Article

Left ventricular assist devices (LVADs) have become an increasingly
popular and effective means for treating advanced heart failure. LVAD
implantation requires extensive surgery and postoperative rehabilitation. The
Functional Independence Measure (FIM) has been used to quantify functional gains
in numerous patient populations, including those with stroke and spinal cord
injury. This study investigated functional improvements in patients undergoing
LVAD implantation using the FIM score. OBJECTIVE: To assess functional
improvements in patients with advanced heart failure who underwent LVAD
implantation. DESIGN: Retrospective. SETTING: Inpatient rehabilitation unit.
SUBJECTS: Ninety consecutive patients who received acute inpatient rehabilitation
after continuous flow LVAD implantation. METHODS: Demographic, laboratory, and
functional outcomes data including inpatient rehabilitation unit (IRU) length of
stay (LOS), discharge disposition, and FIM score were collected for all patients.
Paired t-tests were used to assess change in functional measures and laboratory
data. MAIN OUTCOME MEASURES: Primary outcome measures included FIM gain, FIM
efficiency, discharge disposition, rates of readmission after discharge from
rehabilitation, and LOS in the rehabilitation unit. RESULTS: The FIM gain was
statistically significant at 28.4 +/- 12.3 (P < .001) and compared favorably with
benchmarks for mean FIM gains at our facility (26.4), regionally (21.5), and
nationally (22.7) for patients admitted to IRUs with a cardiac diagnosis. FIM
efficiency (FIM gain/IRU LOS) was 1.9 +/- 1.0 compared with the mean FIM
efficiency at our facility (2.2), regionally (2.1), and nationally (2.2).
Seventy-four percent (n = 67) of patients were discharged directly home after
inpatient rehabilitation, 17% (n = 16) were readmitted to the acute hospital
service, and 8% (n = 7) required additional rehabilitation at a subacute
rehabilitation facility. The IRU LOS was 16.2 +/- 6.9 days. CONCLUSIONS: Our
study indicates that most patients with an LVAD achieve clinically meaningful
functional gains from acute inpatient rehabilitation, with the majority of
patients being discharged home. Further studies need to be performed to analyze
clinical outcomes after acute inpatient rehabilitation.
LEVEL OF EVIDENCE: IV.
CI - Copyright (c) 2017 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS