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ACADEMY ANNUAL ASSEMBLY ABSTRACTS

Measures: Rehabilitation length of stay (LOS), therapies provided in each setting, assistive device usage at discharge, physical function, mortality, rehabilitation charges. Results: Obesity did not influence average daily therapy participation times compared with normalized weight (IRF, 2.7 and 2.6 h/d; SNF, 1.6 and 1.4 h/d) or total therapy times (IRF, 28.5 and 27.7h; SNF, 30.0 and 23.1h) in either setting (P⬎.26). Improvements in walking and bed-chair transfers were not different between groups, based on obesity status. A total 4.4% more obese patients developed infections during the LOS in the IRF than SNF. More stasis ulcers were present in obese SNF than IRF patients (25.0% vs 5.8%). Diabetes prevalence was higher in the obese group than the normalized weight group in the IRF. The need for wheelchairs at discharge was higher for obese SNF patients than for obese IRF patients (62.5% vs 15.9%; P⬍0.05). The number of medications administered to obese patients was higher than normalized weight patients regardless of setting. Mortality rates were not different based on obesity status in patients treated in the IRF and SNF (0.4%, 1.7% and 12.5%, 13.5% of patients). Compared with normalized weight patients, obese patients had 19% and 7.2% higher pharmacy and total charges in the IRF. Conclusions: Obesity did not prevent participation in therapies or gains in physical function regardless of rehabilitation setting. However, obesity was related with more complicated medical needs and greater use of assistive devices during the rehabilitation program. Key Words: Mortality; Obesity; Rehabilitation. Poster 31 Rehabilitation Outcomes in Chronic Obstructive Pulmonary Disease in Two Postacute Care Settings: Influence of Therapy Participation. Heather K. Vincent, PhD, MS (University of Florida, Gainesville, FL); Kevin R. Vincent, MD, PhD. Disclosure: H.K. Vincent, none; K.R. Vincent, none. Objective: To examine the short-term rehabilitation outcomes and quantify the amount of therapies received in patients with chronic obstructive pulmonary disease who receive care in the inpatient rehabilitation facility (IRF) or skilled nursing facility (SNF). Design: Observational study of course of care. Setting: Freestanding IRFs and SNFs. Participants: 214 men and women (76.9⫾10.7y) receiving rehabilitative care for a primary diagnosis of chronic obstructive pulmonary disease (ICD-9 codes 49 – 496). Interventions: Comprehensive rehabilitation (physical, occupational, speech-language therapies, psychology therapy, if applicable). Main Outcome Measures: Volume and type of therapies provided in each setting, assistive device usage at discharge, independent walking greater than 150 feet, discharge location and oxygen supplementation. Results: Patients in the IRF participated in 5.8 more hours of total therapies than those in the SNF (29.8⫾14.1 vs 24.0⫾22.7h). Average daily therapy participation was 1.9⫾0.6 and 0.9⫾0.4 hours in the IRF and SNF, respectively (P⬍.05). IRF patients participated in more group physical and occupational therapies and therapeutic exercise than SNF patients; SNF patients participated more in functional mobility, neuromuscular reeducation, and patient-family training activities than those in the IRF (all P⬍.05). By discharge, IRF patients used wheelchairs less (3.1% vs 54.7%), achieved independent walking of greater than 45m (68.0% vs 35.8%), and improved their living situation from before admission, compared with SNF patients (78.1% vs 62.8%; all P⬍0.05). Supplemental oxygen use was similar between IRF and SNF patients by discharge (7.1% vs 12.8%; P⬎0.05). Adjusted multivariate regression models examining total therapy time and therapy intensity were found to be predictors for independent walking in the IRF, but not SNF; therapy intensity predicted improvements in living situation in both the IRF and SNF. Conclusions: While therapy intensity and program emphases were different between IRF and SNF settings, greater therapy intensity predicted independent walking and improvement in livArch Phys Med Rehabil Vol 89, November 2008

ing situation after rehabilitation regardless of setting. Key Words: Chronic obstructive pulmonary disease; Physical therapy; Rehabilitation. Poster 32 Safety and Efficacy of Enhanced External Counterpulsation in Anticoagulated Patients With Refractory Angina. Debra L. Braverman, MD (Albert Einstein Medical Center, Philadelphia, PA); D. Lynn Morris, MD. Disclosure: D.L. Braverman, none; D. Morris, none. Objective: Many patients with ischemic heart disease have comorbid conditions requiring anticoagulation. Enhanced external counterpulsation (EECP), a noninvasive treatment for refractory angina, has been previously contraindicated in patients on warfarin due to concerns of possible bleeding or bruising complications. This report is the first to assess the safety and efficacy of EECP for anticoagulated patients. Design: Retrospective cohort study. Setting: Outpatient EECP clinic. Participants: 527 consecutive EECP patients (average age, 68y) with Canadian Cardiovascular Society Functional Class III (n⫽348) and Class IV (n⫽179) angina. Interventions: EECP uses computerized electrocardiographic sequencing to trigger pneumatic cuffs wrapped around the lower extremities. The cuffs inflate and deflate during diastole, analogous to the intra-aortic balloon pump, resulting in diastolic augmentation, increased venous return, presystolic unloading, and improved cardiac output. Therapeutic pressures applied to the legs during EECP range from 220mmHg to 300mmHg. We compare EECP treatment outcomes of 79 patients on warfarin with an average international normalized ratio of 2.3⫾0.68 to 448 control patients. Main Outcome Measures: Canadian Cardiovascular Society angina classification, adverse clinical event related to bleeding. Results: 397 (75%) patients completed the treatment regimen (67 (85%) warfarin, 330 (74%) control). Of those who completed the program, they received an average of 42.75 hours of EECP (44.34 warfarin, 42.47 control; P⫽.045). Angina classification improved by at least 1 class in 316 (80%) patients (50 warfarin [75%], 266 controls [81%]). The average improvement in angina was 1.34 classes (0.99 warfarin, 1.39 controls [P⫽.003]). A total of 51 (13%) patients were asymptomatic on treatment completion (10 warfarin [15%], 44 controls [13%]). No patient clinically worsened during EECP and there were no adverse events, including no bleeding or bruising. Conclusions: Patients on warfarin who have refractory angina may be treated safely and effectively with EECP, and should expect symptomatic improvement comparable to those who are not anticoagulated without risk of bleeding or bruising. Key Words: Angina pectoris; Rehabilitation; Warfarin. Poster 33 Understanding the Association Between Health Perception and Impairments of Sufficient Severity to Cause Activity Limitation. Wenchun Qu, MD, PhD (University of Pennsylvania, Philadelphia, PA); Margaret G. Stineman, MD. Disclosure: W. Qu, none; M.G. Stineman, none. Objective: Perception of health has major implications with respect to a person’s quality of life and it is distinct from activity limitation. Consequently, it is essential to understand how health conditions of sufficient severity limit activities of daily living (ADLs) and/or how instrumental ADLs impact on perceptions of health. Design: A population-based study using data from the Second Longitudinal Study of Aging (LSOA II) survey, applying weights necessary to make accurate population prevalence estimates in complex survey studies. SAS procedures of Proc Surveyfreq and Proc Surveylogistic were used in the analysis. Setting: Civilian noninstitutionalized population of the