Activity Measure For Post-Acute Care Scores Research Articles

AM-PAC Mobility Score

Retrospective review. To determine whether the Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" score is associated with the development of postoperative ileus. Adult spinal deformity (ASD) surgery has a high complication rate. One common complication is postoperative ileus, and poor postoperative mobility has been implicated as a modifiable risk factor for this condition. Eighty-five ASD surgeries in which ≥5 levels were fused were identified in a single institution database. A physical therapist/physiatrist collected patients' daily postoperative AM-PAC scores, for which we assessed first, last, and daily changes. We used multivariable linear regression to determine the marginal effect of ileus on continuous AM-PAC scores; threshold linear regression with Bayesian information criterion to identify a threshold AM-PAC score associated with ileus; and multivariable logistic regression to determine the utility of the score thresholds when controlling for confounding variables. Ten of 85 patients (12%) developed ileus. The mean day of developing ileus was postoperative day 3.3±2.35. The mean first and last AM-PAC scores were 16 and 18, respectively. On bivariate analysis, the mean first AM-PAC score was lower in patients with ileus than in those without (13 vs. 16; P<0.01). Ileus was associated with a first AM-PAC score of 3 points lower (Coef. -2.96; P<0.01) than that of patients without ileus. Patients with an AM-PAC score<13 had 8 times greater odds of developing ileus (P=0.023). Neither the last AM-PAC score nor the daily change in AM-PAC score was associated with ileus. In our institutional cohort, a first AM-PAC score of <13, corresponding to an inability to walk or stand for more than 1 minute, was associated with the development of ileus. Early identification of patients who cannot walk or stand after surgery can help determine which patients would benefit from prophylactic management. Level-III.

Excellent Recanalization and Small Core Volumes Are Associated With Favorable AM-PAC Score in Patients With Acute Ischemic Stroke Secondary to Large Vessel Occlusion

ObjectiveTo assess pretreatment and interventional parameters as predictors of favorable Activity Measure for Post-Acute Care (AM-PAC) scores for optimal discharge planning. DesignIn this prospectively collected, retrospectively reviewed multicenter study from 9/1/2017 to 9/22/2022, patients were dichotomized into favorable and unfavorable AM-PAC. Multivariate logistic regression and receiver operator characteristics analyses were performed for the identified significant variables. A P value of ≤.05 was significant. SettingHospitalized care. ParticipantsIn total, 229 patients (mean ±SD 70.65 ±15.2 [55.9% women]) met our inclusion criteria. Inclusion criteria were (a) computed tomography (CT) angiography confirmed LVO from 9/1/2017 to 9/22/2022; (b) diagnostic CT perfusion; and (c) available AM-PAC scores. InterventionsNone. Main Outcome MeasuresFavorable AM-PAC, defined as a daily activity score ≥19 and basic mobility score of ≥17. ResultsPatients with favorable AM-PAC were younger (61.3 vs 70.7, P<.001), had lower admission glucose (mean, 124 vs 136, P=.042), lower blood urea nitrogen (mean, 15.59 vs 19.11, P<.001), and lower admission National Institutes of Health Stroke Scale (NIHSS) (mean, 10.58 vs 16.15, P<.001). No differences in sex were noted. Multivariate regression analyses revealed age, admission NIHSS, relative cerebral blood flow (rCBF) <30% volume, and modified thrombolysis in cerebral infarction (mTICI) score to be independent predictors of favorable AM-PAC (P<.047 for all predictors). The combined model revealed an area under the curve (AUC) of 0.83 (IQR 0.75-0.86). ConclusionExcellent recanalization, smaller core volumes, younger age, and lower stroke severity independently predict favorable outcomes as measured by AM-PAC.

Activity Measure for Postacute Care “6-Clicks” Mobility Scores Predict Length of Stay Following Hip Resurfacing

AbstractNo studies have identified length of stay (LOS) predictors following hip resurfacing arthroplasty (HRA). The activity measure for postacute care (AM-PAC) score is a readily available tool that may allow physicians to predict LOS in patients undergoing HRA. We retrospectively reviewed patients who underwent HRA between February 2017 and April 2021. All patients completed AM-PAC mobility score on postoperative day 0. Age, American Society of Anesthesiology class, body mass index, surgical time, and Charlson comorbidity index were included as possible predictors of LOS. Predictive models were generated predictive for LOS times of more than 24 and more than 48 hours. Analysis was used to determine c. We identified 262 male patients who completed AM-PAC scores following HRA. Patients with a LOS more than 24 hours had significantly lower AM-PAC scores than patients with a LOS less than 24 hours (23.43 ± 1.37 vs. 19.76 ± 2.78; p &lt; 0.001). Similarly, patients with a LOS more than 48 hours had significantly lower AM-PAC scores than patients with a LOS less than 48 hours (22.08 ± 2.56 vs. 18.17 ± 2.23; p &lt; 0.001). AM-PAC scores were 84.5% accurate for predicting LOS more than 24 hours and 86.3% for LOS more than 48 hours. Patients with scores less than 23 were at higher risk for LOS more than 24 hours and less than 19 were likely to have a LOS more than 48 hours. AM-PAC scores following HRA were predictive of LOS. Providers may use the cutoffs in this analysis to determine how mobility influences LOS following HRA. This is a Level III evidence, retrospective cohort study.

Hip Resurfacing is Associated with Significantly Shorter Length of Stay and Increased Postoperative Mobilization than Total Hip Arthroplasty

AbstractMetal-on-metal hip resurfacing (HRA) is performed as an alternative for total hip arthroplasty (THA) for symptomatic hip osteoarthritis in young, active male patients. This article seeks to determine if there is a difference in postoperative pain, mobilization, and opioid consumption between HRA and THA. A single-institution total joint arthroplasty database was utilized to identify adult patients who underwent elective HRA or THA between 2016 and 2019. Baseline demographic data along with operative time and Charlson Comorbidity Index (CCI) were collected. Patients were matched by age, sex, race, smoking status, body mass index (BMI), and CCI. Morphine milligram equivalents (MME) and visual analog scale scores were collected. Activity Measure for Post-Acute Care (AM-PAC) was used to determine physical therapy progress. A total of 7,387 cases were identified: 96.59% THA (7,135) and 3.41% HRA (252). HRA patients were significantly younger (52.52 vs. 64.04 years; p &lt; 0.001), had higher BMI (30.03 vs. 29.40; p = 0.029), and were almost exclusively male as compared with the THA cohort (98.8% vs. 42.2%; p &lt; 0.001). HRA patients had lower CCI scores (0.36 vs. 1.14; p &lt; 0.001). Surgical time was greater for HRA (124.81 vs. 103.82 minutes; p &lt; 0.001). HRA patients had significantly shorter length of stay (LOS) than THA patients (1.17 vs. 1.48 days; p &lt; 0.001) and had significantly better AM-PAC scores (21.52 vs. 20.65; p = 0.032). HRA patients exhibited a trend toward home discharge (0.4% vs. 2.4%; p = 0.057). Aggregate opioid consumption (23.63 vs. 27.89 MME; p = 0.321) and pain scores (3.47 vs. 3.28; p = 0.438) were not different between matched cohorts. HRA patients are younger, almost exclusively male, and have lower CCI scores at time of surgery. HRA is associated with significantly shorter LOS and greater mobilization measures. They tended to have a higher rate of home discharge. Both groups had similar pain scores and opioid consumption. Level III Retrospective Cohort Study.

The AAHKS Best Podium Presentation Research Award: A Second Dose of Dexamethasone Reduces Postoperative Opioid Consumption and Pain in Total Joint Arthroplasty

BackgroundThe optimal administration of dexamethasone for postoperative pain management and recovery following primary elective total joint arthroplasty (TJA) remains unclear. This study aimed to evaluate the effect of a second intravenous (IV) dose of dexamethasone on postoperative pain scores, inpatient opioid consumption, and functional recovery after total hip arthroplasty (THA) and total knee arthroplasty (TKA). MethodsA retrospective review was conducted of 2,256 primary elective THAs and 1,951 primary elective TKAs between May 2020 and April 2021. Patients who received 2 perioperative doses (2D) of dexamethasone 10 mg IV were propensity-matched 1:1 to a control group who received 1 perioperative dose (1D). Primary outcomes were opiate consumption as morphine milligram equivalences (MMEs), postoperative pain as Verbal Rating Scale (VRS) pain scores, and functional status assessed by the Activity Measure for Post-Acute Care (AM-PAC) scores. ResultsThe 2D THA and 2D TKA cohorts consumed significantly less opiates at the 24 to 48-hour and 48 to 72-hour intervals. The 2D TKA cohort had significantly lower total opiate consumption compared to the 1D TKA cohort. Compared to the 1D cohorts, the 2D THA cohort and 2D TKA cohorts had significantly lower pain scores at the 48 to 60-hour interval; additionally, the 2D TKA cohort had significantly lower pain scores in the 36 to 48-hour interval. AM-PAC scores did not differ between cohorts for both TKA and THA at any interval. ConclusionThe administration of a second perioperative dexamethasone dose significantly decreased opioid consumption in the immediate postoperative period. Inpatient opioid administration can be significantly reduced while maintaining comparable functional recovery and superior pain control. Level III EvidenceRetrospective Cohort Study.

Is the Activity Measure for Postacute Care "6-Clicks" Tool Associated With Discharge Destination Postacute Stroke?

To investigate the association of poststroke physical function, measured within 24 hours prior to discharge from the acute care hospital using Activity Measure for Postacute Care (AM-PAC) Inpatient "6-Clicks" scores and discharge destination (home vs facility and inpatient rehabilitation facility [IRF] vs skilled nursing facility [SNF]). Retrospective cross-sectional cohort study. Acute care, University Hospital. Individuals post acute ischemic stroke, N=721, 51.3% male, mean age 63.6±16.4 years. Not applicable. AM-PAC "6-Clicks" 3 domains: basic mobility, daily activity, and applied cognition. AM-PAC basic mobility and daily activity were significant predictors of discharge. Those in the home discharge group had AM-PAC basic mobility mean t scale score of 48.5 compared with a score of 34.8 for individuals sent to a facility and daily activity score of 47.2 compared with 32.7 for individuals sent to a facility. The AM-PAC variables accounted for an additional 24% of the variance in the discharge destination, with basic mobility and daily activity accounting for most of the variance.The AM-PAC scores were not statistically different and were not able to discriminate between placement in an IRF vs SNF. The mean basic mobility t scale score for individuals going to an IRF was 34.9 compared with 34.6 for those going to an SNF. The daily activity score for IRF was 32.8 compared with 32.6 for SNF. The AM-PAC accounted for no additional variance in discharge destination to an IRF or SNF. The AM-PAC Inpatient "6-Clicks" 3 domains are able to distinguish individuals with stroke being discharged to home from postacute care (PAC) but not for differentiating between PAC facilities (IRF vs SNF) in this cohort of individuals post stroke.

The Benefit of Virtual Outpatient Rehabilitative Care: a Pilot Study

<h3>Research Objectives</h3> To examine the feasibility of the Live Long Walk Strong (LLWS) rehabilitation program delivered via telehealth. Secondary objectives are to examine the preliminary efficacy of LLWS on mobility and exercise self-efficacy. <h3>Design</h3> Nonrandomized, noncontrolled pilot with 16-week follow-up. <h3>Setting</h3> Ambulatory Care at the VA Boston Healthcare System. <h3>Participants</h3> Community-dwelling Veterans, aged 50 years and older. <h3>Interventions</h3> An evidence-based outpatient rehabilitation program was adapted as a telehealth program during year one of the COVID-19 pandemic. It included 10 sessions with a physical therapist over 8 weeks via VA Video Connect. LLWS uniquely addresses impairments linked to mobility decline and behavior change strategies targeting exercise adoption. <h3>Main Outcome Measures</h3> The primary outcome was feasibility measured by recruitment and retention, number and type of technology problems, and completion of program components. Secondary outcomes included the Activity Measure for Post-Acute Care (AM-PAC) outpatient mobility measure and the Self-Efficacy for Exercise (SEE) scale. <h3>Results</h3> After contacting 178 primary care patients with self-reported mobility limitations, 21 enrolled in the study (12%). Seven never initiated the study due to intercurrent medical issues (n=5) and delayed disclosure of participation in another exercise study (n=2). Participants averaged 2 technology interruptions. Over 99% of the technology issues were resolved by the PT and fell into 2 broad categories of connectivity and ease of use. Attendance rate was 98% across all intervention visits. We examined the change in self-reported mobility and self-efficacy from baseline through follow-up using linear mixed models with a fixed effect of time. The AM-PAC scores improved from baseline by average of 4.1 points (p = 0.019) at 2 weeks follow-up and remained (4.2 points, p=0.014) at 16 weeks follow-up. This improvement in mobility surpassed clinically meaningful levels. The change in self-efficacy (0.9 points) was not statistically significant. <h3>Conclusions</h3> The telehealth LLWS program appears feasible and capable to produce both short and long term improvements in physical functioning. Its benefits need to be tested in studies scaled to better evaluate efficacy and effectiveness. <h3>Author(s) Disclosures</h3> VA RR&D Merit Award #5I01RX003095-03

Early initiation of physical and occupational therapy while on extracorporeal life support improves patients' functional activity.

Managing acute respiratory distress syndrome (ARDS) patients on venovenous extracorporeal membrane oxygenation (V-V ECMO), without sedation/neuromuscular blockade to allow physical and occupational therapy (PT/OT) participation, is untraditional. Here, we investigate the impact of early PT/OT initiation on discharge functional activity for ARDS patients managed on V-V ECMO. This is a retrospective review of 67 ARDS patients managed with V-V ECMO at a single academic center from February 2018 to June 2021. Data collected included patient characteristics, days of V-V ECMO support, day of PT/OT initiation, and ambulation distance and Activity Measure for Post-Acute Care (AMPAC) Six-Clicks score on day of discharge. Patients with >7 days of V-V ECMO support had decreased ambulation and AMPAC scores compared to those with <7 days (70.5 vs. 162.1, p< 0.01 and 12.3 vs. 16.4, p= 0.01, respectively). PT/OT initiation within 7 days after starting V-V ECMO significantly improved ambulation and AMPAC scores (163.5 vs. 59.5, p< 0.001, and 16.6 vs. 11.8, p< 0.01, respectively). Additionally, in patients with >7 days of V-V ECMO support, those who began PT/OT within 8 days of V-V ECMO cannulation had significantly improved ambulation and AMPAC scores (151.8 vs. 44.2, p< 0.01, and 16.5 vs. 11.0, p< 0.01, respectively). Early PT/OT initiation in severe ARDS patients managed on V-V ECMO is associated with improved patient functional activity on day of discharge. Our study further supports the use of V-V ECMO in treatment of severe ARDS without sedation/neuromuscular blockade and specifically demonstrates PT/OT should be started early following V-V ECMO cannulation.

Activity Measure for Post-acute Care Mobility Scoring System: Comparison of Nursing and Physical Therapy Evaluation for Primary Hip and Knee Arthroplasty Patients.

Optimizing resource utilization after total joint arthroplasty (TJA) has become increasingly vital. The Activity Measure for Post-acute Care (AM-PAC) "6-clicks" scoring system is a validated, physical therapist (PT)-administered metric of patient basic mobility and predicts discharge disposition. This study aimed to determine whether the use of AM-PAC scoring by nurses in the postoperative period could (1) substitute for AM-PAC scoring by therapists and (2) predict 90-day outcomes in TJA patients. We retrospectively reviewed all primary TJAs conducted by two surgeons at a single institution from 2019 to 2021. Patients underwent postoperative AM-PAC evaluation by nursing and physical therapy within 24 hours of surgery, and specific timing of nursing and PT scores was determined. Inter-rater reliability between therapy and nursing scores was analyzed. Multiple regression was used to determine the association between AM-PAC scores and readmissions, complications, length of stay, and nonhome discharge. In total, 1,119 patients were included. Agreement testing between therapy and nursing scores was weak for all six AM-PAC components, with a Spearman correlation of 0.437. Nursing scores were typically conducted earlier than therapist scores (204.0 ± 249.9 minutes versus 523.5 ± 449.4 minutes; P < 0.001). Therapy and nursing scores were not notable predictors for 90-day complications or readmissions. However, higher therapy and nursing scores were predictors of less than 2-day hospitalization (odds ratio [OR] 0.63, P < 0.001; OR 0.88, P < 0.001) and fewer nonhome discharges (OR 0.62, P < 0.001; OR 0.84, P < 0.001). Although nursing-driven mobility assessments could potentially improve efficiency of patient discharge and control costs, nursing AM-PAC scoring did not serve as an appropriate substitute for PT scoring in patients undergoing primary total hip and knee arthroplasty at our institution.

AM-PAC mobility scores predict non-home discharge following adult spinal deformity surgery

BACKGROUND CONTEXTAdult 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. PURPOSETo assess the thresholds of AM-PAC scores that determine non-home discharge disposition in patients who have undergone ASD surgery. STUDY DESIGNRetrospective review PATIENT SAMPLENinety 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 MEASURESNon-home discharge disposition METHODSPatients 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. RESULTSThirty-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. CONCLUSIONSFirst 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.

Patient Versus Clinician Proxy Reliability of the AM-PAC "6-Clicks" Basic Mobility and Daily Activity Short Forms.

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. 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. 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). 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. 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.

Early Initiation of Physical Therapy While on Extracorporeal Life Support Improves Patients’ Functional Activity on Discharge

PurposeTraditionally, severe acute respiratory distress syndrome (ARDS) patients on veno-venous extracorporeal membrane oxygenation (VV ECMO) receive significant sedation and neuromuscular blockade (NMB) to facilitate lung protective mechanical ventilation. However, we previously showed the feasibility of managing these patients without mechanical ventilation, sedation, or NMB. Reduced levels of sedation allows patients to begin physical and occupational therapy (PT/OT) early on. Here, we investigate the impact of early PT/OT initiation on day of discharge (DOD) functional activity for severe ARDS patients managed on VV ECMO.MethodsThis is a retrospective review of all patients who underwent VV ECMO as management for severe ARDS at a single academic center from February 2018 to June 2021. Data collected included patients’ demographics, co-morbidities, etiology of ARDS, days of ECMO support before PT/OT initiation, and ambulation distance and PT/OT Activity Measure for Post-Acute Care (AMPAC) Six-Clicks score on DOD.Results67 patients were included in this study. Those with >7 days on VV ECMO had decreased ambulation and AMPAC scores compared to those with < 7 days (N=41, 70.5 ± 113.3ft vs N=26, 162.1 ± 154.1ft, p<0.01, 12.3 ± 5.9 vs 16.4 ± 6.8, p=0.01, respectively). PT/OT initiation within 7 days after starting VV ECMO significantly improved ambulation and AMPAC scores compared to those with >7 days of VV ECMO prior to any PT/OT (N=30, 163.5 ± 160.5ft vs N=37, 59.5 ± 93.5ft, p<0.001, 16.6 ± 7.1 vs 11.8 ± 5.2, p<0.01, respectively). In patients with >7 days on VV ECMO, those who began PT/OT within 10 days of starting VV-ECMO had improved ambulation and AMPAC scores compared to those with >10 days of VV ECMO prior to PT/OT (N=9, 151.8 ± 164.8ft vs N=32, 44.2 ± 77.8ft, p<0.01, 16.5 ± 7.7 vs 11.0 ± 54.5, p<0.01, respectively).ConclusionEarly PT/OT initiation in severe ARDS patients managed on VV ECMO is associated with improved patient functional activity on DOD. This may provide benefits such as enhanced recovery, increased ability to complete activities of daily living, and improved cognitive health. Our study further supports the use of VV ECMO in treatment of severe ARDS without mechanical ventilation, sedation or NMB and specifically demonstrates PT/OT should be started early following initiation of VV ECMO to improve patients’ functional outcomes.

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

ObjectiveTo 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). DesignRetrospective cohort study. SettingAn academic health system in the United States consisting of 5 inpatient hospitals. ParticipantsAdult patients (N=1486) urgently or emergently admitted who tested positive for COVID-19 and had at least 1 AM-PAC assessment. InterventionsNot applicable. Main Outcome MeasuresDischarge destination, hospital length of stay, in-hospital mortality, and readmission. ResultsA 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. ConclusionsFunctional 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.

Surgical Stabilization for Patients with Mechanical Back Pain Secondary to Metastatic Spinal Disease is Associated with Improved Objective Mobility Metrics: Preliminary Analysis in a Cohort of 26 Patients

To investigate the effect of surgical stabilization for patients with metastatic spinal disease on objective mobility metrics. A retrospective chart review identified patients who had mechanical back pain from metastatic spinal disease and underwent spinal stabilization during 2017. Mobility metrics, the Activity Measure for Post-Acute Care (AM-PAC) inpatient mobility short form (IMSF) and the Johns Hopkins Highest Level of Mobility (JH-HLM), were reviewed. A total of 26 patients were included in the analysis with median hospital stay of 8 days. Preoperative JH-HLM scores were available for 17 patients with a mean score of 5.4, increasing to mean score of 6.6 at last follow-up (P= 0.036). Preoperative AM-PAC IMSF scores were available for 14 patients with a mean score of 19.4, decreasing slightly to a mean score of 18.7 at last follow-up (P= 0.367). Last follow-up with mobility metrics occurred a median of 6.5 days postoperatively (range: 3-66 days). Multivariable analysis showed that American Spinal Injury Association and Karnofsky Performance Status scores were significantly associated with both JH-HLM and AM-PAC mobility scores at last follow-up. A higher JH-HLM or AM-PAC score was significantly associated with direct home discharge and a higher AM-PAC score was associated with shorter hospital stay. Surgical stabilization for patients with mechanical back pain secondary to metastatic spinal disease might lead to an objective improvement in JH-HLM score. JH-HLM and AM-PAC scores may be correlated with length of hospital stay and discharge disposition. Future studies are encouraged to further characterize the role of these mobility metrics in the management plan of these patients.

Discontinuation of the liposomal delivery of bupivacaine has no effect on pain management after primary total knee arthroplasty : no effect on pain scores, opioid consumption, or functional status.

Liposomal bupivacaine (LB) as part of a periarticular injection protocol continues to be a highly debated topic in total knee arthroplasty (TKA). We evaluated the effect of discontinuing the use of LB in a periarticular protocol on immediate postoperative pain scores, opioid consumption, and objective functional outcomes. On 1 July 2019, we discontinued the use of intraoperative LB as part of a periarticular injection protocol. A consecutive group of patients who received LB as part of the protocol (Protocol 1) and a subsequent group who did not (Protocol 2) were compared. All patients received the same opioid-sparing protocol. Verbal rating scale (VRS) pain scores were collected from our electronic data warehouse and averaged per patient per 12-hour interval. Events relating to the opiate administration were derived as morphine milligram equivalences (MMEs) per patient per 24-hour interval. The Activity Measure for Post-Acute Care (AM-PAC) tool was used to assess the immediate postoperative function. A total of 888 patients received Protocol 1 and while 789 received Protocol 2. The mean age of the patients was significantly higher in those who did not receive LB (66.80 vs 65.57 years, p = 0.006). The sex, BMI, American Society of Anesthesiologists physical status score, race, smoking status, marital status, operating time, length of stay, and discharge disposition were similar in the two groups. Compared with the LB group, discontinuing LB showed no significant difference in postoperative VRS pain scores up to 72 hours (p > 0.05), opioid administration up to 96 hours (p > 0.05), or AM-PAC scores within the first 24 hours (p > 0.05). The control of pain after TKA with a multimodal management protocol is not improved by the addition of LB compared with traditional bupivacaine. Cite this article: Bone Joint J2021;103-B(6 Supple A):102-107.

The Effect of Age and Activity Level on Stem Subsidence in Total Hip Arthroplasty

AbstractThe average length of hospital stay (LOS) following total hip arthroplasty (THA) is decreasing due to a variety of factors, including rapid patient mobilization. With increased early joint loading, certain populations, such as those with low systemic bone mineral density, may be at an increased risk for early stem instability. The purpose of this study was to determine whether activity level and patient age affect femoral stem stability and early subsidence. We retrospectively reviewed 821 patients who underwent primary cementless THA. Two cohorts were established based on LOS as a proxy for activity: (1) same calendar day discharge (SDD) and (2) multiple day stay (MDS). Descriptive patient characteristics as well as surgical and clinical data including surgical time, stem alignment, and Activity Measure for Post-Acute Care (AM-PAC) scores were collected. Stem subsidence was assessed by comparing immediate postoperative radiographs with follow-up radiographs taken no less than 3 months after surgery (9.79 ± 6.50 months). Our sample population consisted of 255 SDD (31%) and 566 MDS (69%) patients. Stem subsidence rate was significantly lower in the SDD than the MDS group (0.916 vs. 1.80 mm, p &lt; 0.001). Increasing age was associated with a higher rate of stem subsidence (β = 0.823, p &lt; 0.001). Increased LOS was also associated with increased age (odds ratio = 1.092, p &lt; 0.001). Higher postoperative mobility determined by AM-PAC scores was not associated with shorter LOS (p = 0.630). The result of this study showed increased activity level does not increase rate of subsidence in THA patients, which supports the safety and efficacy of expedited recovery programs. Increased age was found to increase stem subsidence regardless of LOS.

Early Postoperative Functional Assessment Predicts Non-Home Discharge After Pulmonary Lobectomy

Non-home hospital disposition is an important patient-centric quality measure, and is increasingly tied to reimbursements. We sought to determine the value of early postoperative functional assessment to predict non-home discharge. Patients undergoing elective pulmonary lobectomy between May 2017 and December 2018 were identified from The Society of Thoracic Surgery database at a single institution. Early postoperative functional assessment using the Boston University Activity Measure for Post-Acute Care (AM-PAC) basic mobility short form was routinely performed by the inpatient rehabilitation services. The association of baseline patient characteristics and AM-PAC scores with nonhospital discharge was analyzed. A total of 241 patients (median age 65 years, 59% female) underwent lobectomy. First postoperative functional assessment was performed at a median of 1 day (interquartile range, 1 to 2) after surgery. Median AM-PAC score was 18 (interquartile range, 17 to 19), correlating to a 47% functional impairment in daily activities. Thirteen patients (5.4%) were discharged to an extended care facility instead of home. Non-home discharge was more commonly observed for patients of older age or with prior history of stroke. First postoperative AM-PAC score was able to discriminate hospital disposition (area under the curve 0.714; 95% confidence interval, 0.594 to 0.834; P= .009). Adjusted for patient factors and performance status, first postoperative AM-PAC score was independently associated with non-home discharge (odds ratio 0.54, 95% confidence interval, 0.36 to 0.81; P= .003). Early postoperative functional impairment assessment using AM-PAC may be useful to predict non-hospital discharge after pulmonary lobectomy. Attention to these factors may be used to aid early disposition planning, and adjust preventative strategies.

Complete Sternal-Sparing LVAD Implantation Improves Mobility Compared to Full Sternotomy

Purpose Left ventricular assist device (LVAD) implantation via a complete sternal-sparing (CSS) technique is gaining interest due to several associated benefits. We hypothesized that the CSS approach for HeartMate 3 LVAD implantation improves postoperative mobility and physical independence compared to full sternotomy (FS). Methods We retrospectively reviewed all patients implanted with a commercial HeartMate 3 at our institution from September 2017 to August 2018 (N=52). Patients were grouped based on surgical technique, CSS or FS. Patients were excluded if they did not see a physical therapist within three weeks postoperatively. The Activity Measure for Post Acute Care (AM-PAC) short forms and Functional Independence Measure (FIM) scores were used to assess postoperative mobility and physical limitations. Results A total of 43 patients were included in the study; 27 (63%) were implanted via the CSS approach and 16 (37%) underwent FS. Preoperative characteristics were similar between cohorts. By postoperative day 3 (POD3), the CSS cohort demonstrated improved mobility based on AM-PAC scores compared to the FS group (Figure 1) with 40% of the CSS cohort versus 67% of the FS cohort remaining 100% impaired. The CSS cohort also demonstrated greater postoperative independence in the FIM sit-to-stand metric (Figure 2) with 78% of the CSS cohort achieving modified or complete independence by POD15 compared to 21% of the FS patients. Conclusion The CSS approach for HeartMate 3 LVAD implantation improves postoperative mobility and functional independence compared to FS.

Responsiveness of the activity measure for post-acute care (AM-PAC) from discharge from inpatient stroke rehabilitation to six month follow-up

Functional stroke scales must detect significant change over time, but defining “significant” is difficult. The activity measure for post-acute care (AM-PAC) measures activity limitations in 3 domains: basic mobility (BM), daily activity (DA), and applied cognitive (AC). This study assesses the ability of the AM-PAC to detect change from inpatient rehabilitation facility (IRF) discharge (DC) to an outpatient setting 6 months (6 M) later. We analyzed data from a observational database for stroke patients treated at our academic IRF. We assessed AM-PAC domains at IRF DC and again by phone 6 M later. Change between DC and 6 M was calculated by: – standardized response mean (SRM, 0–0.4–0.6 = moderate effect); – proportion achieving the minimal clinically important difference (MCID, estimated as 0.5SD of baseline scores after Norman et al., 2003) with our data; – the published, mixed population minimal detectable change (MDC). Of 273 patients at DC, 139 (51%) had both AM-PAC scores and were included. Those included were not demographically different but were better on physical and cognitive measures at IRF admission. The mean age = 67.1 ± 14.8 y, NIHSS = 7.9 ± 7.5, discharge FIM = 84.1 ± 19.1, FIM Gain = 20.2 ± 10.6, and rehabilitation length of stay = 14.8 ± 7.6d. The mean DC/6 M scores for BM were 51.7 ± 11.2/56.0 + 12.1, DA = 44.4 ± 9.9/49.2 + 14.5 and AC = 40.0 ± 9.8/44.7 + 9.2. Change metrics for the 3 AM-PAC domains are given in Table 1 . Between 40%–50% of stroke patients were classified as “significantly” improved, depending on measure, suggesting the AM-PAC is able to capture “real life” change. The sample experienced change at the lower end of “moderate improvement” by SRM. Estimated MCID and the MDC were similar for DA and AC, not BM. Further research should explore factors, which predict functional success or failure.

The Role of Virtual Rehabilitation in Total and Unicompartmental Knee Arthroplasty.

This study evaluated the use of telerehabilitation during the postoperative period for patients who underwent total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA). Specifically, this study evaluated the following: (1) patient compliance and adherence to the program, (2) time spent performing physical therapy exercises, (3) the usability of the virtual rehabilitation platform, and (4) clinical outcome scores in a selected primary knee arthroplasty cohort. A total of 157 consecutive patients underwent TKA (n = 18) or UKA (n = 139). These patients used a telerehabilitation system with an instructional avatar, three-dimensional motion measurement and analysis software, and real-time televisit capability designed for arthroplasty patients. Compliance was determined by how many times the patients followed prescribed repetitions of exercises. The total time spent performing exercises for each patient was collected. The usability of the virtual rehabilitation platform (on the patient's end) was evaluated using the system usability scale (SUS) questionnaire. The number of in-person and televisits was recorded for each patient. Patient-reported outcomes were collected through the patient and clinician interfaces and included the Knee Society Score (KSS) for pain and functions, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and Boston University Activity Measure for Post-Acute Care (AM-PAC) score. Patients spent an average of 29.5 days partaking in the therapy. TKA and UKA patients had a mean of 3.5 and 3.2 outpatient follow-up visits, each, for in-office therapy with a physical therapist, respectively. This figure exceeded the mean number of real-time virtual patient-clinician visits by 0.8 visits per patient in the TKA cohort and by 1 visit per patient in the UKA cohort. Patients spent on average 26.5 minutes per day conducting an average of 13.5 exercises. By the end of rehabilitation, patients had spent an average of 10.8 hours performing exercises, and of all the exercises performed, approximately 21 exercises were uniquely designed. Mean SUS score in the cohort was 93 points, which was interpreted as being above the 50th percentile point of the scale. Following therapy, KSS pain and function scores improved markedly and the improvements were measured at 368% for TKA and 350% for UKA (pain) and 27% for UKA and 33% for TKA (function). In addition, WOMAC scores improved by 57% and 66% for UKA and TKA patients while the improvement in AM-PAC scores was at 22% and 24%. This telerehabilitation platform encouraged clinician-patient interaction beyond the hospital setting and offers the advantage of cost savings, convenience, at-home monitoring, and coordination of care, all of which are geared to improve adherence and overall patient satisfaction. Additionally, the biometric data can be used to develop custom physical therapy regimens to assure proper rehabilitation, which is lacking in other telerehabilitation applications that use noninteractive videos that can be watched on mobile devices and tablets.