Poster 38: Intrathecal Baclofen for Spasticity Management: A Comparative Analysis of Spasticity of Spinal Versus Cortical Origin

Poster 38: Intrathecal Baclofen for Spasticity Management: A Comparative Analysis of Spasticity of Spinal Versus Cortical Origin

ACADEMY ANNUAL ASSEMBLY ABSTRACTS Poster 37 Long-Term Effectiveness of Sustained-Release Opioids in the Treatment of Nonmalignant Pain. Michael River...

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ACADEMY ANNUAL ASSEMBLY ABSTRACTS

Poster 37 Long-Term Effectiveness of Sustained-Release Opioids in the Treatment of Nonmalignant Pain. Michael Rivera-Weiss, MD (Doctors Hospital, Massillon, OH). Disclosure: M. Rivera-Weiss, Research support: Alpharma Branded Products Division Inc; Honoraria: Alpharma Branded Products Division Inc; Speakers bureau: Alpharma Branded Products Division Inc. Objective: To examine short-term (3mo), mid-term (6mo), and long-term (12mo) effectiveness and dosing of 3 sustained-release opioids (SROs) in managing chronic, moderate to moderately severe, nonmalignant pain. Design: Retrospective chart review of defined patient population. Setting: Hospital-based outpatient pain management center. Participants: Records of adult outpatients (N⫽105) with chronic, nonmalignant pain of moderate to moderately severe intensity who failed to achieve satisfactory pain management from their prior short-acting opioid and subsequently took a selected SRO for ⱖ1 year. Overall, patients had a mean age of 53.8 years and 62.9% were women. Interventions: Records were reviewed on patients taking polymer-coated extended-release morphine sulfate (P-ERMS; Kadian) (n⫽41), transdermal fentanyl (Duragesic) (n⫽40), or controlled-release oxycodone (OxyContin) (n⫽24) for ⱖ1 year. Main Outcome Measures: Visual analog scales (0 [best] to 10 [worst]) for pain and quality of life outcomes (activity, work, relations, sleep, enjoyment). Results: There were no statistically significant demographic differences between treatment groups, with the exception that a higher percentage of patients on P-ERMS versus controlled-release oxycodone were men (46.3% vs 20.8%, P⫽.040). The most common conditions requiring pain relief were degenerative disk disease, osteoarthritis, and postlaminectomy syndrome. Pain scores improved from baseline through 3, 6, and 12 months as follows: P-ERMS (7.6, 6.5, 6.7, 6.3); transdermal fentanyl (8.3, 6.6, 6.5, 6.0); and controlledrelease oxycodone (8.1, 7.0, 6.4, 6.3) (all comparisons vs baseline, P⬍.05). Similar significant changes were reported on the activity, work, relations, sleep, and enjoyment scales. The biggest change in dose of SRO was from baseline to 3 months. Conclusions: Patients who remained on SRO formulations for 12 months demonstrated significant reductions in pain and improvements in other quality of life measures that were evident at 3 months and were maintained through 12 months of therapy. Key Words: Fentanyl; Morphine; Oxycodone; Rehabilitation. Poster 38 Intrathecal Baclofen for Spasticity Management: A Comparative Analysis of Spasticity of Spinal Versus Cortical Origin. April M. Saval, MS, PA-C (University of Michigan, Ann Arbor, MI); Anthony Chiodo, MD. Disclosure: A.M. Saval, None; A. Chiodo, None. Objective: To examine the differences in intrathecal baclofen (ITB) management of patients with spasticity from cortical versus spinal etiologies. Design: Retrospective chart review. Setting: Outpatient clinic. Participants: 44 people with diagnoses of spinal cord injury (SCI), multiple sclerosis (MS), cerebral palsy (CP), and traumatic brain injury (TBI) with severe spasticity requiring an ITB pump. Interventions: Not applicable. Main Outcome Measures: Dosage of medication required, impact on function, complex versus simple continuous delivery modes, physician contact, need for other spasticity treatment, and complications. Serial measurements of these parameters were taken at baseline and multiple follow-up visits. Results: Patients with CP and TBI had less physician contact than MS patients, patients with incomplete SCI, and ambulatory patients in the first 6 months. There was more intragroup variation in dosing than between groups, varying from 37 to 900␮g/d, with 33% of patients on simple continuous mode. Increasing dosages after the 1-year period were needed in

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40% of patients, 40% of patients after 2 years, 16% of whom were diagnosed with SCI and 12% with MS. Many patients who needed increases after 2 years had new onset triggers for spasticity or catheter malfunctions. 5 patients, 80% with TBI or CP, required botulinum toxin after pump implants. 5 subjects had catheter complications—3 from falls or trauma and 2 from catheter migration. Conclusions: Ambulatory patients, predominantly patients with MS and SCI, required more dosing changes than nonambulatory patients and had issues with strength and motor planning, even after spasticity had been optimized. Ongoing dose increases 1 to 2 years after the pump has been placed may denote underlying spasticity triggers or problems with the pump. Patients with CP or TBI appear to have stable spasticity after 6 months to 1 year, but may need other focal treatments. Key Words: Baclofen; Muscle spasticity; Rehabiliation. Poster 39 A Multicenter Examination of the Effect of Body Mass Index on Inpatient Rehabilitation Outcomes Following Total Knee Arthroplasty. 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 whether inpatient rehabilitation outcomes following total knee arthroplasty (TKA) were influenced by body mass index (BMI). Design: A multicenter, retrospective study. Setting: 15 inpatient rehabilitation facilities along the U.S. east coast. Participants: Patients who underwent TKA and were subsequently admitted to an inpatient rehabilitation facility for interdisciplinary rehabilitation (N⫽5428). Patients were separated into 4 groups based on BMI: nonobese (⬍30kg/m2), moderately obese (30⫺40kg/m2), severely obese (40.1⫺50kg/m2), and very severely obese (ⱖ50kg/m2). Interventions: Not applicable. Main Outcome Measures: Data were obtained using a computerized medical database and medical records. Changes in functionality (assessed by FIM instrument), FIM efficiency (points gained/d), length of stay, total and itemized facility charges, and discharge disposition. Results: The percentage of total FIM change was 7.5% greater by discharge in the nonobese than very severely obese (P⬍.05). FIM efficiency was lower in the very severely obese than in the remaining groups (3.7 points/d vs 4.0⫺4.3 points/d; P⬍.05). The change in the FIM motor score from admission to discharge was 6.7% to 15.6% greater in the nonobese than in the remaining 3 groups (P⬍.05). The change in FIM cognition, “toilet transfers,” and “walking without assistance” scores were higher in the nonobese than in the very severely obese group (P⬍.05). The very severely obese group had higher total, physical and occupational therapy, and pharmacy charges than the remaining groups (P⬍.001). There were no differences in discharge frequencies to home, acute care, or other locations among the 4 BMI groups. Conclusions: An excessive BMI does not prevent gains during inpatient rehabilitation, however, these gains are made less efficiently and at a higher cost than those made when BMI is low. Key Words: Arthroplasty, replacement, knee; Body mass index; Outcome assessment (health care); Rehabilitation. Poster 40 Relationship of Admission Hematocrit Level to Inpatient Rehabilitation Outcomes Following Total Knee Arthroplasty: A Multicenter Examination. 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 relationship of admission hematocrit (HCT) levels on inpatient rehabilitation outcomes following total knee arthroplasty (TKA). Design: A multicenter, retrospective study. SetArch Phys Med Rehabil Vol 88, September 2007