Gerald Felsenthal

Effect of cognitive impairment on rehabilitation outcome

Previous studies examining the relationship between cognition and ability to benefit from inpatient rehabilitation have found cognitive dysfunction to be associated with a poor rehabilitation outcome. To examine whether cognitive dysfunction precluded effective rehabilitation, 52 consecutive admissions to a geriatric rehabilitation unit were assigned Mini Mental State Examination (MMSE) scores. Functional gains were assessed by the change in Functional Independence Measure (FIM) score from admission to discharge. Neither MMSE score alone nor in combination with age was significantly associated with change in FIM (r = 0.10; R = 0.25; P< 0.18). MMSE score alone and in combination with age was correlated with functional status on admission (r = 0.58; R = 0.58; P< 0.0001) and discharge (r = 0.49; R = 0.51; P< 0.0004). Patients evidenced a similar increase in functional status regardless of cognitive ability, but cognitively impaired individuals entered the inpatient unit with a lower functional status, and their level of function at discharge was also impaired relative to cognitively intact cohorts. Low MMSE scores were associated with a greater likelihood of nursing home placement, but a considerable percentage (38%) of individuals with severe cognitive impairment and the majority of individuals with mild to moderate cognitive impairment returned home following discharge. These findings suggest that geriatric patients with cognitive dysfunction should be considered for admission to rehabilitation programs if functional gains will affect quality of life or disposition.

Mobility after hip fracture predicts health outcomes.

OBJECTIVES: Balance and gait are essential to physical functioning and the performance of activities of daily living. The objective of this study was to determine the predictive value of a balance and gait test on subsequent mortality, morbidity, and healthcare utilization among older hip fracture patients.

Outcome After Hemiarthroplasty for Femoral Neck Fractures in the Elderly

A prospective outcome study was performed on 270 patients, 65 years of age and older, who sustained a femoral neck fracture and underwent hemiarthroplasty. The treatment compared was the use of a noncemented unipolar versus either a cemented or a press fit bipolar prosthesis. The outcome variables assessed included the occurrence of a postoperative complication, length and cost of hospitalization, and function in various quality of life measurements. Patients who underwent bipolar hemiarthroplasty with either a cemented or a press fit prosthesis had better pain relief and function than patients who had a noncemented unipolar prosthesis at a minimum of 24 months after surgery. However, the mean hospitalization cost for patients who had a bipolar prosthesis was

Correlation of standardized testing results with success on the 2001 American Board of Physical Medicine and Rehabilitation Part 1 Board Certificate Examination.

12,290 compared with

Electrodiagnostse Evaluation of Acute and Chronic Radiculopathy

8876 for a unipolar prosthesis.

Short-term persistent depression following hip fracture: A risk factor and target to increase resilience in elderly people

Fish DE, Radfar-Baublitz LS, Choi H, Felsenthal G: Correlation of standardized testing results with success on the 2001 American Board of Physical Medicine and Rehabilitation part 1 board certificate examination. Am J Phys Med Rehabil 2003;82:686–691. Objective To determine if standardized testing results and other factors correlate with success on the 2001 American Board of Physical Medicine and Rehabilitation part 1 board certification examination (POE). Design An anonymous two-part survey was distributed to 302 senior resident physicians in the American College of Graduate Medicine Education–accredited physical medicine and rehabilitation training programs in the United States deemed eligible for the 2001 POE. Results A total of 94 of 302 distributed surveys (31.1%) were returned; 86 met the inclusion criteria (81 passes and five failures). A significant correlation was found between both quartile ranking on the Self Assessment Examination and United States Medical Licensing Examination (USMLE) passage on the first attempt with POE quartile rank (P < 0.01). Other factors, such as number of hours of faculty-led didactics per week, textbook use, and participation in formal board review courses did not correlate with POE quartile ranking. Conclusion Residents who were successful on previous standardized tests scored well on the POE. Quartile ranking on Self Assessment Examination and USMLE or National Board of Osteopathic Medical Examiners success was found to correlate significantly with POE quartile rank. This information may be helpful for future POE preparation and prospective candidate selection for physical medicine and rehabilitation.

Across-tarsal-tunnel motor-nerve conduction technique

Electrodiagnostic studies have been widely recognized as helpful in the evaluation of possible radiculopathy. Electromyography is the most useful of these techniques, but there also is a role for peripheral nerve conduction studies, H-reflex and F-wave measurement, and, possibly, somatosensory studies.