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2. Identifying clinical complexity in patients affected by severe acquired brain injury in neurorehabilitation: A cross sectional survey

Author

Scarponi, F, Zampolini, M, Zucchella, C, Bargellesi, S, Fassio, C, Pistoia, F, Bartolo, M, Raggi, R, Beatrici, M, Macchetta, C, Cocchini, L, Benedetti, A, Bianconi, F, Bramanti, P, Marino, S, Corallo, F, Brambilla, M, Carboncini M, C, Spina, V, Cervigni, G, Cimenti, F, Previaio, C, Semerjian, M, Colombari, M, De Cicco, D, De Tanti, A, Iardella, L, Diverio, M, Grifoni, C, Carl, V, Pasqualone, E, Estraneo, A, Formisano, R, Ciurli M, P, Galardi, M, Santangelo, A, Giorgini, T, Biasutti, E, Iaia, V, Intiso, D, Lamberti, G, Antoniono, E, Lanfranchi, M, Lavezzi, S, Chiavaroli, R, Lucca L, F, Maggioni, G, Mancuso, M, Canova, S, Mandala, G, Melizza, G, Montis, A, Pilia, F, Mulè, C, Navarro, J, Lanzillotti, C, Perin, C, Petrozzino, S, Schierano, G, Battistini, A, Premoselli, S, Salvi, P, Simonini, M, Sara, M, Serafini, P, Fortuna, R, Sergio M, A, Volanti, P, Scarponi F., Zampolini M., Zucchella C., Bargellesi S., Fassio C., Pistoia F., Bartolo M, Raggi R, Beatrici M, Macchetta C, Cocchini L, Benedetti A, Bianconi F, Bramanti P, Marino S, Corallo F, Brambilla M, Carboncini M C., Spina V, Cervigni G, Cimenti F, Previaio C, Semerjian M, Colombari M, De Cicco D, De Tanti A, Iardella L, Diverio M), Grifoni C, Carl V, Pasqualone E, Estraneo A, Formisano R, Ciurli M P., Galardi M, Santangelo A, Giorgini T, Biasutti E, Iaia V, Intiso D, Lamberti G, Antoniono E, Lanfranchi M, Lavezzi S, Chiavaroli R, Lucca L F., Maggioni G, Mancuso M, Canova S, Mandala G, Melizza G, Montis A, Pilia F, Mulè C., Navarro J, Lanzillotti C, Perin C, Petrozzino S, Schierano G, Battistini A, Premoselli S, Salvi P, Simonini M, Sara M Pardo M, Serafini P, Fortuna R, Sergio M A., Volanti P, Scarponi, F, Zampolini, M, Zucchella, C, Bargellesi, S, Fassio, C, Pistoia, F, Bartolo, M, Raggi, R, Beatrici, M, Macchetta, C, Cocchini, L, Benedetti, A, Bianconi, F, Bramanti, P, Marino, S, Corallo, F, Brambilla, M, Carboncini M, C, Spina, V, Cervigni, G, Cimenti, F, Previaio, C, Semerjian, M, Colombari, M, De Cicco, D, De Tanti, A, Iardella, L, Diverio, M, Grifoni, C, Carl, V, Pasqualone, E, Estraneo, A, Formisano, R, Ciurli M, P, Galardi, M, Santangelo, A, Giorgini, T, Biasutti, E, Iaia, V, Intiso, D, Lamberti, G, Antoniono, E, Lanfranchi, M, Lavezzi, S, Chiavaroli, R, Lucca L, F, Maggioni, G, Mancuso, M, Canova, S, Mandala, G, Melizza, G, Montis, A, Pilia, F, Mulè, C, Navarro, J, Lanzillotti, C, Perin, C, Petrozzino, S, Schierano, G, Battistini, A, Premoselli, S, Salvi, P, Simonini, M, Sara, M, Serafini, P, Fortuna, R, Sergio M, A, Volanti, P, Scarponi F., Zampolini M., Zucchella C., Bargellesi S., Fassio C., Pistoia F., Bartolo M, Raggi R, Beatrici M, Macchetta C, Cocchini L, Benedetti A, Bianconi F, Bramanti P, Marino S, Corallo F, Brambilla M, Carboncini M C., Spina V, Cervigni G, Cimenti F, Previaio C, Semerjian M, Colombari M, De Cicco D, De Tanti A, Iardella L, Diverio M), Grifoni C, Carl V, Pasqualone E, Estraneo A, Formisano R, Ciurli M P., Galardi M, Santangelo A, Giorgini T, Biasutti E, Iaia V, Intiso D, Lamberti G, Antoniono E, Lanfranchi M, Lavezzi S, Chiavaroli R, Lucca L F., Maggioni G, Mancuso M, Canova S, Mandala G, Melizza G, Montis A, Pilia F, Mulè C., Navarro J, Lanzillotti C, Perin C, Petrozzino S, Schierano G, Battistini A, Premoselli S, Salvi P, Simonini M, Sara M Pardo M, Serafini P, Fortuna R, Sergio M A., and Volanti P

Abstract

BACKGROUND: Literature shows that occurrence of comorbidities in people with severe acquired brain injury (sABI) is a common problem in rehabilitation stay. Consequently, patients could require an increase of interventions for diagnosis and treatment of clinical conditions, with a reduction of the rehabilitative take in charge for both clinical and organizational aspects. AIM: The first aim was to evaluate the rate of clinical conditions of sABI patients at admission in rehabilitation and the types of rehabilitative interventions performed in the first week; second objective was to explore the impact of clinical conditions on real rehabilitative take in charge. DESIGN: Cross sectional study. SETTING: Inpatient rehabilitation centers. POPULATION: The study included data from 586 sABI patients. METHODS: Collected data regarded anamnestic information, functional status assessed by means of Glasgow Outcome Scale, Levels of cognitive functioning, Early Rehabilitation Barthel Index, comorbidities at admission and type of rehabilitative interventions carried out in first week of rehabilitation stay. Spearman correlation coefficients were applied to detect possible correlations between the number of treatments in first week and clinical variables; through a multiple regression analysis the effect of patient’s characteristics on rehabilitative take in charge was explored. RESULTS: Data from the sABI patients: mean age 55.1±17.1 years; etiology of sABI was vascular in 315 patients (53.8%), anoxic in 83 (14.2%), neoplastic in 17 (2.9%), infectious in 15 (2.6%), traumatic in 150 (25.6%); 6 subjects (1%) presented a mixed etiology. Need of cardiorespiratory monitoring, pressure sores, infections or presence of multi drug resistant bacteria were the most frequent comorbidities. Passive mobilization, sitting positioning, arousal/awareness stimulation, evaluation and management of dysphagia were the interventions most frequently carried out in the first week. The regression analysi

Published
2019

3. Identifying clinical complexity in patients affected by severe acquired brain injury in neurorehabilitation: a cross sectional survey

Author

Scarponi F., Zampolini M., Zucchella C., Bargellesi S., Fassio C., Pistoia F., Bartolo M, Raggi R, Beatrici M, Macchetta C, Cocchini L, Benedetti A, Bianconi F, Bramanti P, Marino S, Corallo F, Brambilla M, Carboncini M C., Spina V, Cervigni G, Cimenti F, Previaio C, Semerjian M, Colombari M, De Cicco D, De Tanti A, Iardella L, Diverio M), Grifoni C, Carl V, Pasqualone E, Estraneo A, Formisano R, Ciurli M P., Galardi M, Santangelo A, Giorgini T, Biasutti E, Iaia V, Intiso D, Lamberti G, Antoniono E, Lanfranchi M, Lavezzi S, Chiavaroli R, Lucca L F., Maggioni G, Mancuso M, Canova S, Mandala G, Melizza G, Montis A, Pilia F, Mulè C., Navarro J, Lanzillotti C, Perin C, Petrozzino S, Schierano G, Battistini A, Premoselli S, Salvi P, Simonini M, Sara M Pardo M, Serafini P, Fortuna R, Sergio M A., Volanti P, Scarponi, F, Zampolini, M, Zucchella, C, Bargellesi, S, Fassio, C, Pistoia, F, Bartolo, M, Raggi, R, Beatrici, M, Macchetta, C, Cocchini, L, Benedetti, A, Bianconi, F, Bramanti, P, Marino, S, Corallo, F, Brambilla, M, Carboncini M, C, Spina, V, Cervigni, G, Cimenti, F, Previaio, C, Semerjian, M, Colombari, M, De Cicco, D, De Tanti, A, Iardella, L, Diverio, M, Grifoni, C, Carl, V, Pasqualone, E, Estraneo, A, Formisano, R, Ciurli M, P, Galardi, M, Santangelo, A, Giorgini, T, Biasutti, E, Iaia, V, Intiso, D, Lamberti, G, Antoniono, E, Lanfranchi, M, Lavezzi, S, Chiavaroli, R, Lucca L, F, Maggioni, G, Mancuso, M, Canova, S, Mandala, G, Melizza, G, Montis, A, Pilia, F, Mulè, C, Navarro, J, Lanzillotti, C, Perin, C, Petrozzino, S, Schierano, G, Battistini, A, Premoselli, S, Salvi, P, Simonini, M, Sara, M, Serafini, P, Fortuna, R, Sergio M, A, and Volanti, P

Subjects
Patient admission, Male, 030506 rehabilitation, medicine.medical_specialty, Cross-sectional study, medicine.medical_treatment, Population, Glasgow Outcome Scale, Physical Therapy, Sports Therapy and Rehabilitation, Comorbidity, Brain injuries, Rehabilitation Centers, Brain injurie, Disability Evaluation, 03 medical and health sciences, 0302 clinical medicine, Acute care, medicine, Humans, education, Paroxysmal sympathetic hyperactivity, Acquired brain injury, Neurorehabilitation, Cross-Sectional Studie, Rehabilitation Center, Inpatients, Health Services Needs and Demand, education.field_of_study, Rehabilitation, business.industry, Neurological Rehabilitation, Middle Aged, medicine.disease, Brain Injuries, Cross-Sectional Studies, Female, Physical therapy, Inpatient, 0305 other medical science, business, 030217 neurology & neurosurgery, Human
Abstract

Background Literature shows that occurrence of comorbidities in people with severe acquired brain injury (sABI) is a common problem in rehabilitation stay. Consequently, patients could require an increase of interventions for diagnosis and treatment of clinical conditions, with a reduction of the rehabilitative take in charge for both clinical and organizational aspects. Aim The first aim was to evaluate the rate of clinical conditions of sABI patients at admission in rehabilitation and the types of rehabilitative interventions performed in the first week; second objective was to explore the impact of clinical conditions on real rehabilitative take in charge. Design Cross sectional study. Setting Inpatient rehabilitation centers. Population The study included data from 586 sABI patients. Methods Collected data regarded anamnestic information, functional status assessed by means of Glasgow Outcome Scale, Levels of cognitive functioning, Early Rehabilitation Barthel Index, comorbidities at admission and type of rehabilitative interventions carried out in first week of rehabilitation stay. Spearman correlation coefficients were applied to detect possible correlations between the number of treatments in first week and clinical variables; through a multiple regression analysis the effect of patient's characteristics on rehabilitative take in charge was explored. Results Data from the sABI patients: mean age 55.1±17.1 years; etiology of sABI was vascular in 315 patients (53.8%), anoxic in 83 (14.2%), neoplastic in 17 (2.9%), infectious in 15 (2.6%), traumatic in 150 (25.6%); 6 subjects (1%) presented a mixed etiology. Need of cardiorespiratory monitoring, pressure sores, infections or presence of multi drug resistant bacteria were the most frequent comorbidities. Passive mobilization, sitting positioning, arousal/awareness stimulation, evaluation and management of dysphagia were the interventions most frequently carried out in the first week. The regression analysis showed that severe neurological and clinical conditions, acute organ failure, cardio-respiratory instability and paroxysmal sympathetic hyperactivity significantly limit access to rehabilitative sessions. Conclusions In sABI patients clinical comorbidities requiring elevated care assistance are frequent at admission in rehabilitation from acute wards and may interfere with rehabilitative take in charge. Clinical rehabilitation impact The knowledge of clinical complexity of sABI patients may improve their care pathways, promoting early and appropriate transition from acute care to rehabilitation settings.

Published
2019

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