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Mizutani K, Otaka Y, Kato M, Hayakawa M, Ozeki M, Maeda H, Hirano S, Mukaino M, Shibata S, Kagaya H, Sakurai H, Saitoh E. Functional outcomes in acute care settings vary by disease categories but show a consistent pattern of disability. Ann Phys Rehabil Med 2022; 66:101648. [PMID: 35219896 DOI: 10.1016/j.rehab.2022.101648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Koji Mizutani
- Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan; Graduate School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan.
| | - Masaki Kato
- Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan
| | - Miwako Hayakawa
- Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan
| | - Megumi Ozeki
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Hirofumi Maeda
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Satoshi Hirano
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Masahiko Mukaino
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Seiko Shibata
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Hitoshi Kagaya
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Hiroaki Sakurai
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
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Kinney AR, Graham JE, Bukhari R, Hoffman A, Malcolm MP. Activities of Daily Living Performance and Acute Care Occupational Therapy Utilization: Moderating Factors. Am J Occup Ther 2022; 76:23141. [PMID: 34997754 DOI: 10.5014/ajot.2022.049060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Hospitalized patients who have difficulty performing activities of daily living (ADLs) benefit from occupational therapy services; however, disparities in access to such services are understudied. OBJECTIVE To investigate whether need (i.e., limited ADL performance) predicts acute care occupational therapy utilization and whether this relationship differs across sociodemographic factors and insurance type. DESIGN A secondary analysis of electronic health records data. Logistic regression models were specified to determine whether ADL performance predicted use of occupational therapy treatment. Interactions were included to investigate whether the relationship between ADL performance and occupational therapy utilization varied across sociodemographic factors (e.g., age) and insurance type. PARTICIPANTS A total of 56,022 adults admitted to five regional hospitals between 2014 and 2018 who received an occupational therapy evaluation. INTERVENTION None. Outcomes and Measures: Occupational therapy service utilization, Activity Measure for Post-Acute Care "6-Clicks" measure of daily activity. RESULTS Forty-four percent of the patients evaluated for occupational therapy received treatment. Patients with lower ADL performance were more likely to receive occupational therapy treatment; however, interaction terms indicated that, among patients with low ADL performance, those who were younger, were White and non-Hispanic, had significant others, and had private insurance (vs. public) were more likely to receive treatment. These differences were smaller among patients with greater ADL performance. CONCLUSIONS AND RELEVANCE Greater need was positively associated with receiving occupational therapy services, but this relationship was moderated by age, minoritized status, significant other status, and insurance type. The findings provide direction for exploring determinants of disparities in occupational therapy utilization. What This Article Adds: Acute care occupational therapy utilization is driven partly by patient need, but potential disparities in access to beneficial services may exist across sociodemographic characteristics and insurance type. Identifying potential determinants of disparities in acute care occupational therapy utilization is the first step in developing strategies to reduce barriers for those in need.
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Affiliation(s)
- Adam R Kinney
- Adam R. Kinney, PhD, OTR/L, is Research Health Science Specialist, Rocky Mountain Mental Illness Research, Education, and Clinical Center, Department of Veterans Affairs, Aurora, CO, and Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora;
| | - James E Graham
- James E. Graham, PhD, DC, FACRM, is Professor, Department of Occupational Therapy, and Director, Center for Community Partnerships, Colorado State University, Fort Collins
| | - Rayyan Bukhari
- Rayyan Bukhari, MSOT, is PhD Student, Department of Occupational Therapy, Colorado State University, Fort Collins, and Lecturer, Department of Occupational Therapy, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Amanda Hoffman
- Amanda Hoffman, MSOT, OTR/L, BCPR, is Inpatient Rehabilitation Supervisor, UCHealth, University of Colorado Hospital, Anschutz Medical Campus, Aurora
| | - Matt P Malcolm
- Matt P. Malcolm, PhD, OTR/L, is Associate Professor and PhD Program Director, Department of Occupational Therapy, Colorado State University, Fort Collins, and Colorado School of Public Health, Colorado State University, Fort Collins
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Kinney AR, Graham JE, Bukhari R, Hoffman A, Malcolm MP. Activities of Daily Living Performance and Acute Care Occupational Therapy Utilization: Moderating Factors. Am J Occup Ther 2022; 76:23139. [PMID: 34990509 DOI: 10.5014/ajot.121.049060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Hospitalized patients who have difficulty performing activities of daily living (ADLs) benefit from occupational therapy services; however, disparities in access to such services are understudied. OBJECTIVE To investigate whether need (i.e., limited ADL performance) predicts acute care occupational therapy utilization and whether this relationship differs across sociodemographic factors and insurance type. DESIGN A secondary analysis of electronic health records data. Logistic regression models were specified to determine whether ADL performance predicted use of occupational therapy treatment. Interactions were included to investigate whether the relationship between ADL performance and occupational therapy utilization varied across sociodemographic factors (e.g., age) and insurance type. PARTICIPANTS A total of 56,022 adults admitted to five regional hospitals between 2014 and 2018 who received an occupational therapy evaluation. INTERVENTION None. Outcomes and Measures: Occupational therapy service utilization, Activity Measure for Post-Acute Care "6-Clicks" measure of daily activity. RESULTS Forty-four percent of the patients evaluated for occupational therapy received treatment. Patients with lower ADL performance were more likely to receive occupational therapy treatment; however, interaction terms indicated that, among patients with low ADL performance, those who were younger, were White and non-Hispanic, had significant others, and had private insurance (vs. public) were more likely to receive treatment. These differences were smaller among patients with greater ADL performance. CONCLUSIONS AND RELEVANCE Greater need was positively associated with receiving occupational therapy services, but this relationship was moderated by age, minoritized status, significant other status, and insurance type. The findings provide direction for exploring determinants of disparities in occupational therapy utilization. What This Article Adds: Acute care occupational therapy utilization is driven partly by patient need, but potential disparities in access to beneficial services may exist across sociodemographic characteristics and insurance type. Identifying potential determinants of disparities in acute care occupational therapy utilization is the first step in developing strategies to reduce barriers for those in need.
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Affiliation(s)
- Adam R Kinney
- Adam R. Kinney, PhD, OTR/L, is Research Health Science Specialist, Rocky Mountain Mental Illness Research, Education, and Clinical Center, Department of Veterans Affairs, Aurora, CO, and Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora;
| | - James E Graham
- James E. Graham, PhD, DC, FACRM, is Professor, Department of Occupational Therapy, and Director, Center for Community Partnerships, Colorado State University, Fort Collins
| | - Rayyan Bukhari
- Rayyan Bukhari, MSOT, is PhD Student, Department of Occupational Therapy, Colorado State University, Fort Collins, and Lecturer, Department of Occupational Therapy, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Amanda Hoffman
- Amanda Hoffman, MSOT, OTR/L, BCPR, is Inpatient Rehabilitation Supervisor, UCHealth, University of Colorado Hospital, Anschutz Medical Campus, Aurora
| | - Matt P Malcolm
- Matt P. Malcolm, PhD, OTR/L, is Associate Professor and PhD Program Director, Department of Occupational Therapy, Colorado State University, Fort Collins, and Colorado School of Public Health, Colorado State University, Fort Collins
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Jen HJ, Kao CM, Chang KH, Yen CF, Liao HF, Chi WC, Chung WK, Liou TH. Assessment of functioning using the WHODAS 2.0 among people with stroke in Taiwan: A 4-year follow-up study. Ann Phys Rehabil Med 2021; 64:101442. [PMID: 33069868 DOI: 10.1016/j.rehab.2020.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 09/16/2020] [Accepted: 09/19/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Stroke is a leading cause of long-term disability and is considered a major global health burden. OBJECTIVES We aimed to explore the 4-year changes in disability among patients with stroke under the existing health care system in Taiwan. METHODS We used the "Taiwan Data Bank of Persons with Disability" (TDPD), which collects data on candidates nationwide who want to apply for government benefits or social welfare. We included adults>18 years with stroke who were registered between July 11, 2012 and October 31, 2018. This was a longitudinal follow-up study with 2 times of assessments. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) was used to evaluate function initially and at 4-year follow-up. Generalized estimating equations (GEE) were used to analyse changes in disability over 4 years and interaction effects. RESULTS A total of 3506 participants (2080 men) with mean age 62.2 (12.5) years and followed up for more than 4 years were included. Generally, participants with stroke showed improved function over the 4 years. Domain scores of mobility, participation, life activities, and overall score significant improved from 55.9 to 54.3, 53.0 to 43.6, 70.9 to 67.4, and 49.8 to 47.3, respectively (P<0.05). With respect to upper- and lower-limb motor deficiency, participants who required assistance or who were dependent showed significant improvement (P<0.05) in most of the WHODAS 2.0 domains except cognition. Younger patients (<65 years) tended to have significantly better outcomes, and institutionalized residents tended to show a significant and considerable deterioration in all WHODAS 2.0 domains. CONCLUSION Participants with stroke showed an improvement in levels of functioning, specifically in mobility, participation, and life activities, over 4 years of follow-up.
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Affiliation(s)
- Hsiu-Ju Jen
- Department of nursing, Taipei medical university, Shuang Ho hospital, New Taipei, Taiwan; School of nursing, college of nursing, Taipei medical university, Taipei, Taiwan.
| | - Chia-Man Kao
- Department of nursing, Taipei medical university, Shuang Ho hospital, New Taipei, Taiwan.
| | - Kwang-Hwa Chang
- Department of physical medicine and rehabilitation, school of medicine, college of medicine, Taipei medical university, Taipei, Taiwan; Graduate institute of injury prevention and control, college of public health, Taipei medical university, Taipei, Taiwan; Department of physical medicine and rehabilitation, Taipei medical university, Wan Fang hospital, Taipei, Taiwan.
| | - Chia-Feng Yen
- Department of public health, Tzu Chi university, Hualien, Taiwan.
| | - Hua-Fang Liao
- Taiwan Society of International Classification of Functioning, Disability and Health, Taipei, Taiwan; School and graduate institute of physical therapy, college of medicine, National Taiwan university, Taipei, Taiwan.
| | - Wen-Chou Chi
- Department of occupational therapy, Chung Shan medical university, Taichung, Taiwan.
| | - Wen-Kuei Chung
- Department of physical medicine and rehabilitation, Taipei medical university, Wan Fang hospital, Taipei, Taiwan.
| | - Tsan-Hon Liou
- Department of physical medicine and rehabilitation, school of medicine, college of medicine, Taipei medical university, Taipei, Taiwan; Taiwan Society of International Classification of Functioning, Disability and Health, Taipei, Taiwan.
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The Relationship Between Fall Risk and Hospital-Based Therapy Utilization Is Moderated by Demographic Characteristics and Insurance Type. Arch Phys Med Rehabil 2020; 102:1124-1133. [PMID: 33373599 DOI: 10.1016/j.apmr.2020.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate whether indicators of patient need (comorbidity burden, fall risk) predict acute care rehabilitation utilization, and whether this relation varies across patient characteristics (ie, demographic characteristics, insurance type). DESIGN Secondary analysis of electronic health records data. SETTING Five acute care hospitals. PARTICIPANTS Adults (N=110,209) admitted to 5 regional hospitals between 2014 and 2018. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Occupational therapy (OT) and physical therapy (PT) utilization. Logistic regression models determined whether indicators of patient need predicted OT and PT utilization. Interactions between indicators of need and both demographic factors (eg, minority status, presence of significant other) and insurance type were included to investigate whether the relation between patient need and therapy access varied across patient characteristics. RESULTS Greater comorbidity burden was associated with a higher likelihood of receiving OT and PT. Relative to those with low fall risk, those with moderate and high fall risk were more likely to receive OT and PT. The relation between fall risk and therapy utilization differed across patient characteristics. Among patients with higher levels of fall risk, those with a significant other were less likely to receive OT and PT; significant other status did not explain therapy utilization among patients with low fall risk. Among those with high fall risk, patients with VA insurance and minority patients were more likely to receive PT than those with private insurance and nonminority patients, respectively. Insurance type and minority status did not appear to explain PT utilization among those with lower fall risk. CONCLUSIONS Patients with greater comorbidity burden and fall risk were more likely to receive acute care rehabilitation. However, the relation between fall risk and utilization was moderated by insurance type, having a significant other, and race/ethnicity. Understanding the implications of these utilization patterns requires further research.
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Léotard A, Levy J, Pérennou D, Pépin JL, Lofaso F, Bensmail D, Lebret M, Baillieul S. Sleep might have a pivotal role in rehabilitation medicine: A road map for care improvement and clinical research. Ann Phys Rehabil Med 2020; 64:101392. [PMID: 32445976 DOI: 10.1016/j.rehab.2020.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/31/2020] [Accepted: 04/13/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Antoine Léotard
- Département de physiologie, explorations fonctionnelles, unité des pathologies du sommeil, AP-HP, Hôpital Raymond-Poincaré, 104, boulevard Raymond-Poincaré, 92380 Garches, France; Université Versailles-Saint-Quentin-en-Yvelines, "End:icap" U1179 Inserm, UFR Des sciences de la sante-Simone-Veil, Versailles, France; Sleep Lab Initiative In PMR group (SLIIP), Garches, France.
| | - Jonathan Levy
- Service de médecine physique et de réadaptation, Hôpital Raymond Poincaré, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France; Université Versailles-Saint-Quentin-en-Yvelines, "End:icap" U1179 Inserm, UFR Des sciences de la sante-Simone-Veil, Versailles, France; Sleep Lab Initiative In PMR group (SLIIP), Garches, France
| | - Dominic Pérennou
- Département de Rééducation Neurologique, CHU Grenoble Alpes, Grenoble, France; Laboratoire Psychologie et Neurocognition (LPNC), Univ Grenoble Alpes, Grenoble, 38000, Grenoble, France
| | - Jean-Louis Pépin
- HP2, Inserm U1042, Univ Grenoble Alpes, Grenoble, 38000 France; Laboratoire Sommeil et exercice, pole thorax-vaisseaux, CHU Grenoble Alpes, Grenoble, France
| | - Frédéric Lofaso
- Département de physiologie, explorations fonctionnelles, unité des pathologies du sommeil, AP-HP, Hôpital Raymond-Poincaré, 104, boulevard Raymond-Poincaré, 92380 Garches, France; Université Versailles-Saint-Quentin-en-Yvelines, "End:icap" U1179 Inserm, UFR Des sciences de la sante-Simone-Veil, Versailles, France
| | - Djamel Bensmail
- Service de médecine physique et de réadaptation, Hôpital Raymond Poincaré, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France
| | - Marius Lebret
- Groupe de recherche en hypertension pulmonaire, Institut universitaire de cardiologie et de pneumologie de Québec, 2725, Chemin Sainte-Foy, G1V 4G5 Québec, Canada; Sleep Lab Initiative In PMR group (SLIIP), Garches, France
| | - Sebastien Baillieul
- HP2, Inserm U1042, Univ Grenoble Alpes, Grenoble, 38000 France; Laboratoire Sommeil et exercice, pole thorax-vaisseaux, CHU Grenoble Alpes, Grenoble, France; Sleep Lab Initiative In PMR group (SLIIP), Garches, France
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Valenzuela PL, Joyner M, Lucia A. Early mobilization in hospitalized patients with COVID-19. Ann Phys Rehabil Med 2020; 63:384-385. [PMID: 32418848 PMCID: PMC7231737 DOI: 10.1016/j.rehab.2020.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 04/26/2020] [Accepted: 04/26/2020] [Indexed: 01/17/2023]
Affiliation(s)
| | - Michel Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Research Institute of the Hospital 12 de Octubre ('imas12'), Madrid, Spain.
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Dai S, Dieterich K, Jaeger M, Wuyam B, Jouk PS, Pérennou D. Disability in adults with arthrogryposis is severe, partly invisible, and varies by genotype. Neurology 2018; 90:e1596-e1604. [DOI: 10.1212/wnl.0000000000005418] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 02/07/2018] [Indexed: 01/05/2023] Open
Abstract
ObjectiveTo understand the disability of adults with arthrogryposis multiplex congenita (AMC), a rare disease spectrum characterized by at least 2 joint contractures at birth in different body areas.MethodsThis is a retrospective analysis of data for unselected persons with AMC referred to the French center for adults with AMC from 2010 to 2016. All underwent a pluriprofessional systematic and comprehensive investigation of deficits, activity limitation, and participation restriction according to the International Classification of Functioning, Disability and Health and genetic analysis when indicated. Participants were divided by amyoplasia and other AMC types.ResultsMean (SD) age of the 43 participants (27 female) was 33.2 (13.4) years; 28 had amyoplasia and 15 other types of AMC. Beyond joint stiffness, deformities, and muscle weakness, the well-known core symptoms that we quantified and for which first-line treatment involved technical aids, other less visible disorders that could contribute to severe participation restriction were particularly pain and psychological problems including anxiety, fatigue, difficulty in sexual life, altered self-esteem, and feelings of solitude. Severe respiratory disorders were infrequent and were linked to PIEZO2 mutations. Gait disorders were not due to respiratory impairment but to skeletal problems and were always associated with amyoplasia when severe. Functional independence was worse but respiratory and swallowing capacities were better with amyoplasia than other AMC types.ConclusionThis study describes disability patterns of a cohort of adults with AMC by genotype. The disability of adults with AMC is influenced by genotype, with important invisible disability.
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