11.4 Outcome Measures & Medical Complications

ABPMR Physical Medicine and Rehabilitation Board Exam Study Guide Exam

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1 Chapter 1: Introduction & Exam Overview

1.1 ABPMR Part I Exam Overview & Format 1.2 Board Review Strategy & Content Blueprint Breakdown

2 Chapter 2: Musculoskeletal Medicine

2.1 Shoulder & Upper Extremity Diagnostics 2.2 Knee, Hip & Lower Extremity Conditions 2.3 Spine Pathology, Radiculopathy & Myelopathy 2.4 Inflammatory Arthritis, Tendinopathies & Concussion 2.5 Bone Health, Osteoporosis & Metabolic Bone Disease 2.6 Thoracic Outlet Syndrome & Peripheral Nerve Entrapment 2.7 Fracture Rehabilitation & Immobilization Complications 2.8 Overuse Tendinopathies & Regenerative Medicine 2.9 Gait Analysis & Abnormal Gait Patterns

3 Chapter 3: Spinal Cord Injury Rehabilitation

3.1 ASIA Examination & Impairment Scale 3.2 Spinal Cord Injury Syndromes 3.3 Autonomic Dysreflexia & Acute Complications 3.4 Neurogenic Bladder, Bowel & Secondary Complications

4 Chapter 4: Stroke & Neuromuscular Rehabilitation

4.1 Stroke Vascular Syndromes & Acute Assessment 4.2 Stroke Motor Recovery & Hemiplegic Complications 4.3 Spasticity Assessment & Multimodal Management 4.4 ALS, GBS, CIDP & Neuromuscular Disease Rehab 4.5 Multiple Sclerosis & Demyelinating Disease Rehabilitation 4.6 Parkinsonism, Movement Disorders & Functional Neurologic Disorder

5 Chapter 5: Electrodiagnostics (EMG/NCS)

5.1 Nerve Conduction Studies Principles & Physics 5.2 Needle Electromyography & MUAP Analysis 5.3 Mononeuropathies & Radiculopathy Patterns 5.4 Neuromuscular Junction Disorders & Myopathies

6 Chapter 6: Traumatic Brain Injury

6.1 TBI Severity Classification, Glasgow Coma Scale, and Pathophysiology 6.2 Rancho Los Amigos Levels of Cognitive Functioning and Disability Rating Scale 6.3 Neurobehavioral Sequelae and Agitation Management 6.4 Concussion Evaluation, Vestibular-Ocular Dysfunction, and Return-to-Play/Work Protocols

7 Chapter 7: Chronic Pain & Interventional Spine

7.1 Fluoroscopic Spine Interventions 7.2 Opioid Stewardship & Controlled Substance Compliance 7.3 Complex Regional Pain Syndrome, Fibromyalgia & Myofascial Pain 7.4 Spinal Cord Stimulation & Intrathecal Therapy

8 Chapter 8: Amputee Rehabilitation & Prosthetics

8.1 Amputation Surgical Levels & Medicare K-Levels 8.2 Socket Designs & Suspension Systems 8.3 Prosthetic Feet & Microprocessor Knee Mechanisms 8.4 Post-Amputation Care, Residual Limb & Phantom Pain

9 Chapter 9: Pediatric Rehabilitation

9.1 Cerebral Palsy Classification & GMFCS 9.2 Spina Bifida & Myelomeningocele Management 9.3 Muscular Dystrophies & Neuromuscular Disease in Children 9.4 Pediatric Brachial Plexopathy & Congenital Disorders

10 Chapter 10: Prosthetics, Orthotics & Assistive Technology

10.1 Lower Limb Orthoses — AFOs & KAFOs 10.2 Spinal & Upper Extremity Orthoses 10.3 Upper Limb Prosthetics — Body-Powered vs Myoelectric 10.4 Wheelchairs, Seating Systems & Pressure Mapping

11 Chapter 11: Medical Rehabilitation & Outcomes

11.1 Dysphagia Assessment & Management 11.2 Neurogenic Bladder & Bowel Management 11.3 Pressure Injuries & Wound Management 11.4 Outcome Measures & Medical Complications 11.5 Cancer Rehabilitation & Oncologic Rehabilitation 11.6 Burns, Endocrine/Metabolic & Medical Complications Rehabilitation

12 Chapter 12: Cardiopulmonary Rehabilitation

12.1 Cardiac Rehabilitation Phases & Metabolic Equivalents 12.2 Pulmonary Rehabilitation & COPD Management

13 Chapter 13: Foundational Rehabilitation Concepts

13.1 Kinesiology, Biomechanics & Functional Anatomy 13.2 Rehabilitation Pharmacology & Medication Management 13.3 Research Methodology, Biostatistics & Evidence-Based Practice 13.4 Nutrition, Metabolism & Energy Expenditure in Rehabilitation 13.5 Diagnostic Procedures: Imaging, MSK Ultrasound, Urodynamics & Neuropsych Assessment

11.4 Outcome Measures & Medical Complications

Key Takeaways Explain This Topic AI

FIM scores 18 items on a 7-point scale from 1 (Total Assistance, patient <25%) to 7 (Complete Independence, safe/no device).

The Berg Balance Scale (0-56) assesses static and dynamic balance; scores <45 indicate high fall risk in elderly and stroke populations.

Timed Up and Go (TUG) test times standing, walking 3 meters, turning, and sitting; times >12-14 seconds correlate with fall risk.

Venous Thromboembolism (VTE) prophylaxis (LMWH or unfractionated heparin plus mechanical IPCs) is mandatory in acute SCI, TBI, and stroke rehabilitation.

Last updated: July 2026

Functional Rehabilitation Outcome Measures

Standardized outcome measures quantify patient impairment, functional disability, and burden of care across inpatient rehabilitation facilities (IRF).

Functional Independence Measure (FIM)

The Functional Independence Measure (FIM) has historically been the cardinal outcome tool in PM&R (now transitioned in IRF PPS to the Continuity Assessment Record and Evaluation [CARE] Item Set , though FIM scoring principles remain fundamental to board examination content).

Structure : 18 items divided into 13 Motor items (Self-Care, Sphincter Control, Transfers, Locomotion) and 5 Cognitive items (Communication, Social Cognition).

Scoring Scale : Each item is scored on an 8-point ordinal scale from 1 (Total Assistance) to 7 (Complete Independence) . Total FIM score ranges from 18 to 126 .

FIM Level Score Category Operational Definition (% of Task Performed by Patient)

7 Complete Independence Safe, timely execution without devices or modifications.

6 Modified Independence Requires an assistive device, extra time, or safety risk considerations.

5 Supervision / Setup Requires verbal cues, coaxing, setup of items, or orthosis application.

4 Minimal Assistance Patient performs ≥ 75 % \ge 75\% ≥ 75% of the work (helper performs < 25 % <25\% < 25% ).

3 Moderate Assistance Patient performs 50 % to 74 % 50\%\text{ to }74\% 50% to 74% of the work (helper performs 25 % – 50 % 25\%\text{--}50\% 25% – 50% ).

2 Maximal Assistance Patient performs 25 % to 49 % 25\%\text{ to }49\% 25% to 49% of the work (helper performs 50 % – 75 % 50\%\text{--}75\% 50% – 75% ).

1 Total Assistance Patient performs < 25 % <25\% < 25% of the work (helper performs > 75 % >75\% > 75% ).

Barthel Index

Consists of 10 ADL and mobility items (feeding, bathing, grooming, dressing, bowel/bladder control, toilet use, transfers, mobility, stairs).

Total score ranges from 0 to 100 (or 0 to 20 depending on version). Higher scores indicate greater functional independence.

Balance and Gait Assessment Tools

Assessment Tool Items & Primary Focus Clinical Cutoff Scores & Target Interpretation

Berg Balance Scale (BBS) 14-item static and dynamic balance performance test (max score 56). Score < 45 <45 < 45 : High risk for falls. Score < 40 <40 < 40 : 100% fall risk in elderly. Scores 41–56 indicate low-to-moderate fall risk.

Dynamic Gait Index (DGI) 8-item dynamic gait test (gait speed change, head turns, pivot turns, stepping over obstacles, stairs; max score 24). Score ≤ 19 \le 19 ≤ 19 : Indicates high fall risk in community-dwelling elderly and patients with stroke/vestibular disorders.

Timed Up and Go (TUG) Measures time to rise from chair, walk 3 meters, turn 180°, walk back, and sit down. Time > 12 – 13.5 seconds >12\text{--}13.5\text{ seconds} > 12 – 13.5 seconds : Predicts high fall risk in community elderly and neurological disorders.

6-Minute Walk Test (6MWT) Submaximal aerobic endurance test measuring total distance walked in 6 minutes. Measures functional exercise capacity. Average healthy elderly distance: 400–600 m; < 300 <300 < 300 m indicates poor prognosis in heart/lung/stroke populations.

Venous Thromboembolism (VTE) Prophylaxis in Rehabilitation

Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) represent major preventable causes of morbidity and mortality in acute neuro-rehabilitation populations, particularly acute Spinal Cord Injury (SCI), Stroke with hemiplegia, Traumatic Brain Injury (TBI), and major orthopedic procedures. [VTE Prophylaxis Guidelines Summary]

│
┌───────────────┴───────────────┐
▼ ▼
[Acute Spinal Cord Injury] [Acute Ischemic Stroke]
LMWH (Enoxaparin) • LMWH within 24-48h
preferred over UFH (after CT excludes bleed)
Duration: Minimum • Duration: Throughout IRF
8 to 12 weeks until mobile
VTE Prophylaxis in Acute Spinal Cord Injury (SCI)

Risk Profile : Acute SCI carries the highest risk of VTE among all rehabilitation admissions ( > 50 – 80 % >50\text{--}80\% > 50 – 80% without prophylaxis). Risk peaks in the first 2 to 3 weeks post-injury and remains significantly elevated for 3 months due to venous stasis (paralyzed calf muscle pump), hypercoagulability, and endothelial dysfunction (Virchow's triad).

First-Line Pharmacotherapy : Low Molecular Weight Heparin (LMWH) (e.g., Enoxaparin 30 mg SC BID or 40 mg SC daily) is strongly preferred over Unfractionated Heparin (UFH) (5000 units SC TID). LMWH demonstrates superior efficacy in reducing DVT/PE rates, lower risk of major bleeding complications, and lower incidence of Heparin-Induced Thrombocytopenia (HIT).

Renal Impairment Modification : In severe renal failure (Creatinine Clearance < 30 mL/min <30\text{ mL/min} < 30 mL/min ), UFH is preferred due to hepatic elimination, or LMWH dosage must be adjusted (e.g., Enoxaparin 30 mg SC once daily with anti-Xa monitoring).

Recommended Prophylaxis Duration : Pharmacological VTE prophylaxis must be continued for a minimum of 8 to 12 weeks post-injury for acute motor-incomplete or complete SCI.

VTE Prophylaxis in Acute Stroke

Ischemic Stroke : Initiate low-dose LMWH or UFH within 24 to 48 hours of stroke onset, following neuroimaging confirming the absence of hemorrhagic transformation.

Hemorrhagic Stroke : Defer pharmacological prophylaxis until intra-cranial hemorrhage stability is verified on repeat CT (typically 24–48 hours post-bleed); use Mechanical Prophylaxis immediately.

Duration : Prophylaxis is continued throughout the acute inpatient rehabilitation stay until the patient regains independent functional ambulation.

Mechanical Prophylaxis (Sequential Compression Devices - SCDs / IPC)

Intermittent Pneumatic Compression (IPC) devices are indicated as adjuncts to pharmacological prophylaxis, or as monotherapy ONLY when pharmacological anticoagulation is strictly contraindicated due to acute active bleeding, major coagulopathy, or acute spinal/intracranial hemorrhage.