•A retrospective review was conducted on patients who underwent liver transplantation.•Patients were admitted to a free-standing rehabilitation facility within 6 months.•The FIM tool was used to ...measure functional outcomes.•Patients demonstrated statistically significant improvement in functional outcomes.
To describe the outcomes (change in functional independence and discharge disposition) of patients who after liver transplantation received acute inpatient rehabilitation in a freestanding rehabilitation hospital.
A retrospective chart review was conducted of patients admitted to an acute inpatient rehabilitation hospital within 6 months of undergoing liver transplantation between January 2014 and December 2018. Change in function from rehabilitation admission to discharge was measured using FIM Change and FIM Efficiency.
A freestanding rehabilitation hospital.
107 patients who underwent acute inpatient rehabilitation at a freestanding rehabilitation hospital within 6 months after liver transplantation who met inclusion criteria (N=107). Most were men (71.96%), and the mean age of the patient population was 62.15 years.
Acute inpatient rehabilitation consisting of at least 3 hours of therapy 5 days a week split between physical therapy, occupational therapy, and speech language pathology services.
FIM Change, FIM Efficiency, Discharge Disposition.
Participants were found to have statistically significant positive FIM Change (P<.00001) and FIM Efficiency (P<.00001). The mean FIM Change and Efficiency were 35.7±11.8 and 2.4±1.0, respectively. 83.2% (n = 89) were ultimately discharged to the community.
Acute inpatient rehabilitation provides patients who have received a liver transplant with the opportunity to measurably improve their function and independence, with most patients being able to return home.
Background Physician transfer is an alternate option to patient transfer for expedient performance of mechanical thrombectomy in patients with acute ischemic stroke. Methods and Results We conducted ...a systematic review to identify studies that evaluate the effect of physician transfer in patients with acute ischemic stroke who undergo mechanical thrombectomy. A search of PubMed, Scopus, and Web of Science was undertaken, and data were extracted. A statistical pooling with random‐effects meta‐analysis was performed to examine the odds of reduced time interval between stroke onset and recanalization, functional independence, death, and angiographic recanalization. A total of 12 studies (11 nonrandomized observational studies and 1 nonrandomized controlled trial) were included, with a total of 1894 patients. Physician transfer was associated with a significantly shorter time interval between stroke onset and recanalization with a pooled mean difference estimate of −62.08 (95% CI, −112.56 to −11.61; P =0.016; 8 studies involving 1419 patients) with high between‐study heterogeneity in the estimates ( I 2 =90.6%). The odds for functional independence at 90 days were significantly higher (odds ratio, 1.29 95% CI, 1.00–1.66; P =0.046; 7 studies with 1222 patients) with physician transfer with low between‐study heterogeneity ( I 2 =0%). Physician transfer was not associated with higher odds of near‐complete or complete angiographic recanalization (odds ratio, 1.18 95% CI, 0.89–1.57; P =0.25; I 2 =2.8%; 11 studies with 1856 subjects). Conclusions Physician transfer was associated with a significant reduction in the mean of time interval between symptom onset and recanalization and increased odds for functional independence at 90 days with physician transfer compared with patient transfer among patients who undergo mechanical thrombectomy.
Objective: Patients with non-traumatic rupture of an aneurysm located at the anterior communicating artery (ACoA) often experience cognitive disabilities. It is unknown whether location of aneurysm ...also affects the possibility for improvement in functional independence compared to patients with an aneurysmal subarachnoid hemorrhage (a-SAH) located elsewhere. The aim was to explore the association between location of aneurysm (ACoA versus other) and level of functional independence, measured by Functional Independence Measure (FIM), at discharge from rehabilitation. Additionally, age and FIM at admission were explored.
Method: Historical cohort study among 107 patients with a-SAH based on data from a clinical database and a population-based register. Data were analyzed using multivariable logistic regression.
Results: Patients with ACoA were admitted with poorer cognitive FIM (median 6 (IQR 5-14) compared to patients with aneurysms located elsewhere (median 12 (IQR 6-23) (p = 0.0129); no difference at discharge. No association between aneurysm location and functional independence was observed. Higher age was associated with poorer outcome in bowel management OR 0.54 (95% CI 0.31-0.92), bladder management OR 0.59 (95% CI 0.35-0.98), comprehension OR 0.53 (95% CI 0.30-0.94), and memory OR 0.48 (95% CI 0.25-0.93). Overall, FIM at admission was associated with functional independence at discharge with the exception of stair walking and bladder management which did not reach statistical significance.
Conclusion: ACoA was not associated with poorer level of functional independence compared to patients with a-SAH located elsewhere. Higher age was associated with poorer outcome in continence, comprehension, and memory, whereas higher FIM was associated with better functional independence across items at discharge.
Objective: To determine the effects of whole body vibration along with balance training in older individuals. Methodology: This randomized control trial was conducted after the approval of Research ...Ethical Committee of Riphah International University. Total of 112 participants were recruited on the basis of inclusion criteria of both genders with controlled diabetes and hypertension, age ranging from 50 to 70 years, medium fall risk according to Berg balance score of 21-40. Patient with any type of surgical intervention which may hinder assessment or treatment, Individuals were randomly assigned to experimental (n=56) and control groups (n=56) through toss a coin method. Experimental group was given balance and strengthening exercises with whole body vibration whereas, control group received balance and strengthening exercises only. Individuals in both groups were assessed for their balance performance by using Berg Balance Scale, Functional Independence Scale, and Time Up and Go Test. These assessment tools were used before and after the treatment of 4 weeks’ protocol. Results: Mann-Whitney U test was applied for comparison between control and experimental group. The p-values of Berg balance and functional independent measure were 0.001 and 0.003 respectively with statistically significant improvement whereas time up and go test showed statistically non-significant results with the p value 0.044 (less than 0.05) Conclusion: This study concluded that Whole body vibrations along with balance training and strength were more effective in improving functional independence when compared to conventional physical therapy exercises training for strength and balance. Clinical Trial Number: NCT04963387
Studies point to the persistence of symptoms in patients with non-critical COVID-19 after hospitalization, pointing to impairments in functionality, exercise capacity and effort desaturation, which ...characterize the need for continuity of management and treatment after acute illness.
To evaluate functional independence, exercise capacity, and effort desaturation after non-critical COVID-19 after hospital discharge.
A cross-sectional study included adult individuals with a noncritical COVID-19 diagnosis who were hospitalized for at least 24 hours between 30 and 180 days after hospital discharge. Participants were classified into 3 groups: G1M - one month after hospital discharge, G3M - three months after hospital discharge, and G6M - six months after charge. A digital form with clinical and sociodemographic questionnaire, modified MRC scale, Barthel Index, and London Chest Activity of Daily Living Scale was applied, in addition to the 6-minute Walk Test in G3M and G6M. The significance value was p<0.05.
We included 64 individuals (G1M=18, G3M=25, G6M=21). There was a significant difference in Barthel Index between G1M and G6M (p=0.007). G3M walked 420m vs 442m of G6M (p=0.25). 48% of participants in G3M and 52% in G6M walked a distance less than 80% of predicted; 28% of G3M participants had >=4% drop in SpO2, vs 19.05% in G6M (p=0.478). There was a high prevalence of persistent symptoms, with a significant association between dyspnea (p=0.001), cough (p=0.038) and angina (p=0.001) and decreased functional independence.
After non-critical COVID-19, decreased functional independence was observed, with significant improvement 6 months after hospital discharge, in addition to decreased exercise capacity, the occurrence of desaturation on exertion, and high prevalence of persistent symptoms with no improvement 6 months after hospitalization.
Patients with persistent symptoms after COVID-19 should be evaluated and treated in pulmonary rehabilitation clinics. The changes caused by non-critical COVID-19 remain in the short and medium term, as in critical COVID-19.
Background: Sex differences in stroke outcomes are crucial to secondary prevention, but previous reports showed inconsistent results. We aimed to explore the sex differences in stroke outcomes in the ...Third China National Stroke Registry, a prospective multicenter registry study. Methods: Among the 15 166 patients enrolled between 2015 and 2018, 9038 patients with acute ischemic stroke (AIS) were included. The primary outcomes were stroke recurrence, mortality, and unfavorable functional outcome (modified Rankin Scale > 2) at 3, 6, and 12 months. Cox regression model was used for stroke recurrence and mortality and logistic regression was used for the unfavorable functional outcome, and adjusted as follows: (1) Model 1: without adjustment; (2) Model 2: adjusted for potential risk factors, National Institutes of Health Stroke Scale at admission, prestroke modified Rankin Scale, tPA (tissue-type plasminogen activator) treatment, TOAST (Trial of ORG 10172 in Acute Stroke Treatment) classification, and onset-to-door time; (3) Model 3: adjusted for covariates from model 2 in addition to blood pressure and blood serum covariates. Multiple imputation was used for missing values, and sensitivity analyses were conducted to describe sex differences by age groups. Results: One-third (2802/9038) of the patients were women. Women were significantly older than men (64.78±10.84 versus 61.26±11.42, P <0.001). In the fully adjusted model, female patients were more likely to have unfavorable functional outcomes at 3 months (odds ratio, 1.28 1.09–1.50), especially among patients aged 65 years or older (odds ratio, 1.39 1.14–1.70), but no difference was discovered in patients aged <65 years. There were no sex differences in stroke recurrence and mortality at 3, 6, or 12 months or unfavorable functional outcomes at 6 or 12 months after adjustment. Conclusions: Compared with men, women with AIS were less likely to have favorable outcomes at 3 months in China, especially among those over 65 years of age. Experts should aim to tailor secondary prevention strategies for high-risk patients.
Abstract
BACKGROUND
Cranioplasty after decompressive craniectomy is a common neurosurgical procedure, yet the optimal timing of cranioplasty has not been well established.
OBJECTIVE
To investigate ...whether the timing of cranioplasty is associated with differences in neurological outcome.
METHODS
A systematic literature review and meta-analysis was performed using MEDLINE, Scopus, and the Cochrane databases for studies reporting timing and neurological assessment for cranioplasty after decompressive craniectomy. Pre- and postcranioplasty neurological assessments for cranioplasty performed within (early) and beyond (late) 90 d were extracted. The standard mean difference (SMD) was used to normalize all neurological measures. Available data were pooled to compare pre-cranioplasty, postcranioplasty, and change in neurological status between early and late cranioplasty cohorts, and in the overall population.
RESULTS
Eight retrospective observational studies were included for a total of 528 patients. Studies reported various outcome measures (eg, Barthel Index, Karnofsky Performance Scale, Functional Independence Measure, Glasgow Coma Scale, and Glasgow Outcome Score). Cranioplasty, regardless of timing, was associated with significant neurological improvement (SMD .56, P = .01). Comparing early and late cohorts, there was no difference in precranioplasty neurological baseline; however, postcranioplasty neurological outcome was significantly improved in the early cohort (SMD .58, P = .04) and showed greater magnitude of change (SMD 2.90, P = .02).
CONCLUSION
Cranioplasty may improve neurological function, and earlier cranioplasty may enhance this effect. Future prospective studies evaluating long-term, comprehensive neurological outcomes will be required to establish the true effect of cranioplasty on neurological outcome.
•Generic and specific HRQoL six and 12 months after stroke can be predicted in acute phase.•Functional independence is the strongest HRQoL predictor, from a middle-income country.•Functional ...independence needs to be considered in rehabilitation, since can be modified.
To identify acute predictors of generic and specific health-related quality of life (HRQoL) six and 12 months after stroke in individuals from a middle-income country.
This was a prospective study. The dependent outcomes assessed during six and 12 months after stroke included both generic and specific HRQoL (Short Form Health Survey-36 SF-36 and stroke-specific quality of life SSQOL). The predictors were age, sex, education level, length of hospital stay, current living arrangement, stroke severity, functional independence, and motor impairment.
122 (59.9±14 years) and 103 (59.8±14.71 years) individuals were evaluated six and 12 months after stroke, respectively. Functional independence and sex were significant acute predictors of both generic and specific HRQoL. Functional independence was the strongest predictor (0.149≤R2≤0.262; 20.01≤F≤43.96, p<0.001), except for generic HRQoL at 12 months, where sex was the strongest predictor (R2=0.14; F=17.97, p<0.001).
Generic and specific HRQoL in chronic individuals six and 12 months after stroke, from a middle-income country, can be predicted based on functional independence, the strongest predictor, assessed in the acute phase, except for generic HRQoL at 12 months. Functional independence can be modified by rehabilitation strategies and thus should be considered for HRQoL prognoses at chronic phase.
Health-related quality of life (HRQoL), a patient-centered outcome, is essential for healthcare, mainly in stroke, a chronic disease with a broad spectrum of disabilities.
Functional independence is ...a key outcome and should always be a part of characterizing patients before the rehabilitation process.
Functional independence assessed with the Modified Barthel Index in the acute phase of stroke predicts both generic and specific HRQoL at 3-month post-stroke.
Patients post-stroke with lower functional independence at hospital discharge may be at risk of having lower HRQoL at 3-month post-stroke.
To identify acute predictors of both generic and specific health-related quality of life (HRQoL) 3 months after stroke in individuals from a middle-income country.
A 3-month prospective study with individuals who had suffered their first stroke, without previous disability, discharged from a stroke unit. The dependent outcomes, assessed 3 months after stroke, were generic and specific HRQoL (SF-36 and SSQOL total scores, respectively). The predictors assessed in the stroke unit were age, sex, education level, duration of hospital stay, current living arrangement, stroke severity (National Institutes of Health Stroke Scale-NIHSS), functional independence (Modified Barthel Index-MBI), motor impairment (Fugl-Meyer Assessment), and lower- and upper-limb residual muscle strength deficits. Linear multiple regression analyses were employed to identify predictors of both generic (model-1) and specific (model-2) HRQoL (α = 5%).
One hundred twenty-six individuals were assessed at 3-month post-stroke (61.3 ± 13.6 years). Regression analysis showed that functional independence was the best predictor of both generic (R
2
= 21%; F = 34.82; p < 0.001) and specific (R
2
= 29%; F = 51.71; p < 0.001) HRQoL at 3-month post-stroke.
Both generic and specific HRQoL at 3-month post-stroke can be predicted by functional independence assessed in the acute phase with the MBI.
The Functional Independence Measure (FIM) instrument is widely used in the clinical practice, but merely in the lower limb amputees and without differentiation between men and women as well as ...between transtibial (TT) and transfemoral (TF) amputees. Only the total FIM score and/or motor FIM and cognitive FIM subscores are analyzed, in spite that certain parts of motor FIM score attract more interest of practitioners. The aim of this study was to confirm the hypothesis of better functional abilities in the amputee men than women and in TT than TF. We wanted to demonstrate the advantage of a detailed analysis of the motor FIM too.
Two hundred and twenty-nine hospitalization cases of the lower limb amputees were sorted into eight groups according to their gender and amputation level (TT or TF), separately for the first and second hospitalization. The scores of motor FIM, walk, stair climbing, self-care and transfers at the admission and discharge were chosen as variables as well as the age, length of stay (LOS) and the interval between the surgery and admission to rehabilitation department (delay). The Mann–Whitney test was used to set the significant differences at the level P<0.05.
The gender effect on functional independence was ascertained in almost all motor FIM parts, especially at the first discharge and second admission. Amputation level effect was also ascertained frequently at discharge, especially in walk and stair climbing. The effect of age, LOS or delay was very rare.
Expected better functional abilities in men and TT were confirmed. The analysis of selected parts of motor FIM brings more detailed information than the Total FIM exclusively.
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