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McCrary HC, Dunklebarger MF, Fechter BJ, Drejet SM, Monroe MM, Buchmann LO, Hunt JP, Cannon RB. Early ambulation after fibular free flap surgery is associated with reduced length of stay, increased mobility independence, and discharge to home. Head Neck 2024; 46:1160-1167. [PMID: 38494924 DOI: 10.1002/hed.27737] [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: 01/01/2024] [Revised: 03/03/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Fibula free flaps (FFF) are one of the most common bony flaps utilized. This paper describes a quality improvement project aimed at increasing early ambulation. METHODS A review of FFF patients at an academic hospital was completed (2014-2023). In 2018, an institutional change to encourage early ambulation without placement of a boot was made. Changes in hospital disposition and physical therapy outcomes were evaluated. RESULTS A total of 168 patients underwent FFF reconstruction. There was a statistically significant lower length of stay in Group 2 (early ambulation, no boot) (8.1 vs. 9.4; p = 0.04). A higher rate of discharge to a skilled nursing facility was noted in Group 1 (delayed ambulation with boot) (21.3% vs. 11.9%; p = 0.009). A higher proportion of patients in Group 2 demonstrated independence during bed mobility, transfers, and gait (p < 0.05). CONCLUSIONS Early ambulation without boot placement after FFF is associated with decreased length of hospital stay, improved disposition to home and physical therapy outcomes.
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Affiliation(s)
- Hilary C McCrary
- Department of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Mitchell F Dunklebarger
- Department of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Brett J Fechter
- Huntsman Cancer Hospital Rehab Therapy Services, Salt Lake City, Utah, USA
| | - Sarah M Drejet
- Department of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Marcus M Monroe
- Department of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Luke O Buchmann
- Department of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Jason P Hunt
- Department of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Richard B Cannon
- Department of Otolaryngology - Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
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Strauss DH, Davoodi NM, Resnik LJ, Keene S, Serina PT, Goldberg EM. Emergency Department-Based Physical Function Measures for Falls in Older Adults and Outcomes: A Secondary Analysis of GAPcare. J Geriatr Phys Ther 2024:00139143-990000000-00048. [PMID: 38656264 DOI: 10.1519/jpt.0000000000000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND PURPOSE Falls are the leading reason for injury-related emergency department (ED) visits for older adults. The Geriatric Acute and Post-acute Fall Prevention Intervention (GAPcare), an in-ED intervention combining a medication therapy management session delivered by a pharmacist and a fall risk assessment and plan by a physical therapist, reduced ED revisits at 6 months among older adults presenting after a fall. Our objective was to evaluate the relationship between measures of function obtained in the ED and clinical outcomes. METHODS This was a secondary analysis of data from GAPcare, a randomized controlled trial conducted from January 2018 to October 2019 at 2 urban academic EDs. Standardized measures of function (Timed Up and Go [TUG] test, Barthel Activity of Daily Living [ADL], Activity Measure for Post Acute Care [AM-PAC] 6 clicks) were collected at the ED index visit. We performed a descriptive analysis and hypothesis testing (chi square test and analysis of variance) to assess the relationship of functional measures with outcomes (ED disposition, ED revisits for falls, and place of residence at 6 months). Emergency department disposition status refers to discharge location immediately after the ED evaluation is complete (eg, hospital admission, original residence, skilled nursing facility). RESULTS AND DISCUSSION Among 110 participants, 55 were randomized to the GAPcare intervention and 55 received usual care. Of those randomized to the intervention, 46 received physical therapy consultation. Median age was 81 years; participants were predominantly women (67%) and White (94%). Seventy-three (66%) were discharged to their original residence, 14 (13%) were discharged to a skilled nursing facility and 22 (20%) were admitted. There was no difference in ED disposition status by index visit Barthel ADLs (P = .371); however, TUG times were faster (P = .016), and AM-PAC 6 clicks score was higher among participants discharged to their original residence (P ≤ .001). Participants with slower TUG times at the index ED visit were more likely to reside in nursing homes by six months (P = .002), while Barthel ADL and AM-PAC 6 clicks did not differ between those residing at home and other settings. CONCLUSIONS Measures of function collected at the index ED visit, such as the AM-PAC 6 clicks and TUG time, may be helpful at predicting clinical outcomes for older adults presenting for a fall. Based on our study findings, we suggest a novel workflow to guide the use of these clinical measures for ED patients with falls.
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Affiliation(s)
- Daniel H Strauss
- Department of Emergency Medicine, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Natalie M Davoodi
- Department of Emergency Medicine, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Linda J Resnik
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
- Research Department, Providence VA Medical Center, Providence, Rhode Island
| | - Sarah Keene
- Department of Emergency Medicine, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Peter T Serina
- Department of Emergency Medicine, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island
| | - Elizabeth M Goldberg
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
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Tuohy S, Schwartz-Dillard J, McInerney D, Nguyen J, Edwards D. RAPT and AM-PAC "6-Clicks": Do They Correlate on Predicting Discharge Destination After Total Joint Arthroplasty? HSS J 2024; 20:29-34. [PMID: 38356744 PMCID: PMC10863584 DOI: 10.1177/15563316231211318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 02/16/2024]
Abstract
Background: The Risk Assessment and Prediction Tool (RAPT) and the Activity Measure for Post-Acute Care "6-Clicks" Mobility Score (AM-PAC) are validated discharge planning tools for patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). Planning for discharge with these tools considers very different factors and it is important to determine if they relate. Purpose: We sought to determine whether the preoperative RAPT score would correlate with postoperative AM-PAC score for predicting discharge destination for THA and TKA populations. Secondarily, we sought to examine whether the AM-PAC and RAPT scores would remain statistically significant predictors of discharge destination despite covariates. Methods: A retrospective cohort study was performed for patients who underwent THA or TKA from January 2020 to December 2022 at a specialty orthopedic hospital. Primary variables included the RAPT score, the AM-PAC score, and discharge disposition. Correlation between AM-PAC and RAPT scores was tested using Pearson's correlation coefficient, and association between both scores and discharge destination was tested using chi-square tests and multivariable logistic regression. Results: Our comparison of AM-PAC scores and RAPT scores found a statistically significant, positive correlation in both THA and TKA patients. Regression analysis found that increased RAPT and AM-PAC scores resulted in higher odds of being discharged home for both populations, after adjusting for all other variables. In both cohorts, patients discharged to a facility were more likely to be female, be over the age of 70 years, have Medicare/Medicaid insurance, and have a higher number of preoperative social work visits or any incidence of an intraoperative or hospital complication. Conclusions: This retrospective study found that RAPT score correlated with AM-PAC score for predicting discharge destination for elective THA and TKA populations, suggesting that these scores may be predictors of home discharge destination even when accounting for covariates. Further study is recommended.
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Affiliation(s)
- Sharlynn Tuohy
- Rehabilitation and Performance, Hospital for Special Surgery, New York, NY, USA
| | | | - Danielle McInerney
- Rehabilitation and Performance, Hospital for Special Surgery, New York, NY, USA
| | - Joseph Nguyen
- Rehabilitation and Performance, Hospital for Special Surgery, New York, NY, USA
| | - Danielle Edwards
- Rehabilitation and Performance, Hospital for Special Surgery, New York, NY, USA
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Rauzi MR, Ridgeway KJ, Wilson MP, Jolley SE, Nordon-Craft A, Stevens-Lapsley JE, Erlandson KM. Rehabilitation Therapy Allocation and Changes in Physical Function Among Patients Hospitalized Due to COVID-19: A Retrospective Cohort Analysis. Phys Ther 2023; 103:pzad007. [PMID: 37172130 PMCID: PMC10071586 DOI: 10.1093/ptj/pzad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/03/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Limited staffing and initial transmission concerns have limited rehabilitation services during the COVID-19 pandemic. The purpose of this analysis was to determine the associations between Activity Measure for Post-Acute Care (AM-PAC) mobility categories and allocation of rehabilitation, and in-hospital AM-PAC score change and receipt of rehabilitation services for patients with COVID-19. METHODS This was a retrospective cohort study of electronic health record data from 1 urban hospital, including adults with a COVID-19 diagnosis, admitted August 2020 to April 2021. Patients were stratified by level of medical care (intensive care unit [ICU] and floor). Therapy allocation (referral for rehabilitation, receipt of rehabilitation, and visit frequency) was the primary outcome; change in AM-PAC score was secondary. AM-PAC Basic Mobility categories (None [21-24], Minimum [18-21], Moderate [10-17], and Maximum [6-9]) were the main predictor variable. Primary analysis included logistic and linear regression, adjusted for covariates. RESULTS A total of 1397 patients (ICU: n = 360; floor: n = 1037) were included. AM-PAC mobility category was associated with therapy allocation outcomes for floor but not patients in the ICU: the Moderate category had greater adjusted odds of referral (adjusted odds ratio [aOR] = 10.88; 95% CI = 5.71-21.91), receipt of at least 1 visit (aOR = 3.45; 95% CI = 1.51-8.55), and visit frequency (percentage mean difference) (aOR = 42.14; 95% CI = 12.45-79.67). The secondary outcome of AM-PAC score improvement was highest for patients in the ICU who were given at least 1 rehabilitation therapy visit (aOR = 5.31; 95% CI = 1.90-15.52). CONCLUSION AM-PAC mobility categories were associated with rehabilitation allocation outcomes for floor patients. AM-PAC score improvement was highest among patients requiring ICU-level care with at least 1 rehabilitation therapy visit. IMPACT Use of AM-PAC Basic Mobility categories may help improve decisions for rehabilitation therapy allocation among patients who do not require critical care, particularly during times of limited resources.
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Affiliation(s)
- Michelle R Rauzi
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado USA
| | - Kyle J Ridgeway
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado USA
- Inpatient Rehabilitation Therapy Department, University of Colorado Hospital, University of Colorado Health, Aurora, Colorado, USA
| | - Melissa P Wilson
- Department of Biomedical Informatics, University of Colorado, Aurora, Colorado, USA
| | - Sarah E Jolley
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Amy Nordon-Craft
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado USA
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Kristine M Erlandson
- Division of Infectious Diseases, Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
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Coakley K, Friedman L, McLoughlin K, Wozniak A, Hutchison P. Acute Occupational and Physical Therapy for Patients With COVID-19: A Retrospective Cohort Study. Arch Phys Med Rehabil 2023; 104:27-33. [PMID: 35926570 PMCID: PMC9340124 DOI: 10.1016/j.apmr.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/24/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To describe the function of patients with COVID-19 admitted to an acute care hospital early in the pandemic and to characterize change in function among those admitted to intensive care units (ICU) and to non-critical care services. DESIGN This descriptive, retrospective cohort study examined patients infected with SARS-CoV-2 admitted to a tertiary care medical center during the first wave of the pandemic in 2020. Included patients were stratified into 4 cohorts based on whether or not they received therapy during their hospitalization and whether or not their hospitalization included time in the ICU. Data on demographic characteristics, functional impairments, medical interventions, and functional outcomes were collected. SETTING Hospital. PARTICIPANTS 432 adult patients were included in this study (N=432). RESULTS ICU patients receiving therapy were more likely to have impaired cognition, impaired strength, and impaired sensation than non-ICU patients receiving therapy. Patients made improvements from evaluation to discharge on the Functional Status Score for the ICU, Activity Measure for Post-Acute Care Daily Activity, and AM-PAC Basic Mobility Short Forms. CONCLUSION Patients admitted with COVID-19 experienced significant functional impairments but also demonstrated improvement during the course of their hospitalizations. This study can facilitate health care provider awareness of the detrimental functional effects of COVID-19 and the potential role of rehabilitation services for these patients.
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Affiliation(s)
- Katie Coakley
- Corresponding author Katie Coakley, OTR/L, Loyola University Medical Center, Maywood, IL
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Schmerler J, Mo KC, Olson J, Kurian SJ, Skolasky RL, Kebaish KM, Neuman BJ. Preoperative characteristics are associated with increased likelihood of low early postoperative mobility after adult spinal deformity surgery. Spine J 2022; 23:746-753. [PMID: 36509380 DOI: 10.1016/j.spinee.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/12/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND CONTEXT Low early postoperative mobility (LEPOM) has been shown to be associated with increased length of hospital stay, complication rates, and likelihood of nonhome discharge. However, few studies have examined preoperative characteristics associated with LEPOM in adult spinal deformity (ASD) patients. PURPOSE To investigate which preoperative patient characteristics may be associated with LEPOM after ASD surgery. DESIGN Retrospective review. PATIENT SAMPLE Included were 86 ASD patients with fusion of ≥5 levels for whom immediate-postoperative AM-PAC Basic Mobility Inpatient Short Form (6-Clicks) scores had been obtained. OUTCOME MEASURES The primary outcome of this study was the likelihood of LEPOM, defined as an AM-PAC score ≤15, which is associated with inability to stand for more than 1 minute. METHODS Significant cutoffs for preoperative characteristics associated with LEPOM were determined via threshold linear regression. Multivariable logistic regression was used to assess the impact of preoperative characteristics on the likelihood of LEPOM. RESULTS LEPOM was recorded in 38 patients (44.2%). Threshold regression identified the following cutoffs to be associated with LEPOM: preoperative Patient Reported Outcomes Measurement Information System (PROMIS) scores of ≥68 for Pain, <28.3 for Physical Function, and ≥63.4 for Anxiety; preoperative Oswestry disability index (ODI) score of ≥60; and body mass index (BMI) of ≥35.2. On multivariate analysis, preoperative PROMIS scores of ≥68 for Pain (odds ratio [OR] 5.3, confidence interval [CI] 1.2-22.8, p=.03), <28.3 for Physical Function (OR 10.1, CI 1.8-58.2, p=.01), and ≥63.4 for Anxiety (OR 4.7, CI 1.1-20.8, p=.04); preoperative ODI score ≥60 (OR 38.8, CI 4.0-373.6, p=.002); BMI ≥35.2 (OR 14.2, CI 1.3-160.0, p=.03), and male sex (OR 5.4, CI 1.2-23.7, p=.03) were associated with increased odds of LEPOM. CONCLUSIONS Preoperative PROMIS Pain, Physical Function, and Anxiety scores; ODI score; BMI; and male sex were associated with LEPOM. Several of these characteristics are modifiable risk factors and thus may be candidates for optimization before surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jessica Schmerler
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kevin C Mo
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jarod Olson
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shyam J Kurian
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard L Skolasky
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brian J Neuman
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Tennison JM, Asher A, Hui D, Javle M, Bassett RL, Bruera E. Palliative Rehabilitation in Acute Inpatient Rehabilitation: Prognostic Factors and Functional Outcomes in Patients with Cancer. Oncologist 2022; 28:180-186. [PMID: 36367387 PMCID: PMC9907049 DOI: 10.1093/oncolo/oyac229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Prognosis has a vital role for patients with cancer undergoing palliative rehabilitation in acute inpatient rehabilitation. This study aimed to identify the proportion of patients who survived <2 months after discharge and the associated prognostic factors. MATERIALS AND METHODS This was a secondary analysis of a retrospective study of 163 consecutive patients admitted to acute inpatient rehabilitation from September 1, 2017, to February 28, 2018 at a cancer center. Baseline demographics, clinical characteristics, and putative prognostic factors, including Activity Measure for Post-Acute Care (AM-PAC) functional scores, were analyzed. RESULTS Of 163 patients, 27 (17%; 95% CI, 11-23) died within 60 days of discharge. These patients were more likely to be male (OR = 2.83; 95% CI, 1.16-6.92; P = .017); have longer hospital stays (OR = 1.02; 95% CI, 1-1.04; P = .015); receive ≥ weekly packed red blood cell (OR = 5.31; 95% CI, 1.86-15.1; P = .003) or platelet (OR = 4.57; 95% CI, 1.44-14.5; P = .014) transfusions; have lower AM-PAC daily activity scores upon discharge (OR = 0.90; 95% CI, 0.83-0.97; P = .006); and have lower AM-PAC basic mobility scores upon admission (OR = 0.91; 95% CI, 0.85-0.98; P = .018) and discharge (OR = 0.88; 95% CI, 0.82-0.94; P = <.001). Multivariate analysis showed that the male sex (OR = 2.71; 95% CI, 1.03-7.15; P = .037) was independently associated with ≤2 months survival, whereas AM-PAC basic mobility score at admission of >33 (OR = 0.24, 95% CI, 0.07-0.79; P = .022) was less likely. CONCLUSION Approximately 1 in 6 patients who completed acute inpatient rehabilitation died within 2 months of discharge, had poorer baseline functional status, and were less likely to regain function than those who lived longer.
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Affiliation(s)
- Jegy M Tennison
- Corresponding author: Jegy M. Tennison, MD, Department of Palliative, Rehabilitation, and Integrative Medicine, Unit 1414, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Tel: +1 713 745 2327; Fax: +1 713 792 6092;
| | - Arash Asher
- Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - David Hui
- Section of Palliative Medicine, Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Milind Javle
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roland L Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Section of Palliative Medicine, Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Mo KC, Schmerler J, Olson J, Musharbash FN, Kebaish KM, Skolasky RL, Neuman BJ. AM-PAC mobility scores predict non-home discharge following adult spinal deformity surgery. Spine J 2022; 22:1884-1892. [PMID: 35870798 DOI: 10.1016/j.spinee.2022.07.093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/26/2022] [Accepted: 07/14/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Adult spinal deformity (ASD) surgery requires an extended recovery period and often non-routine discharge. The Activity Measure for Post-Acute Care (AM-PAC) Basic Mobility Inpatient Short Form (6-Clicks) is a prediction tool, validated for other orthopedic procedures, to assess a patient's ability to mobilize after surgery. PURPOSE To assess the thresholds of AM-PAC scores that determine non-home discharge disposition in patients who have undergone ASD surgery. STUDY DESIGN Retrospective review PATIENT SAMPLE: Ninety consecutive ASD patients with ≥5 levels fused who underwent surgery from 2015 to 2018, with postoperative AM-PAC scores measured before discharge, were included. OUTCOME MEASURES Non-home discharge disposition METHODS: Patients with routine home discharge were compared to those with non-home discharge. Bivariate analysis was first conducted to compare these groups by preoperative demographics, comorbidities, radiographic alignment, surgical characteristics, HRQOLs, and AM-PAC measurements. Threshold linear regression with Bayesian information criteria was utilized to identify the optimal cutoffs for AM-PAC scores associated with increased likelihood of non-home discharge. Finally, multivariable analysis controlling for age, sex, comorbidities, levels fused, perioperative complication, and home support was conducted to assess each threshold. RESULTS Thirty-six (40%) of 90 patients analyzed had non-home discharge. On bivariate analysis, first AM-PAC score (13.5 vs. 17), last AM-PAC score (17 vs. 20), and AM-PAC change per day (+.387 vs. +1) were all significantly associated with non-home discharge. Threshold regression identified that cutoffs of ≤15 for first AM-PAC score, <17 for last AM-PAC score, and <+0.625 for daily AM-PAC change were associated with non-home discharge. On multivariable analysis, first AM-PAC score ≤15 (odds ratio [OR] 11.28; confidence interval [CI] 2.96-42.99; p<.001), last AM-PAC score <17 (OR 33.57; CI 5.85-192.82; p<.001), and AM-PAC change per day <+0.625 (OR 6.24; CI 2.01-19.43; p<.001) were all associated with increased odds of non-home discharge. CONCLUSIONS First AM-PAC score of 15 or less can help predict non-home discharge. A goal of daily AM-PAC increases of 0.625 points toward a final AM-PAC score of 17 can aid in achieving home discharge. The early AM-PAC mobility threshold of ≤15 may help prepare for non-home discharge, while AM-PAC daily changes per day <0.625 and final AM-PAC <17 may provide goals for mobility improvement during the early postoperative period in order to prevent non-home discharge.
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Affiliation(s)
- Kevin C Mo
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline St, JHOC 5241, Baltimore, MD 21287, USA
| | - Jessica Schmerler
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline St, JHOC 5241, Baltimore, MD 21287, USA
| | - Jarod Olson
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline St, JHOC 5241, Baltimore, MD 21287, USA
| | - Farah N Musharbash
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline St, JHOC 5241, Baltimore, MD 21287, USA
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline St, JHOC 5241, Baltimore, MD 21287, USA
| | - Richard L Skolasky
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline St, JHOC 5241, Baltimore, MD 21287, USA
| | - Brian J Neuman
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline St, JHOC 5241, Baltimore, MD 21287, USA.
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The Predictive Validity of Functional Outcome Measures With Discharge Destination for Hospitalized Medical Patients. Arch Rehabil Res Clin Transl 2022; 4:100231. [PMID: 36545519 PMCID: PMC9761250 DOI: 10.1016/j.arrct.2022.100231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective To investigate the predictive validity for discharge to home or facility of 4 functional mobility outcome measures. Design Retrospective, observational study. Setting Urban, academic hospital in the United States. Participants Adult patients (N=3999) admitted to medical units between June 1, 2019, and February 29, 2020, with 2 or more recorded scores on each of 4 tools: Activity Measure for Post-Acute Care (AM-PAC) 6-Clicks Basic Mobility and Daily Activity, Henry Ford Mobility Level, and The Johns Hopkins Highest Level of Mobility. Interventions Not applicable. Main Outcome Measures Mobility scores and discharge destination. Results For the 3999 subjects, 51.4% went home at discharge and had higher mean scores on each measure than those not returning home. Both early (I) and later (II) time point for each measure had positive predictability for discharge home. AM-PAC 6-Clicks had the highest confidence intervals for early and later recorded scores. The c-statistic value for Basic Mobility I (cut point=16) was 0.74 and for II (cut point=18) was, 0.79. The value for Daily Activity I (cut point=18) was 0.75 and for Daily Activity II (cut point=18) was 0.80). The Johns Hopkins Highest Level of Mobility and Henry Ford Mobility Level measures were less discriminative at initial score (c-statistic 0.704 and 0.665, respectively) and final score (c-statistic 0.74 and 0.75, respectively). Conclusions Functional outcome measures have good predictive validity for discharge destination. The AM-PAC Basic mobility score appears to have a slightly higher confidence interval than the other tools in this study design.
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Herbold J, Rajaraman D, Taylor S, Agayby K, Babyar S. Activity Measure for Post-Acute Care “6-Clicks” Basic Mobility Scores Predict Discharge Destination After Acute Care Hospitalization in Select Patient Groups: A Retrospective, Observational Study. Arch Rehabil Res Clin Transl 2022; 4:100204. [PMID: 36123982 PMCID: PMC9482026 DOI: 10.1016/j.arrct.2022.100204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A standardized Basic Mobility score of 42.9 predicts home vs institution discharge. Orthopedic diagnoses may have a cutoff score of 41.5 to predict home discharge. Cutoff scores vary by diagnostic group and discharge destination. Cutoff scores vary by time of assessment relative to admission for some diagnoses.
Objectives To establish cutoff scores for the Activity Measure for Post-Acute Care “6-Clicks” standardized Basic Mobility scores (sBMSs) for predicting discharge destination after acute care hospitalization for diagnostic subgroups within an acute care population and to evaluate the need for a second score to improve predictive ability. Design Retrospective, observational design. Setting Major medical center in metropolitan area. Participants Electronic medical records of 1696 adult patients (>18 years) admitted to acute care from January to October 2018. Records were stratified by orthopedic, cardiac, pulmonary, stroke, and other neurological diagnoses (N=1696). Interventions: None Main Outcome Measure Physical therapists scored patients’ sBMSs after referral for physical therapy and prior to discharge. Receiver operating characteristic curves delineated sBMS cutoff scores distinguishing various pairings of home, home with services, inpatient rehabilitation, or skilled nursing facility discharges. First and second sBMSs were compared with percentage change of the area under the curve and inferential statistics. Results Home vs institution cutoff score was 42.88 for combined sample, pulmonary and neurological cases. The cutoff score for orthopedic diagnoses score was 41.46. Cardiac and stroke model quality invalidated cutoff scores. Home without services vs skilled nursing discharges and home with services vs skilled nursing discharges were predicted with varying cutoff scores per diagnosis. sBMS cutoff scores collected closer to discharge were either the same or higher than first cutoffs, with varying effects on predictive ability. Conclusions sBMSs can help decide institution vs home discharge and finer distinctions among discharge settings for some diagnostic groups. A single sBMS may provide sufficient assistance with discharge destination decisions but timing of scoring and diagnostic group may influence cutoff score selection.
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Affiliation(s)
- Janet Herbold
- Post Acute Services, Burke Rehabilitation Hospital, White Plains, NY
| | - Divya Rajaraman
- Department of Physical Therapy, Hunter College, The City University of New York, New York, NY
| | - Sarah Taylor
- Department of Physical Therapy, Hunter College, The City University of New York, New York, NY
| | - Kirollos Agayby
- Department of Physical Therapy, Hunter College, The City University of New York, New York, NY
| | - Suzanne Babyar
- Department of Physical Therapy, Hunter College, The City University of New York, New York, NY
- Corresponding author Suzanne Babyar, PT, PhD, Department of Physical Therapy, Hunter College, The City University of New York, 425 East 25th Street, New York, NY 10010.
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11
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Tran Q, Frederick H, Tran C, Baqai H, Lurie T, Solomon J, Aligabi A, Olexa J, Cardona S, Bodanapally U, Schwartzbauer G, Downing J. Blood Pressure Variability and Outcome in Traumatic Brain Injury: A Propensity Score Matching Study. West J Emerg Med 2022; 23:769-780. [PMID: 36205663 PMCID: PMC9541979 DOI: 10.5811/westjem.2022.6.55549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 06/27/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Patients with tIPH (used here to refer to traumatic intraparenchymal hemorrhagic contusion) or intraparenchymal hemorrhage face high rates of mortality and persistent functional deficits. Prior studies have found an association between blood pressure variability (BPV) and neurologic outcomes in patients with spontaneous IPH. Our study investigated the association between BPV and discharge destination (a proxy for functional outcome) in patients with tIPH. Methods We retrospectively reviewed the charts of patients admitted to a Level I trauma center for ≥ 24 hours with tIPH. We examined variability in hourly BP measurements over the first 24 hours of hospitalization. Our outcome of interest was discharge destination (home vs facility). We performed 1:1 propensity score matching and multivariate regressions to identify demographic and clinical factors predictive of discharge home. Results We included 354 patients; 91 were discharged home and 263 to a location other than home. The mean age was 56 (SD 21), 260 (73%) were male, 22 (6%) were on anticoagulation, and 54 (15%) on antiplatelet therapy. Our propensity-matched cohorts included 76 patients who were discharged home and 76 who were discharged to a location other than home. One measure of BPV (successive variation in systolic BP) was identified as an independent predictor of discharge location in our propensity-matched cohorts (odds ratio 0.89, 95% confidence interval 0.8–0.98; P = 0.02). Our model demonstrated good goodness of fit (P-value for Hosmer-Lemeshow test = 0.88) and very good discriminatory capability (AUROC = 0.81). High Glasgow Coma Scale score at 24 hours and treatment with fresh frozen plasma were also associated with discharge home. Conclusion Our study suggests that increased BPV is associated with lower rates of discharge home after initial hospitalization among patients with tIPH. Additional research is needed to evaluate the impact of BP control on patient outcomes.
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Affiliation(s)
- Quincy Tran
- University of Maryland School of Medicine, Baltimore, Maryland; University of Maryland School of Medicine, Research Associate Program in Emergency Medicine & Critical Care, Department of Emergency Medicine, Baltimore, Maryland; The R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland; University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Hannah Frederick
- University of Maryland School of Medicine, Research Associate Program in Emergency Medicine & Critical Care, Department of Emergency Medicine, Baltimore, Maryland
| | - Cecilia Tran
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Hammad Baqai
- University of Maryland School of Medicine, Research Associate Program in Emergency Medicine & Critical Care, Department of Emergency Medicine, Baltimore, Maryland
| | - Tucker Lurie
- University of Maryland School of Medicine, Research Associate Program in Emergency Medicine & Critical Care, Department of Emergency Medicine, Baltimore, Maryland; Wellspan York Hospital, Department of Emergency Medicine, York, Pennsylvania
| | - Julianna Solomon
- University of Maryland School of Medicine, Research Associate Program in Emergency Medicine & Critical Care, Department of Emergency Medicine, Baltimore, Maryland
| | - Ayah Aligabi
- University of Maryland School of Medicine, Research Associate Program in Emergency Medicine & Critical Care, Department of Emergency Medicine, Baltimore, Maryland
| | - Joshua Olexa
- University of Maryland School of Medicine, Department of Neurosurgery, Baltimore, Maryland
| | - Stephanie Cardona
- Mount Sinai Hospital, Department of Critical Care Medicine, York, New York
| | - Uttam Bodanapally
- The R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Gary Schwartzbauer
- The R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland; University of Maryland School of Medicine, Department of Neurosurgery, Baltimore, Maryland
| | - Jessica Downing
- The R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Program in Trauma/Surgical Critical Care, Baltimore, Maryland
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Rehabilitation Course and Management of Intravascular Lymphoma Presenting as Recurrent Strokes: A Case Report. REHABILITATION ONCOLOGY 2022. [DOI: 10.1097/01.reo.0000000000000319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Therapists Predict Discharge Destination More Accurately Than the AM-PAC “6 Clicks” at Evaluation and Discharge for Patients With Isolated Coronary Artery Bypass Graft. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2022. [DOI: 10.1097/jat.0000000000000202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Mclaughlin KH, Young D, Friedman LA, Peters J, Vickery G, Hoyer EH. An Interprofessional Examination of the Johns Hopkins Mobility Goal Calculator among Hospitalized Post-Surgical Patients. Nurs Health Sci 2022; 24:735-741. [PMID: 35780301 DOI: 10.1111/nhs.12972] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 11/28/2022]
Abstract
Individualized mobility goals created using a goal calculator have been shown to increase patient mobility on medical nursing units, but have not been studied among postoperative populations. This study aimed to examine the feasibility of an automated mobility goal calculator on a postoperative nursing unit. To examine this, we utilized the goal calculator to create goals for patients (N=128) following surgery and mobilized each patient with either a nurse or physical therapist. Each patient's highest level of mobility was recorded and providers completed surveys on the appropriateness of calculated goals. Overall, 94% of patients achieved calculated goals. Patients with more pain achieved goals significantly less often than those with less pain. Those with higher mobility achieved their goals similarly with either provider. Providers reported 47% of goals were appropriate, with goals being set too low as the primary reason for goals being inappropriate. We conclude that the automated goal calculator can be used on postoperative nursing units to set realistic goals for patients after surgery. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Kevin H Mclaughlin
- Johns Hopkins University, School of Medicine, Department of Physical Medicine and Rehabilitation
| | - Daniel Young
- University of Nevada, Las Vegas, Department of Physical Therapy
| | - Lisa A Friedman
- Johns Hopkins University, School of Medicine, Department of Medicine
| | | | | | - Erik H Hoyer
- Johns Hopkins University, School of Medicine, Department of Physical Medicine and Rehabilitation
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15
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Johnson JK, Lapin B, Bethoux F, Skolaris A, Katzan I, Stilphen M. Patient Versus Clinician Proxy Reliability of the AM-PAC "6-Clicks" Basic Mobility and Daily Activity Short Forms. Phys Ther 2022; 102:6563497. [PMID: 35385119 DOI: 10.1093/ptj/pzac035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 12/14/2021] [Accepted: 02/08/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to test the reliability of the Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" mobility and activity short forms between patients and therapist proxies. As a secondary aim, reliability was examined when patients completed their self-report before versus after the therapist evaluation. METHODS Patients being seen for an initial physical therapist (N = 70) or occupational therapist (N = 71) evaluation in the acute care hospital completed the "6-Clicks" mobility short form (if a physical therapist evaluation) or activity short form (if an occupational therapist evaluation). Whether patients completed their self-assessment before or after the evaluation was randomized. Patient- and therapist-rated "6-Clicks" raw scores were converted to AM-PAC T-scores for comparison. Reliability was assessed with intraclass correlation coefficients (ICCs) and Bland-Altman plots, and agreement was assessed with weighted kappa values. RESULTS The ICCs for the "6-Clicks" mobility and daily activity short forms were 0.57 (95% CI = 0.42-0.69) and 0.45 (95% CI = 0.28-0.59), respectively. For both short forms, reliability was higher when the patient completed the self-assessment after versus before the therapist evaluation (ICC = 0.67, 95% CI = 0.47-0.80 vs ICC = 0.50, 95% CI = 0.26-0.67 for the mobility short form; and ICC = 0.52, 95% CI = 0.29-0.70 vs ICC = 0.34, 95% CI = 0.06-0.56 for the activity short form). CONCLUSION Reliability of the "6-Clicks" total scores was moderate for both the mobility and activity short forms, though higher for the mobility short form and when patients' self-report occurred after the therapist evaluation. IMPACT Reliability of the AM-PAC "6-Clicks" short forms is moderate when comparing scores from patients with those of therapists responding as proxies. The short forms are useful for measuring participants' function in the acute care hospital; however, it is critical to recognize limitations in reliability between clinician- and patient-reported AM-PAC scores when evaluating longitudinal change and recovery.
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Affiliation(s)
- Joshua K Johnson
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Center for Value-Based Care Research, Community Care, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brittany Lapin
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Francois Bethoux
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alexis Skolaris
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Irene Katzan
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mary Stilphen
- Department of Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
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16
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Johnson JK, Rothberg MB, Adams K, Lapin B, Keeney T, Stilphen M, Bethoux F, Freburger J. Association of Physical Therapy Treatment Frequency in the Acute Care Hospital With Improving Functional Status and Discharging Home. Med Care 2022; 60:444-452. [PMID: 35293885 PMCID: PMC9106906 DOI: 10.1097/mlr.0000000000001708] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Physical therapists (PTs) are consulted to address functional deficits during hospitalization, but the effect of PT visit frequency on patients' outcomes is not clear. OBJECTIVE The objective of this study was to examine whether PT visit frequency is independently associated with functional improvement, discharge home, and both outcomes combined. RESEARCH DESIGN This was a retrospective cohort study. SUBJECTS Patients discharged from hospitals in 1 health system between 2017 and 2020, stratified by diagnostic subgroup: cardiothoracic and vascular, general medical/surgical, neurological, oncology, and orthopedic. MEASURES PT visit frequency was categorized as ≤2, >2-4, >4-7, >7 visits/week. Functional improvement was defined as ≥5-point improvement in Activity Measure for Post-Acute Care mobility score. Other outcomes were discharge home and both outcomes combined. RESULTS There were 243,779 patients included. Proportions within frequency categories ranged from 11.0% (>7 visits/wk) to 40.5% (≤2 visits/wk) and varied by subgroup. In the full sample, 36% of patients improved function, 64% were discharged home, and 27% achieved both outcomes. In adjusted analyses, relative to ≤2 visits/week, the adjusted relative risk (aRR) for functional improvement increased incrementally with higher frequency (aRR=1.20, 95% confidence interval: 1.14-1.26 for >2-4 visits to aRR=1.78, 95% confidence interval: 1.55-2.03 for >7 visits). For all patients and within subgroups, the higher frequency was also associated with a greater likelihood of discharging home and achieving both outcomes. CONCLUSIONS More frequent PT visits during hospitalization may facilitate functional improvement and discharge home. Most patients, however, receive infrequent visits. Further research is needed to determine the optimal delivery of PT services to meet individual patient needs.
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Affiliation(s)
- Joshua K. Johnson
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic
- Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic
- Center for Value-Based Care Research, Community Care, Cleveland Clinic
| | - Michael B. Rothberg
- Center for Value-Based Care Research, Community Care, Cleveland Clinic
- Department of Geriatric and Internal Medicine, Community Care, Cleveland Clinic
| | - Kellie Adams
- Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic
| | - Brittany Lapin
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic
| | - Tamra Keeney
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital
| | - Mary Stilphen
- Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic
| | - Francois Bethoux
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic
| | - Janet Freburger
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh
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17
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Tevald MA, Clancy MJ, Butler K, Drollinger M, Adler J, Malone D. Activity Measure for Post-Acute Care "6-Clicks" for the Prediction of Short-term Clinical Outcomes in Individuals Hospitalized With COVID-19: A Retrospective Cohort Study. Arch Phys Med Rehabil 2021; 102:2300-2308.e3. [PMID: 34496269 PMCID: PMC8418699 DOI: 10.1016/j.apmr.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/09/2021] [Indexed: 12/02/2022]
Abstract
Objective To determine the ability of the Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" assessments of mobility and activity to predict key clinical outcomes in patients hospitalized with coronavirus disease 2019 (COVID-19). Design Retrospective cohort study. Setting An academic health system in the United States consisting of 5 inpatient hospitals. Participants Adult patients (N=1486) urgently or emergently admitted who tested positive for COVID-19 and had at least 1 AM-PAC assessment. Interventions Not applicable. Main Outcome Measures Discharge destination, hospital length of stay, in-hospital mortality, and readmission. Results A total of 1486 admission records were included in the analysis. After controlling for covariates, initial and final mobility (odds ratio, 0.867 and 0.833, respectively) and activity scores (odds ratio, 0.892 and 0.862, respectively) were both independent predictors of discharge destination with a high accuracy of prediction (area under the curve [AUC]=0.819-0.847). Using a threshold score of 17.5, sensitivity ranged from 0.72-0.79, whereas specificity ranged from 0.74-0.83. Both initial AM-PAC mobility and activity scores were independent predictors of mortality (odds ratio, 0.885 and 0.877, respectively). Initial mobility, but not activity, scores were predictive of prolonged length of stay (odds ratio, 0.957 and 0.980, respectively). However, the accuracy of prediction for both outcomes was weak (AUC=0.659-0.679). AM-PAC scores did not predict rehospitalization. Conclusions Functional status as measured by the AM-PAC “6-Clicks” mobility and activity scores are independent predictors of key clinical outcomes individual hospitalized with COVID-19.
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Affiliation(s)
- Michael A Tevald
- Department of Physical Therapy, Arcadia University, Glenside, PA.
| | - Malachy J Clancy
- Good Shepherd Penn Partners, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Kelly Butler
- Good Shepherd Penn Partners, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Megan Drollinger
- Good Shepherd Penn Partners, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Joe Adler
- Good Shepherd Penn Partners, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Daniel Malone
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO
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Chongaway A. Utilization of Isometric Strength Training and Interval Training With a Patient With Cancer in the Acute Care Setting. Cureus 2021; 13:e15570. [PMID: 34277192 PMCID: PMC8272600 DOI: 10.7759/cureus.15570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/05/2022] Open
Abstract
The onset of cancer and subsequent treatments often result in deficits in physical function and quality of life (QoL). Available research has demonstrated that an individualized exercise program has the ability to reduce fatigue, optimize physical function, and improve QoL. However, the exercise program is often lacking appropriate intensity and volume resulting in negligent improvement or even further reduction in function. Thus, the purpose of this case report is to demonstrate the application of isometric strength training (IST) and high-intensity interval training (HIIT) in the acute care setting with an individual with a history of malignant mesothelioma. The patient demonstrated improvement in functional mobility evidenced by improvement in Activity Measure for Post-Acute Care (AM-PAC) score through the hospitalization along with increased ambulation distance. No adverse events occurred during any physical therapy (PT) visits while utilizing HIIT or IST.
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19
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Arnold SM, Naessens JM, McVeigh K, White LJ, Atchison JW, Tompkins J. Can AM-PAC "6-Clicks" Inpatient Functional Assessment Scores Strengthen Hospital 30-Day Readmission Prevention Strategies? Cureus 2021; 13:e14994. [PMID: 34131539 PMCID: PMC8195549 DOI: 10.7759/cureus.14994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Prevention of unplanned hospital readmissions remains a priority in the US healthcare sector. Patient functional status has evolved as an important factor in identifying patients at risk for unplanned readmissions and poor predischarge functional performance has been shown to be predictive of increased readmission risk. Yet, patient functional status appears to be underutilized in readmission prediction models. Methods To examine the impact of inpatient functional status (mobility and activity performance) on unplanned 30-day hospital readmissions at two tertiary care hospitals, retrospective cohort analysis was performed on electronic health record data from adult inpatients (N = 26,298) having undergone completed functional assessments during their index hospitalization. Primary outcomes were functional assessment scores and unplanned all-cause patient readmission within 30 days following hospital discharge. Secondary analysis stratified the assessment by discharge destination. Functional assessment scores from the Activity Measure for Post-Acute Care (AM-PAC) “6-Clicks” Basic Mobility Short Form or Daily Activity Short Form were extracted along with patient demographics, admission diagnoses, comorbid conditions, and hospital readmission risk score. Results Adjusting for age, sex, and comorbidity, lower AM-PAC “6-Clicks” Basic Mobility and Daily Activity scores resulted in higher readmission rates when each score was considered separately. When both scores were considered, only Daily Activity scores were significant. Conclusion Patients with lower Basic Mobility and Daily Activity scores are at a higher risk for readmission. The relative importance of AM-PAC “6-Click” scores on short-term readmission depends on discharge destination. Timely identification of patient mobility and activity performance may lead to earlier intervention strategies to reduce readmissions.
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Affiliation(s)
- Scott M Arnold
- Physical Medicine and Rehabilitation, Mayo Clinic, Jacksonville, USA
| | - James M Naessens
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, USA
| | - Kimberly McVeigh
- Physical Medicine and Rehabilitation, Mayo Clinic, Jacksonville, USA
| | - Launia J White
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, USA
| | - James W Atchison
- Physical Medicine and Rehabilitation, Mayo Clinic, Jacksonville, USA
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