Predictors of balance in older hip fracture patients undergoing standard motor rehabilitation.

PURPOSE: Little is known about the factors predicting balance in hip fracture patients. The aim of this retrospective observational study was to assess balance before and after inpatient rehabilitation and, secondarily, to identify factors predicting the balance levels in older hip fracture patients after motor rehabilitation. METHODS: Data were collected in 124 hip fracture patients over a 2-year period. All patients underwent a standard motor rehabilitation program. A modified version of Berg Balance Scale (BBS) score after rehabilitation, daily gain and percentage of improvement in BBS were the outcome measures. Multivariate regression analysis was performed to identify the predictors of balance. RESULTS: The mean BBS score was 8.33 ± 7.23 at admission and 21.79 ± 12.15 at the end of rehabilitation (p < 0.001). The daily gain in BBS score was 0.39 ± 0.31 and the percent improvement was 32.28 ± 23.04%. Standing with one foot in front and standing on one foot were the BBS items with the lowest score at discharge and the lowest daily gain and percent improvement. The Cognitive-Functional Independence Measure (cognitive-FIM), hip muscles strength, and Katz index at discharge had moderate-to-strong relationships with final score, daily gain and percentage of improvement in BBS. Cognitive-FIM was a predictor of final BBS score (beta 0.49, p < 0.001), daily gain in BBS (beta 0.34, p < 0.001) and percent improvement in BBS (beta 0.44, p < 0.001). Conversely, hip muscles strength was a predictor of final BBS score (beta 0.32, p = 0.001), and Cumulative Illness Rating Scale severity, a predictor of daily gain in BBS (beta -0.29, p = 0.001). The R2 value of the models were, respectively, 0.39, 0.23, and 0.19. CONCLUSIONS: Cognitive function, comorbidities and hip muscles strength are important predictors of balance in hip fracture patients. Knowledge of these specific factors can be useful for physicians to identify patients needing specific rehabilitation programs for balance.

Functional recovery in hip fracture patients: the role of pharmacotherapy.

BACKGROUND AND AIM: The aim of this prospective observational cohort study was to verify the relationship between number of drugs used and functional outcome in hip fracture patients undergoing rehabilitation. METHODS: This study was conducted on 139 patients with hip fracture who underwent a rehabilitation program. Efficiency rate in the Functional Independence Measure (FIM) and Berg Balance Scale (BBS), and length of stay (LOS) were the outcome measures. RESULTS: At the end of rehabilitation, 66.1% of patients showed an increase in number of drugs used, while 33.9% used the same or lower number of drugs than at admission. At the end of rehabilitation patients with increased pharmacotherapy took a higher total number of drug classes (p = 0.001), had longer LOS (p = 0.009) and lower Berg efficiency (p = 0.048) than patients with the same or lower pharmacotherapy. The number of drugs used at discharge was an independent determinant of LOS (beta = 0.19, p = 0.022) and FIM efficiency (beta = - 0.20, p = 0.025). Age was a determinant of LOS (beta = 0.17, p = 0.044) and BBS efficiency (beta = - 0.23, p = 0.009), while CIRS severity was a determinant of BBS efficiency only (beta = - 0.22, p = 0.016). DISCUSSION: Findings of study indicate that in hip fracture patients, the number of drugs prescribed at discharge is an important indicator of LOS and rehabilitation efficiency. CONCLUSIONS: These findings can help the physician to better plan the rehabilitation of hip fracture patients who require polypharmacy.

Pain, disability and adherence to home exercises in patients with chronic neck pain: long term effects of phone surveillance. A randomized controlled study.

BACKGROUND: Effectiveness of phone surveillance and other communication technologies in the management of neck pain patients have been evaluated previously only at the suspension of the service. AIM: To verify whether a phone surveillance program can improve pain, disability, and adherence to home exercises in neck pain patients, and whether the improvement achieved continues to be maintained also after suspension of the support. DESIGN: This is a randomized controlled study. SETTING: Outpatients of Rehabilitation Unit. POPULATION: 84 out of 100 outpatients consecutively randomized (by blocks of four) to Phone group (N.=42, performing a 6-month home-based phone surveillance program) or to Control group (N.=42, with the only recommendation to continue exercising at home without phone surveillance) were considered. The home-based phone surveillance program consisted of 12 scheduled phone calls, each performed every fortnight by a nurse-tutor with expertise in rehabilitation for the first six months of the study. At the end of phone surveillance period, Phone patients were encouraged to continue home exercises for a further 6 months period. METHODS: Pain severity (assessed with Pain VAS), disability (Neck Disability Index), and adherence to exercises performed at home (classified as: ≥5 sessions/week, 2-4 sessions/week, occasional or no sessions) were outcome measures. Pain severity and disability were assessed at entry, at 6 and 12 months, while adherence to exercises was self-reported and recorded at 6 and 12 months. Differences between groups were analyzed with χ2 test, Student's t-test or ANOVA. RESULTS: At 6 months, Pain VAS (P=0.013) and Neck Disability Index scores (P=0.012) were lower in Phone patients than Controls. At 12 months, Neck Disability Index scores (P=0.026) continued to be lower in Phone patients than Controls. At 6 months, 97.6% of Phone patients and 80.9% of Controls performed rehabilitation at home with a range of 2 to 7 sessions/week; while at 12 months, the respective percentages of Phone and Control patients were 92.9% and 73.8%. Adherence to home exercises was higher in Phone patients than in Controls at 6 (P=0.013) and 12 months (P=0.019). CONCLUSIONS: In patients with chronic neck pain, the positive effects of phone surveillance on the neck disability and adherence to home exercises still persist 6 months after the suspension of the support. CLINICAL REHABILITATION IMPACT: This knowledge can be useful for physicians to plan home rehabilitation of neck pain patients.

The minimal clinically-important difference of the Prosthesis Evaluation Questionnaire - Mobility Scale in subjects undergoing lower limb prosthetic rehabilitation training.

BACKGROUND: There is increasing interest in psychometrically sound outcome measures of mobility for people with lower limb amputation (LLA), in order to accurately monitor the impact of the prosthetic training during and after rehabilitation. AIM: To determine the minimum detectable change (MDC) and minimal clinically important difference (MCID) for the Prosthesis Evaluation Questionnaire-Mobility Scale (PEQ-MS) in people with LLA. DESIGN: Prospective single-group observational study. SETTING: Two free-standing Rehabilitation Hospitals. POPULATION: Eighty-seven adult inpatients with LLA undergoing prosthetic rehabilitation. METHODS: Patients completed the self-report PEQ-MS twice, immediately before and after prosthetic rehabilitation training. We administered a 7-point Global Rating of Change scale at the end of training as external anchor, to quantify the effect (improvement/deterioration) of the intervention. RESULTS: Test-retest reliability of the PEQ-MS (N.=24) was high (ICC2,1=0.90). The MDC at the 95% confidence level was 5.5 points. This value, together with those of the mean-change approach and receiver-operating characteristic-curve analysis (AUC>0.89), suggested the selection of a MCID for PEQ-MS of eight points of change, i.e. 16.7% of the maximum possible score (95% CI: 6.5-9.5). CONCLUSIONS: The PEQ-MS showed a high ability to detect change over time (responsiveness).The above MCID value - derived from a triangulation of distribution (MDC) and anchor-based methods - represents a minimal level of change (perceived as important by the patient) in mobility of people with LLA undergoing prosthetic rehabilitation training. CLINICAL REHABILITATION IMPACT: The PEQ-MS is a widely used and analyzed outcome measure. The present study calculated - in a sample of people with LLA undergoing prosthetic training - both the MDC and MCID of the PEQ-MS, showing the high responsiveness of this tool. These values increase confidence in interpreting change in PEQ-MS values, and can help in clinical decision making.

Comparison of exercise training effect with different robotic devices for upper limb rehabilitation: a retrospective study.

BACKGROUND: Several robotic devices have been proposed for upper limb rehabilitation, but they differ in terms of application fields and the technical solutions implemented. AIM: The aim of this study was to compare the effectiveness of three different robotic devices for shoulder-elbow rehabilitation in reducing motor impairment and improving motor performance in post-stroke patients. DESIGN: Retrospective multi-center study. SETTING: Inpatient rehabilitation hospital. POPULATION: Eighty-seven chronic and subacute post-stroke patients, aged 48-85 years. METHODS: Data were obtained through a retrospective analysis of patients who underwent a 3-week rehabilitation program including robot-assisted therapy of the upper limb and conventional physical therapy. Patients were divided into three groups according to the robot device used for exercise training: 'Braccio di Ferro" (BdF), InMotion2 (IMT), and MEchatronic system for MOtor recovery after Stroke (MEMOS). They were evaluated at the beginning and end of treatment using the Fugl-Meyer (FM) and Modified Ashworth (MAS) clinical scales and by a set of robot measured kinematic parameters. RESULTS: The three groups were homogeneous for age, level of impairment, time since the acute event, and spasticity level. A significant effect of time (P<0.001) was evident on FM and kinematic parameters across all groups. The average change in the FM score was 9.5, 7.3 and 7.1 points, respectively, for BdF, IMT and MEMOS. No significant between-group differences were observed at the MAS pre- vs. post-treatment. A significant interaction between time and groups resulted for the mean velocity (MV, P<0.005) and movement smoothness parameters (nPK, P<0.001 and SM, P<0.02). The effect size (ES) was large for the FM score and MV parameter, independently of the type of robot device used. Further, the ES ranged from moderate to large for the remaining kinematic parameters except for the movement accuracy (mean distance, MD), which exhibited a small ES in the BdF and MEMOS groups. CONCLUSIONS: The motor function gains obtained during robot-assisted therapy of stroke patients seem to be independent of the type of robot device used for the training program. All devices tested in this study were effective in improving the level of impairment and motor performance. CLINICAL REHABILITATION IMPACT: This study could help rehabilitation professionals to set-up comparative studies involving rehabilitation technologies.