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Rasch Analysis of the Activities-Specific Balance Confidence Scale in Patients Seeking Outpatient Rehabilitation
e98 and in some cases, using medication to assist; 2) Cannot fall asleep due to being “wound up”; 3) Waking up often during the night due to SMV being awake and/or worrying; and 4) Waking up tired from poor quality of sleep in general. Conclusion/Discussion: These results suggest that there is a high incidence of caregivers of SMVs with TBI experiencing sleep problems. While caregivers of SMVs with moderate-severe and penetrating TBIs were the most prevalent group to report sleep issues, caregivers of SMVs with equivocal mild and mild TBIs also reported sleep issues indicating that inadequate sleep is common for this population of caregivers. The main limitation to this study is that the case examples rely on a small number of focus group interviews. Given this limitation, results should be considered preliminary. Key Words: Caregivers, Military Personnel, Quality of Life, Traumatic Brain Injury, Veterans Disclosures: None. Research Poster 303329 Quantitative EEG Assessment of Emerging Cognitive Function in Children After Acquired Brain Injury Sudhin Shah (Weill Cornell Medicine), Melis Suner, Sophie Nowak, Jason Carmel (Blythedale Children’s Hospital), Nicholas Schiff, Jeremy Hill Research Objectives: To create and test the feasibility of a system that can quickly, reproducibly and efficiently measure EEG correlates of cognitive function in children who have survived a moderate/severe acquired brain injury (ABI). The long-term goal is to use sensitive measures of emerging brain function to accurately track functional recovery, understand the brain processes that support recovery, and evaluate response to treatments. Design: A novel portable EEG system (headset and computer) employing wireless technologies to measure brain response while paying attention to novel stimuli, comprehending language, and generating mental imagery. Tasks have been validated in adults with disordered consciousness. Setting: Pediatric inpatients and outpatients at a rehabilitation hospital. Participants: Controls (non-brain-injury) and children recovering from ABI . Interventions: Not applicable. Main Outcome Measure(s): Feasibility of collecting EEG with good signal-to-noise ratio(SNR) at the bedside with minimal discomfort to subject and in a time-sensitive manner. Results: In 8 ABI (mean 11 years [6 to 15], 14 sessions) and 6 controls (mean 13 years [10 to 16], 8 sessions), we have collected and analysed EEG measures of command following, language comprehension and attention. EEG with acceptable SNR (visual inspection of power spectra error bars) was measured in 78% of ABI and 100% of control sessions. Response to command following was measured in 42% of ABI and 75% control sessions. Average time to collect data for each session was w1 hour for ABI and w45 mins for control. Conclusion/Discussion: Results demonstrate feasibility of collecting functional EEG from children recovering from ABI, including sensitive quantitative correlates of cognitive function. More subjects, studied longitudinally are needed for studies of validation against standard clinical measures and development of prognosis models. Key Words: Acquired Brain Injury, EEG, Severe Injury, Pediatric Rehabiliation Disclosures: None. Research Poster 292480 RAPPER II Trial: Safety and Feasibility of Functional Exercise Programs in the REX Robotic Device Nick Birch (Chris Moody Rehabilitation Centre), Jon Graham, Mohamed Sakel, Angela Gall, Andrew Nunn, Nada Signal, Chris Heywood
Research Posters Research Objectives: Assess feasibility and safety of a shoulder and trunk physiotherapy regime in people with chronic spinal cord injury (CSCI) using the REX robotic exercise device. Design: Prospective, multi-centre, registry study in 56 non-randomised volunteers with CSCI. Setting: Spinal cord injury centres and neurological rehabilitation units in the UK, Australia and New Zealand. Participants: Volunteers with CSCI were enrolled in the RAPPER II trial from neurological physiotherapy practices, SCI centres and the community through social media. Interventions: Volunteers completed a single treatment consisting of transfer into the REX device; training to achieve autonomous control of REX and they completed Timed Up and Go (TUG) tests. Following which they carried out functional upper limb and trunk exercises in standing. Main Outcome Measure(s): Primary outcome: Completion of a transfer into the REX and performance of a set of functional upper limb and trunk exercises. Secondary outcome: Transfer time, ability to achieve autonomous control of the device, Timed Up and Go (TUG) test. Quality of life measures including spasticity, sleep disturbance and pain were introduced as a protocol amendment. Results: All participants could transfer. 53/56 completed the exercise regime. There were no SAEs. Mean transfer time was similar for paraplegic and tetraplegic participants. 54 completed the TUG Tests and 53 achieved autonomous control of the device. Of 36 responses to the amended secondary outcomes, 15 (42%) reported improved sleep. 11 (31%) reported improved sleep + less spasticity and 8 (23%) reported improved sleep + less “Pain woke me up”. Conclusion/Discussion: This report demonstrates the utility and safety of physiotherapy in the REX device in a group of people who have significant neurological impairment. Key Words: Spinal Cord Injury, REX Powered Walking Aid, Assistive Technology, Robotics, Physiotherapy and Rehabilitation Disclosures: None. Research Poster 320242 Rasch Analysis of the Activities-Specific Balance Confidence Scale in Patients Seeking Outpatient Rehabilitation Ying-Chih Wang (University of Wisconsin Milwaukee), Sheng-Che Yen, Leigh Lehman Research Objectives: Falls are common, often dreaded events in the lives of older adults people and are an important focus of both research and clinical care. This study was to examine the psychometric properties of the Activities-Specific Balance Confidence Scale (ABC) in patients seeking outpatient rehabilitation services. Design: Retrospective analysis of longitudinal cohort study. Setting: Outpatient rehabilitation clinics. Participants: Data from 10,038 patients (mean age 71, SD 12, range 18 to 99) being treated in 199 outpatient physical therapy clinics in 25 states (USA). Interventions: NA. Main Outcome Measure(s): Unidimensionality, item fit, item difficulty hierarchy, test precision, and person separation index of the ABC balance item pool were assessed using the Rasch Rating Scale Model (RSM). Results: When analyzing 16 ABC items, item difficulty parameters ranged from -0.55 to 0.89. The most difficult items were walking outside on icy walks and standing on a chair and reaching for something above the head. The easiest items were getting into or out of a car and reaching for a small can off a shelf at eye level. Majority of the ABC items fit the RSM measurement model. Three items at the extreme (i.e., most difficult or the easiest items) had fit statistics greater than the criterion of 1.4. Overall, the patient ability distribution was bell-shaped with mild ceiling and floor effects (8.4% and 1.4% patients were measured at the highest and lowest scores, respectively). With a person-separation index (G) equaled to 3.29 for non-extreme patients, the ABC items separated person ability into 4.72 statistically distinct strata.
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Research Posters Conclusion/Discussion: This study provided the evidence in supporting the clinical use of the ABC scale in routine outpatient rehabilitation practice. Key Words: Activities-Specific Balance Confidence Scale (ABC), Balance, Outpatient Disclosures: None. Research Poster 304486 Readmissions from a Rehabilitation Hospital David Burke (Emory University), Tracie McCargo, Regina Bell Research Objectives: 1. To investigate the preadmission rate from a rehabilitation hospital, back to an acute care hospital; 2. To Investigate the correlations between patient and admission characteristics, and an increased risk of readmission. Design: Retrospective chart review of consecutive patients, over a twomonth period, admitted to an inpatient rehabilitation Hospital. Setting: Academic University inpatient rehabilitation Hospital. Participants: The participants were consecutive patients admitted to an acute rehabilitation hospital. Interventions: No intervention. Main Outcome Measure(s): Adverse outcome events defined as a medical event requiring readmission to the acute care hospital. Results: Of the 111 patients admitted to an acute rehab hospital, 36 were admitted by 3pm. Adverse events occurred in 8.30% of patients admitted before 3pm, and in 17% of patients admitted after 3pm (pZ0.216). Patients with complete document transfers had 9.20% adverse events, while 26% of patients with incomplete document transfers had adverse events (pZ.0267). Adverse events occurred in 15% of patients admitted by a primary team, and in 13.70% of patients admitted by covering or on-call physicians (pZ.845). Of patients with both incomplete documents and admissions after 3pm, 33% resulted in adverse events. Admissions before 3pm with complete documentation resulted in adverse events in 7.10%, compared to those admitted before 3pm, with complete documentation with adverse events in 33% (pZ.028). Conclusion/Discussion: Admissions to an acute Rehab Hospital after 3pm or without complete documentation resulted in a much higher rate of readmisison than patients admitted before 3pm and or with complete documentation. Key Words: IRF, Readmission Rate, Hospital Transfer Disclosures: Nothing to disclose. Research Poster 304514 Reducing Variability in Rehabilitation: The Role of Progressive Sit-to-Stand Training for Hospitalized Patients Lavon Beard (University of Alabama at Birmingham Hospital), Amy Hayes, Kwasi Asare-Acquah, Meredith Erdman, Valeria Makeeva Research Objectives: To evaluate whether sit-to-stand strength training by progressively lowering a seat’s angle-of-inclination over consecutive physical therapy sessions improves mobility and/or confidence in physical therapy in hospitalized moderate-assist patients compared with non-standardized practice. Design: Concurrent Mixed Methods design using the same sample for quantitative and qualitative analyses. Setting: Hospitalized care in a tertiary referral center. Participants: 60 patients (30 control, 30 experimental) over age 18 years derived from the inpatient setting with active physical therapy orders. Interventions: The experimental group will complete five arm-chair pushups and sit-to-stand transfers at progressively lower seat angles-of-inclination daily until the patient is able to perform a sit-to-stand transfer from a standard height with minimal assistance ( < 25% physical therapist effort
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e99 [1]). The control group will utilize standard recliners and traditional methods (transfer training, therapeutic exercise). Main Outcome Measure(s): Quantitative methods: timed sit-to-stand, gait velocity, time from moderate to minimal-assist, and motor/functional change following discharge. Qualitative methods: closed-ended questions investigating perceived confidence, safety, mobility, and pain. Results: Preliminary data from 41 patients indicates patients perceive equipment progressively lowering a seat’s angle-of-inclination to be safer, offers greater mobility, and is less painful to use compared with a hospital recliner during regular use (p < 0.05) obtained as part of quality improvement. The complete protocol will launch across all hospital units for two months starting March 2017. Conclusion/Discussion: No controlled studies exist evaluating sit-to-stand training in moderate-assist patients due to this population’s inherent physical limitations. Equipment progressively lowering a seat’s angle-ofinclination allows this previously excluded population to participate. As preliminary findings indicate such equipment is an effective method to increase patient mobility while minimizing pain during regular use, a protocol utilizing this equipment for sit-to-stand training may further support patient recovery to prior functioning [2]. Key Words: Physical Therapy, Strength Training, Timed Sit-To-Stand, Mixed Methods, Moderate-Assist Patients Disclosures: None. Research Poster 304749 Rehabilitation Challenges for a Cancer Patient Post-Hemipelvectomy: A Case Report Sonal Oza (RIC/Northwestern McGaw Medical Center), Samman Shahpar Research Objectives: N/A. Design: Case Report. Setting: Inpatient Rehabilitation. Participants: Case Report. Interventions: N/A. Main Outcome Measure(s): N/A. Results: A 39 year old male with stage III pelvic angiosarcoma of the ischium, acetabulum, and symphysis underwent right hemipelvectomy including femoral head resection with endoprosthetic saddle reconstruction. Sciatic and femoral nerves, gluteus medius, minimus were intact. Exam revealed severe proximal weakness; right distal weakness suggestive of peroneal nerve palsy. He wore an HKAFO and was weight bearing. Precautions included hip flexion to 40 degrees and ankle to 90 degrees. He was too orthostatic to tolerate ambulation and was started on Midodrine. Orthotist increased padding to reduce brace pain. Gait showed reduced knee extension and hip hiking that improved with a heel lift. He developed a painful right heel ulcer. A disconnect feature was added to enable wearing a PRAFO when supine without compromising proximal stability. Patient improved from minimal assistance to supervision for transfers, total to moderate assistance for stairs and ambulated 100 ft with a rolling walker at supervision. He was discharged home. Conclusion/Discussion: Angiosarcoma is a rare malignancy, comprising 1-2% of primary sarcomas and 0.2% of cancers. Pelvic involvement is uncommon. Treatment involves limb salvage surgery. Altered neuromuscular control results from the large resection. Detached external rotators, adductors, and knee extensors impact gait. Individuals exhibit pelvic hiking, trunk leaning and difficulty loading. Facilitating movement in context of precautions adds to the complexity of rehabilitation. Survivors of pelvic bone tumor resection reported impaired balance, difficulty with daily activities and community participation. 50-75% of non-angiosarcoma hemipelvectomy survivors after inpatient rehabilitation ambulated independently with an assistive device. Rehabilitation outcomes in pelvic angiosarcoma has not been reported to our knowledge. Key Words: Cancer, Rehabilitation, Survivorship Disclosures: None.
Research Posters Research Objectives: Assess feasibility and safety of a shoulder and trunk physiotherapy regime in people with chronic spinal cord injury (CSCI) using the REX robotic exercise device. Design: Prospective, multi-centre, registry study in 56 non-randomised volunteers with CSCI. Setting: Spinal cord injury centres and neurological rehabilitation units in the UK, Australia and New Zealand. Participants: Volunteers with CSCI were enrolled in the RAPPER II trial from neurological physiotherapy practices, SCI centres and the community through social media. Interventions: Volunteers completed a single treatment consisting of transfer into the REX device; training to achieve autonomous control of REX and they completed Timed Up and Go (TUG) tests. Following which they carried out functional upper limb and trunk exercises in standing. Main Outcome Measure(s): Primary outcome: Completion of a transfer into the REX and performance of a set of functional upper limb and trunk exercises. Secondary outcome: Transfer time, ability to achieve autonomous control of the device, Timed Up and Go (TUG) test. Quality of life measures including spasticity, sleep disturbance and pain were introduced as a protocol amendment. Results: All participants could transfer. 53/56 completed the exercise regime. There were no SAEs. Mean transfer time was similar for paraplegic and tetraplegic participants. 54 completed the TUG Tests and 53 achieved autonomous control of the device. Of 36 responses to the amended secondary outcomes, 15 (42%) reported improved sleep. 11 (31%) reported improved sleep + less spasticity and 8 (23%) reported improved sleep + less “Pain woke me up”. Conclusion/Discussion: This report demonstrates the utility and safety of physiotherapy in the REX device in a group of people who have significant neurological impairment. Key Words: Spinal Cord Injury, REX Powered Walking Aid, Assistive Technology, Robotics, Physiotherapy and Rehabilitation Disclosures: None. Research Poster 320242 Rasch Analysis of the Activities-Specific Balance Confidence Scale in Patients Seeking Outpatient Rehabilitation Ying-Chih Wang (University of Wisconsin Milwaukee), Sheng-Che Yen, Leigh Lehman Research Objectives: Falls are common, often dreaded events in the lives of older adults people and are an important focus of both research and clinical care. This study was to examine the psychometric properties of the Activities-Specific Balance Confidence Scale (ABC) in patients seeking outpatient rehabilitation services. Design: Retrospective analysis of longitudinal cohort study. Setting: Outpatient rehabilitation clinics. Participants: Data from 10,038 patients (mean age 71, SD 12, range 18 to 99) being treated in 199 outpatient physical therapy clinics in 25 states (USA). Interventions: NA. Main Outcome Measure(s): Unidimensionality, item fit, item difficulty hierarchy, test precision, and person separation index of the ABC balance item pool were assessed using the Rasch Rating Scale Model (RSM). Results: When analyzing 16 ABC items, item difficulty parameters ranged from -0.55 to 0.89. The most difficult items were walking outside on icy walks and standing on a chair and reaching for something above the head. The easiest items were getting into or out of a car and reaching for a small can off a shelf at eye level. Majority of the ABC items fit the RSM measurement model. Three items at the extreme (i.e., most difficult or the easiest items) had fit statistics greater than the criterion of 1.4. Overall, the patient ability distribution was bell-shaped with mild ceiling and floor effects (8.4% and 1.4% patients were measured at the highest and lowest scores, respectively). With a person-separation index (G) equaled to 3.29 for non-extreme patients, the ABC items separated person ability into 4.72 statistically distinct strata.
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Research Posters Conclusion/Discussion: This study provided the evidence in supporting the clinical use of the ABC scale in routine outpatient rehabilitation practice. Key Words: Activities-Specific Balance Confidence Scale (ABC), Balance, Outpatient Disclosures: None. Research Poster 304486 Readmissions from a Rehabilitation Hospital David Burke (Emory University), Tracie McCargo, Regina Bell Research Objectives: 1. To investigate the preadmission rate from a rehabilitation hospital, back to an acute care hospital; 2. To Investigate the correlations between patient and admission characteristics, and an increased risk of readmission. Design: Retrospective chart review of consecutive patients, over a twomonth period, admitted to an inpatient rehabilitation Hospital. Setting: Academic University inpatient rehabilitation Hospital. Participants: The participants were consecutive patients admitted to an acute rehabilitation hospital. Interventions: No intervention. Main Outcome Measure(s): Adverse outcome events defined as a medical event requiring readmission to the acute care hospital. Results: Of the 111 patients admitted to an acute rehab hospital, 36 were admitted by 3pm. Adverse events occurred in 8.30% of patients admitted before 3pm, and in 17% of patients admitted after 3pm (pZ0.216). Patients with complete document transfers had 9.20% adverse events, while 26% of patients with incomplete document transfers had adverse events (pZ.0267). Adverse events occurred in 15% of patients admitted by a primary team, and in 13.70% of patients admitted by covering or on-call physicians (pZ.845). Of patients with both incomplete documents and admissions after 3pm, 33% resulted in adverse events. Admissions before 3pm with complete documentation resulted in adverse events in 7.10%, compared to those admitted before 3pm, with complete documentation with adverse events in 33% (pZ.028). Conclusion/Discussion: Admissions to an acute Rehab Hospital after 3pm or without complete documentation resulted in a much higher rate of readmisison than patients admitted before 3pm and or with complete documentation. Key Words: IRF, Readmission Rate, Hospital Transfer Disclosures: Nothing to disclose. Research Poster 304514 Reducing Variability in Rehabilitation: The Role of Progressive Sit-to-Stand Training for Hospitalized Patients Lavon Beard (University of Alabama at Birmingham Hospital), Amy Hayes, Kwasi Asare-Acquah, Meredith Erdman, Valeria Makeeva Research Objectives: To evaluate whether sit-to-stand strength training by progressively lowering a seat’s angle-of-inclination over consecutive physical therapy sessions improves mobility and/or confidence in physical therapy in hospitalized moderate-assist patients compared with non-standardized practice. Design: Concurrent Mixed Methods design using the same sample for quantitative and qualitative analyses. Setting: Hospitalized care in a tertiary referral center. Participants: 60 patients (30 control, 30 experimental) over age 18 years derived from the inpatient setting with active physical therapy orders. Interventions: The experimental group will complete five arm-chair pushups and sit-to-stand transfers at progressively lower seat angles-of-inclination daily until the patient is able to perform a sit-to-stand transfer from a standard height with minimal assistance ( < 25% physical therapist effort
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e99 [1]). The control group will utilize standard recliners and traditional methods (transfer training, therapeutic exercise). Main Outcome Measure(s): Quantitative methods: timed sit-to-stand, gait velocity, time from moderate to minimal-assist, and motor/functional change following discharge. Qualitative methods: closed-ended questions investigating perceived confidence, safety, mobility, and pain. Results: Preliminary data from 41 patients indicates patients perceive equipment progressively lowering a seat’s angle-of-inclination to be safer, offers greater mobility, and is less painful to use compared with a hospital recliner during regular use (p < 0.05) obtained as part of quality improvement. The complete protocol will launch across all hospital units for two months starting March 2017. Conclusion/Discussion: No controlled studies exist evaluating sit-to-stand training in moderate-assist patients due to this population’s inherent physical limitations. Equipment progressively lowering a seat’s angle-ofinclination allows this previously excluded population to participate. As preliminary findings indicate such equipment is an effective method to increase patient mobility while minimizing pain during regular use, a protocol utilizing this equipment for sit-to-stand training may further support patient recovery to prior functioning [2]. Key Words: Physical Therapy, Strength Training, Timed Sit-To-Stand, Mixed Methods, Moderate-Assist Patients Disclosures: None. Research Poster 304749 Rehabilitation Challenges for a Cancer Patient Post-Hemipelvectomy: A Case Report Sonal Oza (RIC/Northwestern McGaw Medical Center), Samman Shahpar Research Objectives: N/A. Design: Case Report. Setting: Inpatient Rehabilitation. Participants: Case Report. Interventions: N/A. Main Outcome Measure(s): N/A. Results: A 39 year old male with stage III pelvic angiosarcoma of the ischium, acetabulum, and symphysis underwent right hemipelvectomy including femoral head resection with endoprosthetic saddle reconstruction. Sciatic and femoral nerves, gluteus medius, minimus were intact. Exam revealed severe proximal weakness; right distal weakness suggestive of peroneal nerve palsy. He wore an HKAFO and was weight bearing. Precautions included hip flexion to 40 degrees and ankle to 90 degrees. He was too orthostatic to tolerate ambulation and was started on Midodrine. Orthotist increased padding to reduce brace pain. Gait showed reduced knee extension and hip hiking that improved with a heel lift. He developed a painful right heel ulcer. A disconnect feature was added to enable wearing a PRAFO when supine without compromising proximal stability. Patient improved from minimal assistance to supervision for transfers, total to moderate assistance for stairs and ambulated 100 ft with a rolling walker at supervision. He was discharged home. Conclusion/Discussion: Angiosarcoma is a rare malignancy, comprising 1-2% of primary sarcomas and 0.2% of cancers. Pelvic involvement is uncommon. Treatment involves limb salvage surgery. Altered neuromuscular control results from the large resection. Detached external rotators, adductors, and knee extensors impact gait. Individuals exhibit pelvic hiking, trunk leaning and difficulty loading. Facilitating movement in context of precautions adds to the complexity of rehabilitation. Survivors of pelvic bone tumor resection reported impaired balance, difficulty with daily activities and community participation. 50-75% of non-angiosarcoma hemipelvectomy survivors after inpatient rehabilitation ambulated independently with an assistive device. Rehabilitation outcomes in pelvic angiosarcoma has not been reported to our knowledge. Key Words: Cancer, Rehabilitation, Survivorship Disclosures: None.