2005 ACADEMY ANNUAL ASSEMBLY ABSTRACTS with greater baseline HCT values associated with greater probability of excellent 3-month outcome (P⫽.04). The association between poor outcome on the NIHSS and HCT level was not significant. Conclusions: In patients presenting with ischemic stroke, higher baseline HCT levels are associated with better 3-month outcome. Further research into this association could lead to new stroke interventions to improve outcome. Key Words: Hematocrit; Rehabilitation; Stroke; Treatment outcome. Poster 48 Toxin Neutralizing Antibody Formation With Botulinum Toxin Type A Treatment in Neuromuscular Disorders. Stuart A. Yablon, MD (Methodist Rehabilitation Center, Jackson, MO); Simon Daggett; Mitchell Brin, MD, e-mail: [email protected]
Disclosure: Yablon, Consultant for Allergan, Inc.; Daggett, Stock options from Allergan, Inc., Allergan, Inc., employee; Brin, Stock options from Allergan, Inc., Allergan Inc. employee. Objective: To assess the rate of neutralizing antibody formation with intramuscular injection of botulinum toxin type A (BTX-A) in botulinum toxin–naive patients. Design: Open-label analysis of serum antibody samples obtained from 6 clinical trials. Setting: Movement disorder, rehabilitation, and headache treatment centers. Participants: Patients with cervical dystonia (CD), headache, or poststroke spasticity. Intervention: BTX-A. Main Outcome Measures: The presence of neutralizing antibodies to BTX-A was assessed using the mouse protection assay (MPA). Results: Serum samples were obtained at baseline, prior to each repeat injection, and at study exit. Patients treated for CD (326 patients) received 1 to 14 treatments of BTX-A (mean per treatment, 186.4U, range, 20 –500U; maximum total exposure per patient, 4115U); patients treated for chronic headache (356 patients) received 3 treatments (mean, 157U; range, 75–260U; maximum exposure, 780U); and patients treated for poststroke spasticity (247 patients) received 1 to 4 treatments (mean, 241U; range, 100 –360U; maximum exposure, 960U). Of the 929 patients treated, 880 had analyzable samples. MPA was negative for 872 (99.0%), inconclusive for 4 (0.5%), and positive for 4 (0.5%). Of the 4 patients with a positive result, 3 were CD patients. A patient had received a single treatment of 300U, 1 had received 6 treatments of 100 to 150U (exposure, 750U), and the third patient had received 8 treatments of 100 to 400U (exposure, 2300U). The other patient with a positive result was a spasticity patient who received 1 treatment with 200U of BTX-A. Only the spasticity patient did not demonstrate clinical improvement after treatment at the time of reporting the positive MPA. Conclusions: There is a very low rate of antibody formation in patients who received repeat BTX-A intramuscular injections with the specific BTX-A preparation used in these studies. Key Words: Botulinum toxin type A; Cervical dystonia; Muscle spasticity; Rehabilitation. Poster 49 Long-Term Effects of Sustained-Release Morphine Sulfate Versus Controlled-Release Oxycodone HCl on Relief of Moderate-to-Severe Pain. Bruce Nicholson (Pain Specialist of Greater Lehigh Valley, Allentown, PA); Arnold Weil; Edgar Ross; John Sasaki. Disclosure: Nicholson, Consultant for Alpharma Branded Products Division, Inc; Weil, Consultant for Alpharma Branded Products Division, Inc; Ross, Consultant for Alpharma branded Products Division, Inc. and Janssen Pharmaceutical; Sasaki, Consultant for Alpharma Branded Products Division, Inc. Objective: To assess long-term efficacy and tolerability of sustained-release morphine sulfate (Kadian formulation) compared with controlled-release oxycodone HCl (OxyContin) in treating chronic nonmalignant moderate-to-severe pain. Design: Prospective, randomized, open-label, blinded endpoint. Setting: Outpatient pain clinics. Participants: Adults (N⫽112) with visual numeric scale (VNS) scores ⱖ4 (0, no pain; 10, worst pain). Intervention: Patients were randomized to Kadian (QD) or OxyContin (BID) for a 24-week treatment period. Up-titration of dose and switching Kadian to BID or OxyContin to TID was allowed weeks 2 to 24. Main Outcome Measures: Pain and sleep scores (0 –10), changes in quality of life (physical [PCS] and mental [MCS] component summary scores of the Medical Outcomes Study 36-Item Short-Form Health Survey, version 2), and patient and clinician assessment of current therapy (⫺4 to ⫹4). A 2-point difference in pain scores was considered clinically meaningful. Results: Patients in both treatment groups attained a statistically significant reduction from baseline to 24 weeks in pain (Kadian, ⫺2.0⫾2.8; OxyContin, ⫺1.4⫾2.8); the reduction with Kadian was clinically meaningful. Patients in both groups attained significant reductions in sleep scores (Kadian, ⫺2.6⫾3.6; OxyContin, ⫺1.6⫾3.2). Both treatment groups experienced significant improvements in PCS scores (P⬍.05); patients taking OxyContin also demonstrated improvements in MCS scores (P⬍.05). Both groups indicated significantly increased patient (Kadian, 2.6⫾3.1; OxyContin, 1.7⫾3.1) and clinician (Kadian, 4.0⫾2.5; OxyContin, 3.1⫾2.8) global assessment of therapy. After 24 weeks, all patients on Kadian were dosing within the FDA-approved frequencies (65% QD, 35% BID); 56% of patients on OxyContin were dosing BID, but 38% were dosing TID and 6% were dosing QID. Most common adverse events were constipation, nausea, and somnolence; there was no significant difference between treatment groups. Conclusions: Kadian and OxyContin both effectively relieved chronic nonmalignant pain in this community-based population; however, patients on Kadian dosed less frequently than those on OxyContin. Key Words: Analgesics; Opioids; Pain; Rehabilitation.
Poster 50 Outcomes of Inpatient Rehabilitation for Deconditioning. Patrick Kortebein, MD (University of Arkansas for Medical Sciences, Little Rock, AR); Melinda M. Bopp; Carl V. Granger, MD; Dennis H. Sullivan, MD, e-mail: [email protected]
Disclosure: Granger, Uniform Data System for Medical Rehabilitation employee; Other authors: None. Objectives: To collect information on the outcomes of older adults who have received inpatient rehabilitation for deconditioning and to investigate whether the diagnosis of deconditioning (ICD-9 code 799.3) might be included as a criterion medical condition for classification as an inpatient rehabilitation facility under the Center for Medicare and Medicaid Services 75% rule. Design: Retrospective cohort study of patients included in the Uniform Data System for Medical Rehabilitation (UDSMR) database for 2002 to 2003. Setting: Inpatient rehabilitation facilities in the United States subscribing to UDSMR. Participants: 63,171 individuals ⱖ65 years old (62% women, 98%
previously living independently) with a primary (23%) or secondary (77%) diagnosis of deconditioning. Interventions: Not applicable. Main Outcome Measures: FIM efficiency (change in FIM score/length of stay [in days]), FIM efficiency subscores for locomotion and self-care, and discharge settings. Results: Individuals with a primary diagnosis of deconditioning (PDD) had a significantly lower FIM efficiency compared with the remaining subjects (1.78 vs 1.90, P⬍.001), or to the subgroup of subjects with a 75% rule primary diagnosis (1.67 vs 1.88, P⬍.001). The individuals with PDD also had lower FIM efficiency subscores, were less likely to be discharged to the community (73% vs 76%, P⬍.001) or home (68% vs 73%, P⬍.001), and were more likely to be discharged to a hospital (7% vs 4%, P⬍.001). Conclusions: Older individuals with PDD appear to recover at a slower rate than those with a secondary diagnosis of deconditioning, and are somewhat less likely to return home. The clinical significance of these findings is uncertain, but further investigation is warranted. Key Words: Deconditioning; Elderly; Rehabilitation. Poster 51 Inpatient Rehabilitation: Impact of Obesity on Functional Recovery. Kanakadurga R. Poduri, MD (University Of Rochester, Rochester, NY); Barbara R. Mchenry, PT; Catherine Flanagan, RN, MBA; Rohaan Mehta, MD; Annie G. Philip, MD, e-mail: [email protected]
Disclosure: None. Objective: To test the hypothesis that morbidly obese patients do not show the same functional gains as their counterparts and that they require longer rehabilitation stays. Design: Retrospective study of rehabilitation patients. Setting: Inpatient rehabilitation unit of a tertiary care teaching hospital. Participants: Subjects who underwent rehabilitation between 2003 and 2004. Intervention: Medical records of 20 consecutive discharges with a diagnostic code of 728.01 (morbid obesity) were reviewed and compared with 20 patients with similar diagnoses. A Student t test with 38 degrees of freedom was utilized to compare the 2 groups. Mean Outcome Measures: Admission FIM and discharge FIM scores, length of stay (LOS), total FIM gain, and FIM efficiency ratios. Results: In group I patients with morbid obesity (n⫽20), there were 11 women and 9 men with a mean age of 54 years and group II patients were (n⫽20) without obesity with mean age of 55 years had diagnoses of debility, orthopedic conditions, spinal cord injuries, and strokes. The average admission FIM scores were 70 and 67 for group I and II, respectively. The discharge FIM scores were 94 and 92, the LOSs were 15 and 13 days and the efficiency ratios were 2.2 and 2.1, respectively. The statistical analysis showed no significant differences between the groups in either their functional gains on FIM scores (P⫽.40 for admission FIM; P⫽.60 for discharge FIM) or the LOSs or their efficiency ratios (P⫽0.9 for LOS; P⫽.95 for efficiency ratios). Conclusions: Our data does not support that patients with obesity show less functional gains. They did not stay longer and had almost the same efficiency ratio as the nonobese patients. Key Words: Obesity; Rehabilitation. Poster 52 Pharmacy Versus Physician Warfarin Dosing. David T. Burke, MD (Spaulding Rehabilitation Hospital, Boston, MA); Tim Young, MD; Tim Young, MD, e-mail: [email protected]
Disclosure: None. Objective: To compare the efficacy a new method of intervention for the monitoring of international normalized ratios (INRs) for patients taking warfarin (Coumadin) in an inpatient rehabilitation hospital. Design: Retrospective study including all data from all patients taking Coumadin in an inpatient rehabilitation study over the past year. During that year, the pharmacy ordered Coumadin based on normograms and INRs. Data were compared with those using a previous method of Coumadin ordering. Setting: Freestanding rehabilitation hospital laboratory and pharmacy. Participants: All inpatients taking Coumadin over the past year. Interventions: Not applicable. Main Outcome Measures: The number of blood draws in which the INR was within therapeutic range. Results: The percentage of blood draws that were in the target INR range was 67% over the 12 months of this trial. Compared with data from the same institution when physicians looked at INRs, it was 36.7%. Conclusions: This retrospective study demonstrates that the use of a normagram by pharmacists should be involved in INRs being maintained with the target therapeutic range at a better rate than physicians dosing without computer assistance or a normagram. Key Words: Anticoagulation; Coumadin; International normalized ratios; Rehabilitation; Warfarin.
Poster 53 Acute Medical Illnesses Necessitating Transfer From Acute Rehabilitation Facilities to an Acute Care Hospital: Its Effect on Rehabilitation Length of Stay and Functional Independence—A Research Abstract. Clinton Faulk, MD (Brody School of Medicine, East Carolina University, Greenville, NC); Scott Morioka, MD; Daniel P. Moore, MD; James D. Wells, MD, MPH, e-mail: [email protected]
Disclosure: None. Objective: To determine the effect of serious acute medical illnesses on rehabilitation length of stay (LOS) and the FIM instrument. Design: Retrospective cohort. Setting: Regional rehabilitation hospital with spinal cord, traumatic brain injury, stroke, general rehabilitation, and an attached tertiary care hospital. Participants: All admissions to the regional rehabilitation inpatient facility over a 26-month period, January 1, 2002 through February 29, 2004. Interventions: Not applicable. Main Outcome Measures: Total rehabilitation LOS, initial FIM score, final FIM score, FIM gain, and FIM efficiency. Results: There were 2698 admissions over this 26-month period. Of these 2698 admissions, 189 (7.0%) required transfer back to an attached tertiary care hospital (national average, 9.0%). Of these 189, 92 (48.7%), returned to complete their rehabilitation course, 70 (37%) were discharged from the attached tertiary care hospital without further inpatient rehabilitation, and 27 expired (14.3%). Functional independence was measured using the FIM. Those transferred back to the tertiary care hospital and then returned to complete rehabilitation had a (1) mean total rehabilitation LOS of 23.2 days, 9.2 days longer than the rehabilitation mean of 14 days; (2) initial FIM score of 53.54, 13.51 less than rehabilitation mean of 67.05; (3) mean final FIM score of 69.95, 15.24 less than rehabilitation mean of 85.19; (4) mean FIM gain of 15.41, 2.73 less than rehabilitation mean of 18.14; and (5) FIM efficiency of 0.66, about 50% less than rehabilitation mean of 1.30. Conclusions: These data show that patients transferred back to the acute care hospital because
Arch Phys Med Rehabil Vol 86, September 2005