Poster 44 Factors and Outcomes Associated with Venous Thromboembolism in an Acute Inpatient Cancer...

PM&R Vol. 6, Iss. 9S, 2014 S197

Future research should compare PROMIS T-scores pre- versuspost-geriatric rehabilitation programs.

Poster 44Factors and Outcomes Associated with VenousThromboembolism in an Acute Inpatient CancerRehabilitation Unit.Amy H. Ng, MD (UT MD Anderson Cancer Center,Houston, TX, United States); Liat Goldman, MD;Anuja Bedi, MPH; Gary B. Chisholm, MS; Eduardo Bruera.

Disclosures: A. H. Ng, No Disclosures: I Have No RelevantFinancial Relationships to Disclose.Objective: To determine factors associated with VenousThromboembolism (VTE) among patients presenting to our cancercenter’s inpatient rehabilitation unit. We hypothesized that VTEpositive (VTEþ) cancer patients have a longer hospital stay, lesschange in Functional Independence Measure (FIM) scores,increased pain and increased fatigue.Design: Retrospective analysis of 611 cancer patients admitted toan acute inpatient rehabilitation unit from September 2011 to June2013. ICD-9 codes for deep vein thrombosis (DVT), pulmonaryembolism (PE), and inferior vena cava filter (IVC) were used toidentify VTEþ patients (n¼34). A control group was selectedrandomly from the remaining sample (n¼59).Setting: Acute Inpatient Rehabilitation Unit of a ComprehensiveCancer Center.Interventions: Not applicable.Main Outcome Measures: Cancer type (high- versus low-VTE risk); FIM scores at admission; change in FIM scores; lowerextremity edema; pain and fatigue levels; Foley catheterization;anticoagulation prophylaxis; length of stay.Results or Clinical Course: VTE occurred in 34/611 patients(6%). Higher FIM transfer (OR 0.436, P¼.0132), toilet transfer (OR0.439, P¼.0016) and tub transfer (OR 0.403, P¼.0019) scores wereassociated with decreased frequency of VTE. Lower extremityedema (odds ratio [OR]8.287, P�.0001) showed increasedfrequency of VTE . Cancer type, Foley catheterization, FIM scorechange, pain and fatigue levels were not associated with VTE.VTEþ patients had increased length of stay in rehabilitation (OR1.085, P¼.0139). Prophylactic anticoagulation was associated withlower risk of VTE (OR 0.159, P¼.0003). No significant differencein FIM changes were found between the groups.Conclusions: Cancer patients presenting to acute inpatientrehabilitation units with low transfer FIM scores and lowerextremity edema are at higher risk for VTE. For such patients,clinicians may consider further VTE assessment and use ofprophylactic anticoagulation. Mobilization in VTEþ group did notresult in embolization. FIM changes were achieved in both groups,regardless of VTE.

Poster 45Functional Improvement for Heart Failure Patientsafter Left Ventricular Assistive Device Placement ina Free Standing Rehabilitation Hospital.Vittal R. Nagar, MD (University of Kentucky, Lexington,KY, United States); Robert Nickerson, MD.

Disclosures: V. R. Nagar, No Disclosures: I Have No RelevantFinancial Relationships to Disclose.

Objective: The purpose of this study was to examine effective-ness of acute inpatient rehabilitation (AIR) in improving functionaloutcomes in people who have undergone left ventricular assistdevice (LVAD) placement.Design: A retrospective review of existing medical records.Setting: Free-standing rehabilitation hospital.Participants: 20 LVAD patients admitted to Cardinal Hill Reha-bilitation Hospital, Lexington, KY, over a 34-month period,between January 2011 and November 2013.Interventions: Selected patients’ hospital records were reviewedand analyzed irrespective of initial admission diagnoses.Main Outcome Measures: The change in total FunctionalIndependence Measure (FIM) scores; change in motor and cogni-tive components of FIM scores; change in self-care, sphinctercontrol, transfer mobility, locomotion, communication, socialcognition sub-components of FIM scores; length of stay (LOS); totalFIM gain; total FIM efficiency; discharge setting after AIR stay.Results or Clinical Course: LVAD patients with AIR hadsignificantly higher FIM scores from admission to discharge onseveral FIM categories. Specifically, two-tailed paired t-testdemonstrated that AIR resulted in a significant increase in: (1) totalFIM score (p< .0001); (2) motor (p< .0001) and cognitive (p <.0001) FIM components; (3) self-care (p< .0001), transfer-mobility(p ¼ .0001), communication (p < .0001), and social cognition(p < .0001) sub-components. The mean � standard deviation (SD)for (a) length of stay was 12.3 � 6.3 days; (b) total FIM gain was27.05 � 13.41 compared to the national mean of 23 for patientsadmitted to AIR for cardiac diagnosis; (c) total FIM efficiency was2.454 � 1.4, compared to the national mean for cardiac-related AIRstay of 2.28. Ninety-five percent of patients were dischargeddirectly to home.Conclusions: Our findings suggest that patients with LVADsachieved both motor and cognitive functional gains from AIR stay.The beneficial effect of AIR stay promotes safe discharge home. Themultidisciplinary rehabilitation approach used in a free-standingrehabilitation hospital improves overall functional activity of LVADpatients.

Poster 46Outcomes of Acute Inpatient Rehabilitation inPatients with Simultaneous Bilateral Total KneeArthroplasty.Samuel K. Chu, MD (Northwestern University FeinbergSchool of Medicine/Rehabilitation Institute of Chicago,Chicago, IL, United States); Zack McCormick, MD;Ashwin N. Babu, MD; Santiago D. Toledo, MD;Matthew Oswald.

Disclosures: S. K. Chu, No Disclosures: I Have No RelevantFinancial Relationships to Disclose.Objective: As of 2010, over 700,000 primary total kneearthroplasty (TKA) surgeries are performed annually in the UnitedStates. There has been ongoing debate about the benefits ofsimultaneous one-stage bilateral joint replacements versus two-stage bilateral joint replacements. We investigated outcomes ofacute inpatient rehabilitation (AIR) in patients with bilateral TKAs.Design: Retrospective cohort study.Setting: Acute inpatient rehabilitation hospital.Participants: 99 patients admitted to AIR after simultaneousbilateral TKA placement from 2008-2013.