Psychiatric symptom severity and length of stay on an intensive rehabilitation unit.

The purpose of this study was to evaluate the role of psychiatric symptoms in the medical and surgical rehabilitation of patients on an intensive rehabilitation unit and to examine whether psychiatric symptom severity contributes to length of hospital stay (LOS). Forty-four patients (21 men and 23 women) were assessed at admission and before discharge with the Functional Independence Measure (FIM). Subjects were evaluated with the Mini-Mental State Exam (MMSE), the Hamilton Rating Scale for Depression (Ham-D), Positive and Negative Symptom Scale, (PANSS), and Scale for the Assessment of Negative Symptoms (SANS). Thirty-six percent of subjects were cognitively impaired (MMSE < 25), 14% had significant depressive symptoms (Ham-D > 12), and 52% had significant negative symptomatology (PANSS-N > 15). A regression analysis yielded a model of three predictive factors. Gender, the PANSS General subscale, and the SANS Attention subscale accounted for 42.4% of LOS variance. These results indicate that psychiatric symptoms are common in medical rehabilitation inpatients and, together with demographic factors, are associated with increased LOS.

Negative symptoms in stroke patients and length of hospital stay.

The purpose of this study was to assess whether the presence and severity of psychiatric symptoms in stroke patients correlate with their length of stay (LOS) in a rehabilitation unit, with special emphasis on the role of negative symptoms (NS). Twenty-three stroke patients, consecutively recruited from the inpatient rehabilitation unit, were evaluated on admission with the Mini-Mental State Examination (MMSE), the Positive and Negative Symptom Scale (PANSS), the Hamilton Depression Rating Scale (HDRS), the Scale for Assessment of Negative Symptoms (SANS), and the Functional Independent Measure (FIM). NS scores significantly correlated with LOS, with SANS total score being the most informative, and the attentional impairment subscale the least. The group of patients with pronounced NS stayed in the hospital twice as long as patients with the score on the NS subscale of PANSS below 16. These two groups did not differ in their cognitive performance or in the positive symptom subscale of PANSS scores. Total FIM score on admission was lower and HDRS scores higher in patients with pronounced NS. However, these differences, unlike those of LOS, have not reached statistical significance. The presence and severity of NS in stroke patients are associated with a longer hospital stay. Identification and treatment of NS might lead to a faster discharge from rehabilitation unit.

Cardiac rehabilitation exercise program: outcome assessment.

Medically supervised exercise programs have increasingly gained acceptance in management of the coronary patient. Beneficial postexercise results published include: Improved exercise and work tolerance, a decrease in frequency and severity of angina, and earlier return to work. The present retrospective study evaluates the outcome of a three-month cardiac rehabilitation exercise program with changes in exercise performance, compliance with postdischarge exercise routine, and return to work pattern. The study group included 38 patients with documented coronary artery disease and two participants free of ischemic heart disease. Thirty patients were treated with beta blocker medications, ten were not. Time of follow-up ranged from six months to two years. Pre- and postexercise performance expressed in VO2 ml/kg/min was assessed at target heart rate using a modified exercise protocol. Training resulted in statistically significant increases in median exercise performance in both patient groups: 2.38 ml O2/kg/min (range 1.33, 7.18; p 0.0068, one-tail) in the untreated group, and 3.45 ml O2/kg/min (range 2.63, 11.48; p 0.001, one-tail) in the beta blocker treated group. Fifty-seven percent of the participants complied with a postdischarge exercise routine while 7/12 (58%) patients unemployed at time of referral resumed work during or following completion of the exercise program. Such programs appear to be a valuable component in the management of the coronary patient. Further studies involving larger numbers of patients are indicated to document cost effectiveness of such programs.