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likely benefit from rehabilitation and this points to the need for
greater awareness within surgical and ICU teams of the indications and
benefits of PMR consultation.
Level of Evidence:
Level II
Poster 77:
Treatment at an Integrated Stroke Model of Care
Yields Higher FIM Efficiency than Community Based
Inpatient Rehabilitation
Nneka L. Ifejika, MD, MPH, FAAPMR (UT Health Department of
Neurology, Houston, TX, United States), Elizabeth A. Noser, MD,
Chunyan C. Cai, PhD, Sean I. Savitz, MD, James C. Grotta, MD
Disclosures:
Nneka Ifejika: I Have No Relevant Financial Relationships
To Disclose
Objective:
An integrated stroke model of care (SMOC), combining the
expertise of physiatry and vascular neurology, provides seamless
treatment from the emergency department through inpatient reha-
bilitation. We analyzed the difference in Functional Independence
Measure efficiency (FIM eff) between patients treated at a SMOC and
Community Inpatient Rehabilitation Facilities (IRFs).
Design:
Retrospective Observational Study.
Setting:
One integrated SMOC (Comprehensive Stroke Center plus
Inpatient Rehabilitation Facility), Six Community IRFs in an urban
metropolitan area.
Participants:
Stroke patients identified by ICD9/10 from a prospec-
tively collected rehabilitation registry between Jan 2005 & July
2016(n
¼
4599).
Interventions:
Descriptive statistics were used for demographics.
Medical comorbidities and post-stroke impairments were included.
After adjusting for potential confounders, propensity score matching
and a sensitivity analysis using a multivariable model assessed differ-
ences in FIM eff between SMOC and Community IRFs.
Main Outcome Measures:
FIM efficiency.
Results:
1541 patients were treated at SMOC, 3058 at community
IRFs. SMOC had more young, male, uninsured minorities, and those
with brain hemorrhage (P
<
.0001). UTI, depression, aphasia and
dysphagia were more prevalent at SMOC (P
<
.0001). Cardiac disease,
neurogenic bowel/bladder (P
<
.0001) and hypertension (P
<
.0017)
were more prevalent at community IRFs. Propensity score matching:
1059 pairs were identified; covariate balance was achieved across
groups. The mean difference between SMOC and Community IRFs was
0.42, favoring SMOC (95% CI:0.31
e
0.54; P
<
.0001). Multivariable model
(sensitivity analysis): FIM eff was higher at SMOC (1.9) than community
IRFs (1.6; P
<
.0001). Adjusted difference between SMOC and Commu-
nity IRFs was 0.37, favoring SMOC (95% CI: 0.29-0.45; P
<
.0001). FIM eff
increased with SMOC and ambulation. FIM eff decreased with
advancing age, UTI, dysphagia, depression, diabetes, brain hemor-
rhage and neurogenic bowel/bladder.
Conclusions:
Treatment at an integrated stroke model of care yields
higher FIM efficiency compared to community based inpatient reha-
bilitation. Future studies are needed to determine the effects of in-
tegrated SMOC on disability rates and return to work for this
population.
Level of Evidence:
Level II
Poster 78:
Examining the Role of Botulinum Toxin on Functional
Outcomes in an Inpatient Setting (Preliminary
Results)
Aaron A. Hanyu-Deutmeyer, DO (Marianjoy Rehab Hosp),
Michael Fitzgerald, Student, Anjum Sayyad, MD
Disclosures::
Aaron Hanyu-Deutmeyer: My spouse/partner has a
relationship with Allergan-Speakers bureau, My spouse/partner has a
relationship with Allergan-provided Botox for injection
Objective:
To test the hypothesis that botulinum toxin administered
during the acute inpatient setting leads to measurable improvements
in functional outcomes by the time of discharge.
Design:
Retrospective Analysis.
Setting:
Acute inpatient rehabilitation.
Participants:
13 patients have been identified and analyzed that meet
the selection criteria.
Interventions:
Not applicable.
Main Outcome Measures:
Mobility Functional Independence Measure
(FIM) scores as measured by mean improvement per day before bot-
ulinum toxin administration, and mean improvement per day after
administration.
Results:
Mean inpatient rehabilitation length of stay was 33.6 days.
Patients received traditional therapies an average of 14 days before
receiving botulinum toxin, and stayed an average of 19.6 days
following botulinum toxin administration while continuing to receive
traditional therapies. Mean FIM motor gain per day prior to botulinum
toxin administration was 0.6385. Following botulinum toxin, the mean
FIM motor gain per day increased significantly to 1.0554 (p
¼
.04). Mean
FIM motor score immediately before administration was 34.6538 and at
discharge was 48.4231 (p .0001) showing a significant increase in
overall functional ability.
Conclusions:
To our knowledge, botulinum toxin and its effect on
functional outcomes during an acute inpatient admission has never
been investigated. Preliminary results suggest receiving botulinum
toxin for spasticity during an acute inpatient rehabilitation stay
will increase the rate of a patient’s functional recovery as
compared to only traditional therapies. As an adjunct to tradi-
tional therapy, early treatment of spasticity with botulinum toxin
can not only increase a patient’s short term gains in acute rehab
but potentially have more profound effects in their recovery after
discharge.
Level of Evidence:
Level III
Poster 79:
The Adult Spasticity International Registry (ASPIRE)
Study: 1-Year Results
Gerard E. Francisco, MD, FAAPMR (Univ of TX - Houston, Houston, TX,
United States), Daniel S. Bandari, MD, Ganesh Bavikatte, MD, FRCP,
FEBPRM, Wolfgang H. Jost, MD, PhD, Aubrey Manack Adams, PhD,
Joan Largent, PhD, MPH, Alberto Esquenazi, MD, FAAPMR
Disclosures:
Gerard Francisco: Research Grants - Allergan, Ipsen,
Mallinckrodt, Medtronic, Merz, Microtransponder, Nexstim
Objective:
To assess 1-year interim results from the ASPIRE study on
onabotulinumtoxinA treatment, utilization, safety and effectiveness
to help guide onabotulinumtoxinA administration strategies to opti-
mize its effectiveness in spasticity management.
Design:
ASPIRE is an international, prospective, observational study
(ClinicalTrials.gov NCT01930786).
Setting:
54 clinical practice sites.
Participants:
Adult patients ( 18 years) with focal spasticity related
to upper motor neuron syndrome.
Interventions:
OnabotulinumtoxinA administered at the treating
physician’s discretion in accordance with usual clinical practice.
Main Outcome Measures:
Follow-up assessments including utilization
patterns, patient and physician satisfaction were undertaken at each
treatment visit, 6 weeks post-treatment, and approximately 12 weeks
after final visit.
Results:
At the 1-year assessment, 731 patients received 1 onabo-
tulinumtoxinA treatment; 1345 and 1429 treatment sessions for upper
and lower limb spasticity, respectively, and 265 patients received
treatment for both upper and lower limbs. Most commonly treated
presentations were clenched fist (2121 treatment sessions) and
equinovarus foot (2938 treatment sessions) for upper and lower
limbs respectively. Of the various localization techniques (anatomical,
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Abstracts / PM R 9 (2017) S131-S290