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McNair K, Botticello A, Stubblefield MD. Using Performance Status to Identify Risk of Acute Care Transfer in Inpatient Cancer Rehabilitation. Arch Phys Med Rehabil 2024; 105:947-952. [PMID: 38232794 DOI: 10.1016/j.apmr.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/20/2023] [Accepted: 12/29/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE To identify patient factors associated with acute care transfer (ACT) among cancer survivors admitted for inpatient medical rehabilitation. DESIGN An exploratory, observational design was used to analyze retrospective data from electronic medical records. SETTING Data were obtained from 3 separate inpatient rehabilitation hospitals within a private rehabilitation hospital system in the Northeast. PARTICIPANTS Medical records were reviewed and analyzed for a total of 416 patients with a confirmed oncologic diagnosis treated in 1 of the inpatient rehabilitation hospitals between January and December 2020. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The primary outcome measure was the incidence of an ACT. Covariates included the adapted Karnofsky Performance Scale (KPS) for inpatient rehabilitation, demographic information, admission date, re-admission status, discharge destination, and cancer-related variables, such as primary cancer diagnosis and presence/location of metastases. RESULTS One in 5 patients (21.2%) were transferred to acute care. Patients with hematologic cancer had a higher risk of ACT compared with those with central nervous system (CNS) cancer. Lower functional status, measured by the adapted KPS, was associated with a higher likelihood of ACT. Patients with an admission KPS score indicating the need for maximum assistance had the highest transfer rate (59.1%). CONCLUSIONS These findings highlight the medical complexity of this population and increased risk of an interrupted rehabilitation stay. Considering patients' performance status, cancer type, and extent of disease may be important when assessing the appropriateness of IRF admission relative to patient quality of life. Earlier and improved understanding of the patient's prognosis will allow the cancer rehabilitation program to meet the patient's unique needs and facilitate an appropriate discharge to the community in an optimal window of time.
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Affiliation(s)
- Keara McNair
- Kessler Institute for Rehabilitation, West Orange, NJ; Rutgers, Department of Rehabilitation and Movement Sciences, School of Health Professions, Newark, NJ.
| | - Amanda Botticello
- Center for Outcomes and Assessment Research, Kessler Foundation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ
| | - Michael D Stubblefield
- Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ
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Fu JB, Morishita S. Inpatient Rehabilitation of Hematopoietic Stem Cell Transplant Patients: Managing Challenging Impairments and Medical Fragility. Am J Phys Med Rehabil 2024; 103:S46-S51. [PMID: 38364030 PMCID: PMC10878715 DOI: 10.1097/phm.0000000000002408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
ABSTRACT Hematopoietic stem cell transplants play an important role in the treatment of cancer, particularly hematologic malignancies. These patients can encounter functional impairments unique to hematopoietic stem cell transplant, including deconditioning, cancer-related fatigue, steroid myopathy, graft versus host disease, and capillary leak syndrome. Medical fragility and increased risk of infection may make rehabilitation challenging on the acute care and postacute care settings. Patients admitted to acute inpatient rehabilitation experience a high rate of transfer to the primary acute service and high rate of mortality after transfer back. Physical medicine and rehabilitation physicians can use a number of strategies to mitigate these patients' risk of medical complications including evidence-based predictive models to assist with postacute rehabilitation triage, physiatry-led consult-based rehabilitation, and oncology hospitalist comanagement on inpatient rehabilitation.
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Affiliation(s)
- Jack B. Fu
- Department of Palliative, Rehabilitation and Integrative Medicine, Section of Physical Medicine & Rehabilitation, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
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3
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Kiefer T, Lüders C, Völler H, Daeschlein G. Update on the risk assessment of a rehabilitation stay for patients after allogeneic stem cell transplantation. Transpl Immunol 2023; 79:101865. [PMID: 37230394 DOI: 10.1016/j.trim.2023.101865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE High-dose chemotherapy with allogeneic stem cell transplantation is the only chance of cure for many haemato-oncological patients. After such therapy, the immune system is weakened, and the contact with other people should therefore be limited as much as possible. The question arises whether a rehabilitation stay can be recommended to these patients, which risk factors for complications during the rehabilitation stay can be identified, and whether physicians and patients can be provided with decision-making aids as to when the optimal time is to start rehabilitation. METHODS We report about 161 rehabilitation stays of patients after high-dose chemotherapy with allogeneic stem cell transplantation. Premature discontinuation of the rehabilitation was selected as the criterion for a serious complication during the rehabilitation and the underlying reasons were analysed. RESULTS The rate of prematurely terminated rehabilitation stays (13.6%) corresponds to our previous result from 2020. The analysis of the reasons for early termination comes to the conclusion that the rehabilitation stay is only considered as a reason for termination in very few cases, if at all. The risk factors identified for premature termination of the rehabilitation stay were male sex, the period (days) between transplantation and the beginning of the rehabilitation stay, haemoglobin value, platelets and presence of immunosuppressing agent. The most significant risk factor is a decreased platelet count at the time rehabilitation begins. The platelet count, the likelihood that it will improve in the further course and the urgency of the rehabilitation stay can be used to help decide when the optimal time for rehabilitation is given. CONCLUSION Rehabilitation can be recommended to patients after allogeneic stem cell transplantation. Based on various factors, recommendations can be made for the right time for rehabilitation.
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Affiliation(s)
- Thomas Kiefer
- Klinik am See, Rehabilitationszentrum, Rüdersdorf, Germany; Medical University Brandenburg "Theodor Fontane", Germany.
| | | | - Heinz Völler
- Klinik am See, Rehabilitationszentrum, Rüdersdorf, Germany; Universität Potsdam, Professur für Rehabilitationswissenschaften, humanwissenschaftliche Fakultät, Germany
| | - Georg Daeschlein
- Clinic of Dermatology, Immunology and Allergology, Medical Center Dessau, Medical University Brandenburg "Theodor Fontane" Medical Center Dessau, Germany
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Frequency and reasons for unplanned transfer to the primary acute care service of inpatient rehabilitation glioblastoma multiforme patients. Support Care Cancer 2023; 31:122. [PMID: 36653554 DOI: 10.1007/s00520-023-07591-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 01/12/2023] [Indexed: 01/20/2023]
Abstract
PURPOSE To determine the percentage of and factors associated with unplanned transfer to the acute care service of glioblastoma multiforme acute rehabilitation inpatients. METHODS Retrospective review of glioblastoma multiforme acute rehabilitation inpatients admitted 4/1/2016-3/31/2020 at a National Cancer Institute Comprehensive Cancer Center. RESULTS One hundred thirty-nine consecutive admissions of unique glioblastoma multiforme acute rehabilitation inpatients were analyzed. Fifteen patients (10.7%, 95% confidence interval 6.5-17.1%) were transferred to the acute care service for unplanned reasons. The most common reasons for transfer back were neurosurgical complication 6/15(40%), neurologic decline due to mass effect 4/15(26.7%), and pulmonary embolism 2/15(13.3%). Older age (p = 0.010), infection prior to acute inpatient rehabilitation transfer (p = 0.020), and lower activity measure of post-acute care 6-click basic mobility scores (p = 0.048) were significantly associated with transfer to the acute care service. Patients who transferred to the acute care service had significantly lower overall survival than patients who did not transfer off (log-rank test p = 0.001). CONCLUSION Acute inpatient physiatrists should closely monitor patients for neurosurgical and neurologic complications. The variables significantly associated with transfer to the acute care service may help identify patients at increased risk for medical complications who may require closer observation.
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Nam GH, Chang WH. Factors Associated with Unplanned Transfer of Patients with Brain Tumor from Inpatient Rehabilitation Unit to Primary Acute Care Units. J Pers Med 2023; 13:jpm13010131. [PMID: 36675792 PMCID: PMC9865004 DOI: 10.3390/jpm13010131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/30/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
Inpatient rehabilitation should be assessed to improve each functional domain in patients with brain tumor. However, no previous study has reported risk factors for unplanned transfer of this patient population to primary acute care units during a comprehensive inpatient rehabilitation. The objective of this study was to investigate the percentage of unplanned transfer of brain tumor rehabilitation inpatients to primary acute care units compared with stroke patients and factors associated with such unplanned transfer. Data of 137 patients with brain tumor who were transferred to the department of physical and rehabilitation medicine were retrospectively reviewed. For comparison, data of 438 patients with subacute stroke were also obtained. Included patients were divided into an unplanned transfer group and a control group based on whether they required a transfer to another department for acute care before completing their comprehensive inpatient rehabilitation. Reasons for unplanned transfers were classified based on medical or surgical conditions. The incidence of unplanned transfers to the medical or surgical department was significantly higher in patients with brain tumor (15.3%) than in stroke patients (7.1%) (p < 0.05). Most of unplanned transfers occurred within two weeks of the comprehensive inpatient rehabilitation for patients with brain tumor. There was a significantly higher incidence of unplanned transfers in patients with a primary tumor than in those with a metastatic tumor (15.9% vs. 4.8%, p < 0.05). In addition, the frequency of chemotherapy or radiotherapy was significantly (p < 0.05) higher in the unplanned transfer group than in the control group. The most common cause of an unplanned transfer was a neurologic cause (90.0%) in patients with brain tumor and an infectious disease such as pneumonia (51.6%) in stroke patients. In conclusion, these results demonstrated a higher incidence of unplanned transfers in patients with brain tumor than in stroke patients during intensive inpatient rehabilitation. Proportions of those with neurological problems were relatively higher in patients with brain tumor than in patients with subacute stroke.
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Affiliation(s)
- Gyoung Ho Nam
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Department of Health Sciences and Technology, Department of Medical Device Management & Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul 06355, Republic of Korea
- Correspondence: ; Tel.: +82-2-3410-6068
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6
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Bhakta A, Roy I, Huang K, Spangenberg J, Jayabalan P. Factors associated with unplanned transfers among cancer patients at a freestanding acute rehabilitation facility. PM R 2021; 14:1037-1043. [PMID: 34296529 DOI: 10.1002/pmrj.12681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cancer patients undergoing inpatient rehabilitation often have high risk of complications leading to unplanned transfer to acute care. Prior studies have identified factors associated with these transfers but have been limited to examining factors that pertain to initial admission to rehabilitation and were not conducted in a freestanding inpatient rehabilitation facility. OBJECTIVE The study aimed to include these prerehabilitation factors in addition to factors upon initial assessment in rehabilitation. It was hypothesized that specific factors from each of these periods would be associated with unplanned transfer to acute care. DESIGN Retrospective cohort study. SETTING Freestanding academic inpatient rehabilitation facility affiliated with an academic tertiary care facility with a comprehensive cancer center. PATIENTS Retrospective review of 330 specific encounters unique to 250 patients from March 2017 to September 2018. MAIN OUTCOME MEASURES The outcome measure was unplanned transfer to acute care. A binary logistic regression model was used to examine the relationship between factors from oncologic history, acute care course, and factors upon admission to rehabilitation to unplanned transfer to acute care. RESULTS From 330 encounters, there were 111 unplanned transfers (34%). Unplanned transfer to acute care was independently associated with gastrointestinal malignancy (odds ratio [OR] 4.4, p = .01), 6-minute walk test less than 90 m (OR 4.6, p = .003), and prior unplanned transfer (OR 3.5, p = .007). CONCLUSIONS The study suggests that oncologic and functional prerehabilitation markers are associated with an increased likelihood of unplanned transfer during inpatient cancer rehabilitation. These findings will provide a framework for creating predictive tools for unplanned transfers in cancer rehabilitation patients.
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Affiliation(s)
- Akash Bhakta
- Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Huntington Hospital, Pasadena, California, USA
| | - Ishan Roy
- Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kevin Huang
- Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jacqueline Spangenberg
- Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | - Prakash Jayabalan
- Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Tennison JM, Fricke BC, Fu JB, Patel TA, Chen M, Bruera E. Medical Complications and Prognostic Factors for Medically Unstable Conditions During Acute Inpatient Cancer Rehabilitation. JCO Oncol Pract 2021; 17:e1502-e1511. [PMID: 33683918 DOI: 10.1200/op.20.00919] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Acute inpatient rehabilitation provides concurrent medical care and intensive rehabilitation. We sought to describe the nature of types of medical complications and to identify the more frequent types of medical complications management in patients with cancer undergoing acute inpatient rehabilitation. METHODS We reviewed the records of all consecutive patients admitted to acute inpatient rehabilitation from September 1, 2017, through February 28, 2018. Presenting problem noted to be a significant change in medical status using the Centers for Medicare & Medicaid Services' Evaluation and Management Service Guide was defined as a medical complication. We recorded demographic and clinical characteristics. Multivariable logistic regression analysis was performed to assess prognostic factors for returning to acute care. RESULTS Among 165 evaluable patients, 158 (96%) had at least one medical complication, and 31 (19%) had an unplanned return to acute care. After excluding three patients who had planned return to acute care, there was a cohort of 162 patients and the most common medical complication categories were electrolyte abnormalities 81 (50%), musculoskeletal 70 (43%), genitourinary or renal 61 (38%), hematologic 58 (36%), and cardiovascular problems 46 (28%). Multivariable analysis showed that tachycardia (odds ratio [OR], 7.83; 95% CI, 2.23 to 27.54; P = .001) and weekly or more frequent RBC transfusions (OR, 5.23; 95% CI, 1.39 to 19.64; P = .014) were independently associated with unplanned return to acute care. CONCLUSION A high frequency and wide range of medical complications and interventions occur in patients with cancer undergoing acute inpatient rehabilitation. Close monitoring and expertise are needed for this patient population.
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Affiliation(s)
- Jegy M Tennison
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brian C Fricke
- Department of Rehabilitation Medicine, UT Health San Antonio Long School of Medicine, San Antonio, TX
| | - Jack B Fu
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tejal A Patel
- Department of General Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Minxing Chen
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
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Bilek AJ, Borodin O, Carmi L, Yakim A, Shtern M, Lerman Y. Older patients with active cancer have favorable inpatient rehabilitation outcomes. J Geriatr Oncol 2021; 12:799-807. [PMID: 33358109 DOI: 10.1016/j.jgo.2020.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 12/06/2020] [Accepted: 12/12/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To investigate the characteristics and rehabilitation outcomes of older patients with active cancer (OPAC) undergoing post-acute inpatient rehabilitation (IR), and to evaluate which clinical factors are associated with poor rehabilitation outcomes. MATERIALS AND METHODS This is a retrospective study of patients aged ≥65 with active cancer undergoing IR following acute hospitalization at our tertiary hospital centre (N = 330). We collected data on patient, malignancy, and hospitalization characteristics, and IR outcomes including function, mobility, discharge destination, and mortality. Multivariate stepwise logistic regression was used to identify independent associations with the composite outcome of death within three months or discharge to long-term care (LTC). RESULTS Patient mean age was 80.1 ± 7.2 years. The most common malignancies were colon (30.9%) and hematologic (16.1%). Most patients were hospitalized urgently (64.8%) and underwent surgery (72.4%). From IR admission to discharge, patients ambulating independently increased from 14.0% to 52.0%. Discharge destination was to the community (80.4%), to LTC (7.6%), and transfer to an acute ward (7.2%), while 4.8% died during IR. One-year survival was 62.1%. The composite outcome was met by 24.8% of patients with multivariate logistic regression revealing independent associations (p < 0.05) with high baseline dependency, metastatic disease, low mobility score on IR admission, complications during acute care, and ≥ 75th percentile values for lactate dehydrogenase and alkaline phosphatase. CONCLUSION OPAC have favorable IR outcomes including high rate of community discharge, function and mobility gains, and lower mortality rates when compared with previously studied cancer rehabilitation populations. We identified several clinical markers associated with the composite outcome, which can guide post-acute discharge planning in patients with an unclear prognosis.
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Affiliation(s)
- Aaron Jason Bilek
- Tel Aviv Sourasky Medical Center, Geriatric Division, 6 Weizmann Street, Tel Aviv 62431, Israel.
| | - Oksana Borodin
- Tel Aviv Sourasky Medical Center, Geriatric Division, 6 Weizmann Street, Tel Aviv 62431, Israel; Tel Aviv University, Faculty of Medicine, P.O. box 39040, Tel Aviv 69978, Israel
| | - Liad Carmi
- Tel Aviv University, Faculty of Medicine, P.O. box 39040, Tel Aviv 69978, Israel
| | - Ariel Yakim
- Tel Aviv Sourasky Medical Center, Geriatric Division, 6 Weizmann Street, Tel Aviv 62431, Israel
| | - Michael Shtern
- Tel Aviv Sourasky Medical Center, Geriatric Division, 6 Weizmann Street, Tel Aviv 62431, Israel
| | - Yaffa Lerman
- Tel Aviv Sourasky Medical Center, Geriatric Division, 6 Weizmann Street, Tel Aviv 62431, Israel; Tel Aviv University, Faculty of Medicine, P.O. box 39040, Tel Aviv 69978, Israel
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El Majzoub I, Cheaito RA, Cheaito MA, Bazarbachi A, Sweidan K, Sarieddine A, Al Chami F, Tamim H, El Cheikh J. Clinical characteristics and outcomes of bone marrow transplantation patients presenting to the ED of a tertiary care center. Am J Emerg Med 2020; 46:295-302. [PMID: 33046319 DOI: 10.1016/j.ajem.2020.07.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Bone marrow transplantation is a breakthrough in the world of hematology and oncology. In our region, there is scarce literature studying emergency department visits among BMT patients, as well as their predictors of mortality. OBJECTIVES This study aimed to assess the frequency, reasons, clinical characteristics and outcomes of patients presenting to the ED after a BMT, and to study the predictors of mortality in those patients. This study also compares those variables among the different types of BMT. METHODS This was a retrospective cohort study conducted on all adult patients who have completed a successful BMT and visited the ED. RESULTS Our study included 115 BMT patients, of whom 17.4% died. Those who died had a higher median number of ED visits than those who did not die. Around 36.5% presented with fever/chills with 29.6% diagnosed with pneumonia on discharge. We found that the odds of mortality were significantly higher among those who presented with dyspnea (p < .0005) and AMS (p = .023), among septic patients (p = .001), those who have undergone allogeneic BMT (p = .037), and those who were admitted to the ICU (p = .002). Moreover, the odds of mortality were significantly higher among hypotensive (p ≤0005) and tachycardic patients (p = .015). CONCLUSION In our study, we have shown that BMT patients visit the ED very frequently and have high risk of in-hospital mortality. Moreover, our study showed a significant association between mortality and patients with dyspnea, AMS, sepsis, allogeneic BMT type, ICU admission, hypotension and tachycardia.
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Affiliation(s)
- Imad El Majzoub
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Rola A Cheaito
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Mohamad Ali Cheaito
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Ali Bazarbachi
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Kinda Sweidan
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Aseel Sarieddine
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Farouk Al Chami
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Hani Tamim
- Department of Internal Medicine, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Jean El Cheikh
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Kiefer T, Krahl D, Kohlmann T, Nogai A, Baurmann H, Schüler F, Krüger W, de Wit M, Pink D, Dietz M, Völler H, Buhlert H, Daeschlein G. Does rehabilitation pose a risk to patients suffering from haemato-oncological diseases? Results of a monocentric, retrospective analysis in Germany. Eur J Cancer Care (Engl) 2019; 29:e13201. [PMID: 31808982 DOI: 10.1111/ecc.13201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 10/16/2019] [Accepted: 11/22/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Patients suffering from haemato-oncological diseases tend to have a weakened immune system after the end of their therapy. To avoid infections, patients are advised to limit contact with other people. This poses the question whether a stay at a rehabilitation facility can be recommended. METHODS We report about 134 rehabilitation stays of patients. Premature discontinuation of the rehabilitation stay was selected as the criterion for a serious complication during the rehabilitation, and the underlying reasons were analysed. RESULTS Compared to the discontinuation rates of patients suffering from solid tumours (2.4%), the percentage of haemato-oncological patients ending prematurely their rehabilitation stay (8.2%) is significantly increased. This rises to 17.1% for patients who have undergone an allogeneic stem cell transplantation. The analysis of the discontinuation reasons revealed that they were not directly connected to the rehabilitation. Apart from the already known risk factors for premature termination of the rehabilitation stay, we have identified the period (days) between the last therapy and the beginning of the rehabilitation stay as a risk factor. CONCLUSIONS We show for the first time that a rehabilitation stay does not pose additional risks for patients suffering from haemato-oncological diseases.
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Affiliation(s)
- Thomas Kiefer
- Klinik am See, Rehabilitationszentrum, Rüdersdorf, Germany
| | - Dorothea Krahl
- Klinik am See, Rehabilitationszentrum, Rüdersdorf, Germany
| | - Thomas Kohlmann
- Institut für Community Medicine, Methods of Community Medicine, Universität Greifswald, Greifswald, Germany
| | - Axel Nogai
- Department of Hematology, Oncology and Tumor Immunology, Charite Medical School, Berlin, Germany
| | - Herrad Baurmann
- Klinik für Hämatologie, Onkologie, Tumorimmunologie und Palliativmedizin, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - Frank Schüler
- Abteilung Hämatologie/Onkologie, DRK Krankenhaus Luckenwalde, Luckenwalde, Germany
| | - William Krüger
- Klinik und Poliklinik für Innere Medizin C, Hämatologie und Onkologie, Transplantationszentrum, Palliativmedizin, Universität Greifswald, Greifswald, Germany
| | - Maike de Wit
- Klinik für Innere Medizin, Hämatologie, Onkologie und Palliativmedizin, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Daniel Pink
- Klinik und Poliklinik für Innere Medizin C, Hämatologie und Onkologie, Transplantationszentrum, Palliativmedizin, Universität Greifswald, Greifswald, Germany.,Klinik für Hämatologie, Onkologie und Palliativmedizin, Sarkomzentrum Berlin-Brandenburg, HELIOS Klinikum Bad-Saarow, Bad Saarow, Germany
| | - Marion Dietz
- Klinik am See, Rehabilitationszentrum, Rüdersdorf, Germany
| | - Heinz Völler
- Klinik am See, Rehabilitationszentrum, Rüdersdorf, Germany.,humanwissenschaftliche Fakultät, Universität Potsdam, Potsdam, Germany
| | | | - Georg Daeschlein
- Klinik und Poliklinik für Hautkrankheiten, Universität Greifswald, Greifswald, Germany
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11
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Fu JB, Molinares DM, Morishita S, Silver JK, Dibaj SS, Guo Y, Bruera E. Retrospective Analysis of Acute Rehabilitation Outcomes of Cancer Inpatients with Leptomeningeal Disease. PM R 2019; 12:263-270. [PMID: 31222952 DOI: 10.1002/pmrj.12207] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/14/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Evaluate Functional Independence Measure (FIM) changes and incidence of serious medical complications requiring return to the primary acute care service of acute rehabilitation cancer inpatients with leptomeningeal disease (LMD). DESIGN Retrospective chart review. SETTING Tertiary referral based comprehensive cancer center acute inpatient rehabilitation unit. PARTICIPANTS Thirty cancer patients admitted to acute inpatient rehabilitation between 8 January 2014 and 8 August 2018 with pathology confirmed LMD within 6 months. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES FIM and incidence of return to the primary acute care service. RESULTS Twenty five of 30 (83.3%) patients were noted to have neurologic impairments and 13/30 (43.3%) were noted to have cognitive impairments. Five of 30 patients (16.7%) received intrathecal chemotherapy and 4/30 (13.3%) received radiation during acute inpatient rehabilitation for LMD treatment. Median days in acute care prior to acute inpatient rehabilitation was 22.5. Median days from acute inpatient rehabilitation admission until death of the 23 deceased patients as of 1 January 2019 was 180.00. Twenty of 30 (66.7%) patients were discharged home, 9/30 (30%) transferred to the primary acute care service, and 1/30 (3.3%) discharged to a skilled nursing facility. Reasons for return to the primary acute care service included additional chemotherapy 3/9 (33%), neurologic decline 2/9 (22%), fever 2/9 (22%), altered mental status 1/9 (11%), and progressive polyarthritis 1/9 (11%). Of the 21 patients who completed acute inpatient rehabilitation without return to the primary acute care service, mean FIM subscore changes from admission to discharge for Activities of Daily Living, Mobility, and Motor were 5.1 (P < .001), 4.8 (P < .001) and 11.7 (P < .001), respectively (Wilcoxon signed rank test, significance P < .05). CONCLUSION LMD patients who completed acute inpatient rehabilitation made statistically significant improvements on the majority of FIM items. Most patients were discharged home. Our data suggest LMD should not be a reason for exclusion from acute inpatient rehabilitation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jack B Fu
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Diana M Molinares
- Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine and Sylvester Comprehensive Cancer Center, Miami, FL
| | - Shinichiro Morishita
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Julie K Silver
- Department of Physical Medicine & Rehabilitation, Harvard Medical School and Spaulding Rehabilitation Hospital, Boston, MA
| | - Seyedeh S Dibaj
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ying Guo
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX
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Smith S, Wilson CM, Lipple C, Avromov M, Maltese J, Siwa E, Colombo R, Seidell JW. Managing Palliative Patients in Inpatient Rehabilitation Through a Short Stay Family Training Program. Am J Hosp Palliat Care 2019; 37:172-178. [PMID: 31370678 DOI: 10.1177/1049909119867293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective Analysis of a Quality Improvement Program. PURPOSE To describe the development, implementation, and outcomes of an inpatient rehabilitation-based Short Stay Family Training (SSFT) program for patients with life-limiting conditions. BACKGROUND Patients with terminal illnesses often have functional limitations that prohibit discharge home after hospitalization, but their condition limits their ability to participate in rehabilitation in an inpatient setting. METHODS AND MEASURES After a needs assessment, an interdisciplinary team developed an SSFT program to empower patients, caregivers, and family members by giving them the tools to be independent in caring for a patient with a life-limiting condition. Patients qualifying for the program were tracked in terms of acute care physical therapy and occupational therapy discharge recommendations, diagnosis, inpatient rehabilitation unit length of stay (LoS), caregiver involvement, and discharge location. Data were retrospectively analyzed from patients over the first 16 months. RESULTS Since program implementation, 30 patients and their family members participated in the program. Overall, these patients experienced decreased LoS, increased discharge to home, and increased palliative care involvement in the plan of care. CONCLUSION Short Stay Family Training is a viable alternative to traditional inpatient rehabilitation to allow patients with life-limiting conditions to discharge home safely with caregiver support.
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Affiliation(s)
- Suzette Smith
- Inpatient Rehabilitation Unit, Beaumont Health, Troy, MI, USA
| | - Christopher M Wilson
- School of Health Sciences, Oakland University, Rochester, MI, USA.,Physical and Occupational Therapy Department, Beaumont Hospital, Troy, MI, USA
| | - Christine Lipple
- Acute Care Physical and Occupational Therapy, Beaumont Health, Troy, MI, USA
| | - Meghan Avromov
- Inpatient Rehabilitation Unit, Beaumont Health, Troy, MI, USA
| | - John Maltese
- Inpatient Rehabilitation Unit, Beaumont Health, Troy, MI, USA
| | - Eliezer Siwa
- Inpatient Rehabilitation Unit, Beaumont Health, Troy, MI, USA
| | - Reyna Colombo
- Physical and Occupational Therapy Services, Beaumont Health, Troy, MI, USA
| | - Janet Wiechec Seidell
- Inpatient Physical and Occupational Therapy Services, Beaumont Health, Troy, MI, USA
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13
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Predicting the risk of acute care readmissions among rehabilitation inpatients: A machine learning approach. J Biomed Inform 2018; 86:143-148. [DOI: 10.1016/j.jbi.2018.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/05/2018] [Accepted: 09/13/2018] [Indexed: 12/29/2022]
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Robinson DM, Bazzi MS, Millis SR, Bitar AA. Predictors of readmission to acute care during inpatient rehabilitation for non-traumatic spinal cord injury. J Spinal Cord Med 2018; 41:444-449. [PMID: 29355465 PMCID: PMC6055975 DOI: 10.1080/10790268.2018.1426235] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES To investigate the frequency of and reasons for readmissions to acute care (RTAC) during inpatient rehabilitation (IPR) after non-traumatic spinal cord injury (NT-SCI). To develop a predictive model for RTAC using identified risk factors. DESIGN Retrospective case-control. SETTING Academic IPR hospital. PARTICIPANTS Individuals with NT-SCI admitted to an academic SCI rehabilitation unit from January 2014-December 2015. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Readmissions to acute care services from IPR. RESULTS Thirty-seven participants (20%) experienced a RTAC for a total of 39 episodes. Thirty-five experienced 1 RTAC, while two had 2. The most common medical reasons for RTAC were infection (27%), neurological (27%), and noninfectious respiratory (16%). Multivariable logistic regression was used to develop a model to predict RTAC. Paraplegia was associated with 3.2 times increase in the odds of RTAC (P = 0.03). For every unit increase in FIM-Motor, there was a 5% reduction in the odds of RTAC (P = 0.03) Body mass index less than 30 decreased odds of RTAC by 61% (P = 0.004). CONCLUSION RTACs were associated with body mass index greater than 30, decreased FIM-Motor subscore on admission, and paraplegia. Physiatrists caring for the non-traumatic SCI patient need be more circumspect of individuals with these parameters to potentially prevent the problems necessitating acute care transfer.
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Affiliation(s)
- David M. Robinson
- School of Medicine, Wayne State University, Detroit, Michigan, USA,Correspondence to: David M. Robinson, MD. 5420 Wessex Ct. Apt 106, Dearborn, MI 48126, USA.
| | - Moussa S. Bazzi
- Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Michigan, Detroit, Michigan, USA
| | - Scott R. Millis
- Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Michigan, Detroit, Michigan, USA
| | - Ali A. Bitar
- Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Michigan, Detroit, Michigan, USA
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Fu JB, Morishita S, Yadav R. Changing Paradigms in the Rehabilitation of Inpatients with Brain Tumors. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018; 6:115-120. [PMID: 29868247 PMCID: PMC5983897 DOI: 10.1007/s40141-018-0182-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Neurologic tumors account for over 50% of American acute inpatient rehabilitation facility cancer admissions. WHO Grade IV astrocytoma (also known as glioblastoma multiforme, high grade glioma or GBM) is the most common primary brain tumor in adults and is invariably fatal. The majority of primary brain tumor patients experience neurologic deficits. However, under-referral from oncology to rehabilitation has been reported. This brief narrative review article covers functional, medical and regulatory considerations when rehabilitating brain tumor inpatients.
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Affiliation(s)
- Jack B. Fu
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shinichiro Morishita
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Rajesh Yadav
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
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Bleeding frequency and characteristics among hematologic malignancy inpatient rehabilitation patients with severe thrombocytopenia. Support Care Cancer 2018; 26:3135-3141. [PMID: 29594490 DOI: 10.1007/s00520-018-4160-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 03/12/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To identify the frequency and characteristics of bleeding complications during acute inpatient rehabilitation of hematologic malignancy patients with severe thrombocytopenia. DESIGN Retrospective descriptive analysis. SETTING Comprehensive cancer center acute inpatient rehabilitation unit. PARTICIPANTS Consecutive hematologic malignancy patients with a platelet count of less than or equal to 20,000/microliter (μL) on the day of acute inpatient rehabilitation admission from 1/1/2005 through 8/31/2016. INTERVENTIONS Medical records were retrospectively analyzed for demographic, laboratory, and medical data. Patients were rehabilitated using the institutional exercise guidelines for thrombocytopenic patients. MAIN OUTCOME MEASURES Bleeding events noted in the medical record. RESULTS Out of 135 acute inpatient rehabilitation admissions, 133 unique patients were analyzed with a total of 851 inpatient rehabilitation days. The mean platelet count was 14,000/μL on the day of admission and 22,000/μL over the course of the rehabilitation admission. There were 252 days of inpatient rehabilitation where patients had less than 10,000/μL platelets. A total of 97 bleeding events were documented in 77/135 (57%) admissions. Of the 97 bleeding events, 72 (74%), 14 (14%), and 11 (11%) were considered to be of low, medium, and high severity, respectively. There were 4/97 (4%) bleeding events that were highly likely attributable to physical activity but only 1/4 was considered high severity. Bleeding rates were .09, .08, .17, and .37 for > 20,000, 15-20,000, 10-15,000, and < 10,000/μL mean platelet counts respectively (p = .003). Forty-four percent of patients were transferred back to the primary acute care service with infection being the most common reason for transfer. CONCLUSIONS This study is the first to examine exercise-related bleeding complications during acute inpatient rehabilitation in severely thrombocytopenic hematologic cancer patients. Bleeding rates increased with lower platelet counts. However, using the exercise guidelines for severely thrombocytopenic patients, the risk of severe exercise-related bleeding events was low.
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Neal J, Shahpar S, Spill G, Semik P, Marciniak C. Bleeding Events in Thrombocytopenic Patients With Cancer Undergoing Acute Rehabilitation. Rehabil Process Outcome 2018. [DOI: 10.1177/1179572718761379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To determine incidence of bleeding in thrombocytopenic patients with cancer undergoing acute inpatient rehabilitation. Design: This is an observational cross-sectional retrospective study. Setting: Acute inpatient academic rehabilitation facility. Participants: Adult patients admitted to acute inpatient rehabilitation with functional impairments secondary to cancer. Methods: Electronic records were reviewed for thrombocytopenic patients with cancer to determine platelet counts, bleeding events during rehabilitation, and anticoagulant medications prescribed. Main outcomes measurements: Type and number of bleeding events, severity of bleeding by World Health Organization criteria. Results: Of the 278 patients with cancer admitted to acute rehabilitation over a 27-month time frame, 119 had at least one platelet count <150 000/µL. In all, 37 (31.1%) had a history of a bleeding event prior to the rehabilitation admission and 34 (28.6%) had at least one bleeding complication during their stay. Most events (87.5%) were of low grade (Grade 1 and 2 World Health Organization criteria). There was no association between platelet counts <11 000 or counts 11 000 to 20 000/µL and the occurrence of bleeding ( P = .106 and P = .319, respectively). Although anticoagulants were common, there was no association found with a bleeding event and either anticoagulation status (receiving or not on such agents), specific anticoagulant or antiplatelet agents, or a combination. Conclusions: Bleeding events in patients with cancer with thrombocytopenia during acute rehabilitation stay are not uncommon but are typically mild in severity and not associated with the degree of thrombocytopenia. Patients taking anticoagulants when platelet levels rose did experience bleeding events, but not at a statistically greater rate than those not taking such medications.
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Affiliation(s)
- Jacqueline Neal
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Physical Medicine and Rehabilitation, Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Samman Shahpar
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Rehabilitation Institute of Chicago, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Gayle Spill
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Rehabilitation Institute of Chicago, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Patrick Semik
- Rehabilitation Institute of Chicago, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Christina Marciniak
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Rehabilitation Institute of Chicago, Shirley Ryan AbilityLab, Chicago, IL, USA
- The Ken & Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Fu JB, Raj VS, Guo Y. A Guide to Inpatient Cancer Rehabilitation: Focusing on Patient Selection and Evidence-Based Outcomes. PM R 2017; 9:S324-S334. [PMID: 28942907 PMCID: PMC5736373 DOI: 10.1016/j.pmrj.2017.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 03/23/2017] [Accepted: 04/05/2017] [Indexed: 11/18/2022]
Abstract
Cancer inpatients commonly suffer from impairments that can prohibit safe discharge home from the acute care inpatient medical service and thus require transfer to a postacute inpatient rehabilitation facility. It has been demonstrated in multiple studies that cancer rehabilitation inpatients are able to make statistically significant functional improvements and at a similar pace as their noncancer counterparts. Medical fragility and reimbursement regulations are concerns that affect acceptance and triage of cancer rehabilitation inpatients. Strategies to rehabilitate these challenging patients include considering risk factors for medical complications, consult-based inpatient rehabilitation, and improved communication and coordination with oncology teams.
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Affiliation(s)
- Jack B Fu
- Department of Palliative, Rehabilitation & Integrative Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1414, Houston, TX 77030(∗).
| | - Vishwa S Raj
- Department of Physical Medicine & Rehabilitation, Carolinas Rehabilitation and Levine Cancer Institute, Charlotte, NC(†)
| | - Ying Guo
- Department of Palliative, Rehabilitation & Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX(‡)
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