge from inpatient rehabilitation

Purpose: To evaluate the predictive capacity of caregiver availability on functional ability at time of discharge from inpatient rehabilitation in individuals with severe first-time stroke.

Methods: A retrospective chart review was conducted of severe stroke inpatients admitted to a stroke rehabilitation unit between April 2005 and December 2009. Follow-up telephone interviews were conducted with patients to determine caregiver availability at time of discharge. Hierarchical linear regression analysis was performed to assess the predictive capacity of caregiver availability on functional ability at discharge from an inpatient rehabilitation unit after controlling for covariates.

Results: Data from 180 individuals were included in the analysis. Individuals with a caregiver had significantly higher levels of functional ability at discharge compared to those without (85.8?±?23.6 versus 72.9?±?20.3; p?F (5,174)?=?26.21, p?Conclusions: The presence of a caregiver at time of discharge from inpatient rehabilitation is predictive of significantly higher functional ability at discharge in individuals with severe stroke.

• Implications for rehabilitation

• The availability of a caregiver at time of discharge from inpatient rehabilitation is predictive of improved functional ability at discharge in individuals with severe stroke.

• The presence of an available caregiver positively influences the functional recovery of individuals with severe stroke and may be an important element to successful rehabilitation.

     

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.

     

Factors influencing the provision of oral hygiene care following stroke: an application of the Theory of Planned Behaviour

Objectives: This study aimed to examine “intention to” and “performance of” oral hygiene care to stroke patients using the Theory of Planned Behavior.

Materials and methods: A large scale survey of 13 centers in Malaysia was conducted involving 806 nurses in relation to oral hygiene care intentions and practices. In addition, information on personal and environmental factors was collected.

Results: The response rate was 95.6% (778/806). The domains of the Theory of Planned Behavior were significantly associated with general intention to perform oral hygiene care: attitudes (β?=?0.21, p?p?p?p?<0.01), controlling for other factors. Knowledge scores, training, access to oral hygiene guidelines and kits, as well as working ward type were identified as key factors associated with intention and practice of oral hygiene care.

Conclusion: The Theory of Planned Behavior provides understanding of “intention to” and “performance of” oral hygiene care to stroke patients. Several provider and environmental factors were also associated with intentions and practices. This has implications for understanding and improving the implementation of oral hygiene care in stroke rehabilitation.

• Implications for Rehabilitation

• Oral hygiene care is crucial for stroke patients as it can prevent oral health problems and potentially life threatening events (such as aspiration pneumonia).

• Despite oral hygiene care being relative simple to perform, it is often neglected during stroke rehabilitation.

• A large-scale national survey was conducted to understand “intentions to” and “performance of” oral hygiene care to stroke patients using the Theory of Planned Behavior social cognition model.

• These study findings may have implications and use in promoting oral hygiene care to stroke patients:i) by understanding the pathways and influences to perform oral hygiene care.ii) to conduct health promotion and health education based on behavioral models such as Theory of Planned Behavior.

     

New rehabilitation models for neurologic inpatients in Brazil

Abstract

Purpose: To describe the effects of a rehabilitation program in a neurological inpatient unit in terms of independence for activities of daily living and return to work. Method: Retrospective study with 148 adults with stroke, traumatic brain injury (TBI), spinal cord injury, and Guillain–Barré syndrome admitted as rehabilitation inpatients within a 1-year period for hospitalization at the Instituto de Reabilitação Lucy Montoro, Brazil. According to their diagnostic groups, subjects undergone semi-standardized models of intensive multidisciplinary rehabilitation for 4–6 weeks. Primary outcome measures: Functional Independence Measure (FIM?), Modified Rankin scale (Rankin), and Glasgow Outcome Scale (GOS Subjects were evaluated at admission, discharge, and 6 months after discharge. Results: Improvement in motor FIM?, Rankin and GOS was observed in all groups. Cognitive FIM? increase was less evident in TBI patients. After 6 months, 37.6% of patients were unemployed, 34% underwent outpatient rehabilitation, and 65.2% maintained gains. Conclusions: This is the first report on the effects from an inpatients rehabilitation model in Brazil. After a short intensive rehabilitation, there were motor and cognitive gains in all groups. Heterogeneity in functional gains suggests more individualized programs may be indicated. Controlled studies are required with larger samples to compare inpatient and outpatient programs.

• Implications for Rehabilitation

• The proposed brief model of rehabilitation for stroke, traumatic brain injury, spinal cord injury, and Guillain–Barre syndrome inpatients shows promising results in terms of functional improvement.

• Apparent improvements in cognitive and motor levels can be observed after 30?d of the intensive hospital-based program five times a week focusing on caregiver and patients training.

• After 6 months of discharge, more than one third of patients remained out of work, but appeared to have kept the benefits attained during hospitalization, and performed physical activities in the community as outpatients.

     

Functional independence measure scores predict level of long-term care required by patients after stroke: a multicenter retrospective cohort study

Abstract

Purpose: To examine whether Functional Independence Measure (FIM) scores on admission can predict the future care levels of patients after acute stroke. Methods: In this multicenter retrospective cohort study, we enrolled post-acute stroke patients and assessed stroke subtypes, self-care abilities using FIM scores, and discharge destination. Patients’ care levels were assessed according to the Long-Term Care Insurance (LTCI) system (0–5: slight impairment to bedridden), the national insurance plan for care in Japan, at discharge. We divided patients into two groups according to LTCI care levels (0–2 versus 3–5) to compare their clinical characteristics using multivariate logistic regression analysis. The trial was registered with the UMIN Clinical Trials Registry (UMIN000012653). Results: Of the 1261 patients (47% female, mean age 75 years), 492 (39%) fulfilled LTCI care levels 0–2. FIM scores on admission were significantly correlated with LTCI care levels (p?<?0.001). On multivariate analysis, age and FIM scores on admission were found to be independent predictors of LTCI care levels 0–2. Conclusions: FIM scores on admission after stroke can independently predict later care requirements. Early prediction of LTCI care levels may contribute to the early supported discharge and improve the efficiency of healthcare planning.

• Implications for Rehabilitation

• There is a clear relationship between Functional Independence Measure (FIM) scores and the care levels certified by the Long-Term Care Insurance (LTCI) system, a national healthcare and insurance system in Japan.

• FIM scores on admission can predict future LTCI care levels required for patients after acute stroke.

• Early prediction of LTCI care levels may contribute to early supported discharge, improve the efficiency of stroke management and assist healthcare planning.

     

Goal setting practice in services delivering community-based stroke rehabilitation: a United Kingdom (UK) wide survey

Abstract

Purpose: We investigated the nature of services providing community-based stroke rehabilitation across the UK, and goal setting practice used within them, to inform evaluation of a goal setting and action planning (G-AP) framework. Methods: We designed, piloted and electronically distributed a survey to health professionals working in community-based stroke rehabilitation settings across the UK. We optimised recruitment using a multi-faceted strategy. Results: Responses were analysed from 437 services. Services size, composition and input was highly variable; however, most were multi-disciplinary (82%; n?=?335/407) and provided input to a mixed diagnostic group of patients (71%; n?=?312/437). Ninety one percent of services (n?=?358/395) reported setting goals with “all” or “most” stroke survivors. Seventeen percent (n?=?65/380) reported that no methods were used to guide goal setting practice; 47% (n?=?148/315) reported use of informal methods only. Goal setting practice varied, e.g. 98% of services (n?=?362/369) reported routinely asking patients about goal priorities; 39% (n?=?141/360) reported routinely providing patients with a copy of their goals. Conclusions: Goal setting is embedded within community-based stroke rehabilitation; however, practice varies and is potentially sub-optimal. Further evaluation of the G-AP framework is warranted to inform optimal practice. Evaluation design will take account of the diverse service models that exist.

• Implications for Rehabilitation

• Community-based stroke rehabilitation services across the UK are diverse and tend to see a mixed diagnostic group of patients.

• Goal setting is implemented routinely within community-based stroke rehabilitation services; however, practice is variable and potentially sub-optimal.

• Further evaluation of the G-AP framework is warranted to assess its effectiveness in practice.

     

A systematic review of studies reporting multivariable models to predict functional outcomes after post-stroke inpatient rehabilitation

Abstract

Purpose: This systematic review summarizes the utility of variables available at acute discharge after stroke for predicting functional independence at discharge from inpatient rehabilitation. Methods: A systematic review of four electronic databases (Medline, EMBASE, PsycINFO and CINAHL) was conducted to identify studies reporting multivariable models predicting post-rehabilitation Barthel Index (BI) or Functional Independence Measure (FIM®) scores. In studies meeting inclusion criteria, the frequency with which candidate predictors were found statistically significant was calculated and summarized. Results: A total of 3260 articles were screened, of which 27 were included and 63 multivariable models of discharge BI or FIM® were reported. In all, 126 candidate predictors of BI or FIM® were explored. Variables found to be significant most frequently included admission functional level (BI or FIM®), National Institute of Health Stroke Scale (NIHSS), dysphasia, impulsivity, neglect, previous stroke, and age. Conclusions: Only a selected group of variables have repeatedly proven to be significant predictors of functional ability after post-stroke inpatient rehabilitation.

• Implications for Rehabilitation

• This review identifies, and summarizes, studies that have used a multivariable model to predict Barthel Index (BI) or Functional Independence Measure (FIM®) after post-stroke inpatient rehabilitation.

• Clinicians making decisions about admission to inpatient rehabilitation should consider age and a measure of stroke severity, functional status and progress to date.

• Variables that have been demonstrated to be useful most commonly included age, admission functional level (BI or FIM), National Institute of Health Stroke Scale, dysphasia, impulsivity, neglect, and previous stroke.

     

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.

     

Outcomes among older people in a post-acute inpatient rehabilitation unit

Purpose: Designated multidisciplinary rehabilitation units have been shown to provide several benefits for the frail older population. The aim of this research was to evaluate changes in strength, mobility, balance, endurance, frailty and quality of life (QoL) following a 6-week multidisciplinary inpatient rehabilitation programme. Method: This was a prospective, observational study performed in a post-acute multidisciplinary geriatric inpatient rehabilitation service. A consecutive sample of heterogenous frail older adults (n?=?32) participated. Subjects were assessed on admission to the rehabilitation service (T1) and following 6 weeks of rehabilitation (T2). A range of outcome measures were used to assess function and QoL: Berg Balance Scale (BBS), Timed Up and Go (TUG), 6-Minute Walk Test (6MWT), Barthel Index (BI), EuroQol-Visual Analogue Scale (EQ-VAS), Clinical Frailty Scale (CFS), lower limb and grip dynamometry. Results: The majority were female (n?=?25), the mean age was 82.9 years (SD 6.35). The median length of stay was 49 days. Patients improved significantly between T1 and T2 assessments in the BBS (p?≤?0.0001); TUG (p?≤?0.0001); 6MWT (p?≤?0.0001); BI (p?≤?0.0001); EQ-VAS (p?=?0.002); CFS (p?≤?0.0001); and in some aspects of grip and lower limb strength. Conclusion: This study has demonstrated that positive outcomes occurred in a range of measures in an older, frail inpatient rehabilitation population.

Implications for Rehabilitation

• Elderly inpatients undergoing rehabilitation programmes improve across a range of measures looking at impairment, activity, participation and quality of life.

• However, gains were modest and patients did not attain their baseline level of performance after a 6-week programme of inpatient rehabilitation.

• Using outcome measures in clinical rehabilitation practice can facilitate comparison between units and can form the basis for future research in this population.

     

Correlates of depressive symptoms in individuals attending outpatient stroke clinics

Background and purpose Depressive symptoms are common post-stroke. We examined stroke deficits and lifestyle factors that are independent predictors for depressive symptomology. Methods A retrospective chart review was performed for patients’ post-stroke who attended outpatient clinics at a hospital in Southwestern Ontario between 1 January 2014 and 30 September 2014. Demographic variables, stroke deficits, secondary stroke risk factors and disability study measures [Patient Health Questionnaire-9 (PHQ-9) and Montreal Cognitive Assessment (MoCA)] were analyzed. Results Of the 221 outpatients who attended the stroke clinics (53% male; mean age?=?65.2?±?14.9 years; mean time post-stroke 14.6?±?20.1 months), 202 patients were used in the final analysis. About 36% of patients (mean?=?5.17?±?5.96) reported mild to severe depressive symptoms (PHQ-9?≥?5). Cognitive impairment (CI), smoking, pain and therapy enrollment (p?r=??0.39, p?Conclusions High levels of depressive symptoms are common in the chronic phase post-stroke and were partially related to cognition, pain, therapy enrollment and lifestyle factors.

• Implications for Rehabilitation

• Stroke patients who report cognitive deficits, pain, tobacco use or being enrolled in therapy may experience increased depressive symptoms.

• A holistic perspective of disease and lifestyle factors should be considered while assessing risk of depressive symptoms in stroke patients.

• Patients at risk for depressive symptoms should be monitored at subsequent outpatient visits.

     

Predictors of referral uptake in children with disabilities in Bangladesh – Exploring barriers as a first step to improving referral provision

Purpose: Making services available to children with disabilities in low- and middle-income countries does not guarantee their use. This study aims to identify factors associated with the uptake of referrals in order to investigate barriers to service use. Methods: Children with impairments identified in two districts of Bangladesh were invited to attend screening camps where their condition was confirmed; they were provided with referrals for rehabilitation and treatment services. Predictors of referral uptake were identified using logistic regression. Results: Overall referral uptake was 47%, 32% in Sirajganj and 61% in Natore. There was no association between age or gender and referral uptake. Factors predictive of referral uptake were higher income in Sirajganj (OR?=?2.6 95%CI 1.4–5.0), and the districts combined (OR?=?1.6 95%CI 1.1–2.1); maternal literacy in Natore (OR?=?1.6 95%CI 1.0–2.5); and epilepsy in all three models (Sirajganj: OR?=?2.6 95%CI 1.7–4.0; Natore: OR?=?13.5 95%CI 6.5–28.3; Combined: OR?=?4.6 95%CI 3.3–6.5). Physical impairment was associated with increased odds of uptake in Sirajganj and in the combined model (OR?=?2.7 95%CI 1.8–4.1; OR?=?3.34 95%CI 2.2–5.2). Conclusions: Even when some logistical and financial assistance is available, children with impairment from low-income families may require additional support to take up referrals. There may be greater willingness to accept treatment that is locally provided, such as medication for epilepsy or therapy at village level.

Implications for Rehabilitation

• Providing a referral for treatment or rehabilitation is often not enough to ensure access to service for children with disabilities in low and middle income countries.

• Uptake of referral can be influenced by many factors, and individuals face different types of barriers.

• Financial and logistical support can help increase referral uptake.

• Low monthly income and maternal illiteracy is associated with lower uptake even when assistance is provided.

     

Does vibration training reduce the fall risk profile of frail older people admitted to a rehabilitation facility? A randomised controlled trial

Purpose: To determine the effect of Vibration Training (VT) on functional ability and falls risk among a group of frail older people admitted to an inpatient rehabilitation unit in a regional hospital in New Zealand. Method: A randomized controlled trial of 56 participants (mean 82.01 years in the intervention group and 81.76 years in the control group). VT targeting lower limb muscles with a frequency 30–50 Hz occurred three times per week until discharge. Amplitude progressively increased from 2 to 5?mm to allow the programme to be individually tailored to the participant. The control group received usual care physiotherapy sessions. Outcome measures were: Physiological profile assessment (PPA); and Functional Independence measure (FIM) and Modified Falls Efficacy Scale (MFES). Results: There was a statistically significant difference observed between the two groups in terms of FIM score (F?=?5.09, p?=?0.03) and MFES (F?=?3.52, p?=?0.007) but no difference was observed in terms of PPA scores (F?=?0.96, p?=?0.36). Conclusions: Among older people admitted to an inpatient rehabilitation facility there may be some beneficial effect to the use of VT in conjunction with usual care physiotherapy in terms of improved functional ability. The study design and the small dosage of VT provided may have precluded any change in falls risk among participants.

• Implications for Rehabilitation

• Vibration training (VT) may assist in reducing the risk of falling among at risk older people.

• Current pressures on health systems (ageing population, reduced hospital length of stay) necessitate the development of innovative strategies to maximise the rehabilitation potential of older people.

• Among older people admitted to an inpatient rehabilitation facility there may be some beneficial effect to the use of vibration training in conjunction with usual care physiotherapy in terms of improved functional ability.

     

Italian adaptation of the functional outcome questionnaire – aphasia: initial psychometric evaluation

Abstract

Purpose: To evaluate the psychometric properties of the Italian version of Functional Outcome Questionnaire – Aphasia.

Methods: Two hundred and five persons with stroke-related aphasia and right hemiparesis who received ongoing assistance from a family caregiver were assessed using the Functional Outcome Questionnaire – Aphasia, Aachener Aphasie Test, Token Test, Raven’s Coloured Progressive Matrices, Functional Independence Measure (FIM), Functional Assessment Measure (FAM), and Quality of Life Questionnaire for Aphasics (QLQA). The Functional Outcome Questionnaire – Aphasia was translated into the Italian language using a translation and back-translation method. Reliability and construct validity of the Functional Outcome Questionnaire – Aphasia were evaluated.

Results: The Italian version of the Functional Outcome Questionnaire – Aphasia showed good internal consistency and test–retest reliability for the overall scale (α?=?0.98; ICC?=?0.95) and subscales (α?=?0.89 for the communicating basic needs (CBN), α?=?0.92 for the making routine requests (MRR), α?=?0.96 for the communicating new information (CNI), α?=?0.93 for the attention/other communication skills (AO); ICC?=?0.95 for CBN, ICC?=?0.96 for MRR, ICC?=?0.97 for CNI and ICC?=?0.92 for AO). Significant correlations were found between the Functional Outcome Questionnaire – Aphasia and Token Test, QLQA, Aachener Aphasie Test scores, and FAM linguistic scores, indicating good convergent validity. Low correlations were found between Functional Outcome Questionnaire – Aphasia and Raven’s Coloured Progressive Matrices and FIM motor scores, showing good discriminant validity.

Conclusions: The overall findings of this study supported the reliability and construct validity of the Italian version of the Functional Outcome Questionnaire – Aphasia. This measure holds considerable promise in assessing the functional outcomes of aphasia rehabilitation in Italian-speaking persons with aphasia.

• Implications for Rehabilitation

• Functional Outcome Questionnaire – Aphasia is a reliable and valid questionnaire in assessing functional communication of Italian-speaking people with aphasia.

• This measure provides critical information about people with aphasia’s functional and pragmatic communication in home and community settings, contributing significantly to overall quality of life.

• Since the use of measures of functional communication is recommended in the clinical evaluation of language disease, the Italian version of Functional Outcome Questionnaire – Aphasia may be effective in tailoring rehabilitation treatment to the presenting communication problems of people with aphasia and their caregivers.

     

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).

     

How active are patients in setting goals during rehabilitation after stroke? A qualitative study of clinician perceptions

Purpose: We investigated stroke rehabilitation clinician’s perceptions of the patient as an active partner in setting goals within stroke rehabilitation and factors that influence patient engagement.

Methods: Semi-structured interviews, subject to general inductive analysis with 20 Clinicians’ working in three UK based stroke rehabilitation teams (one in-patient ward and two community based rehabilitation teams).

Results: There were three key themes that impacted on the patients active involvement in setting goals for rehabilitation after stroke: Patient barriers to goal setting (knowledge of the patient and family, who is the patient and the stroke’s impact); How we work as a team (the role of the patient in setting goals, the effect of clinician attributes on goal setting); and How systems impact goal setting (goal-setting practice, home versus hospital, and professional/funder expectations of clinicians’).

Conclusions: Goal setting served a range of different, sometimes conflicting, functions within rehabilitation. Clinicians’ identified the integral nature of goals to engage and motivate patients and to provide direction and purpose for rehabilitation. Further, there was an identified need to consider the impact of prioritizing clinician-derived goals at the expense of patient-identified goals. Lastly the reliance on the SMART goal format requires further consideration, both in terms of the proposed benefits and whether they disempower the patient during rehabilitation.

• Implications for rehabilitation

• Goal setting is often promoted as a relatively simple, straightforward way to structure interactions with patients

• Patient-related factors together with resourcing constraints are significant barriers to patient-centered goal setting, particularly during inpatient rehabilitation

• Clinicians need to have pragmatic tools that can be integrated into practice to ensure that goal-setting practice can be maximized for patients with different intrinsic characteristics