Outcomes for Traumatic Brain Injury in Inpatient Rehabilitation by Facility Volume

e62 Research Poster 3755 Be Aware of Differences When Comparing Results of Stroke Rehabilitation in Different Countries Katharina S. Sunnerhagen (Univ. of Gothenburg/Inst. of Neuroscience and Physiology) Objective(s): To describe results of in-patient stroke rehabilitation as a complex intervention for and explore possible differences between the two countries. Design: A retrospective cohort study. Qualitative description of systems, as well as information on basic medical and sociodemographic information, and organizational aspects were reported. The change in FIM during rehabilitation was investigated. In 6 domains of the instrument, the shifts for ‘total dependence’, ‘partial dependence’ and ‘independence’ were analyzed using ordinal regression analysis. Setting: Latvia (Vaivari) and Sweden (quality register). Participants: Data from 1055 Latvian and 1748 Swedish adult patients after stroke receiving in-patient rehabilitation, during 2011-2013. Interventions: N/A. Main Outcome Measure(s): FIM, time since stroke and length of stay. Results: The components of stroke care seem to be similar in Latvia and Sweden, but there are potential differences in the content. There were differences regarding start of rehabilitation as well as its length. Patients in Latvia are more likely to be independent at the admittance and discharge from rehabilitation. However, patients in Sweden are more likely to improve during rehabilitations period. Conclusions: The content of in-patient rehabilitation is different in the two countries, although the components of the rehabilitation are reported the same, contextual factors may influence results. Therefore, comparison of stroke rehabilitation requires caution. Key Words: Stroke, ADL, Statistics, Nonparametric Disclosure(s): None Disclosed. Research Poster 3756 The Impact of an External Breast Prosthesis on the Posture of Post-mastectomy Women Katarzyna Hojan (Greater Poland Cancer Centre), Faustyna Manikowska, Po-Jung Brian Chen Objective(s): This study evaluated the impact of breast prosthesis weight on posture and an association between the prosthesis weight, time since mastectomy and asymmetry of posture changes. Design: Cross-sectional study. Setting: Outpatient rehabilitation unit in the local cancer center. Participants: Fifty one post-mastectomy women, divided by the operation side into subgroups (R-right, L-left). Interventions: Asymmetry of body posture was evaluated using surface electromyography (EMG) activity of the erector spinae muscles (ESM) with four wear-types: A e no prosthesis; B e prosthesis Z 10 grams; C e prosthesis Z 50% of the total removed breast mass; D e prosthesis of equal weight to the operated breast. The mean rectified surface electromyographic amplitude and muscle strength were measured during maximal voluntary contraction (MVC). Main Outcome Measure(s): Our main outcome measure was postural asymmetry defined as the difference between the means of erector spinae EMG activities on the operated and the non-operated side of the body. Results: The activity of ESM was larger on the non-operative than operated side in all patients in subgroup R and in subgroup L only in subjects wearing heavier breast prosthesis (p<.05). The differences in the activity of ESM were associated with the left side of operation (coefficientZ2.73, pZ.017), height (coefficientZ2.26, pZ.012), weight (coefficientZ-2.35, pZ.019) and BMI (coefficientZ6.49, pZ.016). No associations were observed between the weight of the prosthesis, time since mastectomy, and asymmetry in posture changes.

Research Posters Conclusions: The differences in muscle activity between the operated and non-operated sides were observed in all patients but those who underwent left-side mastectomy and wore no or very light prosthesis. The weight of breast prosthesis, however, had no impact on the magnitude of differences. Key Words: Rehabilitation, Breast prostheses, Mastectomy, Biomechanics Disclosure(s): None Disclosed. Research Poster 3757 Outcomes for Traumatic Brain Injury in Inpatient Rehabilitation by Facility Volume Amol M. Karmarkar (UTMB), Kshitija Kulkarni, James Graham, Amit Kumar, Timothy Reistetter, Kenneth Ottenbacher Objective(s): Examine the association between facility volume and rehabilitation outcomes in patients with traumatic brain injury discharged from inpatient rehabilitation facilities. Design: Retrospective analysis of Uniform Data System for Medical Rehabilitation data (2008-2010). Setting: Inpatient rehabilitation facilities in the United States. Participants: Patients with traumatic brain injury discharged following initial inpatient rehabilitation (nZ102,321). Patients were: admitted directly from acute hospitals, previously living in the community, and aged 18 years or older. Interventions: N/A. Main Outcome Measure(s): Discharge FIMÒ total and, community discharge after rehabilitation stay, were the primary outcomes. Relative volume was calculated as the number of patients with traumatic brain injury divided by the overall facility-level patient volume. Clustering of patients in facilities was addressed using multilevel regression modeling adjusting for patient-level variables (socio-demographic, comorbidity, rehabilitation length of stay, and admission functional status), facility level variables (relative volume as quintiles, facility type, and number of operating beds), and crosslevel interaction between patient-level and facility-level variables. Results: Facilities with the lowest relative volume had a maximum of 6% patients with traumatic brain injury, versus 34% for those with highest relative volume. Discharge FIMÒ total was 5 points higher for facilities with highest relative volume compared to lowest relative volume facilities (bZ5.34, SEZ0.78, p<.001). The discharge FIMÒ total for facilities with medium relative volume was approximately 4 points higher than that for facilities with lowest relative volume (bZ3.82, SEZ0.77, p<.001). Likelihood of community discharge from high relative volume facilities was significantly higher than that from facilities with lowest relative volume (ORZ1.34, 95% CIZ1.06-1.69). Conclusions: Our results suggest that traumatic brain injury patients entering inpatient rehabilitation facilities with high to moderate relative volume have overall better rehabilitation outcomes than those entering facilities with low relative volume. Key Words: Inpatient rehabilitation facilities, Facility patient volume, Rehabilitation outcomes Disclosure(s): None Disclosed. Research Poster 3758 WITHDRAWN

Research Poster 3760 Trialling an Online Intervention Treating Mood Disturbance in Persons with SCI Christine Migliorini (Summer Foundation), Andrew James Sinclair, Peter W. New, Doug J. Brown, Bruce Tonge

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