The British Society of Physical & Rehabilitation Medicine (BSPRM), representing over 350 members, hosted its annual scientific meeting on 6 to 8 November 2024 in Coventry, UK. The conference, a key event for professionals in the field of physical and rehabilitation medicine, featured a diverse range of sessions, workshops and networking opportunities. All submitted abstracts underwent a rigorous peer-review process before being considered for oral or poster presentations. Following this review, 16 abstracts were selected for oral presentation and publication in this supplement. The selection process was conducted by a panel of experts from the meeting’s abstract adjudication committee and scientific committee.
BSPRM Email: admin@bsprm.org.uk.
Trainee Collaborative Research and Quality Improvement Group Project: Anti-epileptic Prescribing Following Traumatic Brain Injury [Best Oral Presentation, Joint First Prize]
Harry Mee1,2, Jonathan Stewart3, Emily Mason4, Jo Corrado5, Parisa Torabi6, Emily Burns7, Edwin Eshun8, Phoebe Owen9, Michelle Lumley5, Bayo Lawal10, Atif Rana11, Hitesh Jiandani12, Ayan Omar13, Hui Min Knight14, Daniel Beese15, Ismail Ibrahim Abdulfattah16, Dhanishta Ramdin17, Dinushi Dikowita6and Fahim Anwar2
1University of Cambridge, Cambridge, United Kingdom
2Cambridge University Hospital Foundation Trust, Cambridge, United Kingdom
3Queens University, Belfast, United Kingdom
4University Hospital Dorset, Poole, United Kingdom
5Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
6Cardiff and Vale University Health Board, Cardiff, United Kingdom
7Colman Hospital, Norwich, United Kingdom
8Astley Ainsley Hospital, Edinburgh, United Kingdom
9Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
10London Northwest University Healthcare NHS trust, London, United Kingdom
11University Hospitals of Derby and Burton, Derby, United Kingdom
12Queens University Hospital, Belfast, United Kingdom
13Royal National Orthopaedic Hospital, London, United Kingdom
14Oxford University Hospital NHS Trust, Oxford, United Kingdom
15St Georges Hospital, London, United Kingdom
16Manchester Foundation NHS Trust, Manchester, United Kingdom
17University Hospital Leicester, Leicester, United Kingdom
Background: Seizures can follow traumatic brain injury (TBI), with some studies reporting an incidence of up to 25%. Seizures are classified as early (within 7 days) or late (after 7 days). Uncertainty remains regarding antiepileptic drugs (AEDs) management, including prophylaxis administration and optimal treatment duration post-early seizure. An ongoing NIHR-funded randomised trial seeks to enhance the evidence base, but clinical uncertainty continues.
Aim: To document current practices in prescribing and managing anti-epileptic medications post-TBI across various UK rehabilitation settings.
Methods: A multi-centre service evaluation by the rehabilitation medicine trainee research and quality improvement group summarising TBI patient case notes in different rehabilitation settings over a 2-month period in early 2024.
Results: Among 81 TBI patients from 11 UK centres, 67% were male (54), most common aged 60 to 69 years (20). Alcoholism was noted in 23% (19). Severe TBI, based on initial GCS scores, was seen in 44% (36). Seizures occurred in 33% (27), with 63% (17) of these experiencing early seizures, all treated with levetiracetam, though only 12% (2) had a specified treatment duration. There were 12 late seizures (15%), with significant treatment variations. Only 30% of those on AEDs at rehabilitation centres had a documented plan for continuation or weaning.
Conclusions: This is the first multi-centre service evaluation undertaken by the trainee collaborative group and demonstrates the benefits of collaborative teamworking. It demonstrates the continuing variation in practice and uncertainty in the management of post traumatic seizures and highlights the need for clear guidelines regarding prescribing and weaning of AED’s.
Diaphragmatic Resonant Breathing With Digital Heart Rate Variability Monitoring in Management of Long COVID: HEARTLOC Study [Best Oral Presentation, Joint First Prize]
Nafi Iftekhar1, Joanna Corrado1,2,3, Stephen Halpin1,2,3, Mengyao Li4, Rachel Tarrant2, Jennifer Grimaldi2, Rory O’Connor1,3, Alexander Casson1,4and Manoj Sivan1,2,3
1University of Leeds, Leeds, UK
2Leeds Community Healthcare NHS Trust, Leeds, UK
3Leeds Teaching Hospitals NHS Trust, Leeds, UK
4University of Manchester, Manchester, UK
Introduction: COVID-19 causes Long COVID (LC), with symptoms like breathlessness and fatigue linked to dysautonomia. Studies suggest Heart Rate Variability Biofeedback (HRVB) can mitigate the impacts of dysautonomia. Consumer Heart Rate Variability and BP monitoring equipment may be used to provide dynamic recording of fluctuations and undertake targeted personalised interventions to manage symptoms.
Methods and Analysis: A total of 26 patients were assessed with a 10-minute NASA Lean Test (NLT) to confirm Orthostatic Intolerance (dysautonomia). Subsequently, patients enrolled into a 6-week HRVB interventional trial, with 1-week pre interventional period, 4-week interventional period and 1-week post intervention period. HRVB intervention involved a 10-minute 4s inspiration:6s expiration resonant diaphragmatic breathing, twice a day for 4 weeks using the Polar H10 sensor and EliteHRV. C19YRS, WHODAS 2.0, EQ5D COMPASS-31 were measured pre and post intervention for capturing symptom burden, disability, quality of life and dysautonomia. Fitbit Sleep and HRV data was collected throughout the 6-week period.
Results: Total COMPASS-31 improved significantly (42.61-38.56, P = .012). C19YRSm symptoms score (19.19-14.50, P = .0011), functional ability (7.346-6.007, P = .014) and overall score (3.846-4.731, P = .011) respectively; the latter in line with significant improvements in EQ5D VAS (48.96-54.35, P = .0151). Statistically significant improvements were seen in HRV rMSSD (P = .0007) and resting HR (P = .0060), Total WHODAS 2.0 improved (38.64%-33.80%, P = .0079), with significant improvements in 4/9 subdomains.
Conclusion: Technology aided HRVB resonant breathing interventions can significantly improve dysautonomia and LC symptoms using consumer equipment at within the community.
Not just CANH! Life Sustaining Treatment Decisions for Patients in Long-term Care Settings Lacking Capacity Following Acquired Brain Injury [Highly Commended Oral Presentation]
Adèle Evans-Tomlinson, Lloyd Bradley and Patrick Byrne
The Royal Hospital for Neurodisability, London, UK
Introduction: Patients with acquired brain injury (ABI) who lack the capacity to consent to treatment may be prescribed life sustaining treatments (LST) in what is considered their ‘best interest’. This is well delineated in the RCP guidelines1 regarding the continuation of artificial nutrition and hydration (CANH) in those with prolonged disorders of consciousness (PDOC). In accordance with the mental capacity act, these considerations should apply to any patient that lacks capacity (not just those in PDOC) having any LST (not just CANH).
Methods: Retrospective descriptive cohort study of patients with ABI, including those with PDOC, in a specialist long-term care facility. Notes reviewed to determine diagnosis, provision of LTS, capacity to consent to treatment and documented best interest decisions.
Results: Of 98 patients 63 met the inclusion criteria. Of the 34 patients in PDOC, 29 had formal best interest meetings around continuation of CANH. Of the remaining 29 not in PDOC 17 were receiving CANH none of whom had documented discussions regarding continuation. Across the whole cohort best interest discussions had not taken place for continuation of any of the other LST (ventilation, cardioprotective agents, anti-coagulation, seizure prophylaxis, pacemakers/defibrillators and insulin).
Conclusions: There is a need to consider decision making regarding ongoing administration of LST apart from CANH for this patient group. Adoption of a structured approached, as currently occurs for CANH, is potential though there are implications for the long-term care workforce in terms of training and support.
Reference
1. Royal College of Physicians. Prolonged disorders of consciousness following sudden onset brain injury: national clinical guidelines; 2020. Accessed January 01, 2025. https://www.rcplondon.ac.uk/guidelines-policy/prolonged-disorders-consciousness-following-sudden-onset-brain-injury-national-clinical-guidelines
A Pilot to Implement the National Clinical Guideline for Stroke 2023: Feasibility of a direct pathway From a Hyperacute Stroke Unit to a Community Stroke Rehabilitation Unit [Highly Commended Oral Presentation]
William Goodison1,2, Sorfina Ghazali1, Elisa Sanchez1, Matthew Pountain1, Mireille Youl2, Ryan Bruce2, Mary-Anne Nathan2, Jasper Mckenzie2, Jolly Rabella2, Stacey Underdown2, Sheela Shah2, Evelyn Frank1, Kavita Shastri3, Simmone Browning1, Robert Simister1, Carole Walters1 and Arvind Chandratheva1,2
1University College Hospitals NHS Foundation Trust, London, UK
2Central and North West London NHS Foundation Trust, London, UK
3North Middlesex University Hospital NHS Trust, London, UK
Introduction: The 2023 National Stroke Guidelines highlighted the role of Community Stroke Rehabilitation Units (CSU). We review the feasibility, effectiveness and safety of transferring patients directly from a Hyperacute Stroke Unit (HASU) to a multiborough CSU in North Central London (NCL).
Methods: Prospective cohort of consecutive stroke patients from 16/06/2024 to 30/07/2024. We replaced standard rehabilitation referral forms with streamlined acute stroke unit repatriation paperwork. CSU barriers for admission: nasogastric tube; intravenous antibiotics; active psychiatric issue; oxygen requirement; new diarrhoea. We collected baseline demographics, stroke type and severity, length of stay (LOS), MDT input, discharge destination and ongoing rehabilitation/care needs.
Results: A total of 15 referrals: 13 direct transfers from HASU to CSU; 1 transferred to local ASU; 1 developed new psychosis. Male (47%); Ischaemic (60%): haemorrhagic (40%); NIHSS: mean= 9 (SD = 5); PCAT: mean= 29 (SD = 2). 87% accepted within 24 hours. About 54% transferred within 48 hours. LOS on CSU mean 22 days (SD = 8.8). Two patients re-admitted to acute (1 for UTI; 1 for cardiac interventions). Both returned to CSU. About 100% received input from physiotherapy and occupational therapy; 69% from speech and language; 38% from psychology. About 84% attended additional group sessions. About 100% received therapy 7 days a week. About 100% discharged home. About 72% required onward referral (ESD/Community/Care); 28% no further needs.
Conclusion: This novel stroke pathway has cut down referral paperwork, transferred over half of patients within 48 hours, all receiving 7-day therapy and discharge home. This pilot offers an effective addition to traditional stroke pathways and would benefit from validation in other sectors.
Evaluation of the BLARt score to Predict Functional Outcome in Lower LIMB amputees in Northern Ireland
Jonathan Stewart1,2, Andrea Hall3, Mark Currie3 and Lorraine Graham1
1Belfast Health and Social Care Trust, Belfast, UK
2Queen’s University, Belfast, UK
3Opcare, Belfast Prosthetics Service, Belfast, UK
Background: Lower limb amputation affects around 5000 people annually in the UK and 60 000 in USA. A key challenge is identifying patients most likely to benefit from a lower limb prosthesis. The BLARt assessment tool demonstrated strong ability to predict whether a patient would be able to walk with a prosthetic limb during initial development. However, it’s external validity remains unclear.
Aim: Evaluate whether the BLARt score predicts prosthetic walking amongst patients from Northern Ireland with a lower limb amputation.
Methods: Retrospective review of 280 patients with lower limb amputations on a vascular surgery ward (2021-2023). BLARt scores were routinely collected following amputation. Functional outcome using the SIGAM mobility grading was routinely assessed at completion of early walking training. We compared ability to transfer (SIGAM B), walk (SIGAM C, SIGAM D, SIGAM E or SIGAM F) and not walk (SIGAM A, died or did not complete rehabilitation) with a prosthesis.
Results: The majority of patients with a high BLARt score did not walk or transfer with a lower limb prosthesis (>12 = 92%, >16 = 96% and >18 = 95%). Area under the receiver operator curve for inability to walk with a prothesis confirmed the predictive ability of the BLARt score (AUC = 0.808, SE = 0.03, 95% CI = 0.75-0.86).
Conclusions: High BLARt score was a strong predictor of whether patients would walk with a lower limb amputation after surgery. Patients with a moderately high BLARt score (13-19) may benefit from a prosthesis for transfers.
Botulinum Toxin for Sialorrhea in Adults With Severe Brain Injury: A Retrospective Review
Teresa Clark1, Ezgi Arikan2 and Lloyd Bradley1
1Royal Hospital for Neurodisability, London, UK
2Buckinghamshire NHS Trust, Amersham, UK
Background: Sialorrhea can occur following acquired brain injury (ABI) due to a variety of mechanisms. Intrasalivary gland botulinum toxin (BONT) injections are used in the management of sialorrhea but the evidence base for this intervention is almost exclusively based around patients with progressive disease (Parkinson’s and Motor Neuron Disease).
Aim: To determine the safety and clinical effectiveness of intra-salivary BOTN injections in the treatment of sialorrhea for a cohort of people requiring long term nursing care following an ABI.
Methods: A retrospective cohort analysis utilising notes and prescribing chart review to determine; (1) the change in recorded Drooling Severity and Frequency Scale (DSFS) pre and post injection, (2) change in frequency of chest infections in the 3/12 pre and post injection, (3) The effect of higher or lower doses and repeated injections and (4) the incidence of complications and side effects.
Results: A total of 79 injections were given to 49 patients (25 patients received more than 1). All treatments were Botox (Abbvie) or Xeomin (Merz). Doses ranged from 100 to 200 U. The mean DSFS score across the cohort significantly reduced post treatment (z = −6.92, P < .0001). There were significantly fewer chest infections post treatment (z = −3.15, P = .0016) following repeated treatments (2 or more) and/or higher BOTN doses. There were no adverse events, even in patients on anticoagulants.
Conclusions: This study demonstrates that intra-salivary BOTN is an effective treatment for this complex group with multi-factorial sialorrhea where evidence has been lacking. Treatment appeared safe without adverse effects, even at higher doses.
Reference
1. Jost WH, Friedman A, Michel O, et al. SIAXI: Placebo-controlled, randomized, double-blind study of incobotulinumtoxinA for sialorrhea. Neurology. 2019;92:e1982-e1991.
Complex Specialist Rehabilitation Needs Identified by the Inpatient Trauma Service in a Major Trauma Centre
Aoife Murray1,2, Adrian Sheahan1,3, Sinéad Meade1,2, Úna Reidy1,3, Mike Dunphy1,3, Éanna Mac Suibhne1,3 and Ruairí Connolly1,2
1Inpatient Trauma Service, Cork University Hospital (CUH), Cork, Ireland
2Trauma Rehabilitation, CUH, Cork, Ireland
3Emergency & Trauma Medicine, CUH, Cork, Ireland
Background: Cork University Hospital is the major trauma centre (MTC) for the South Trauma Network. The inpatient trauma service (IPTS), established in June 2023, assesses trauma and rehabilitation needs, delivers acute rehabilitation and provides onward referral. Ireland has 1 Level 1 inpatient rehabilitation centre. There are no Level 2a units in the South Trauma Network.
Objectives: To describe trauma patients requiring referral to a Level 1 rehabilitation unit. To assess if patients are assessed and transferred to rehabilitation units in a timely fashion.
Methods: A retrospective observational cohort study including all patients reviewed by the IPTS in the first year. In the absence of Irish standards, the UK NCASRI standards for a timely assessment and transfer to rehabilitation were used. Patients should be assessed by a rehabilitation specialist within 10 days of referral and transferred to a specialist rehabilitation within 6 weeks of being fit for transfer.
Results: A total of 833 patients were reviewed by the IPTS. The average age was 58 years. About 3.4% (n = 28) were referred to the Level 1 rehabilitation centre. About 82% of those patients (n = 23) were under 65 years. About 64% had a TBI, 29% SCI, 1 patient had an amputation and 1 had a SCI and TBI. About 100% of patients were assessed within 10 days of referral. No patients were admitted to a post-acute rehabilitation unit within 6 weeks of referral.
Conclusions: The inclusion of a rehabilitation physician as part of the IPTS ensures a timely assessment and appropriate onward referral to rehabilitation. There are significant delays in accessing timely post-acute rehabilitation in the South Trauma Network.
Side Effects and Complications of Neurostimulant Medication in Patients With Prolonged Disorders of Consciousness: Four Years of Real World Experience
Zachary Baxter and Lloyd Bradley
Royal Hospital for Neuro-disability, London, UK
Background: Neurostimulants are potential therapies for improving arousal in patients with prolonged disorders of consciousness (PDOC). In the UK, there are no specific prescribing guidelines, and their use is unlicensed for this patient group. Information on risks and side effects is generally extrapolated from other treatment settings. Given that many patients with PDOC may have co-morbidities and increased susceptibility to complications, it is important to understand the frequency, types and predictors of side effects of neurostimulants in this setting.
Aim: To describe neurostimulant prescribing in a cohort of patients in PDOC, focussing on the occurrence and range of side effects and complications.
Method: A retrospective study reviewing medical records and prescribing charts of PDOC patients admitted to 1 specialist centre from 2019 to 2023.
Results: Of the 185 patients admitted for assessment of PDOC, 89 were prescribed neurostimulants during their admission (on average 191 days post-injury). The rate and type of complications identified (n/number of patients prescribed medication) were; Amantadine 6/11 (4 seizures, 2 movement disorder), Levodopa 5/25 (3 low BP, 1 unresponsive episode, 1 vomiting), Modafinil 8/60 (3 behavioural change, 4 movement disorder, 1 deranged renal function), Methylphenidate 1/5 (behavioural change), Donepezil 0/7. The side effects described were seen across all diagnostic groups (trauma, anoxic and cerebrovascular).
Conclusion: There is a need for ongoing vigilance on the part of clinicians prescribing neurostimulants, particularly with respect to the development of seizures and movement disorders with certain drugs. This is important in trying to determine risk-benefit profiles in different patient groups.
Enhanced Spinal Trauma REhabilitation (ESTRE): A Pilot Study to Enhance Rehabilitation at the Acute Phase of Spinal Cord Injury and Cost Benefit
Jonathan P Mamo1,2
1Solent NHS Trust, Southampton, UK
2Wessex Trauma Network, Southampton, UK
Introduction: Major Trauma Centres in the UK admit patients for management of acute spinal cord injuries. They require specialist inpatient neurorehabilitation to maximise their functional outcomes. This level of rehabilitation was not provided by the Wessex Major Trauma Centre (MTC) and the average wait for a specialist rehabilitation bed at the Regional Spinal Cord Injury (SCI) Rehabilitation Centre was around 12 to 18 weeks.
Objectives: The aim of ESTRE was to provide early specialist neurorehabilitation within the MTC prior to patients accessing specialist neurorehabilitation. We anticipated this would reduce inpatient length of stay and improve patient outcomes.
Method: Funding was acquired through NHS England to provide enhanced rehabilitation within the Trauma Centre for the provision of specialist rehabilitation input to 6 spinal cord injury rehabilitation beds. The enhanced rehabilitation MDT included 2 physiotherapists, 1 occupational therapist, 1 rehabilitation assistant, 1 nursing assistant and input from a Consultant in Physical and Rehabilitation Medicine.
Results: A total 52 patients were included in the pilot. Average length of stay was reduced by 64 days (105 days down to 41 days). The cost saving of around £1.85m per annum was saved on the cost of care only, not including savings relating to medical staffing costs. There was also 9% increase in the number of patients able to return directly home, from 16% up to 25%, resulting in improved community pathways locally.
Conclusion: Acute Rehabilitation Input in SCI can improve multiple areas including length of stay, transfers, clinical outcomes, as well as patient & staff experience.
References
1. Kirshblum SC, Priebe MM, Ho CH, Scelza WM, Chiodo AE, Wuermser LA. Spinal cord injury medicine. 3. Rehabilitation phase after acute spinal cord injury. Arch Phys Med Rehabil. 2007;88:S62-S70.
2. Scivoletto G, Morganti B, Molinari M. Early versus delayed inpatient spinal cord injury rehabilitation: an Italian study. Arch Phys Med Rehabil. 2005;86:512-516.
3. Sumida M, Fujimoto M, Tokuhiro A, Tominaga A, Uchida R. Early rehabilitation effect for traumatic spinal cord injury. Arch Phys Med Rehabil. 2001;82:391-395.
Holistic Approach for Rehabilitation and Medical OptimisatioN after IntenSivE care (HARMONISE): Intervention Development and Feasibility Study
Jonathan Stewart, Judy Bradley, Nigel Hart, Ellen Pauley, Danielle Wilson, Richard Mayne and Elaine Trainor
Queen’s University, Belfast, UK
Background: People who survive a critical illness commonly experience long-term physical, psychological and cognitive complications following hospital discharge, commonly known as post-intensive care syndrome (PICS). Most previous research examining rehabilitation strategies to address PICS have failed to demonstrate benefit in clinical trials for chosen outcomes. Critical illness survivors with multimorbidity (2 or more long term conditions) are significantly more likely to experience poor long-term outcomes. This high-risk group may be more likely to benefit from comprehensive holistic approach to care.
Objectives: (1) Co-design an intervention (called HARMONISE) which addresses multimorbidity and related factors and can be integrated with rehabilitation interventions. (2) Assess the feasibility and acceptability of intervention delivery and procedures for a future clinical trial.
Methods: Literature reviews informed intervention development, including (1) examining the relationship between multimorbidity and critical illness outcomes and (2) factors impacting post-ICU intervention delivery. Qualitative and quantitative data from surveys, interviews and focus groups informed design of the intervention and feasibility study.
Results: Interventions components include screening for unmet needs, optimisation of care, self-management support and informal carer orientation. We have designed a mixed methods randomised feasibility study. We will randomly allocate 60 participants to intervention or usual care. Feasibility of intervention delivery and procedures for a future clinical trial will be assessed using qualitative and quantitative data.
Conclusion: If HARMONSE is feasible and acceptable, we will design a clinical trial to test whether it improves the outcomes for patients. The programme could be offered across the UK and could lead to improved outcomes for patients.
Effectiveness of an Integrated Rehabilitation Team in Major Trauma: A Retrospective Analysis of Outcomes
Sinead Long, Maria Flynn, Marie Howard, Andrea Moloney, Sinead Brosnan, Stephen Halpin, Sinead Meade, Aoife Murray, Mike Dunphy, Eanna MacSuibhne and Ruairi Connolly
Inpatient Trauma Service, Cork University Hospital, Cork, Ireland
Background: Rehabilitation plays a key role in improving patient outcomes following major trauma.1 Major trauma centres (MTCs) were launched in Ireland in 2023. This study evaluates an embedded trauma rehabilitation service at a recently designated major trauma centre.
Aims: To assess the effectiveness of an embedded trauma rehabilitation service in a major trauma centre in reducing rehabilitation complexity and improving outcomes for major trauma patients.
Methods: A retrospective analysis was conducted on 100 patients who underwent rehabilitation at Cork University Hospital MTC. Included patients had brain, spinal cord or polytraumatic injuries. The primary outcome measure used was the Rehabilitation Complexity Scale-Extended trauma (RCSE-t) scores from admission and discharge.2 Secondary outcomes included time to mobilisation, discharge destination and rehabilitation metrics such as cognitive rehabilitation, exercise prescription and respiratory care.
Results: The average RCSE-t score decreased from 15 (range = 9-25) on admission to 7 (range = 0-18) at discharge, with multidisciplinary team involvement. About 45% of patients were discharged home, and 48% were mobilised within 24 hours of admission or surgery. All patients received a Rehabilitation Needs Assessment. Other key metrics included communication and swallowing assessments (56%), cognitive rehabilitation (48%), exercise prescription (86%) and respiratory care (63%).
Conclusions: The trauma rehabilitation service within a newly designated major trauma centre effectively reduces rehabilitation complexity and improves patient outcomes, highlighting the need for continued development of these services.
References
1. Scott J, Kandala NB, Fearon P, Robinson L. Embedded rehabilitation in major trauma: retrospective pre-post observational study of service and patient outcomes. Injury. 2021;52:160-166.
2. Hoffman K, West A, Nott P, Cole E, Playford D, Liu C, Brohi K. Measuring acute rehabilitation needs in trauma: preliminary evaluation of the Rehabilitation Complexity Scale. Injury. 2013;44:104-109.
Outcome for Non-traumatic Subarachnoid Haemorrhage Following Inpatient Rehabilitation: A Cohort Analysis of Data From UKRoC
Alasdair Sandland1, Sachin Watve1,2, Kathleen Baster1, Lynne Turner-Stokes3,4 and Krishnan Padmakumari Sivaraman Nair1,2
1The University of Sheffield, Sheffield, UK
2Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
3UK Rehabilitation Outcomes Collaboration, Northwick Park Hospital, London, UK
4Department of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
Background and Methods: Non-traumatic subarachnoid haemorrhage (nt-SAH) is associated with high mortality and disability. This cohort analysis assessed the impact of inpatient rehabilitation after nt-SAH on functional independence (UKFIM + FAM) and care costs (Northwick Park Care Needs Assessment) using the UK Rehabilitation Outcomes Collaborative database 2012 to 2023. Patients who gained a Minimally Clinically Important Difference (MCID) of 26.2 on UKFIM + FAM were compared with those who did not using binary logistic regression.
Results: Data from 2928 patients with nt-SAH (1209 men and 1719 women, mean age 58 years [SD = 13.2]) were analysed, 1287 of whom achieved MCID. Inpatient rehabilitation improved the mean total UKFIM + FAM by 42.3 points (95% CI = 41.0-43.6, P = .001), reduced mean care needs by 26.6 hours/week (95% CI = 25.2-28.1, P = .001) and reduced mean care costs by £1998.10/week (95% CI = 1872.20-2124.10, P = .001). Factors associated with achieving MCID were female gender (OR = 1.23, 95% CI = 1.06-1.54, P = .001), admission <30 days from referral (OR = 2.261, 95% CI = 1.826-0.798, P = .001) and length of stay <90 days (OR = 1.25, 95% CI = 1.02-1.54, P = .001).
Conclusion: Inpatient rehabilitation following nt-SAH significantly improved functional independence and reduced care costs. Female gender, prompt admission and stays <90 days were associated with improved outcomes.
Percutaneous Needle Tenotomy for Spastic Hemiplegic Hand: A Case Series
Julide Oncu Alptekin1 and Ece Yilmaz Kara2
1Seyrantepe Etfal Education & Research Hospital, Istanbul, Turkey
2Oxford University Hospitals NHS Trust, Oxford, UK
Background: Post-stroke hemiplegia often leads to poor recovery of hand function, with approximately 20% of patients seeing no improvement and 65% to 85% achieving partial recovery. Hand flexor spasticity complicates rehabilitation, impacting daily activities and hand hygiene. Standard treatments, including neurotoxin injections and splinting, have yielded inconsistent results. Surgery may be risky due to medical conditions, highlighting the need for alternative methods.
Methods: This case series provides preliminary data from a prospective study involving 10 hemiplegic patients with spastic hand finger flexors, conducted at Etfal Education & Research Hospital in Istanbul, Turkey. Outcomes were evaluated using goal attainment scaling (GAS), range of motion in distal and proximal interphalangeal joints (DIP and PIP) and the distance between the palm and the pulp of the most flexed digit. Treatment involved ultrasonography-guided percutaneous needle tenotomy, performed by a Physical&Rehabilitation Medicine specialist. Aims: This case series sets the stage for future multicentre studies.
Results: All patients had ischaemic stroke and received percutaneous tenotomy with an 18 G needle on non-functional fingers. Mean age was 58 ± 6.2 years, with a disease duration of 13 ± 1.1 months. Pre-treatment spasticity was 3 on the Modified Ashworth Scale, and the Brunnstrom stage was 3. At 1 month, 6 patients achieved all of their GAS goals, while 4 achieved partial goals. Goniometric measurements showed improvement in PIP and DIP extension. No adverse events or complications occurred.
Conclusion: Percutaneous needle tenotomy is a promising, safe and effective treatment for spastic hemiplegic hand, for patients unresponsive to standard treatments or at risk from surgery.
References
1. Coroian F, Jourdan C, Froger J, et al. Percutaneous needle tenotomy for the treatment of muscle and tendon contractures in adults with brain damage: results and complications. Arch Phys Med Rehabil. 2017;98:915-922.
2. Schnitzler A, Diebold A, Parratte B, Tliba L, Genêt F, Denormandie P. An alternative treatment for contractures of the elderly institutionalized persons: Microinvasive percutaneous needle tenotomy of the finger flexors. Ann Phys Rehabil Med. 2016;59:83-86.
Effects of Remote Ischaemic Preconditioning on Cardiovascular Response to 6-Minute Walk Test in People With Multiple Sclerosis: A Double-Blinded Randomised Control Trial
Amin Mohamed Abu Baker1,2, Ellen Buckley1, Linda Van Gelder1, Kathleen Baster1, Gavin Brittain2, David Paling2, Basil Sharrack2, Claudia Mazzà1 and Krishnan Padmakumari Sivaraman Nair2
1The University of Sheffield, UK
2Sheffield Teaching Hospitals NHS Foundation Trust, UK
Background: Remote ischaemic preconditioning (RIPC), involving cycles of circulatory occlusion and reperfusion, enhances exercise performance and delays fatigue in healthy individuals.
Aim: This study (NCT03967106) examines the impact of RIPC on cardiovascular responses to walking in people with Multiple Sclerosis (pwMS).
Methods: Participants were randomised into Active or Sham groups. Participants self-administered RIPC daily for 6 weeks. Inflation pressures were 30 mmHg above systolic blood pressure (BP) and 30 mmHg below diastolic BP for the active and the sham group respectively. Two 6-minute walk tests (6MWT) were completed per visit at baseline (6MWT1 and 6MWT2) and after intervention (6MWT3 and 6MWT4), with heart rate and blood pressure recorded.
Results: About 70/92 (76%) pwMS recruited completed the protocol (Active = 32, Sham = 38). No significant differences were observed in the distance walked during the 6MWTs. A greater decrease in resting heart rate was noted in the active group immediately after RIPC at 6MWT2 (Active: ∆ = −6.3, P < .001; Sham: ∆ = −1.9, P = .135) and 6MWT4 (Active: ∆ = −5.5, P = .008; Sham: ∆ = −3.6, P = .003). Systolic BP rise following 6MWT was higher in the sham group at 6MWT2 (Active: ∆ = +6.1, P = .006; Sham: ∆ = +8.0, P = .002) and 6MWT4 (Active: ∆ = +7.0, P = .017; Sham: ∆ = +8.0, P < .001).
Conclusion: In pwMS, RIPC results in a greater decrease in resting heart rate and a lower systolic BP rise following 6MWT. The lack of change in the distance walked during 6MWT could be due to ataxia, weakness and spasticity masking the impact of RIPC.
Clinical impact statement: This is the first study to examine the impact of RIPC on pwMS. RIPC improved cardiovascular responses to exercise. It could be a potential intervention for fatigue in MS.
Tracheostomy Weaning Following Acquired Brain Injury (ABI): A Comparison Between 2 Units. Analysis From the UK Rehabilitation Outcomes Collaborative (UKROC) National Clinical Registry
Moheb Gaid1, Alex O’Sullivan2, Anna Money1, Aideen Steed2, Mylene Sacatani2 and Lynne Turner-Stokes2,3,4
1Colman Centre for Specialist Rehabilitation Services, Norfolk Community Health and Care NHS Trust, Norwich, UK
2Regional Hyperacute Rehabilitation Unit, London North West University Healthcare NHS Trust, Harrow, UK
3UK Rehabilitation Outcomes Collaborative, London North West University Healthcare NHS Trust, Harrow, UK
4King’s College London, London, UK
Background and Aims: Tracheostomy decannulation is an important goal for rehabilitation, but there are different approaches and different populations. Here we compare the decannulation rates and outcomes between 2 units.
Methods and Design: Two-centre retrospective cohort analysis of prospectively collected data from the UKROC registry. Data Extraction: Adults with ABI admitted for specialist rehabilitation with a tracheostomy between 2012 and 2024 (Total N = 477: Unit A (n = 94), Unit B (n = 383)).
Measures: UK Functional Assessment (UKFIM + FAM), Rehabilitation Complexity Scale (RCSE).
Results: Mean (95% CI) age 48 years (47.9, 48.1) years, Males:Females 63:37%. Mean (95% CI) Length of stay 112.7 (112.5, 112.9) days. Aetiology: Trauma 29%, Anoxia/diffuse 29%, Stroke 37%, other 6%. Overall, 268/477 (56%) were successfully weaned. Logistic regression demonstrated that ‘Level of consciousness at discharge’, ‘Time since onset’ and ‘Length of stay’, together predicted decannulation with 60% sensitivity, 70% specificity. Age and aetiology were excluded from the model. Comparing Unit A and Unit B at discharge; 65% versus 54% were successfully decannulated (P = .037), 26% versus 53% remained in a prolonged disorder of consciousness (P < 0.001), mean (95% CI) Length of stay: 165 (149, 181) versus 100 (95, 105) days (P < .001), mean (95% CI) Time since onset: 230 (128, 332) versus 178 (108, 248) days (P = .497), mean (95% CI) Total UKFIM + FAM score: 71 (62, 78) versus 54 (50, 58; P < .001) and mean (95% CI) Total RCSE score: 13.9 (13.4, 14.4) versus 16.2 (16.4, 15.9; P < .001).
Conclusion: Both approaches resulted in successful decannulation for more than half the patients. However, an ongoing requirement for tracheostomy is, to some extent, a marker for severity of brain injury. When comparing decannulation rates, it is important to take account of known confounding factors, disability and caseload complexity.
The Impact of Tracheostomy Weaning on Outcome and Care Costs in Patient With Prolonged Disorders for Consciousness (PDOC): Analysis From the UK Rehabilitation Outcomes Collaborative National Clinical Registry
Alex O’Sullivan1, Chris Dungca1, Moheb Gaid2, Heather Williams3, Lynne Turner-Stokes1,3,4
1Regional Hyperacute Rehabilitation Unit, London North West University Healthcare NHS Trust, Harrow, UK
2Colman Centre for Specialist Rehabilitation Services, Norfolk Community Health and Care NHS Trust, Norwich, UK
3UK Rehabilitation Outcomes Collaborative, London North West University Healthcare NHS Trust, Harrow, UK
4Department of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
Background: Tracheostomy decannulation is a common goal for patients in PDOC, but the cost implications are unknown.
Aims: To examine outcomes for successfully decannulated PDOC patients.
Design: Multicentre retrospective cohort analysis of prospectively collected data from the UK Rehabilitation Outcomes Collaborative clinical registry.
Data Extraction: Data were extracted for adults, discharged from specialist rehabilitation from 2010 to 2024. Patients admitted in PDOC (n = 4192) were identified using previously published criteria.1
Measures: The UK Functional Assessment (UKFIM + FAM). The Northwick Park Care Needs Assessment provided estimated savings in ongoing costs of care needs.
Results: About 1567/4192 (37%) patients had a tracheostomy on admission: Mean age 48 years, Males: Females 66:34%. Mean length of stay 129 (SD = 76) days. Aetiology: Trauma 35%, Anoxia 22%, Stroke 28%, other 15%. About 768/1567 (49%) were successfully weaned.
Comparing Weaned versus Tracheostomised on discharge; 56% versus 21% had emerged from PDOC, both groups remained severely disabled but mean FIM + FAM scores were significantly higher (54.8 vs 34.5), and weaned patients stayed on average 15 days longer; episode costs were slightly higher (£98 523 vs £93 589). Nevertheless, the difference in mean weekly saving in basic care costs (£534) amounted to a mean group difference in net estimated lifetime savings of £762 994 (95% CI = £556 944, £969 043) per patient. Total net lifetime savings across the whole weaned cohort (n = 768) were £586 million.
Conclusion: Ongoing tracheostomisation is likely a marker of severity, so savings in ongoing care costs cannot be attributed to decannulation alone. Nevertheless, our findings provide evidence that exploration of tracheostomy weaning provides overall value for money.
Reference
1. Turner-Stokes L, Rose H, Knight A, Williams H, Siegert RJ, Ashford SA. Prolonged disorders of consciousness: identification using the UK FIM + FAM and cohort analysis of outcomes from a UK national clinical database. Disabil Rehabil. 2023;45:620-629.
