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Poster 46: The 10-Bottle Test: Preliminary Validation Data
ACADEMY ANNUAL ASSEMBLY ABSTRACTS
Poster 44 Acute Hospital Length of Stay Predictive of Rehabilitation Outcome Following Multiple Trauma. Michael S. Cicchetti, MD (University of Virginia, Charlottesville, VA); Mark R. Conaway, PhD; Paul T. Diamond, MD. Disclosure: M.S. Cicchetti, None; M.R. Conaway, None; P.T. Diamond, None. Objective: To examine the association between early select variables and rehabilitation outcome following multiple trauma. Design: Retrospective analysis of a trauma registry and rehabilitation outcomes database. Setting: University hospital level 1 trauma center and acute rehabilitation hospital. Participants: 525 subjects (age range, 18⫺55y) with multisystem blunt trauma, lower-extremity long bone fracture and/or major pelvic fracture, who were functionally independent prior to trauma. Interventions: Separate analyses were done for age, sex, race, total Abbreviated Injury Scale (AIS) score, and acute care hospital length of stay (LOS) to identify correlations with rehabilitation outcome. Main Outcome Measures: Admission FIM, discharge FIM, change in FIM, and rehabilitation hospital LOS. Results: 75 (15%) subjects received acute inpatient rehabilitation. Of these, 48% were men, 52% were women, 85% white, 13% African American, and 2% other. Total AIS score correlated negatively with admission FIM (P⫽.004). Acute care LOS correlated negatively with admission FIM (P⬍.001) and correlated positively with change in FIM (P⬍.009). Age, sex, and race did not correlate with any of the selected outcome measures. Conclusions: Acute care LOS following multiple trauma is a better predictor of functional gains during acute rehabilitation than total AIS score. Further study of predictors of outcome following multiple trauma is indicated. Key Words: Rehabilitation; Treatment outcome; Wounds and injuries. Poster 45 Individual Goal Attainment Scaling Versus Standardized Measures for Evaluation Outcome in Rehabilitation. Lynne TurnerStokes, DM, FRCP (King’s College London, Middlesex, UK); Heather Williams, MSc; Jane Johnson, MSc. Disclosure: L. Turner-Stokes, None; H. Williams, None; J. Johnson, None. Objective: To compare Goal Attainment Scaling (GAS) and standardized measures in the evaluation of outcome following rehabilitation. Design: A prospective cohort analysis. Setting: A tertiary inpatient neurorehabilitation service for younger adults with complex neurologic disability. Participants: Consecutive patients (n⫽77; male/female ratio, 3:2; mean age ⫾ SD, 45.5⫾14y) admitted for rehabilitation between January 3, 2005, and January 8, 2006, with diagnosis of 65% strokes, 22% other brain injury (eg, trauma, anoxia inflammation), and 13% other neurologic conditions. Interventions: An individualized goal-orientated rehabilitation program. Main Outcome Measures: Functional Assessment Measure (UK FIM⫹FAM), FIM instrument, and Barthel Index were measured on admission and discharge. GAS-rated achievement of 1 to 6 individual priority goals selected by the patients and agreed to by the treating team. Results: Mean length of stay was 82⫾45 days. All measures changed significantly between admission and discharge (P⬍.001). The mean GAS score was 32.2⫾5.0 at baseline and 45.9⫾7.2 at discharge. Median FIM⫹FAM scores were 124 (IQR, 93⫺151) baseline, and 168 (IQR, 136⫺191) at discharge. There was a moderately strong correlation between change in FIM⫹FAM and change in GAS score (Spearman ⫽0.4, P⬍.001); and slightly weaker correlations with change in FIM and Barthel Index (⫽.35, ⫽.37; P⬍.001), respectively. Of 317 goals set, 241 were achieved or partially achieved, of which 10% were in areas not reflected in the standard measures (eg, parenting, workrelated, use of computers). Conclusions: GAS provides an alternative
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individualized approach to assessment of outcome following rehabilitation, which may be used to assess change in areas of critical importance to the individual. While many goals overlap with items in commonly used standardized outcome measures, the relationship is only moderate, suggesting that GAS may perhaps offer added value as an adjunct to outcome measurement in patients with complex disability. Key Words: Outcome assessment (health care); Rehabilitation. Poster 46 The 10-Bottle Test: Preliminary Validation Data. Lynne TurnerStokes, DM, FRCP (King’s College London, Middlesex, UK); Sachin Shetty, MBBS; Anuka Parapuram, MBBS; Heather Williams, MSc; Ian Baguley, MD. Disclosure: L. Turner-Stokes, None; S. Shetty, None; A. Parapuram, None; H. Williams, None; I. Baguley, None. Objectives: To obtain preliminary normative data as proof of conceptual design and utility of the 10-Bottle Test (10BT), a cheap and simple clinical test of upper-limb function using internationally ubiquitous hospital equipment; and to refine the methodology and equipment used. Design: Times were recorded for placement of 10 bottles (10BT), one at a time using 1 hand only, into (1) a crockery coffee mug and (2) a Styrofoam cup. Data were collected for 3 trials under each condition using alternating upper limbs. Starting order was randomized with respect to dominancy. Setting: Multicenter trial at sites in the United Kingdom and Australia. Participants: A convenience sample of 137 subjects (49 men, 88 women; age range, 16⫺85y) without upper-limb functional limitation, recruited from the 2 countries (94 UK, 43 Australia). Interventions: Not applicable. Main Outcome Measure: Timed observation of task. Results: The median times to place 10 bottles in a mug were 9.0 (IQR, 8.2⫺10.0) seconds (dominant) and 9.6 (8.7⫺10.8) seconds (nondominant). Equivalent times for the Styrofoam cup were 11.2 (9.9⫺12.3) seconds and 12.2 (10.8⫺13.7) seconds, respectively. Subjects showed a clear but inconsistent learning effect with repetitions. The cup task took an average of 24% longer than the mug (95% CI, 22.0%⫺25.5%) due to instability of the receptacle. There were significant interactions between task completion and both age and sex. Subjects over age 35 averaged 9.4% longer than younger subjects, whereas men were 11.5% slower. Conclusions: Preliminary analysis suggests that the 10BT is easy to use and shows reproducible effects. The coffee mug provided a more representative test of upper-limb dexterity than the cup, which required additional use of cognitive strategies to overcome instability. Further investigation of the tool is warranted with people with upper-limb impairment to determine the limits of normality. Key Words: Handedness; Rehabilitation; Upper extremity. Poster 47 Is Smoking Associated With an Increased Likelihood of Developing Foot Ulcers in Patients With Type 2 Diabetes Mellitus? David Berbrayer, MD, FRCPC (University of Toronto, Thornhill, ON, Canada). Disclosure: D. Berbrayer, None. Objectives: To determine if there is an association between smoking and the development of ulcers in type 2 diabetes (T2D) mellitus. Design: A 3-month case-control study. Setting: Not provided. Participants: 26 people with T2D were interviewed. They were divided into an ulcer group (n⫽17) and nonulcer group (n⫽9). Interventions: Not applicable. Main Outcome Measures: A detailed smoking history was obtained. A comparison of smoking exposure (yes, no) between groups (ulcer vs nonulcer) was conducted. Kaplan-Meier survival curves were plotted for groups divided by smoking exposure. A comparison of the median pack-year history between ulcer and Arch Phys Med Rehabil Vol 88, September 2007
Poster 44 Acute Hospital Length of Stay Predictive of Rehabilitation Outcome Following Multiple Trauma. Michael S. Cicchetti, MD (University of Virginia, Charlottesville, VA); Mark R. Conaway, PhD; Paul T. Diamond, MD. Disclosure: M.S. Cicchetti, None; M.R. Conaway, None; P.T. Diamond, None. Objective: To examine the association between early select variables and rehabilitation outcome following multiple trauma. Design: Retrospective analysis of a trauma registry and rehabilitation outcomes database. Setting: University hospital level 1 trauma center and acute rehabilitation hospital. Participants: 525 subjects (age range, 18⫺55y) with multisystem blunt trauma, lower-extremity long bone fracture and/or major pelvic fracture, who were functionally independent prior to trauma. Interventions: Separate analyses were done for age, sex, race, total Abbreviated Injury Scale (AIS) score, and acute care hospital length of stay (LOS) to identify correlations with rehabilitation outcome. Main Outcome Measures: Admission FIM, discharge FIM, change in FIM, and rehabilitation hospital LOS. Results: 75 (15%) subjects received acute inpatient rehabilitation. Of these, 48% were men, 52% were women, 85% white, 13% African American, and 2% other. Total AIS score correlated negatively with admission FIM (P⫽.004). Acute care LOS correlated negatively with admission FIM (P⬍.001) and correlated positively with change in FIM (P⬍.009). Age, sex, and race did not correlate with any of the selected outcome measures. Conclusions: Acute care LOS following multiple trauma is a better predictor of functional gains during acute rehabilitation than total AIS score. Further study of predictors of outcome following multiple trauma is indicated. Key Words: Rehabilitation; Treatment outcome; Wounds and injuries. Poster 45 Individual Goal Attainment Scaling Versus Standardized Measures for Evaluation Outcome in Rehabilitation. Lynne TurnerStokes, DM, FRCP (King’s College London, Middlesex, UK); Heather Williams, MSc; Jane Johnson, MSc. Disclosure: L. Turner-Stokes, None; H. Williams, None; J. Johnson, None. Objective: To compare Goal Attainment Scaling (GAS) and standardized measures in the evaluation of outcome following rehabilitation. Design: A prospective cohort analysis. Setting: A tertiary inpatient neurorehabilitation service for younger adults with complex neurologic disability. Participants: Consecutive patients (n⫽77; male/female ratio, 3:2; mean age ⫾ SD, 45.5⫾14y) admitted for rehabilitation between January 3, 2005, and January 8, 2006, with diagnosis of 65% strokes, 22% other brain injury (eg, trauma, anoxia inflammation), and 13% other neurologic conditions. Interventions: An individualized goal-orientated rehabilitation program. Main Outcome Measures: Functional Assessment Measure (UK FIM⫹FAM), FIM instrument, and Barthel Index were measured on admission and discharge. GAS-rated achievement of 1 to 6 individual priority goals selected by the patients and agreed to by the treating team. Results: Mean length of stay was 82⫾45 days. All measures changed significantly between admission and discharge (P⬍.001). The mean GAS score was 32.2⫾5.0 at baseline and 45.9⫾7.2 at discharge. Median FIM⫹FAM scores were 124 (IQR, 93⫺151) baseline, and 168 (IQR, 136⫺191) at discharge. There was a moderately strong correlation between change in FIM⫹FAM and change in GAS score (Spearman ⫽0.4, P⬍.001); and slightly weaker correlations with change in FIM and Barthel Index (⫽.35, ⫽.37; P⬍.001), respectively. Of 317 goals set, 241 were achieved or partially achieved, of which 10% were in areas not reflected in the standard measures (eg, parenting, workrelated, use of computers). Conclusions: GAS provides an alternative
E23
individualized approach to assessment of outcome following rehabilitation, which may be used to assess change in areas of critical importance to the individual. While many goals overlap with items in commonly used standardized outcome measures, the relationship is only moderate, suggesting that GAS may perhaps offer added value as an adjunct to outcome measurement in patients with complex disability. Key Words: Outcome assessment (health care); Rehabilitation. Poster 46 The 10-Bottle Test: Preliminary Validation Data. Lynne TurnerStokes, DM, FRCP (King’s College London, Middlesex, UK); Sachin Shetty, MBBS; Anuka Parapuram, MBBS; Heather Williams, MSc; Ian Baguley, MD. Disclosure: L. Turner-Stokes, None; S. Shetty, None; A. Parapuram, None; H. Williams, None; I. Baguley, None. Objectives: To obtain preliminary normative data as proof of conceptual design and utility of the 10-Bottle Test (10BT), a cheap and simple clinical test of upper-limb function using internationally ubiquitous hospital equipment; and to refine the methodology and equipment used. Design: Times were recorded for placement of 10 bottles (10BT), one at a time using 1 hand only, into (1) a crockery coffee mug and (2) a Styrofoam cup. Data were collected for 3 trials under each condition using alternating upper limbs. Starting order was randomized with respect to dominancy. Setting: Multicenter trial at sites in the United Kingdom and Australia. Participants: A convenience sample of 137 subjects (49 men, 88 women; age range, 16⫺85y) without upper-limb functional limitation, recruited from the 2 countries (94 UK, 43 Australia). Interventions: Not applicable. Main Outcome Measure: Timed observation of task. Results: The median times to place 10 bottles in a mug were 9.0 (IQR, 8.2⫺10.0) seconds (dominant) and 9.6 (8.7⫺10.8) seconds (nondominant). Equivalent times for the Styrofoam cup were 11.2 (9.9⫺12.3) seconds and 12.2 (10.8⫺13.7) seconds, respectively. Subjects showed a clear but inconsistent learning effect with repetitions. The cup task took an average of 24% longer than the mug (95% CI, 22.0%⫺25.5%) due to instability of the receptacle. There were significant interactions between task completion and both age and sex. Subjects over age 35 averaged 9.4% longer than younger subjects, whereas men were 11.5% slower. Conclusions: Preliminary analysis suggests that the 10BT is easy to use and shows reproducible effects. The coffee mug provided a more representative test of upper-limb dexterity than the cup, which required additional use of cognitive strategies to overcome instability. Further investigation of the tool is warranted with people with upper-limb impairment to determine the limits of normality. Key Words: Handedness; Rehabilitation; Upper extremity. Poster 47 Is Smoking Associated With an Increased Likelihood of Developing Foot Ulcers in Patients With Type 2 Diabetes Mellitus? David Berbrayer, MD, FRCPC (University of Toronto, Thornhill, ON, Canada). Disclosure: D. Berbrayer, None. Objectives: To determine if there is an association between smoking and the development of ulcers in type 2 diabetes (T2D) mellitus. Design: A 3-month case-control study. Setting: Not provided. Participants: 26 people with T2D were interviewed. They were divided into an ulcer group (n⫽17) and nonulcer group (n⫽9). Interventions: Not applicable. Main Outcome Measures: A detailed smoking history was obtained. A comparison of smoking exposure (yes, no) between groups (ulcer vs nonulcer) was conducted. Kaplan-Meier survival curves were plotted for groups divided by smoking exposure. A comparison of the median pack-year history between ulcer and Arch Phys Med Rehabil Vol 88, September 2007