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Further, the prognostic validity was explored to see whether EFA scores on admission were predictive of later outcomes and length of stay LOS. It offers acute hospital treatment including stroke unit and intensive care treatment , neurological and neurosurgical early rehabilitation, as well as subsequent rehabilitation e.

Each item of the ERI intensive care treatment, mechanical ventilation, confused patient, behavioural disturbances, impairment of communication, dysphagia is rated on a dichotomic scale [ 4 ]. If an item is applicable, it scores with a minus value or points [ 4 ]. BI served as primary outcome variable. In addition, length of stay LOS , period of time until first remission signs were observed remission time in patients with disorders of consciousness, e.

In the results section, mean values and standard deviations in brackets are displayed. Correlations were computed using the Spearman-Rho correlation coefficient r s. Local ethics committee BDH-Clinic Hessisch Oldendorf determined that the study was exempt from ethics approval and hence waived approval because the study was a retrospective database analysis, only no intervention. A mean of There was, however, no significant correlation between remission time and EFA vegetative.

Autonomic instability was observed for a mean of Patients with tracheostomy indicating dysphagia and danger of aspiration had a significantly lower EFA oro-facial score than patients without: 7. Mean length of stay LOS in early rehabilitation was This model explained Correlation between EFA total score and number of co-diagnoses.

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The more co-diagnoses the smaller EFA scores were recorded. Mean EFA values bars and mean standard deviation is indicated on top of bars. Further, mean standard deviation is indicated on top of bars. The ERBI is frequently used in Germany to assess the progress of neurological and neurosurgical early rehabilitation patients [ 4 ]. However, the ERBI has some limitations. It focuses on activities of daily living ADL and some items relevant to this group of patients, such as tracheotomy or mechanical ventilation [ 4 ].

Wakefulness and cognitive items are missing in the ERBI. The EFA assessment has been developed to evaluate cognitive abilities including wakefulness as well as items of ADL among neurosurgical early rehabilitation patients [ 24 , 25 ]. While inter-rater reliability was found to be moderate to good [ 25 ], no studies on its validity are available, yet. The rationale of the present study was to contribute further knowledge to the question whether the EFA scale is a valid instrument to assess progress of early rehabilitation patients as well as its prognostic value.

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While neurological early rehabilitation patients suffer from different disorders, no significant differences of EFA scores on admission could be detected when comparing stroke and head injury patients suggesting that EFA scale may be useful for a broad spectre of diagnoses. These findings indicate that patients with higher morbidity had lower EFA values on admission.

It seems reasonable to believe, that critically ill patients have worse functional abilities than healthier subjects. EFA also predicted outcome. As a neurophysiologic measure of wakefulness, faster EEG rhythms could be observed among patients with higher EFA scores. Some limitations of the study need to be addressed.

First of all, it has to be pointed out that it was a retrospective data analysis. In general, the quality of the database is better in prospective controlled studies. Secondly, the study contributes some knowledge to the concurrent and prognostic validity of the EFA scale, but inter-rater-reliability has not been examined at all. Only well experienced in early rehabilitation staff has been involved in the study, but rating of BI, ERI and EFA might differ considerably between different professions e. The concurrent and prognostic validity of the EFA scale is supported by the finding that it correlates with morbidity, LOS, established scales of wakefulness, ADL and outcome.

The EFA scale may be used to evaluate progress of vegetative, oro-facial, sensorimotor and cognitive functions of critically ill neurological and neurosurgical early rehabilitation patients. Prospective and controlled studies on reliability, in particular inter-rater reliability, and validity of the EFA assessment are strongly encouraged. The authors thank Dr. Skip to main content Skip to sections. Advertisement Hide. Download PDF. Open Access. First Online: 19 October Part of the following topical collections: Neurocritical care.

Background It is difficult to assess neurological and neurosurgical early rehabilitation patients comprehensively.

Conclusions The results suggest that EFA is a valid instrument to assess critically ill neurological and neurosurgical early rehabilitation patients. Background Patients with severe neurological impairment, e. The German Early Functional Abilities EFA scale has been introduced to assess both — ADL and cognitive functions including wakefulness of neursosurgical early rehabilitation patients [ 24 , 25 ].


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Thus, EFA total scores may range from 20 to [ 24 , 25 ]. Besides vegetative abilities, inter-rater reliability of the EFA scale was found to be moderate to good for most other items [ 25 ]. With respect to its validity, however, there is a considerable lack of evidence. In the present study, the EFA scale was used in a cohort of neurological and neurosurgical early rehabilitation patients.

Examination of prognostic validity Further, the prognostic validity was explored to see whether EFA scores on admission were predictive of later outcomes and length of stay LOS.

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Mean age was Table 2 Main diagnoses. Diagnosis Number Percent Ischemic stroke Table 3 Scores of the different scales on admission. Scale Mean standard deviation EFA vegetative [4 — 20] Open image in new window. Table 4 EFA scores on admission and outcome at discharge. Skip to main content Skip to sections.

Advertisement Hide. Download PDF. Open Access. First Online: 19 October Part of the following topical collections: Neurocritical care. Background It is difficult to assess neurological and neurosurgical early rehabilitation patients comprehensively. Conclusions The results suggest that EFA is a valid instrument to assess critically ill neurological and neurosurgical early rehabilitation patients. Background Patients with severe neurological impairment, e.

The German Early Functional Abilities EFA scale has been introduced to assess both — ADL and cognitive functions including wakefulness of neursosurgical early rehabilitation patients [ 24 , 25 ]. Thus, EFA total scores may range from 20 to [ 24 , 25 ]. Besides vegetative abilities, inter-rater reliability of the EFA scale was found to be moderate to good for most other items [ 25 ]. With respect to its validity, however, there is a considerable lack of evidence. In the present study, the EFA scale was used in a cohort of neurological and neurosurgical early rehabilitation patients.

Examination of prognostic validity Further, the prognostic validity was explored to see whether EFA scores on admission were predictive of later outcomes and length of stay LOS. Mean age was Table 2 Main diagnoses. Diagnosis Number Percent Ischemic stroke Table 3 Scores of the different scales on admission.

Scale Mean standard deviation EFA vegetative [4 — 20] Open image in new window. Table 4 EFA scores on admission and outcome at discharge. Acknowledgements The authors thank Dr. Rollnik JD. Challenges for neurological rehabilitation in Germany. Akt Neurol.

CrossRef Google Scholar. Rollnik JD, Janosch U. Current trends in the length of stay in neurological early rehabilitation. Dtsch Arztebl Int. Early and long-term outcome of rehabilitation in stroke patients: the role of patient characteristics, time of initiation, and duration of interventions. Arch Phys Med Rehabil. Rehabilitation Stuttg. Weaning from prolonged mechanical ventilation in neurological weaning units: an evaluation of the German Working Group for early Neurorehabilitation. Outcome of MRSA carriers in neurological early rehabilitation.

Barthel index as a length of stay predictor in neurological rehabilitation. Google Scholar. Operationalization and feasibility of the early rehabilitation index "lower-saxony early rehabilitation index". Revision — German Modification. Berlin Wallesch CW. Early neurological rehabilitation in the German DRG-system. Teasdale G, Jennett B.

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Assessment of coma and impaired consciousness. A practical scale. Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research.