Activity Measure For Post-Acute Care Research Articles

The Impact of Executive Function on Retention and Compliance in Physical Therapy in Veterans

ObjectiveTo examine retention and compliance to a novel Physical Therapy (PT) treatment among Veterans with and without executive function deficits (EFD+/EFD-). DesignThis study was a preplanned secondary analysis of an ongoing randomized controlled trial. SettingOutpatient PT at VA Boston Healthcare System (VABHS). ParticipantsSeventy-two community-dwelling middle-aged and older Veterans (mean age 72, (range 51-91); 87% male) with gait speed between 0.5 and 1.0 m/s were recruited from primary care practices. InterventionsEight-week moderate to vigorous intensity PT program. Main outcome measureVeterans’ baseline mobility, retention (dropouts), and treatment compliance and post-treatment exercise compliance to 8-week PT treatment were evaluated based on their baseline EFD status. ResultsOf the 72 participants, 22% (n=16) were EFD+. Veterans with EFD+ at baseline had worse mobility performance (Short Physical Performance Battery (SPPB), 7.7 vs. 9.5, p<0.001) and patient-reported mobility (Activity Measure for Post-Acute Care (AM-PAC), 57.6 vs. 62.2, p<0.01) after adjusting for age, gender, number of comorbidities, depressive symptoms, and pain interference. Dropout rates for EFD+ and EFD- were 44% and 25%, respectively (p>0.05). In multivariable logistic regression modeling, pain interference, depressive symptoms, mobility, and living alone but not EFD status were associated with dropping out. There was no evidence of significant differences in treatment compliance or post-treatment exercise compliance, measured by the number of attended sessions and the number of post-treatment exercise days by EFD status. ConclusionEFD+ was associated with poor baseline mobility. While the dropout rate was higher among Veterans with EFD+, we were unable to conclude whether EFD status impacts retention or compliance due to the small sample size. Further investigation is needed to determine whether EFD status may identify individuals who need additional support during and/or after rehabilitation treatment.

Risk Categories for Discharge Planning Using AM-PAC "6-Clicks" Basic Mobility Scores in Non-Surgical Hospitalized Adults.

Early discharge planning is important for safe, cost-effective, and timely hospital discharges.Patients with deconditioning are at risk for prolonged lengths of stay related to discharge needs. Functional mobility outcome measures are associated with discharge disposition. The purpose of this study is to examine the clinical usefulness of risk categories based on the Activity Measure for Post-Acute Care (AM-PAC) "6-clicks" Basic Mobility (6cBM) scores on predicting discharge destination. A retrospective cohort study of 3739 adults admitted to general medical units at an urban, academic hospital between January 1, 2018 and February 29, 2020 who received at least twophysical therapy visits and had an AM-PAC 6cBM recorded within 48 hours of admission and before discharge. The outcome variable was discharge destination dichotomized to post-acute care facilities (PACF); inpatient rehabilitation, skilled nursing facility, or subacute rehabilitation) or home (with or without home care services). The predictor variables were 6cBM near admission and discharge. Logistic regression was used to estimate the odds of being discharged to PACF compared to home, based on the Three-level risk categorization system: (a) low (6cBM score > 20), (b) moderate (6cBM score 15-19), or (c) high (6cBM score < 14) risk. Analysis indicated important differences between the three risk categories in both time periods. Based on 6cBM at admission, patients in the high-risk category were nine times more likely to be discharged to PACF than those in the low-risk category. At discharge, those in the high-risk category were 29 times more likely to go to PACF than those in the low-risk category. Other characteristics differentiating patients who went to PACF were sex (males), age (older) and longer hospitalization. Predicting risk for discharge to a PACF using risk categories based on AM-PAC 6cBM can be useful for early discharge planning.

B - 43 Utility of the Activity Measure for Post-Acute Care (AM-PAC) as a Measure of Functional Recovery across the TBI Rehabilitation Continuum

Abstract Objective To evaluate the utility of the AM-PAC (Activity Measure for Post-Acute Care) for functional assessment of patients with Traumatic Brain Injury (TBI) across inpatient and outpatient rehabilitation settings. We evaluated (1) Longitudinal changes (1-year) in cognitive and physical recovery patterns across the rehabilitation continuum (2) Concurrent validity of AM-PAC as compared to traditional measures. Method A prospective repeated measures cohort study of adults with TBI (n = 186), where 87 participants received inpatient rehabilitation (IR), and 99 participants received outpatient cognitive rehabilitation (CR). Functional recovery was assessed at IR admission, discharge, 6 months and 1 year, and at admission/discharge from CR for post-acute participants. Functional measures included AM-PAC-Basic Mobility (BM), Daily Activities (DA), and Applied Cognitive (AC) domains, Neuropsychological Assessment Battery (NAB), Texas Functional Living Scale (TFLS), Functional Independence Measure (FIM), Participation Assessment with Recombined Tools-Objective (PART-O), and Mayo-Portland Adaptability Inventory (MPAI-4: self-awareness). Results The AMPAC was sensitive to changes throughout the care continuum, demonstrating medium effect sizes across all three functional domains. Notably, AMPAC scores showed greater change compared to traditional tools (90% and 68% confidence levels). Additionally, analysis of Minimum Detectable Change thresholds demonstrated significant improvements, across settings and within moderate/severe TBI (p &amp;lt; 0.05), followed by predictably smaller gains in the mild TBI population (p &amp;lt; 0.05), underscoring the clinical relevance of these findings. Conclusions Results demonstrate that the AM-PAC is a practical, valid and sensitive scale responsive to longitudinal ecological and functional change in TBI. Analysis confirms the effectiveness of functional assessments, particularly emphasizing strengths of the AMPAC.

Efficacy of the Simulation-Based Education Approach Enhanced by Music on Anxiety, Physical Activity, and Respiratory Outcomes in Patients under Open Heart Surgery: A Randomized Three-Group Clinical Study.

Many patients with advanced cardiovascular disease need Coronary Artery Bypass Graft (CABG) surgery, indicating the importance of cardiac rehabilitation. Our study explored the combined efficacy of simulation (using demonstration and return-demonstration approach) with music on post-Open Heart Surgery (OHS) outcomes. This randomized, controlled trial was conducted at Imam Reza Hospital, Mashhad, Iran, on 90 patients awaiting OHS. The participants were allocated to 3 groups: education via simulation, education via simulation enhanced by instrumental music, and conventional instruction. Evaluations were performed pre-education and 2-days post-surgery using the activity measure for post-acute care (AM-PAC) "6-Clicks" Questionnaire, 18-item Nursing Outcomes Classification (NOC) index, and State-Trait Anxiety Inventory (STAI). JASP software (JASP Team, 2023, Version 0.17.3) was employed for statistical analyses, using RM-ANOVA and ANCOVA test. The results revealed a significant effect in immediate post-intervention and 2-day follow-up periods across all outcome measures (all p < 0.05), except for activity. Post hoc tests demonstrated substantial variations in effect sizes between intervention and control groups. Both intervention groups had significantly greater impact than the control group, particularly the composite group, showing heightened effects in state and trait anxiety and respiratory scores (p < 0.05). The combined use of the simulation with rhythmic music in phase one cardiac rehabilitation notably improved post-surgical outcomes, outperforming the method without music. This approach shows promise as an effective instructional strategy in cardiac rehabilitation stages.

Frequent Error Augmentation Training in Physical Therapy Post Stroke.

The purpose of this pilot trial was to evaluate the impact of increased frequency of physical therapy sessions with error augmentation on functional mobility and disability outcomes in patients with acute stroke. We hypothesized that participants receiving frequent error augmentation physical therapy interventions (F-EA-PT) would demonstrate a higher degree of improvement on functional mobility and disability measures from admission to three post-intervention time points (treatment day 3, discharge, or 90-day follow-up). We allocated 100 individuals to receive either F-EA-PT or standard-of-care physical therapy (SOC-PT). The F-EA-PT group received physical therapy with error augmentation twice daily for 3 out of the first 5 days of hospitalization, and daily treatment sessions thereafter. Error augmentation training emphasizes impairments throughout mobility to challenge the individual, rather than facilitating normal movement patterns. The SOC-PT group received treatment once daily for 3 to 5 days per week. Assessments included National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), Activity Measure for Post-Acute Care (AM-PAC) and Postural Assessment Scale for Stroke (PASS). A repeated measures mixed model approach compared treatment groups for all outcomes. The F-EA-PT group demonstrated larger magnitudes of reduction of -1.34 on NIHSS (p=0.0426) and -0.81 on mRS (p=0.0037) from admission to 90-day follow-up compared to the SOC-PT group. The F-EA-PT group demonstrated larger magnitudes of change in AM-PAC of 2.12 at treatment day 3 (p=0.0009) and 2.75 at discharge (p<0.0001) compared to SOC-PT. F-EA-PT group experienced greater improvement in PASS over the SOC-PT group with a difference in change of 4.08 at treatment day 3 (p=0.0019) and 4.45 at discharge (p=0.001). Intervening with a regimen focused on increased frequency and error augmentation from a physical therapy standpoint was safe with only one adverse event. It demonstrated significant improvements in functional outcomes post stroke above those seen with standard-of-care regimen, as evidenced by PASS and AM-PAC scores. URL: https://www.clinicaltrials.gov. Unique identifier: NCT04778475.Medical University of South Carolina IRB II Approved 04/20/2021 PRO00108635.

Long-Term Functional Limitations and Predictors of Recovery After COVID-19: A Multicenter Prospective Cohort Study

BackgroundLimited data exist on post-severe COVID-19 functional trajectory, particularly considering premorbid status. We characterized 1-year functional recovery post-hospitalization for COVID-19, highlighting predictors of long-term recovery. MethodsWe enrolled adult patients with lab-confirmed SARS-CoV-2 infection and hospitalized for COVID-19 sequelae, from five major Ontario, Canada hospitals in a prospective cohort study. Assessments included telephone interviews on admission followed by telephone and in-person assessments at 3-, 6-, 9-, and 12-months post-discharge. The Activity-Measure for Post-Acute Care (AM-PAC) Mobility and Cognition scales were administered at baseline and every 3 months for 1 year. Secondary outcomes included symptoms, spirometry, physical performance, dyspnea, fatigue, distress, anxiety and depression, and quality of life. ResultsA total of 254 patients (57.1% male) with a mean age of 60.0 (±13.1) years and an average hospital stay of 14.3 (±19.7) days agreed to participate. At 12 months, 55.3% demonstrated clinically important deficits in mobility and 38.8% had cognitive deficits compared to premorbid levels. Fatigue was reported in 44.2%, followed by difficulty walking long distances in 35.8% and dyspnea in 33.0%. Almost 40% of patients had an FEV1(% Pred) < 80% at 12 months, 60.3% had impairments in physical performance, and 44.5% had problems with anxiety or depression. Predictors of better mobility at 12 months included higher premorbid mobility status, male sex, shorter hospital stay, fewer comorbidities, and higher FEV1 (% pred) at the 3-month follow-up. ConclusionsOur study provides compelling evidence of the long-term impact of COVID-19 on functional and cognitive status 1-year post-infection.

Effects on the Physical Functioning of Two Exercise Interventions in Patients with Multiple Myeloma: A Pilot Feasibility Study.

Because of the high prevalence of bone destruction in patients with multiple myeloma (MM), physical exercise is oftentimes discouraged by healthcare providers. The goal of this prospective trial was to investigate the feasibility of two six-month exercise interventions in patients with MM (N = 42): a remotely prompted home-based walking intervention or a supervised strength training intervention. Physical function and pain were assessed with the Activity Measure for Post-Acute Care (AM-PAC) Basic Mobility Short Form raw score, a six-minute walk test (6 MWT), a 30-second sit-to-stand test (30 SST), a timed up-and-go (TUG) test, a visual analog scale (VAS) for pain, handheld dynamometer tests, heart rate at rest, blood oxygen saturation at rest, and body mass index. No intervention-related serious adverse events were observed. Adverse events mostly affected the musculoskeletal system. In the resistance training group (n = 24), patients showed significant improvements in AM-PAC, TUG, 6 MWT, and 30 SST, with all effects but the 6 MWT sustained six months after the intervention. The walking group (n = 18) saw improvements in the AM-PAC, TUG, 6 MWT, and 30 SST, with a sustained change in the AM-PAC and TUG. This trial shows the feasibility of both exercise interventions with a sustained beneficial effect on the physical functioning of a six-month strength training intervention and, to a lesser extent, a six-month unsupervised walking intervention. A larger study building on these findings is currently underway.

Exploring the relationship between AM-PAC scores and mobility components in falls and pressure injury risk assessment tools: A pathway to improve nursing clinical efficiency.

Nurses routinely perform multiple risk assessments related to patient mobility in the hospital. Use of a single mobility assessment for multiple risk assessment tools could improve clinical documentation efficiency, accuracy and lay the groundwork for automated risk evaluation tools. We tested how accurately Activity Measure for Post-Acute Care (AM-PAC) mobility scores predicted the mobility components of various fall and pressure injury risk assessment tools. AM-PAC scores along with mobility and physical activity components on risk assessments (Braden Scale, Get Up and Go used within the Hendrich II Fall Risk Model®, Johns Hopkins Fall Risk Assessment Tool (JHFRAT) and Morse Fall Scale) were collected on a cohort of hospitalised patients. We predicted scores of risk assessments based on AM-PAC scores by fitting of ordinal logistic regressions between AM-PAC scores and risk assessments. STROBE checklist was used to report the present study. AM-PAC scores predicted the observed mobility components of Braden, Get Up and Go and JHFRAT with high accuracy (≥85%), but with lower accuracy for the Morse Fall Scale (40%). These findings suggest that a single mobility assessment has the potential to be a good solution for the mobility components of several fall and pressure injury risk assessments.

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.

Prehabilitation Maximizing Functional Mobility in Patients With Cardiogenic Shock Supported on Axillary Impella.

Physical therapy (PT) benefits for critically ill patients are well recognized; however, little data exist on PT in patients receiving temporary mechanical circulatory support. In this single-center retrospective study (February 2017-January 2022), we analyzed 37 patients who received an axillary Impella device (Abiomed, Danvers, MA) and PT to "prehabilitate" them before durable left ventricular assist device (dLVAD) implantation. The Activity Measure for Post-Acute Care (AM-PAC) Basic Mobility tool assessed the functional status at different points during admission. Immediately after Impella placement, the median AM-PAC score was 12.7 (interquartile range [IQR], 9-15), and the scores continued to significantly increase to 18.4 (IQR, 16-23) before dLVAD and up to 20.7 (IQR, 19-24) at discharge, indicating improved independence. No PT-related complications were reported. Thus, we hypothesize that critically ill patients initially deemed equivocal candidates may safely participate in PT while maximizing functional activities before dLVAD placement.

Using Outcome Measures to Transition Ambulation From Physical Therapy to Nursing for Patients With Mechanical Circulatory Support

Purpose: The primary aim of this pilot study was to propose cutoff scores for the functional outcome measures at which patients with mechanical circulatory support (MCS) device can transition ambulation from a skilled physical therapy service to a nursing-led ambulation program. Methods: This was an exploratory pilot study (N = 46) of patients in an intensive care unit (ICU) with MCS devices. Three functional outcome measures were used: Activity Measure for Post-Acute Care (AM-PAC), Perme ICU Mobility Score (Perme Score), and 5-m gait speed test (gait speed). Cutoff scores were identified using area under the curve (AUC) of receiver operating characteristic. Results: Twenty-two patients (intra-aortic balloon pump n = 16; Impella n = 6) were transitioned to a nursing-led ambulation program. The proposed cutoff scores to transition to a nursing-led ambulation program were 19.5 raw score (whole number &gt;19) (&gt;45.44 t score) for AM-PAC, 29.5 (whole number &gt;29) for Perme Score, and 0.57 m/s or more for gait speed. Conclusion: The proposed cutoff scores for the 3 commonly used outcome measures for patients in the ICU are possibly useful when transitioning the ambulation program safely from skilled physical therapy to nursing service.

High Risk of Readmission After THA Regardless of Functional Status in Patients Discharged to Skilled Nursing Facility.

The postoperative period and subsequent discharge planning are critical in our continued efforts to decrease the risk of complications after THA. Patients discharged to skilled nursing facilities (SNFs) have consistently exhibited higher readmission rates compared with those discharged to home healthcare. This elevated risk has been attributed to several factors but whether readmission is associated with patient functional status is not known. After controlling for relevant confounding variables (functional status, age, gender, caregiver support available at home, diagnosis [osteoarthritis (OA) versus non-OA], Charlson comorbidity index [CCI], the Area Deprivation Index [ADI], and insurance), are the odds of 30- and 90-day hospital readmission greater among patients initially discharged to SNFs than among those treated with home healthcare after THA? This was a retrospective, comparative study of patients undergoing THA at any of 11 hospitals in a single, large, academic healthcare system between 2017 and 2022 who were discharged to an SNF or home healthcare. During this period, 13,262 patients were included. Patients discharged to SNFs were older (73 ± 11 years versus 65 ± 11 years; p < 0.001), less independent at hospital discharge (6-click score: 16 ± 3.2 versus 22 ± 2.3; p < 0.001), more were women (71% [1279 of 1796] versus 56% [6447 of 11,466]; p < 0.001), insured by Medicare (83% [1497 of 1796] versus 52% [5974 of 11,466]; p < 0.001), living in areas with greater deprivation (30% [533 of 1796] versus 19% [2229 of 11,466]; p < 0.001), and had less assistance available from at-home caregivers (29% [527 of 1796] versus 57% [6484 of 11,466]; p < 0.001). The primary outcomes assessed in this study were 30- and 90-day hospital readmissions. Although the system automatically flags readmissions occurring within 90 days at the various facilities in the overall healthcare system, readmissions occurring outside the system would not be captured. Therefore, we were not able to account for potential differential rates of readmission to external healthcare systems between the groups. However, given the large size and broad geographic coverage of the healthcare system analyzed, we expect the readmissions data captured to be representative of the study population. The focus on a single healthcare system also ensures consistency in readmission identification and reporting across subjects. We evaluated the association between discharge disposition (home healthcare versus SNF) and readmission. Covariates evaluated included age, gender, primary payer, primary diagnosis, CCI, ADI, the availability of at-home caregivers for the patient, and the Activity Measure for Post-Acute Care (AM-PAC) 6-clicks basic mobility score in the hospital. The adjusted relative risk (ARR) of readmission within 30 and 90 days of discharge to SNF (versus home healthcare) was estimated using modified Poisson regression models. After adjusting for the 6-clicks mobility score, age, gender, ADI, OA versus non-OA, living environment, CCI, and insurance, patients discharged to an SNF were more likely to be readmitted within 30 and 90 days compared with home healthcare after THA (ARR 1.46 [95% CI 1.01 to 2.13]; p= 0.046 and ARR 1.57 [95% CI 1.23 to 2.01]; p < 0.001, respectively). Patients discharged to SNFs after THA had a slightly higher likelihood of hospital readmission within 30 and 90 days compared with those discharged with home healthcare. This difference persisted even after adjusting for relevant factors like functional status, home support, and social determinants of health. These results indicate that for suitable patients, direct home discharge may be a safer and more cost-effective option than SNFs. Clinicians should carefully consider these risks and benefits when making postoperative discharge plans. Policymakers could consider incentives and reforms to improve care transitions and coordination across settings. Further research using robust methods is needed to clarify the reasons for higher SNF readmission rates. Detailed analysis of patient complexity, care processes, and causes of readmission in SNFs versus home health could identify areas for quality improvement. Prospective cohorts or randomized trials would allow stronger conclusions about cause-and-effect. Importantly, no patients should be unfairly "cherry-picked" or "lemon-dropped" based only on readmission risk scores. With proper support and care coordination, even complex patients can have good outcomes. The goal should be providing excellent rehabilitation for all, while continuously improving quality, safety, and value across settings. Level III, therapeutic study.

Frequency and Characteristics of Integrative Oncology Referrals for Patients With Cancer Receiving Inpatient Rehabilitation.

Integrative Oncology (IO) interventions may decrease physical, psychological, and social distress related to cancer and its treatments. Little is known about the frequency and predictors of IO referral for symptom management for cancer rehabilitation inpatients. A retrospective review was performed of patients with cancer who underwent inpatient rehabilitation at a specialized tertiary cancer center from 5/2016 to 3/2020. Patient demographics and IO consultation details, including patient-reported outcome measures of symptom burden using ESAS-FS and functional status using the Activity Measure for Post-Acute Care "6 clicks," were extracted. Descriptive summary statistics and logistic regression were used to analyze the data. Out of 1196 inpatient rehabilitation admissions, 100 (8.4%) were referred to IO. The Activity Measure for Post-Acute Care "6 clicks" basic mobility admission scores were significant at a 1-point difference between the intervention and control group (39.5 vs 40.8, P < .05); both scores equate to a ˃50% degree of functional impairment. Referred patients were younger (62, P = .02) and Hispanics or Latinos (P = .02). The top symptoms for IO consultation included pain (N = 73), integrative approach (N = 41), relaxation (N = 38), and stress/anxiety (N = 33). Patients who reported a baseline symptom score ≥ 1 in the ESAS-FS, had both statistically (P < .05) and clinically significant improvements (≥1 point change) for pain, fatigue, well-being, anxiety, and sleep after massage therapy. Cancer rehabilitation inpatients were commonly referred to IO to address pain, with observed improvements across multiple symptoms with massage therapy. Lower mobility scores and younger patients received significantly higher referrals to IO. Larger trials are needed to characterize the effects of IO interventions on the inpatient rehabilitation of patients with cancer.

HOW DOES EXECUTIVE FUNCTION IMPACT ADHERENCE AND COMPLIANCE TO NOVEL PHYSICAL THERAPY INTERVENTION AMONG VETERANS?

Abstract Executive function problems may make it difficult for a person to adhere to and comply with Physical Therapy (PT) treatment. This study examined adherence and compliance to a novel PT intervention among Veterans with and without executive function deficits (EFD+/EFD-). This study was a preplanned secondary analysis of an ongoing Randomized Controlled Trial among middle to older Veterans (≥50yrs) with slow walking speed. Participants’ adherence (dropouts) and compliance (attendance, post-treatment exercise) to 8-week PT treatment were evaluated based on their baseline EFD status. Seventy-two participants were included in this study (mean age 72) and 22% (n=16) were EFD+. Veterans with EFD+ at baseline had worse mobility both objectively (Short Physical Performance Battery, 7.7 ± 1.9 vs. 9.5 ± 2.2, p&amp;lt; 0.01) and subjectively (Activity Measure for Post-Acute Care (AM-PAC), 57.6 ± 4.7 vs. 62.2 ± 5.7, p&amp;lt; 0.01). Dropout rates for EFD+ and EFD- were 44% and 25%, respectively. In the multivariable logistic regression, dropouts were associated with pain interference, depressive symptoms, mobility, and living alone. There were no differences in treatment attendance or post-treatment exercise compliance based on EFD status measured by number of attended sessions or number of post-treatment exercise days. In conclusion, EFD+ was associated with poor mobility and higher rates of dropping out. Screening for EFD is critical and may assist in predicting individuals who will need more support to enhance mobility.

Impaired hospitalized patient mobility is associated with nurse injuries.

Staff injuries adversely affect the health of staff members as well the ability of health care teams to effectively care for patients. Identifying patients who pose an increased risk of injury may allow for the planning of risk mitigation strategies, but few studies have examined patient factors associated with staff injury risk. Examine the relationship between staff injury and patient mobility, which has been linked to other key hospital outcomes. Linking occupational health and electronic medical record data, we examined documented patient mobility levels, based on the Activity Measure for Post-Acute Care (AM-PAC) and the Johns Hopkins Highest Level of Mobility (JH-HLM) Scale, on the day prior to injury. In addition, we created a matched cohort of control patients not associated with staff injury to examine the influence of patient mobility on the odds of staff injury. We identified 199 staff injuries associated with 181 patients with 1063 matched controls. Patients had median scores of 11 and 3 on the AM-PAC and JH-HLM, respectively, indicating moderate-severe mobility impairments. In addition, scores in the lowest AM-PAC tertile (6-15) and lowest JH-HLM tertile (1-4) were associated with a 4.46-fold and 2.90-fold increase in the odds of nurse injury, respectively. These results indicate that moderate-severe mobility impairments are associated with increased risk of nurse injury. Hospitals and clinical care teams should consider documenting mobility routinely and utilizing these values to identify patients who pose an increased risk of nurse injury.

RAPT and AM-PAC "6-Clicks": Do They Correlate on Predicting Discharge Destination After Total Joint Arthroplasty?

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.

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.

Prediction of Changes in Functional Outcomes During the First Year After Inpatient Stroke Rehabilitation: A Longitudinal Study

ObjectiveTo identify meaningful changes in patients in 3 functional domains (basic mobility [BM], daily activity [DA], and applied cognition [AC]) after discharge from inpatient stroke rehabilitation and to identify the predictors of 1-year functional improvement. DesignA longitudinal, multicenter, prospective cohort study. SettingThe acute care wards of 3 hospitals in the Greater Taipei area of Taiwan. ParticipantsFive hundred patients with stroke in acute care wards (mean age=60±12.2 years, 62% men, N=500). InterventionsNot applicable. Main Outcome Measure(s)The Mandarin version of the Activity Measure for Post-Acute Care (AM-PAC) short forms were assessed at discharge and 3-, 6-, and 12-month follow-up. The minimal detectable change (MDC) was used to categorize changes in the scores as improved and unimproved at the 4 time points. ResultsThe mean scores of the AM-PAC BM and DA subscales substantially increased over the first 3 months after discharge (86% of participants exhibited improvement) and slightly increased during the subsequent 9 months (5∼26% of participants exhibited improvement). However, the mean score of the AC subscale decreased within the first 3 months and increased over the subsequent 9 months (22-23% of participants exhibited improvement). The BM, AC scores at discharge were the dominant predictors of subsequent functional improvement (P<.05). Patients with a higher functional stage at discharge were more likely to experience significant improvement. ConclusionThis study established the capacity of the AM-PAC to predict functional improvement in 3 domains during the early, middle, and late stages of recovery. The findings can assist clinicians in identifying patients at risk of unfavorable long-term functional recovery and providing such patients with tailored interventions during the early stage of rehabilitation.

Prehospital tourniquet application in extremity vascular trauma: Improved functional outcomes

BackgroundSupport for prehospital tourniquet use has increased, with recent data suggesting that tourniquet usage decreases shock without increasing limb complications. We hypothesized that prehospital tourniquet application in extremity vascular trauma, compared with no prehospital tourniquet application, is associated with lower rates of delayed amputation and better functional mobility. MethodsWe retrospectively studied adult patients with extremity vascular trauma at an urban civilian Level 1 trauma center (June 2016–May 2021). Outcomes of interest included delayed amputation and mobility at hospital discharge, measured by the Activity Measure for Post-Acute Care “6 Clicks” Basic Mobility Score. The “6 Clicks” Basic Mobility Score was documented by physical therapy; higher scores indicate more independent mobility. Injury mechanism, initial lactate, 24-hour transfusions, mortality, and acute kidney injury were also collected. Comparisons were performed using χ2 analysis and Fisher Exact and Wilcoxon rank-sum tests. ResultsOf 232 patients, prehospital tourniquet application was not associated with mortality or lactate level (both P > .05). The prehospital tourniquet application group had more transfusions, lower rates of acute kidney injury, and fewer delayed amputations (all P < .05). Ninety-one patients (45 prehospital tourniquet application and 46 without prehospital tourniquet application) were evaluated for “Moving between Bed and Chair” in the “6 Clicks” Basic Mobility Score, with patients in the prehospital tourniquet application group demonstrating higher levels of independence (P = .034). ConclusionPrehospital tourniquet application was associated with favorable outcomes, including higher functional mobility and decreased delayed amputation. This suggests that tourniquet use should be encouraged in the civilian setting to improve outcomes and reduce the risk of limb loss.

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.