In view of current emphasis on evaluation of benefits derived from rehabilitation programs, it is important that there be easily replicated measures for demonstrating the efficiency and effectiveness of services provided, as well as for transmitting information on patient functional status when transferring service responsibilities from one agency or facility to another. The authors used the PULSES profile and the Barthel index to measure severity of disability and to monitor rehabilitation progress in a heterogeneous sample of 307 severely disabled persons in 10 comprehensive medical rehabilitation centers, geographically selected. Gains in functional independence were registered for up to 2 years after admission. Cutting points of PULSES score totals or Barthel score totals distinguished the degree of severity of disability. The 2 scoring modalities appear valid, reliable, and sensitive for describing functional abilities and change over a period of time. They can be applied both to medical records and direct observations, and staff of medical facilities can readily be trained in their use.
"As of 2011, a total of 261,746 persons were registered, and 333,798 were presumed to be 'disabled by brain disorders', representing 0.73 persons per 1,000.1 When the dysfunction level was estimated using the Modified Barthel Index,2 22.8% of patients 'disabled by brain disorders' were classified as level 1 and 2.1 "
[Show abstract][Hide abstract] ABSTRACT: To describe inpatient course and length of hospital stay (LOS) for people who sustain brain disorders nationwide.
We interviewed 1,903 randomly selected community-dwelling patients registered as 'disabled by brain disorders' in 28 regions of South Korea.
Seventy-seven percent were initially admitted to a Western medicine hospital, and 18% were admitted to a traditional Oriental medicine hospital. Forty-three percent were admitted to two or more hospitals. Mean LOS was 192 days. Most patients stayed in one hospital for more than 4 weeks. The transfer rate to other hospitals was 30-40%. Repeated admissions and increased LOS were related to younger onset age, higher education, non-family caregiver employment, smaller families, and more severe disability.
Korean patients with brain disorders showed significantly prolonged LOS and repeated admissions. Factors increasing burden of care influenced LOS significantly.
Annals of Rehabilitation Medicine 10/2012; 36(5):609-17. DOI:10.5535/arm.2012.36.5.609
"Activities of daily living were assessed using the Barthel Index (BI: ). The measure is widely used in stroke research, and Granger and Albrecht et al.  report good test–retest reliability (r = 0.89). The modified 0–20 scoring system was used, with a higher score indicating better functioning. "
[Show abstract][Hide abstract] ABSTRACT: To investigate the association between the illness representations of recently diagnosed stroke patients and their carers and distress in the months after stroke.
Forty-two stroke survivors and their carers were assessed at 3 months and 32 couples returned data at 6 months after stroke. Patients and carers completed the Illness Perceptions Questionnaire-Revised, Barthel Index, Significant Others Scale and General Health Questionnaire. Analyses were conducted using the Actor-Partner Interdependence Model.
Carers were more pessimistic than patients about the symptoms, timeline and consequences of the stroke. Patient distress was associated with both patient and carer illness representations at Time 1, and their own illness representations and discrepancy in the illness representations of patients and carers at Time 2. Carer distress was associated with their own illness representations at Time 1, but not the patient's illness representations. Discrepant illness representations were associated with higher carer distress at Time 1 but not Time 2.
Illness representations of stroke patients and carers have implications for adjustment for both partners. It is important to understand couples' views of stroke, as discrepancy was as strongly associated with patient and carer distress as was physical disability.
Journal of psychosomatic research 03/2012; 72(3):220-5. DOI:10.1016/j.jpsychores.2011.12.004 · 2.74 Impact Factor
"Measurements took place at 1) baseline; which was after admission to hospital and before surgery, 2) after 40 days and 3) after 4 months. Baseline measures included weight, height, mid upper-arm circumference (MUAC), grip strength, serum albumin (g/L), activities of daily living as assessed by the Barthel Index , Short Portable Mental Status Questionnaire (SPMSQ)  to assess participant's cognitive status, and the Charlson Index to evaluate the presence of co morbidities . The participant's knee height was used to calculate the estimated actual height so that body mass index (BMI) could be calculated . "
[Show abstract][Hide abstract] ABSTRACT: Malnutrition is a problem for many older people recovering from a hip and other major fractures. Oral supplementation with high calorie high protein nutrients is a simple intervention that may help older people with fractures to improve their recovery in terms of rehabilitation time, length of hospital stay and mortality. This paper reports a pilot study to test the feasibility of a trial initiated in a hospital setting with an oral supplement to older people with recent fractures.
A randomized controlled trial with 44 undernourished participants admitted to a hospital following a fracture. The intervention group (n = 23) received a high calorie high protein supplement for forty days in addition to their diet of choice. The control group (n = 21) received high protein milk during their hospital stay in addition to their diet of choice and their usual diet when discharged from hospital.
All participants were women and their mean age was 85.3 (± 6.1) years. Twenty nine (65%) participants had a hip fracture. At baseline no differences were measured between the two groups regarding their nutritional status, their cognitive ability or their abilities in activities of daily living. There were no significant differences between the intervention and control group with reference to nutritional or functional parameters at 40 day and 4 month follow-ups. Median length of stay in hospital was 18.0 days, with 12 participants being readmitted for a median of 7.0 days.
It is feasible to perform a randomised trial in a hospital and community setting to test the effect of an oral high energy high protein supplement for older people. Due to the limited number of participants and incomplete adherence with use of the supplements no conclusion can be drawn about the efficacy or effectiveness of this intervention.
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