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Poster 68
E23 Poster 67 Relationships Among Manual Ability, Physical Functioning, and General Well-Being Among Patients With Multiple Sclerosis. Christine Chen (New York University, New York, NY), Nicole Kasven. Disclosure: None declared. Objective: To investigate the relationships among strength, selfreported manual ability (hand use for daily tasks), pain, physical functioning, and socioemotional well-being among patients with multiple sclerosis (MS). Design: Interview and research questionnaires and measurements of hand and finger strength. Participants: Community-dwelling adults who were monitored by rehabilitation practitioners. Interventions: Not applicable. Main Outcome Measures: Grip and pinch strengths, 36-item Manual Ability Measure (MAM), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and LIFEware outpatient measure. Results: 43 MS patients participated in the research. Their Rasch-derived manual ability measure ranged from ⫺1.85 to 6.83 logits. Preliminary analyses indicated that there were no significant correlations between manual ability and grip and pinch strengths, nor with general health, general physical function, social function, pain, and vitality, constructs measured by 2 healthrelated quality of life measures. However, moderate to high correlations were found between grip and pinch strengths (r range, .62–.70; P⬍.05) and between various types of grip strengths (r range, .73–.82). Significant correlations were also found among the constructs measured by the SF-36 and LIFEware (r range, .39 –.72), especially between similar constructs (eg, r⫽.67 between SF-36 mental health score and LIFEware placid). Conclusions: The MAM appears to measure disability as the scores do not have significant associations with the indicators of impairment (strengths, pain) or the more global constructs of physical health or psychosocial well-being. As patients pointed out, the disabling symptoms of MS had a negative impact on their sense of well-being. However, they had learned to compensate by using their hands the best they could and to live and work in the community as long as possible. Key Words: Multiple sclerosis; Rehabilitation; Outcome assessment (health care).
clusions: Directions for future research emerging from this review will be described. Key Words: Neurogenic communication disorders; Treatment; Rehabilitation. Poster 69 The 75% Rule for Cardiac Surgery Patients: Does Dysphagia Make a Difference? Noel Rao (Marianjoy Rehabilitation Hospital, Wheaton, IL), Susan Brady, Kathleen Ruroede, Rachel Caldwell. Disclosure: None declared. Objective: To identify outcome measures to justify adding cardiac patients into the Centers for Medicare and Medicaid Services §412.23(b)(2). Design: Retrospective chart reviews were completed for all patients who were admitted to the rehabilitation hospital over 24 months, as identified by predetermined impairment codes. Setting: Rehabilitation hospital. Participants: Consecutive cardiac and stroke admissions: group 1 (n⫽179), nondysphagia cardiac patients; group 2 (n⫽44), cardiac dysphagia patients; group 3 (n⫽381), nondysphagia stroke patients; and group 4 (n⫽527), stroke dysphagia patients. Interventions: Not applicable. Main Outcome Measures: FIM instrument, cost of care, and length of stay (LOS). Results: Mean admission FIM score for cardiac nondysphagia was 55.99, for cardiac dysphagia it was 46.95, for stroke nondysphagia it was 48.38, and for stroke dysphagia it was 32.34. Average FIM gain for cardiac dysphagia was 15.75, for nondysphagia cardiac it was 16.68, for stroke dysphagia it was 15.99, and for nondysphagia stroke it was 18.15. FIM gain for all groups was similar. Average cost of care for nondysphagia cardiac was $13,772, for cardiac dysphagia it was $16,217, for nondysphagia stroke it was $17,856, and for stroke dysphagia it was $23,013. Cost of care differences between cardiac dysphagia and nondysphagia stroke were not statistically significant. LOS for cardiac dysphagia was 14.80 days, for nondysphagia cardiac it was 13.29, for stroke dysphagia it was 22.09, and for nondysphagia stroke it was 16.14. Differences in LOS were statistically significant. Conclusions: The cardiac dysphagia patients were similar to the nondysphagia stroke patients with regard to admission FIM score and cost of care, rendering a powerful argument for delivering services to them at this level of care. Key Words: Rehabilitation; Dysphagia; Cardiac.
Practice, Policy & Reimbursement Poster 68 Evidence-Based Practice Guidelines in Neurologic Communication Disorders: A Progress Report. Kathryn Yorkston (University of Washington, Seattle, WA), Lee Ann Golper, Kathryn Bayles, Pelagie Beeson, Mary Kennedy, Don Robin, Julie Wambaugh. Disclosure: None declared. Objective: To describe the efforts of the Academy of Neurologic Communication Disorders and Sciences to develop practice guidelines in neurologic communication disorders. Data Sources: All committees accessed electronic databases, including PsycINFO, MEDLINE, and CINAHL. In addition, hand searches of relevant edited books and ancestral searches of extant references (eg, studies cited within an article or chapter) were conducted. Study Selection: Each writing committee developed specific inclusionary and exclusionary criteria for selection. Intervention studies were defined as those focusing on treatment for at least 1 person with a primary neurologic communication diagnosis. Data Extraction: Tables of evidence were constructed that focused on the following questions: What type of research is represented by the study? How well is the treatment described? How well are the subjects described? What measures of control are imposed in the study? and Are the consequences of the intervention well described? Data Synthesis: Evidence for effectiveness of various interventions is documented and candidacy criteria highlighted. Con-
Poster 70 Rehabilitation Outcomes in Patients at Rancho Los Amigos Level II/III. Nelson Escobar (Marianjoy Rehabilitation Hospital, Wheaton, IL), Susan Brady, Noel Rao. Disclosure: None declared. Objective: To evaluate rehabilitation outcomes in patients with severely disordered consciousness. Design: Retrospective study. Setting: Rehabilitation hospital. Participants: Consecutive admissions over 30 months identified by predetermined admission impairment codes. Interventions: Comprehensive inpatient rehabilitation. Main Outcome Measures: FIM instrument gain, length of stay (LOS), expected net revenue, and discharge destination. Results: 581 patients’ charts were reviewed. Of those, 25 were classified as Rancho Los Amigos level II/III. Group 1 (n⫽12) represents patients who made FIM gains. Group 2 (n⫽13) represents patients who did not make FIM gains. Average time from onset to rehabilitation admission for group 1 was 38.55 days and for group 2 it was 138.1 days (P⫽.002). Average rehabilitation LOS for group 1 was 42.25 days and for group 2 it was 34.92 days (P⫽.54). Expected net revenue (cost of care ⫺ expected reimbursement) was ⫺$884 for group 1 and ⫺$5259 for group 2. Average FIM gain for group 1 was 16.83. For group 1, 75% were discharged to home. For group 2, 8% were discharged to home. Conclusions: With both groups, cost of care far exceeded the expected reimbursement. Rehabilitation LOS was similar; however, patients Arch Phys Med Rehabil Vol 86, October 2005
clusions: Directions for future research emerging from this review will be described. Key Words: Neurogenic communication disorders; Treatment; Rehabilitation. Poster 69 The 75% Rule for Cardiac Surgery Patients: Does Dysphagia Make a Difference? Noel Rao (Marianjoy Rehabilitation Hospital, Wheaton, IL), Susan Brady, Kathleen Ruroede, Rachel Caldwell. Disclosure: None declared. Objective: To identify outcome measures to justify adding cardiac patients into the Centers for Medicare and Medicaid Services §412.23(b)(2). Design: Retrospective chart reviews were completed for all patients who were admitted to the rehabilitation hospital over 24 months, as identified by predetermined impairment codes. Setting: Rehabilitation hospital. Participants: Consecutive cardiac and stroke admissions: group 1 (n⫽179), nondysphagia cardiac patients; group 2 (n⫽44), cardiac dysphagia patients; group 3 (n⫽381), nondysphagia stroke patients; and group 4 (n⫽527), stroke dysphagia patients. Interventions: Not applicable. Main Outcome Measures: FIM instrument, cost of care, and length of stay (LOS). Results: Mean admission FIM score for cardiac nondysphagia was 55.99, for cardiac dysphagia it was 46.95, for stroke nondysphagia it was 48.38, and for stroke dysphagia it was 32.34. Average FIM gain for cardiac dysphagia was 15.75, for nondysphagia cardiac it was 16.68, for stroke dysphagia it was 15.99, and for nondysphagia stroke it was 18.15. FIM gain for all groups was similar. Average cost of care for nondysphagia cardiac was $13,772, for cardiac dysphagia it was $16,217, for nondysphagia stroke it was $17,856, and for stroke dysphagia it was $23,013. Cost of care differences between cardiac dysphagia and nondysphagia stroke were not statistically significant. LOS for cardiac dysphagia was 14.80 days, for nondysphagia cardiac it was 13.29, for stroke dysphagia it was 22.09, and for nondysphagia stroke it was 16.14. Differences in LOS were statistically significant. Conclusions: The cardiac dysphagia patients were similar to the nondysphagia stroke patients with regard to admission FIM score and cost of care, rendering a powerful argument for delivering services to them at this level of care. Key Words: Rehabilitation; Dysphagia; Cardiac.
Practice, Policy & Reimbursement Poster 68 Evidence-Based Practice Guidelines in Neurologic Communication Disorders: A Progress Report. Kathryn Yorkston (University of Washington, Seattle, WA), Lee Ann Golper, Kathryn Bayles, Pelagie Beeson, Mary Kennedy, Don Robin, Julie Wambaugh. Disclosure: None declared. Objective: To describe the efforts of the Academy of Neurologic Communication Disorders and Sciences to develop practice guidelines in neurologic communication disorders. Data Sources: All committees accessed electronic databases, including PsycINFO, MEDLINE, and CINAHL. In addition, hand searches of relevant edited books and ancestral searches of extant references (eg, studies cited within an article or chapter) were conducted. Study Selection: Each writing committee developed specific inclusionary and exclusionary criteria for selection. Intervention studies were defined as those focusing on treatment for at least 1 person with a primary neurologic communication diagnosis. Data Extraction: Tables of evidence were constructed that focused on the following questions: What type of research is represented by the study? How well is the treatment described? How well are the subjects described? What measures of control are imposed in the study? and Are the consequences of the intervention well described? Data Synthesis: Evidence for effectiveness of various interventions is documented and candidacy criteria highlighted. Con-
Poster 70 Rehabilitation Outcomes in Patients at Rancho Los Amigos Level II/III. Nelson Escobar (Marianjoy Rehabilitation Hospital, Wheaton, IL), Susan Brady, Noel Rao. Disclosure: None declared. Objective: To evaluate rehabilitation outcomes in patients with severely disordered consciousness. Design: Retrospective study. Setting: Rehabilitation hospital. Participants: Consecutive admissions over 30 months identified by predetermined admission impairment codes. Interventions: Comprehensive inpatient rehabilitation. Main Outcome Measures: FIM instrument gain, length of stay (LOS), expected net revenue, and discharge destination. Results: 581 patients’ charts were reviewed. Of those, 25 were classified as Rancho Los Amigos level II/III. Group 1 (n⫽12) represents patients who made FIM gains. Group 2 (n⫽13) represents patients who did not make FIM gains. Average time from onset to rehabilitation admission for group 1 was 38.55 days and for group 2 it was 138.1 days (P⫽.002). Average rehabilitation LOS for group 1 was 42.25 days and for group 2 it was 34.92 days (P⫽.54). Expected net revenue (cost of care ⫺ expected reimbursement) was ⫺$884 for group 1 and ⫺$5259 for group 2. Average FIM gain for group 1 was 16.83. For group 1, 75% were discharged to home. For group 2, 8% were discharged to home. Conclusions: With both groups, cost of care far exceeded the expected reimbursement. Rehabilitation LOS was similar; however, patients Arch Phys Med Rehabil Vol 86, October 2005