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reinjection. Further ULIS-III data will provide additional clarity to
these preliminary analyses.
Level of Evidence:
Level II
Poster 59:
Patient Characteristics Influencing Inpatient
Rehabilitation Outcomes for Individuals with a Brain
Tumor
Carrie M. Gould, MD (Marianjoy Rehabilitation Hospital, Wheaton, IL,
United States), Anton N. Dietzen, DC, MD, Anjum Sayyad, MD,
Rishi S. Shah, MD, Colleen McQuillan, PT, Susan L. Brady, DHEd
Disclosures:
Carrie Gould: I Have No Relevant Financial Relationships
To Disclose
Objective:
The primary objective of this study was to describe
rehabilitation outcomes for adult patient with the diagnosis of a brain
tumor. The secondary objective was to investigate if differences in
rehabilitation outcomes were present based upon specific patient
characteristics.
Design:
This study involved a retrospective medical chart review
study of all adult admissions to inpatient rehabilitation with the
diagnosis of a brain tumor from 2011-2015 (convenience sample).
Setting:
Acute inpatient rehab.
Participants:
Adult patients with the diagnosis of a brain tumor.
Interventions:
Not applicable.
Main Outcome Measures:
FIM scores.
Results:
Forty-nine patients identified by medical chart reviews
became the subjects of this investigation, with age range 23
e
91
(mean 59.4 years; SD 16.2 years), including 23 males and 26 fe-
males. LOS ranged from 11 to 58 days (mean 23 days; SD 8.2 days).
Mean total admission FIM score was 45.2 (SD 13.8) and mean
discharge score was 62.33. Differences between admission and
discharge FIM scores were statistically significant (t
¼
-7.997,
p
¼
.0001). Patients who were experiencing their first brain tumor
occurrence demonstrated a mean FIM gain of 19.6 as compared to a
FIM gain of 11.23 for patients experiencing a recurrence of the brain
tumor (p
¼
.06). Patients who underwent a brain tumor resection prior
to IRF admission (n
¼
40) performed better during inpatient rehabili-
tation with a FIM gain per day of .89 as compared to .31 for patients
who did not undergo a resection (t
¼
-2.053, p
¼
.04). Final discharge
destination from the IRF was as follows: 12% acute care; 43% sub-
acute; 45% home.
Conclusions:
Overall, patients with a brain tumor who participated in
IP rehabilitation made significant functional improvements. Patients
with a first occurrence of a brain tumor and patients who underwent
surgical resection of the brain tumor tended to have greater FIM gains
during inpatient rehabilitation. Patients with a brain tumor should be
afforded the opportunity to participate with inpatient rehabilitation.
Level of Evidence:
Level III
Poster 60:
Efficacy of IncobotulinumtoxinA in Treatment of
Lower Limb Spasticity, Including Pes Equinovarus in
Adults
John R. McGuire, MD, FAAPMR (Med Coll of WI, Milwaukee, WI, United
States), Jo¨rg Wissel, MD FRCP, Djamel Bensmail, MD,
Astrid Scheschonka, MD, PhD, Birgit Flatau-Baque´, MD, Olivier Simon,
MD, David M. Simpson, MD
Disclosures:
John McGuire: Speakers bureau
e
Allergan; Consulting
fees or other remuneration (payment) - Allergan, Medtronic; Research
Grants - Medtronic, Mallinckrodt, Merz
Objective:
This post-hoc analysis was performed to assess the effec-
tiveness of incobotulinumtoxinA for treating lower limb (LL) spasticity
including pes equinovarus.
Design:
Prospective, single-arm, dose-titration study (TOWER;
NCT01603459).
Setting:
Thirty sites in 8 countries (United States, Canada, Germany,
Norway, Spain, Italy, France, Portugal).
Participants:
Adult subjects (N
¼
155) with UL and LL spasticity.
Interventions:
Increasing fixed total doses of incobotulinumtoxinA:
cycle 1, 400 U; cycle 2, 600U; cycle 3, 600
e
800 U.
Main Outcome Measures:
Muscle tone (Ashworth Scale [AS]); AS
responder rates (ie, proportion of subjects with 1 point improvement
at 4-weeks); Resistance to Passive Movement Scale (REPAS).
Results:
A total of 109 subjects with LL spasticity and 100 subjects
with pes equinovarus received treatment with incobotulinumtoxinA
during the first cycle (mean SD dose for pes equinovarus:
166.3 94.9 U). The mean AS score improvement ( SD) for the
ankle joint at 4 weeks post-injection was 0.63 0.76 in subjects
treated for pes equinovarus and 0.16 0.63 in subjects not treated
for this pattern. Pes equinovarus AS score improvements demon-
strated significant dose-dependence (P
¼
.0096; multiple regression
analysis adjusting for AS baseline). A significantly higher proportion
of treated subjects were considered AS responders compared with
untreated subjects (55% vs 12.7%; P
<
.0001; Mantel-Haenszel Chi-
Square test). Mean improvement ( SD) in REPAS LL scores from
baseline at 4 weeks post-injection was 1.6 2.0 in subjects with LL
treatment and 0.3 1.5 in subjects without. Multiple regression
analysis on LL REPAS baseline value and LL dose demonstrated a
significant dose dependence (P
¼
.0022).
Conclusions:
Results show that incobotulinumtoxinA is a safe and
effective treatment for LL spasticity and pes equinovarus in adult
subjects.
Level of Evidence:
Level II
Poster 61:
Utilizing the NIH Stroke Scale as a Tool to Predict the
Need for Physical Medicine and Rehabilitation
Consultation and Post-Acute Inpatient Rehabilitation
Justin L. Weppner, DO (Univ of VA), Paul Diamond, MD
Disclosures:
Justin Weppner: I Have No Relevant Financial Relation-
ships To Disclose
Objective:
Identification of stroke patients in need of post-acute
rehabilitation care can be difficult to determine early in the initial
hospitalization. The aim of this study was to evaluate utilizing the NIH
Stroke Scale (NIHSS) to identify patients that will require inpatient
rehabilitation.
Design:
Our institution’s clinical data repository (CDR) was searched
for patients with an initial admission for ischemic or hemorrhagic
stroke from October 2014 through October 2016. Subjects with tran-
sient ischemic stroke (TIA), subarachnoid hemorrhage, died during
hospitalization, or left the hospital against medical advice were
excluded. Demographic information, NIHSS stroke scale on admission
to the acute hospital, disposition to the next level of care, and length
of hospital stay was recorded.
Setting:
Quaternary acute care hospital.
Participants:
Adults admitted to our institution with a stroke.
Interventions:
Not applicable.
Main Outcome Measures:
Bivariate analysis was performed to test the
relationship of disposition with patient characteristics. Multivariant
logistic regression was performed to identify the independent vari-
ables associated with each disposition.
Results:
536 patients met the inclusion criteria with a mean age of
67 16, 53% male, 83% ischemic stroke, and 17% hemorrhagic stroke. At
the time of discharge, 57.6% of patients were discharged home, 20.7%
to acute rehabilitation, and 21.7% to skilled nursing facilities (SNF).
Most patients (90%) with NIHSS 4 were discharged home, those with
scores between 5 and 15 most frequently discharge to acute rehabil-
itation (60%), and those with scores
>
15 required SNF placement
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Abstracts / PM R 9 (2017) S131-S290