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Adam MD, Ness DK, Hollman JH. Physical Therapy Provider Continuity Predicts Functional Improvements in Inpatient Rehabilitation. J Neurol Phys Ther 2023; 47:91-98. [PMID: 36279402 DOI: 10.1097/npt.0000000000000422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE Health care continuity has been linked to improved patient outcomes in a variety of professions and settings. Patients in inpatient rehabilitation receive a consistent dosage of physical therapy (PT) treatment; however, the providing physical therapist may vary. Despite the potential influence of PT provider continuity on functional outcomes in the inpatient rehabilitation setting, this association has not yet been studied. METHODS An observational retrospective chart review was conducted on 555 discharged inpatient rehabilitation patients. The relationship between the number of PT providers from whom a patient received care and Quality Indicator (QI) Mobility discharge scores was examined with Pearson product-moment correlation coefficients, initially with the entire patient group and secondarily with distinct diagnostic groups. Data from subgroups for whom a significant relationship was established were then included in a hierarchical linear regression analysis accounting for relevant covariates. RESULTS The number of PT providers correlated negatively with QI Mobility discharge scores ( r = -0.41, P ≤ 0.001). When controlling for QI Mobility admission scores, the "Stroke" (partial r = -0.17, P = 0.02), "Spinal Cord Injury" (partial r = -0.28, P = 0.002), and "Other Neuromuscular" (partial r = -0.35, P = 0.03) groups demonstrated significant inverse relationships. A hierarchical linear regression incorporating these 3 diagnostic groups revealed that the number of PT providers remained a significant predictor of QI Mobility discharge scores ( B = -1.50, P ≤ 0.001) when accounting for covariates. DISCUSSION AND CONCLUSIONS PT provider continuity is related to the functional improvement of neurologically impaired patients in inpatient rehabilitation.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A405 , which discusses the findings of this work in a narrative format).
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Affiliation(s)
- Mitchell D Adam
- Department of Physical Medicine and Rehabilitation (M.D.A), Mayo Clinic Hospital, Saint Mary's Campus, Rochester, Minnesota; and Mayo Clinic Neurologic Physical Therapy Residency Program (D.K.N) and Program in Physical Therapy in the Mayo Clinic School of Health Sciences (J.H.H.), Mayo Clinic College of Medicine and Science, Rochester, Minnesota
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Toth M, Palmer L, Marino ME, Smith A, Schwartz C, Deutsch A, McMullen T. Validation of the Standardized Function Data Elements among Medicare Skilled Nursing Facility Residents. J Am Med Dir Assoc 2023; 24:307-313.e1. [PMID: 36632833 DOI: 10.1016/j.jamda.2022.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To examine the distribution of admission and discharge functional abilities among Medicare fee-for-service beneficiaries with a skilled nursing facility (SNF) stay. Further, to assess the validity of the standardized discharge self-care and mobility data by examining their association to community discharge. DESIGN Observational study of SNF Medicare fee-for-service residents' self-care and mobility scores at admission and discharge. SETTING AND PARTICIPANTS Medicare beneficiaries with Medicare Part A SNF stays in 2017 from 15,127 Medicare-certified SNFs. METHODS We calculated self-care and mobility score frequencies and percentages at admission and discharge to describe the functional abilities of SNF residents; we examined discharge scores by percentage discharge to the community to evaluate item construct validity. RESULTS Between admission and discharge, SNF resident scores showed overall improvements in function for all self-care and most mobility activities. For example, between admission and discharge the percentage of residents independent with toileting hygiene and sit to lying increased from 3.7% and 8.2%, to 25.3% and 32.7%, respectively. For all but 2 data elements, residents with lower functional abilities had a lower percentage of being discharged into the community, and the percentage of residents discharged into the community increased as residents performed functional activities of self-care and mobility at higher score ratings. There was a consistent monotonic relationship between residents' discharge self-care and mobility scores and community discharge rates for all but 2 data elements. CONCLUSIONS AND IMPLICATIONS Our study found measurable improvements for each self-care and mobility function item for SNF Medicare Part A resident stays in 2017. The results also demonstrated a positive association between higher discharge self-care and mobility scores and higher discharge to community rates. These findings support the validity of the data elements in measuring functional abilities among SNF Medicare Part A residents.
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Affiliation(s)
- Matt Toth
- Comprehensive Health Innovation, Research and Policy Division, RTI International, Research Triangle Park, NC, USA.
| | - Lauren Palmer
- Comprehensive Health Innovation, Research and Policy Division, RTI International, Waltham, MA, USA
| | | | - Alice Smith
- Comprehensive Health Innovation, Research and Policy Division, RTI International, Waltham, MA, USA
| | - Carole Schwartz
- Quality Measurement and Health Policy Program, RTI International, Chicago, IL, USA; RUSH University Medical Center, Chicago, IL, USA
| | - Anne Deutsch
- Comprehensive Health Innovation, Research and Policy Division, RTI International, Center for Rehabilitation Outcomes Research, Shirley Ryan Ability Lab, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Tara McMullen
- Opioid Safety, Pain Management, Opioid Safety, Prescription Drug Monitoring Program (PMOP), US Department of Veterans Affairs, Washington, DC, USA
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Deutsch A, Palmer L, Vaughan M, Schwartz C, McMullen T. Inpatient Rehabilitation Facility Patients’ Functional Abilities and Validity Evaluation of the Standardized Self-Care and Mobility Data Elements. Arch Phys Med Rehabil 2022; 103:1070-1084.e3. [DOI: 10.1016/j.apmr.2022.01.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/02/2022]
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A Post-Acute Care Function Process Quality Measure for the Collection of Standardized Self-Care and Mobility Data: Development, Implementation, and Quality Measure Scores. Arch Phys Med Rehabil 2022; 103:1061-1069. [DOI: 10.1016/j.apmr.2022.01.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/18/2022]
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Patel R, Savrides I, Cahalan C, Doulatani G, O'Dell MW, Toglia J, Jaywant A. Cognitive impairment and functional change in COVID-19 patients undergoing inpatient rehabilitation. Int J Rehabil Res 2021; 44:285-288. [PMID: 34156035 DOI: 10.1097/mrr.0000000000000483] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cognitive impairment is increasingly recognized as a sequela of COVID-19. It is unknown how cognition changes and relates to functional gain during inpatient rehabilitation. We administered the Montreal Cognitive Assessment (MoCA) at admission to 77 patients undergoing inpatient rehabilitation for COVID-19 in a large US academic medical center. Forty-five patients were administered the MoCA at discharge. Functional gain was assessed by change in the quality indicator for self-care (QI-SC). In the full sample, 80.5% of patients exhibited cognitive impairment on admission, which was associated with prior delirium. Among 45 patients with retest data, there were significant improvements in MoCA and QI-SC. QI-SC score gain was higher in patients who made clinically meaningful changes on the MoCA, an association that persisted after accounting for age and delirium history. Cognitive impairment is frequent among COVID-19 patients, but improves over time and is associated with functional gain during inpatient rehabilitation.
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Affiliation(s)
- Ruchi Patel
- Department of Rehabilitation Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center
| | - Irene Savrides
- Department of Rehabilitation Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center
| | - Christine Cahalan
- Department of Rehabilitation Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center
| | - Gargi Doulatani
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York
| | - Michael W O'Dell
- Department of Rehabilitation Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York
| | - Joan Toglia
- Department of Rehabilitation Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry
| | - Abhishek Jaywant
- Department of Rehabilitation Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
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Solon K, Larson A, Ronnebaum J, Stevermer C. Rehabilitation Outcomes for Patients With Severe Presentation of COVID-19: A Case Series. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2021; 12:115-121. [PMID: 34192092 PMCID: PMC8224693 DOI: 10.1097/jat.0000000000000153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/16/2020] [Accepted: 09/25/2020] [Indexed: 11/30/2022]
Abstract
To provide an outline of the timeline from acute care admission to inpatient rehabilitation facility discharge and describe the functional progress and tolerance of 2 individuals who were hospitalized but not intubated because of COVID-19. METHOD Retrospective data were collected from the electronic medical record to describe the rehabilitation course of the first 2 consecutive patients admitted to the rehabilitation facility who were recovering from COVID-19. Both patients were octogenarian men who experienced functional decline while hospitalized for symptoms of COVID-19 and were recommended for further inpatient rehabilitation services. Progress during inpatient rehabilitation was tracked using the following outcome measures: Centers for Medicare & Medicaid Services Quality Indicators (QI), 6-Minute Walk Test, 10-Meter Walk Test, Timed Up and Go, and Berg Balance Scale. RESULTS Patient 1 had an 18-day acute care stay, a 13-day inpatient rehabilitation facility stay, and was discharged to home. Patient 2 had an interrupted 19-day acute care stay, a 15-day inpatient rehabilitation facility stay, and was discharged to a skilled nursing facility. Patient 1 improved 160.98 m in the 6-Minute Walk Test, 0.08 m/s in self-selected walking speed, and 85 points in the total Quality Indicators score. Patient 2 improved 115.22 m in the 6-Minute Walk Test, 0.14 m/s in self-selected walking speed, and 39 points in the total Quality Indicators score. CONCLUSION The patients made clinically meaningful improvements in each outcome measure during their length of stay for inpatient rehabilitation. This reveals the positive rehabilitation potential of 2 older adult patients with COVID-19 and demonstrates the patients' ability to maintain inpatient rehabilitation facility level of activity. With individualized care and discharge planning, similar patients may make significant gains in function despite advanced age and comorbid conditions.
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Affiliation(s)
- Kathryn Solon
- Therapy Department, MercyOne Clive Rehabilitation Hospital 1401 Campus Dr Clive, IA 50325 (USA).
- Therapy Department, MercyOne Clive Rehabilitation Hospital Clive, Iowa
- Department of Physical Therapy, Des Moines University Des Moines, Iowa
- Department of Physical Therapy, Des Moines University Des Moines, Iowa
| | - Allison Larson
- Therapy Department, MercyOne Clive Rehabilitation Hospital 1401 Campus Dr Clive, IA 50325 (USA).
- Therapy Department, MercyOne Clive Rehabilitation Hospital Clive, Iowa
- Department of Physical Therapy, Des Moines University Des Moines, Iowa
- Department of Physical Therapy, Des Moines University Des Moines, Iowa
| | - Julie Ronnebaum
- Therapy Department, MercyOne Clive Rehabilitation Hospital 1401 Campus Dr Clive, IA 50325 (USA).
- Therapy Department, MercyOne Clive Rehabilitation Hospital Clive, Iowa
- Department of Physical Therapy, Des Moines University Des Moines, Iowa
- Department of Physical Therapy, Des Moines University Des Moines, Iowa
| | - Catherine Stevermer
- Therapy Department, MercyOne Clive Rehabilitation Hospital 1401 Campus Dr Clive, IA 50325 (USA).
- Therapy Department, MercyOne Clive Rehabilitation Hospital Clive, Iowa
- Department of Physical Therapy, Des Moines University Des Moines, Iowa
- Department of Physical Therapy, Des Moines University Des Moines, Iowa
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Sisto SA. Archives of Physical Medicine and Rehabilitation and ACRM Recognize the Elizabeth and Sidney Licht Award Winner and Nominees for Excellence in Scientific Writing. Arch Phys Med Rehabil 2020; 101:722-727. [PMID: 32007237 DOI: 10.1016/j.apmr.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Sue Ann Sisto
- Department of Rehabilitation Science, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY
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Jesus TS, Papadimitriou C, Pinho CS, Hoenig H. Key Characteristics of Rehabilitation Quality Improvement Publications: Scoping Review From 2010 to 2016. Arch Phys Med Rehabil 2017; 99:1141-1148.e4. [PMID: 28965737 DOI: 10.1016/j.apmr.2017.08.491] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/14/2017] [Accepted: 08/18/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To characterize the peer-reviewed quality improvement (QI) literature in rehabilitation. DATA SOURCES Five electronic databases were searched for English-language articles from 2010 to 2016. Keywords for QI and safety management were searched for in combination with keywords for rehabilitation content and journals. Secondary searches (eg, references-list scanning) were also performed. STUDY SELECTION Two reviewers independently selected articles using working definitions of rehabilitation and QI study types; of 1016 references, 112 full texts were assessed for eligibility. DATA EXTRACTION Reported study characteristics including study focus, study setting, use of inferential statistics, stated limitations, and use of improvement cycles and theoretical models were extracted by 1 reviewer, with a second reviewer consulted whenever inferences or interpretation were involved. DATA SYNTHESIS Fifty-nine empirical rehabilitation QI studies were found: 43 reporting on local QI activities, 7 reporting on QI effectiveness research, 8 reporting on QI facilitators or barriers, and 1 systematic review of a specific topic. The number of publications had significant yearly growth between 2010 and 2016 (P=.03). Among the 43 reports on local QI activities, 23.3% did not explicitly report any study limitations; 39.5% did not used inferential statistics to measure the QI impact; 95.3% did not cite/mention the appropriate reporting guidelines; only 18.6% reported multiple QI cycles; just over 50% reported using a model to guide the QI activity; and only 7% reported the use of a particular theoretical model. Study sites and focuses were diverse; however, nearly a third (30.2%) examined early mobilization in intensive care units. CONCLUSIONS The number of empirical, peer-reviewed rehabilitation QI publications is growing but remains a tiny fraction of rehabilitation research publications. Rehabilitation QI studies could be strengthened by greater use of extant models and theory to guide the QI work, consistent reporting of study limitations, and use of inferential statistics.
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Affiliation(s)
- Tiago S Jesus
- Global Health and Tropical Medicine & World Health Organization Collaborating Center for Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal.
| | | | - Cátia S Pinho
- ISVOUGA-Superior Institute of Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - Helen Hoenig
- Physical Medicine and Rehabilitation Service, Durham Veterans Administration Medical Center, Durham, NC; Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC
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