Determinants of outcome in hip fracture: role of daily living activities.

BACKGROUND: Very few studies have investigated activities of daily living (ADLs) post hip-surgery as a possible determinant of functional outcome after hip fracture. AIM: This prospective, observational study aimed to correlate hip-fracture patients' ADLs on admission to in-hospital rehabilitation with their functional outcome post-rehabilitation. METHODS: Of 216 consecutive hip-fracture patients admitted to our Rehabilitation Unit, 204 patients were eligible for the final analyses. All patients underwent the usual rehabilitation. At admission, basic ADLs were assessed by the Functional Independence Measure (FIM) scale. Discharge scores, efficiency and effectiveness in motor-FIM, and discharge destination were outcome measures. Backward stepwise regressions were performed to identify determinants of outcome measures. Age, sex, education, number of relatives, orthopedic treatment, onset to admission interval, Mini Mental State Examination (MMSE), Cumulative Illness Rating Scale, Neuropsychiatric Inventory, ROM, Muscle Strength, and FIM scores at admission were independent variables. RESULTS: There was functional gain in all ADLs post-rehabilitation, walking being the FIM-item with the highest efficiency and effectiveness (respectively, 0.14±0.0 and 64.2±21). Multivariate analyses showed that MMSE was a determinant of final score, efficiency, and effectiveness in motor-FIM. Bladder control was a determinant of final score and effectiveness in motor-FIM, while eating and bathing were determinants of final motor-FIM score. Bowel management was the only determinant of discharge destination. CONCLUSION: Basic ADLs, in particular eating, bathing, bladder and bowel management, are important determinants of outcome in hip fracture. CLINICAL REHABILITATION IMPACT: The results of this study suggest that, in designing studies on outcome prediction in hip fracture, researchers should include tests assessing performance of basic ADLs as independent variables, as this could allow to identify new prognostic indicators that may be helpful for physicians in managing hip fracture patients post-rehabilitation.

Walking and mobility before and after rehabilitation in patients with infratentorial stroke.

AIM: Few data exist about walking and motility after infratentorial stroke (IS). The aim of this study was to objectively quantify pre-rehabilitation and post-rehabilitation walking and mobility in a group of IS patients admitted for inpatient rehabilitation and to determine factors influencing functional outcomes. MATERIALS AND METHODS: Seventy-two patients with IS were selected on the basis of clinical criteria and computer tomography (CT) images. Mean age was 76.5 +/- 10 (31 men and 41 women). The stroke was ischemic in 55 patients and hemorrhagic in 17 Walking (Lindmark scale), mobility (Rivermead Mobility Index) (RMI) and stroke severity (National Institute of Health Stroke Scale) (NIH) were evaluated in all patients at admission to study and at discharge. RESULTS: Before rehabilitation 1.4% of patients were independent in walking and 23.7% were over 75th percentile in RMI. After rehabilitation, 80.5% of the patients were able to walk independently and 84.7% were over 75th percentile of mobility. Age, onset to admission interval, and extent of the stroke did non correlate with Lindmark and RIM. Lindmark and RMI were correlated only with NIH. Patients with higher NIH score (NIH+) had significantly worse walking capacity and mobility than patients with lower NIH score (NIH-) before and after rehabilitation. Moreover, in patients NIH+ length of rehabilitation therapy was significantly longer compared to patients NIH-. In addition, patients NIH+ had efficiency in walking and in mobility significantly lower than patients NIH-. CONCLUSIONS: The study shows that: (1) IS patients have a significant functional recovery in walking and mobility after rehabilitation, (2) stroke severity is related with walking and mobility.

Walking and disability after rehabilitation in patients with cerebellar stroke.

AIM: Aim of this study is to verify if the presence of extracerebellar stroke lesions negatively affects walking and functional capacities recovery of patients with cerebellar stroke. METHODS: This study was carried out on 43 patients. Patients' selection was made through CT and MRI scans. Neuroimaging data were used to divide patients into 2 groups: 1) a group composed of 20 patients with isolated cerebellar involvement (group C); (2) a group composed of 23 patients with cerebellar plus extracerebellar involvement (group C+E). Patients were assessed through trunk control test (TCT), Lindmark scale and Rankin scale at admission and at discharge. Before rehabilitation, there were no significant differences in disability, TCT and Lindmark scores between the 2 groups of patients. RESULTS: After rehabilitation, Lindmark scale (P=0.022) and TCT (P=0.015) scores of group C were statistically higher than those of group C+E. Disability was greater in group C+E (P=0.036). In these patients disability was absent in 17.4% of subjects, moderate-slight in 47.8% and severe in 34.8%. In group C disability was absent in 40% of subjects, slight-moderate in 55% and severe in 5%. Effectiveness in walking was 79.1% in group C and 57% in group C+E. Efficiency in walking was 0.13 in C group and 0.07 in C+E subjects. Effectiveness (P=0.008) and efficiency (P=0.008) of group C were significantly greater than of group C+E. CONCLUSIONS: The study shows that the rehabilitation prognosis of cerebellar stroke is affected by the presence of extracerebellar stroke lesions.