Family coaching to promote behavior modification in children and adolescents with obesity undergoing inpatient rehabilitation and in their carers: A feasibility study

Purpose Occupation-based practice involves the inclusion of meaningful occupations in the therapeutic process and is promoted within hospital-based general rehabilitation contexts for individual clients or within a group setting. The purpose of this paper is to summarise the current literature regarding the types of occupation-based group programs used within general inpatient rehabilitation and the reported outcomes. Methods A scoping review was conducted and included papers if they described an occupation-based intervention, delivered in a group setting, conducted in an inpatient rehabilitation hospital context, with an adult population. Studies were collated, summarized and key findings are presented. Results Ten articles met inclusion criteria. The results indicate that occupation-based groups are used in inpatient rehabilitation across a variety of settings, the approach is valued by the occupational therapy profession and it appears to have an influence on patient satisfaction and experience. However, the impact on a patient’s confidence and occupational performance outcomes post-inpatient rehabilitation remains unclear. Conclusions There is a dearth of evidence on the impact of occupation-based group service focus in the inpatient rehabilitation setting. Considering the importance of occupation to the profession, further investigation into the use of this approach in a group setting is required. Implications for rehabilitation Occupation-based groups are used in inpatient rehabilitation to achieve more therapy time but there is variability in group processes and outcomes measured. Patient centred occupation-based groups appear to have an influence on patient satisfaction and experience. For the occupation-based groups reviewed, providing explicit links between patient goals, therapeutic activity and real life was important for improving outcomes. There is a growing focus for the use of occupation-based groups in occupational therapy and more research is needed to establish effectiveness.

ABSTRACTBackgroundAn allied health weekend service in subacute inpatient stroke rehabilitation can improve patient and organisational outcomes. However, there is insufficient evidence to justify the role of a speech and language therapy (SLT) weekend service in this setting. Exploring the perspectives of individuals who have received SLT services in inpatient stroke rehabilitation will assist with understanding the current role of SLT and the potential for SLT weekend services in inpatient stroke rehabilitation.AimsThis study aimed to: (1) determine the aspects of an SLT inpatient rehabilitation service that are perceived to be important to people with stroke who have an acquired communication and/or swallowing impairment, and (2) establish which of these valued aspects are also relevant to the provision of an SLT weekend service.Methods and ProceduresA generic qualitative approach was employed. Adults admitted to inpatient rehabilitation for a minimum 2‐week stay, including two weekends, and who engaged in communication and/or swallowing‐related rehabilitation were invited to participate in semi‐structured, in‐depth interviews. Interview data were recorded, transcribed, and analysed using reflexive thematic analysis.Outcomes and ResultsSix people with stroke were interviewed. Two main themes informed participants’ perspectives of important aspects of inpatient rehabilitation: (1) ‘recovering from my stroke’ which described factors relating to the patients’ participation in their rehabilitation program and their therapy progress, and (2) ‘supporting my wellbeing’ which reflected the value of social connections, feeling supported by staff, dedicated rest periods, and engagement in meaningful activities outside of scheduled therapy sessions. Although some participants supported the idea of an SLT weekend service to receive additional therapy, weekends were also perceived as important to support wellbeing by participating in activities that were not directly part of their rehabilitation program.Conclusions and ImplicationsWeekends were perceived to provide both the opportunity for additional therapy and to facilitate valued experiences that went beyond participation in the rehabilitation program. These experiences included rest, maintaining or developing social connections and engagement in social‐based activities. This study's findings have important implications for the development of an SLT weekend service in inpatient stroke rehabilitation.WHAT THIS PAPER ADDSWhat is already known on the subjectExisting evidence on allied health weekend services within inpatient stroke rehabilitation has primarily focused on the outcomes of physical‐based interventions, provided by physiotherapy and /or occupational therapy. The effectiveness of an SLT weekend service in this setting remains unclear. Furthermore, the perspectives of people with lived experience of this service are unknown.What this paper adds to existing knowledgeThis study provides insights into the perspectives of people with acquired communication and/or swallowing impairments post stroke on the role of an SLT weekend service within inpatient stroke rehabilitation. Although weekends were considered to provide an opportunity for the delivery of additional therapy, participants also perceived weekends to play an important role in ensuring rest, facilitating social connections with existing social networks, and participating in meaningful, social activities outside of the therapeutic context.What are the potential or actual clinical implications of this work?Participants perceived that weekends were important not only to extend their weekday rehabilitation program but also to facilitate rest, social connections and engagement in socially‐based activities. Understanding the experiences and preferences of people with lived experience of inpatient stroke rehabilitation is essential when planning and implementing an SLT weekend service within an inpatient stroke rehabilitation setting.

Methylphenidate and Behavior Modification in Children With ADHD and Comorbid ODD or CD: Main and Incremental Effects Across Settings

Purpose Professional interpreters can improve healthcare quality and outcomes when there is language discordance between patients and health care providers. Multidisciplinary rehabilitation relies on nuanced communication; however, the use of interpreters in rehabilitation is underexplored. This study aimed to examine patterns of health care interpreter use in an inpatient rehabilitation setting. Methods A retrospective cohort study was conducted including patients admitted for subacute rehabilitation during 2019–2020 identified as having limited English proficiency. Patterns of interpreter use (professional and “ad hoc”) and rehabilitation outcomes were evaluated via medical record review. Results Eighty-five participants were included. During inpatient rehabilitation (median 17 [12–28] days), most clinical interactions (95%) occurred without an interpreter present. Patterns of interpreter use were variable; with greater use of ad hoc versus professional interpreters (received by 60% versus 49% of the cohort, respectively). Those who interacted with a professional interpreter had a longer length-of-stay, larger Functional Independence Measure (FIM) gain, and lower rate of hospital readmission six months post-discharge. The number of professional interpreter sessions correlated positively with FIM gain. Conclusions Access to professional interpreters in inpatient rehabilitation was variable, with some patients having no or minimal access. These findings provide preliminary evidence that professional interpreter use may be associated with clinical rehabilitation outcomes. Implications for rehabilitation Professional health care interpreters can be used to overcome language barriers in rehabilitation. In an inpatient rehabilitation setting, professional interpreters appeared to be underutilized, with many patients having no or minimal access to interpreters. Use of ad hoc, untrained interpreters and informal communication strategies was common during rehabilitation. Use of professional interpreters appeared to be associated with favorable rehabilitation outcomes.

The purpose of this study was to determine independent influences of functional level and lower limb amputation type on inpatient rehabilitation outcomes. We conducted a secondary data analysis for patients with lower limb amputation who received inpatient medical rehabilitation (N = 26,501). The study outcomes included length of stay, discharge functional status, and community discharge. Predictors included the 3-level case mix group variable and a 4-category amputation variable. Age of the sample was 64.5 years (13.4) and 64% were male. More than 75% of patients had a dysvascular-related amputation. Patients with bilateral transfemoral amputations and higher functional severity experienced longest lengths of stay (average 13.7 days) and lowest functional rating at discharge (average 79.4). Likelihood of community discharge was significantly lower for those in more functionally severe patients but did not differ between amputation categories. Functional levels and amputation type are associated with rehabilitation outcomes in inpatient rehabilitation settings. Patients with transfemoral amputations and those in case mix group 1003 (admission motor score less than 36.25) generally experience poorer outcomes than those in other case mix groups. These relationships may be associated with other demographic and/or health factors, which should be explored in future research.

Poster 40: Effect of Falls on Length of Stay in Different Stroke Rehabilitation Settings

Introduction Obstructive Sleep Apnea (OSA) is prevalent after moderate to severe traumatic brain injury (TBI) and may diminish recovery when left untreated. Despite the demonstrated importance of treating OSA following TBI, assessment for OSA during or soon after inpatient rehabilitation for TBI is limited. Little is known about barriers to implementing OSA screening and early diagnosis during inpatient rehabilitation thus hindering the translation of evidence-based OSA assessment procedures into clinical practice and potentially delaying necessary OSA treatment. The current analysis explored facilitators and barriers to implementing OSA screening tools in an inpatient rehabilitation setting from the perspectives of end user stakeholders. Methods Patients, families, industry, clinical providers and administrators participated in a two-day meeting following completion of a diagnostic clinical trial of OSA screening and diagnostic tools during inpatient rehabilitation. Stakeholders were provided with open ended questions generated by study investigators and given the opportunity to respond on paper or a “graffiti wall” (i.e., white board). Example questions include “What are the greatest needs of the healthcare system related to sleep apnea and TBI?” and “What are the key things we need to consider to move results into real-world practice?” Qualitative content analyses using a rapid matrix approach were conducted from stakeholder feedback obtained during the two-day meeting, which included a guided review of emerging OSA research and discussion of potential implementation barriers of OSA assessment during inpatient rehabilitation. Results Improved screening and treatment practices for OSA were the greatest needs identified. To meet these needs, stakeholders identified the importance of improving patient, family, and staff understanding of OSA (e.g., health literacy) and other sleep disorders through education; inpatient rehabilitation access to resources (technology; sleep providers); and reimbursement for additional inpatient procedures. Conclusion Although treatment of OSA is crucial for recovery during inpatient rehabilitation following TBI, barriers to earlier recognition, diagnosis, and treatment of OSA exists across several different domains, including education, resources, and funding policies. Findings support future implementation efforts to translate evidence-based care into practice to improve patient outcomes. Support (if any) PCORI-NCT03033901

This study examines the tolerability and efficacy of methylphenidate (MPH) and behavior modification therapy (BMOD) in children with attention-deficity/hyperactivity disorder (ADHD) and severe mood dysregulation (SMD). Children (ages 5-12) from a summer program for ADHD were screened for SMD and additional manic-like symptoms using structured assessments and direct clinical interview with the Young Mania Rating Scale (YMRS). The SMD group was comprised of 33 subjects with SMD and elevated YMRS scores (mean = 23.7). They underwent weekly mood assessments plus the daily ADHD measures that are part of the program. The comparison group (n = 68) was comprised of the rest of the program participants. Using a crossover design, all subjects in both groups were treated with three varying intensities of BMOD (no, low, high) each lasting 3 weeks, with MPH dose (placebo, 0.15 mg/kg t.i.d., 0.3mg/kg t.i.d., and 0.6 mg/kg t.i.d.) varying daily within each behavioral treatment. Groups had comparable ADHD symptoms at baseline, with the SMD group manifesting more oppositional defiant disorder/conduct disorder (ODD/CD) symptoms (p < 0.001). Both groups showed robust improvement in externalizing symptoms (p < 0.001). There was no evidence of differential treatment efficacy or tolerability. Treatment produced a 34% reduction in YMRS ratings in SMD subjects (p - 0.001). However, they still exhibited elevated YMRS ratings, more ODD/CD symptoms (p < 0.001), and were more likely to remain significantly impaired at home than non-SMD subjects (p < 0.05). MPH and BMOD are tolerable and effective treatments for children with ADHD and SMD, but additional treatments may be needed to optimize their functioning.

Behavior modification in children: Case studies and illustrations from a summer camp: Rickard, Henry C., & Dinoff, Michael (Eds.) University, AL: University of Alabama Press, 1974, 174 Pp. $6.75

Current status of stuttering and behavior modification—I: Recent trends in the application of behavior modification in children and adults

Faculty Opinions recommendation of The efficacy and tolerability of methylphenidate and behavior modification in children with attention-deficit/hyperactivity disorder and severe mood dysregulation.

The Overt Behavior Scale-In Session: A behavioral assessment tool for individuals with acquired brain injury in the inpatient rehabilitation setting.

Purpose To explore specialist amputee physiotherapists’ experiences and subsequent views about specialist inpatient rehabilitation (IPR) as a National Health Service (NHS) pathway option for adult primary amputees and their perceptions and beliefs about the effects of inpatient amputee rehabilitation. Materials and methods A qualitative study using a phenomenological approach. Semi-structured interviews were completed with seven physiotherapists experienced in working in both specialist amputee inpatient and outpatient rehabilitation settings. Interviews were audio-recorded and fully transcribed. Data were analysed using thematic analyses; inductive coding was completed; emerging themes are shown and a conceptual framework was developed. To promote rigour, this study was peer reviewed and coding was done by two people. Results Clinicians believed inpatient amputee rehabilitation to be the preferred model of rehabilitation for the majority of adult primary amputees. A central theme of healthcare inequality within primary amputee rehabilitation provision emerged with four sub-themes: IPR, outpatient rehabilitation, barriers, the ideal world. Geographical variation was described in: type of rehabilitation provided, timescales of prosthetic rehabilitation provision, fitting a prosthesis with wounds, and the availability of community rehabilitation services. Conclusions Healthcare inequality is a central concern identified by clinicians who work within amputee rehabilitation in the UK. Clinicians interviewed believe NHS specialist amputee inpatient rehabilitation should be a more accessible pathway. Implications for rehabilitation Clinicians believe healthcare inequality exists within primary amputee rehabilitation provision in the UK National Health Service (NHS). Geographical variation in type of care provision, fitting a prosthesis with wounds, timescales in prosthetic rehabilitation provision and community rehabilitation services were described. Clinicians believe inpatient amputee rehabilitation to be the preferred model of care for the majority of adult primary amputees and should be a more accessible pathway within the NHS. Inpatient rehabilitation facilities may be a way of compensating for amputee rehabilitation inequalities.

Context:The multifactorial benefits of yoga have been well documented in the literature, with the integration of yoga therapy into healthcare being an emerging field. In general, yoga therapy programs are utilized in the community as an adjunct to other therapy. At present, limited rehabilitation units routinely incorporate integrative therapy options within a hospital environment.Aims:The aim of this study is to explore the lived experience and patient-reported benefits of yoga in an inpatient brain injury rehabilitation setting.Settings and Design:Thirty-one participants were recruited to the study after voluntarily participating in a yoga class within an inpatient brain injury rehabilitation unit of a major metropolitan hospital. Yoga sessions were held weekly for 60 min and consisted of a modified Hatha yoga style. This was a mixed-methods, quasi-experimental one-group pretest–posttest study.Methodology:Quantitative data were collected to measure perceptions of relaxation and well-being before and after yoga classes, along with the satisfaction of the class. Semi-structured interviews were utilized to collect qualitative data of experiences and perceptions associated with yoga participation.Statistical Analysis Used:Thematic analysis was completed for qualitative data. Quantitative data were analyzed using nonparametric statistical methods, and descriptive statistics were also provided.Results:The benefits described by participants are reported in this paper. These include improved relaxation, physical well-being, emotional well-being, being present, and self-awareness.Conclusions:This study describes the personal benefits experienced from regular yoga participation within an inpatient rehabilitation setting.

Outcomes of Inpatient Rehabilitation in Patients With Simultaneous Bilateral Total Knee Arthroplasty