Kurtis M. Hoppe

Discharge Destination and Motor Function Outcome in Severe Stroke as Measured by the Functional Independence Measure/Function-Related Group Classification System

OBJECTIVES Function-related groups based on the Functional Independence Measure have been proposed as a model for a prospective payment system for medical rehabilitation. This study describes discharge destination and motor function outcomes in a sample of patients with stroke from the FIM-FRG STR1 classification. STUDY DESIGN A retrospective review of 293 cases of stroke from the years 1993 to 1995. The demographic and outcome characteristics of this sample were described. RESULTS/CONCLUSIONS Forty-five percent of the patients were discharged to home after a mean length of stay of 23.8 days in acute medical rehabilitation. Patients who were discharged home had higher admission and discharge motor FIM scores than those discharged to a subacute facility or long-term care facility, although the correlation between motor FIM score and discharge destination was low to moderate. Median discharge motor FIM scores indicate considerable residual disability in this classification after rehabilitation. Research problems that address methods to improve the usefulness of the FIM-FRG system in a prospective payment system are discussed.

Functional Outcomes and Quality of Life After Tumor-Related Hemipelvectomy

Background and Purpose: Hemipelvectomy is a life-changing treatment for pelvic malignancies. This study compared functional outcomes and quality of life of patients following internal or external hemipelvectomies. Subjects: Ninety-seven patients who underwent tumor-related internal (n=39) or external (n=58) hemipelvectomy surgery between January 1, 1988, and December 31, 2004, participated in the study. Methods: Using a descriptive retrospective cohort study design, functional status was evaluated with the Barthel Index at 3 time points. Quality-of-life parameters were evaluated at follow-up using the Linear Analog Self-Assessment tool (LASA). Results: Data were collected on all 97 patients at rehabilitation consultation and hospital discharge. Follow-up data were obtained via survey on 44% of the original group at a median of 5.8 years (interquartile range [IRQ]=1.7–10.4) after surgery. Median total Barthel Index scores were similar between the internal and external hemipelvectomy groups at the initial physical medicine and rehabilitation assessment (10 [IQR=10–15] versus 10 [IQR=3.75–15]), at discharge (40 [IQR=30–65] versus 50 [IQR=35–66.25]), and at follow-up (92.5 [IQR=76.25–100] versus 92.5 [IQR=78.75–96.25]). Participants with external hemipelvectomies were less independent in bladder function and experienced greater pain severity at follow-up compared with those with internal hemipelvectomies. Overall quality-of-life parameters were similar between the groups. Discussion and Conclusion: Despite significant differences in surgical procedures, immediate and long-term functional outcomes and quality-of-life parameters were similar among participants with internal and external hemipelvectomies.

The Convention on the Rights of Persons With Disabilities: What Is at Stake for Physiatrists and the Patients We Serve

In 1945, in the aftermath of World War II, former First Lady Eleanor Roosevelt (and wife of our first president with a disability when elected) was appointed by President Harry Truman to chair the United Nation’s (UN) Human Rights Commission. By all accounts, she relished the experience and recognized the moral force that a Universal Declaration of Human Rights could have in establishing international norms. In 1948, the UN Assembly adopted the Declaration. What followed over the subsequent decades were a series of UN human rights treaties and conventions that called out and underscored that various vulnerable populations (such as children, women, racial minority groups) deserved human rights protections too. Whereas, a UN declaration was intended to be aspirational and not legally binding, such was not the case with a human rights convention or treaty [2]. In addition to being a commitment to the international community, a convention also would require appropriate oversight and monitoring and reporting of the signatory countries. Unfortunately, concerns about national sovereignty have often impeded U.S. Senate ratification of UN human rights conventions, including the Convention on the Elimination of All Forms of Discrimination against Women, the Convention on the Rights of the Child, and, more recently, the Convention on the Rights of Persons with Disabilities (CRPD) [3]. Attention to the rights of people with disabilities has gained traction since the 1970s, both in the United States and internationally. In 1971, the UN General Assembly adopted The Declaration on the Rights of Mentally Retarded Persons, followed 4 years later by The Declaration on the Rights of Disabled Persons [4]. A push for civil rights laws for people with disabilities in the United States began in the 1960s, which culminated in such landmark legislation as Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA) in 1990. Not surprisingly, those who helped to draft the ADA in the United States also became leaders in the international movement for disability civil rights and helped to craft the language for the UN CRPD. The document, whose stated purpose is “to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity” [5] was adopted by the UN in 2006 and has been ratified by 141 countries to date [4]. Despite being signed by President Obama in 2009, efforts to obtain the supermajority (two-thirds or 66 votes) needed for U.S. Senate ratification have thus far fallen short. The reasons for opposition include concerns that the CRPD will infringe on parental rights, endorse abortion rights, and compromise U.S. sovereignty. To learn more about these issues, please see the fact sheet prepared by the U.S. International Council on Disabilities that addresses these concerns (http://www.usicd.org/doc/CRPD%20MythsFacts%200719%202013.pdf).

Direct medical costs of accidental falls for adults with transfemoral amputations

Background: Active individuals with transfemoral amputations are provided a microprocessor-controlled knee with the belief that the prosthesis reduces their risk of falling. However, these prostheses are expensive and the cost-effectiveness is unknown with regard to falls in the transfemoral amputation population. The direct medical costs of falls in adults with transfemoral amputations need to be determined in order to assess the incremental costs and benefits of microprocessor-controlled prosthetic knees. Objective: We describe the direct medical costs of falls in adults with a transfemoral amputation. Study design: This is a retrospective, population-based, cohort study of adults who underwent transfemoral amputations between 2000 and 2014. Methods: A Bayesian structural time series approach was used to estimate cost differences between fallers and non-fallers. Results: The mean 6-month direct medical costs of falls for six hospitalized adults with transfemoral amputations was US

Predictors of Receiving a Prosthesis for Adults With Above-Knee Amputations in a Well-Defined Population

25,652 (US

Rehabilitation Confronts Technology: Knowing How to Manage Innovations and Expectations

10,468, US

The risk of major cardiovascular events for adults with transfemoral amputation

38,872). The mean costs for the 10 adults admitted to the emergency department was US

Original ResearchdCME Predictors of Receiving a Prosthesis for Adults With Above-Knee Amputations in a Well-Defined Population

18,091 (US

Poster 183: Postoperative Visual Loss Following Spine Surgery: A Case Series

-7,820, US

Poster 6: A Newly Diagnosed Human Immunodeficiency Virus (HIV) Patient With HIV Myelitis: A Case Report

57,368). Conclusion: Falls are expensive in adults with transfemoral amputations. The 6-month costs of falls resulting in hospitalization are similar to those reported in the elderly population who are also at an increased risk of falling. Clinical relevance Estimates of fall costs in adults with transfemoral amputations can provide policy makers with additional insight when determining whether or not to cover a prescription for microprocessor-controlled prosthetic knees.