The relationship between cognition and functional outcomes in rehabilitation: FIMCog vs. MoCA.

AIM: To understand the relationship between scores on two standardized measures of cognition, the Montreal Cognitive Assessment (MoCA) and the cognitive subscale of the Functional Independence Measure (FIMCog), and whether these scores can predict functional outcomes in rehabilitation. METHODS: Retrospective data analysis was conducted on all inpatients admitted to a general rehabilitation unit within a 6-month period (N = 477). The average age of patients was 74 years. The Functional Independence Measure (FIM) was completed for all patients on admission and discharge. The MoCA was administered to patients on clinical suspicion of cognitive impairment. The MoCA was completed with 116 patients. Cognitive status was assessed using FIMCog and MoCA. The motor subscale of FIM was used to assess functional status in calculating the motor Rehabilitation Functional Gain (mRFG) and motor Rehabilitation Functional Efficiency (mRFE) scores. Discharge destination was also used as an outcome measure. RESULTS: There was a moderate correlation between FIMCog and MoCA scores on admission (r = 0.49, P < 0.001). Higher FIMCog and MoCA scores were associated with higher mRFG and mRFE scores. There was an indication that patients with higher MoCA scores were more likely to be discharged to a private residence (adjusted odds ratio 1.11; 95% confidence interval: 0.99, 1.25, P = 0.072). Cut-off points of <25 on the MoCA (sensitivity 88.9%, specificity 48.9%), and <29 on the FIMCog (sensitivity 77.8%, specificity 53.3%) predicted those patients who were less likely to discharge to a private residence. CONCLUSIONS: FIMCog and MoCA scores on admission were moderately correlated, and strongly correlated with functional rehabilitation outcomes. The FIMCog and MoCA had moderately high utility in predicting discharge destination. Geriatr Gerontol Int 2020; 20: 336-342.

Altered trapezius muscle behavior in individuals with neck pain and clinical signs of scapular dysfunction.

OBJECTIVE: The purpose of this study was to compare the behavior of the trapezius muscle in patients with chronic mechanical neck pain (MNP) and clinical signs of scapula dysfunction to healthy controls. METHODS: This is a cross-sectional, between-participant study of trapezius muscle behavior. Eighteen volunteers with chronic MNP and 20 healthy controls participated in the study. Participants performed isometric shoulder abduction, external rotation, and flexion at 3 intensities of effort (maximum voluntary contraction [MVC], 50% MVC, and 20% MVC). Electromyographic signals were recorded unilaterally from the upper, middle, and lower portions of the trapezius muscle during isometric shoulder contractions. RESULTS: Significantly greater levels of lower trapezius electromyographic signals were observed in patients with MNP compared with controls for the abduction (P < .027) and external rotation (P < .036) conditions but not for the flexion condition (P > .392). No differences in activity were observed in the upper (P > .248) or middle (P > .052) portions of trapezius between groups during any of the isometric shoulder girdle conditions. CONCLUSIONS: These findings represent a change in the behavior of the lower trapezius muscle in individuals with MNP who exhibit clinical signs of scapular dysfunction. Clinicians should consider the potential involvement of the axioscapular muscles when assessing patients with chronic neck pain, as retraining scapular function may be required for the successful management of these patients.