Activity Measure For Post-Acute Care Research Articles

Discontinuation of Intraoperative Liposomal Bupivacaine in Primary THA Does Not Clinically Change Postoperative Subjective Pain, Opioid Consumption, or Objective Functional Status

BackgroundThere is debate regarding the benefit of liposomal bupivacaine (LB) as part of a periarticular injection (PAI) in total hip arthroplasty (THA). Here, we evaluate the effect of discontinuing intraoperative LB PAI on immediate postoperative subjective pain, opioid consumption, and objective functional outcomes. MethodsOn July 1, 2019, an institutional policy discontinued the use of intraoperative LB PAI. A consecutive cohort that received LB PAI and a subsequent cohort that did not were compared. All patients received the same opioid-sparing protocol. Nursing documented verbal rating scale pain scores were averaged per patient per 12-hour interval. Opiate administration events were converted into morphine milligram equivalences per patient per 24-hour interval. The validated Activity Measure for Postacute Care (AM-PAC) tool was used to evaluate functional outcomes. ResultsSix hundred thirty eight primary THAs received LB followed by 939 that did not. In the non-LB THAs, BMI was higher (30.06 vs 29.43; P < .05). Besides marital status, the remaining baseline demographics were similar between the two cohorts (P > .05). The non-LB THA cohort demonstrated a marginal increase in verbal rating scale pain scores between 12 to 24 hours (4.42 ± 1.70 vs 4.20 ± 1.87; P < .05) and 36 to 48 hours (4.49 ± 1.72 vs 4.21 ± 1.83; P < .05). There was no difference in inpatient opioid administration up to 96 hours postoperatively (P > .05) or AM-PAC functional scores within the first 24 hours (P > .05). ConclusionA small statistical, but not clinically meaningful, difference was observed in subjective pain scores with LB PAI discontinuation. Opioid consumption and postoperative AM-PAC functional scores were unchanged after LB PAI discontinuation.

The Johns Hopkins Post-Acute COVID-19 Team (PACT): A Multidisciplinary, Collaborative, Ambulatory Framework Supporting COVID-19 Survivors

The Johns Hopkins Post-Acute COVID-19 Team (PACT): A Multidisciplinary, Collaborative, Ambulatory Framework Supporting COVID-19 Survivors

Changes in the Activity Measure for Post-Acute Care Domains in Persons With Stroke During the First Year After Discharge From Inpatient Rehabilitation

ObjectiveTo describe functional changes after inpatient stroke rehabilitation using the Activity Measure for Post-Acute Care (AM-PAC), an assessment measure sensitive to change and with a low risk of ceiling effect. DesignRetrospective, longitudinal cohort study. SettingInpatient rehabilitation unit of an urban academic medical center. ParticipantsAmong 433 patients with stroke admitted from 2012-2016, a total of 269 (62%) were included in our database and 89 of 269 patients (33.1%) discharged from inpatient stroke rehabilitation had complete data. Patients with and without complete data were very similar. The group had a mean age of 68.0±14.2 years, National Institutes of Health Stroke Score of 8.0±8.0, and rehabilitation length of stay of 14.7±7.4 days, with 84% having an ischemic stroke and 22.5% having a recurrent stroke. InterventionNone. Main Outcome MeasuresChanges in function across the first year after discharge (DC) were measured in a variety of ways. Continuous mean scores for the basic mobility (BM), daily activity (DA), and applied cognitive domains of the AM-PAC were calculated at and compared between inpatient DC and 6 (6M) and 12 months (12M) post DC. Categorical changes among individuals were classified as “improved,” “unchanged,” or “declined” between the 3 time points based on the minimal detectable change, (estimated) minimal clinically important difference, and a change ≥1 AM-PAC functional stage (FS). ResultsFor the continuous analyses, the Friedman test was significant for all domains (P≤.002), with Wilcoxon signed-rank test significant for all domains from DC to 6M (all P<.001) but with no change in BM and DA between 6M and 12M (P>.60) and a decline in applied cognition (P=.002). Despite group improvements from DC to 6M, for categorical changes at an individual level 10%-20% declined and 50%-70% were unchanged. Despite insignificant group differences from 6M-12M, 15%-25% improved and 20%-30% declined in the BM and DA domains. ConclusionsDespite group gains from DC to 6M and an apparent “plateau” after 6M post stroke, there was substantial heterogeneity at an individual level. Our results underscore the need to consider individual-level outcomes when evaluating progress or outcomes in stroke rehabilitation.

Predictive utility of the Activity Measure for Post-Acute Care ‘6-Clicks’ short forms on discharge disposition and effect on readmissions: a retrospective observational cohort study

ObjectivesTo evaluate the predictive utility of the Activity Measure for Post-Acute Care ‘6-Clicks’ daily activity and basic mobility functional assessment short forms on inpatient discharge to home compared with skilled...

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.

Oncologist- versus hospitalist-led service: Differences in hospital utilization for solid tumor patients.

53 Background: Hospitalists have been practicing alongside oncologists to provide high quality care for hospitalized cancer patients. We examined the differences in hospital utilization and outcomes among solid tumor patients admitted to oncologist-led teams (OT) versus hospitalist-led teams (HT). Methods: We performed a retrospective cohort study of patients with solid tumors admitted to the OT or HT at Mount Sinai Hospital from July to December 2019. We excluded patients less than 18 years of age, primary hematologic malignancies, or admission to intensive care or surgical units. We used the Activity Measure for Post Acute Care (AMPAC) and Charlson Comorbidity Index as a measure of functional ability and illness severity, respectively. We performed bivariate and multivariate analyses comparing differences in length of stay, ICU transfers, palliative care consults, healthcare proxy (HCP) decision, new DNR decision, readmission within 30 days and inpatient mortality by type of admitting service (OT vs HT). Results: A total of 544 patients were identified; 61% (334) admitted to HT. There were significant differences according to race and cancer type (p= 0.001 for both). HT patients had more functional impairment (p&lt;0.0001) and poorer prognosis (p=0.0002). In bivariate analysis, HT had significantly more ICU transfers (OT, 2% vs HT, 8%; p=0.008), new DNR decisions (OT, 7% vs HT, 16%; p=0.002), and inpatient mortality (OT, 4% vs HT, 9%; p=0.02) while OT had significantly more palliative care consults (OT, 45% vs HT, 20%; p&lt;0.0001). Multivariate analysis (Table) demonstrates HT had significantly more new DNR decisions (odds ratio [OR]: 0.46, 95% confidence interval [CI]: 0.23-0.93) and OT had significantly more palliative care consults (OR: 4.01, 95% CI: 2.51-6.43). Conclusions: At our academic hospital, inpatient cancer care led by hospitalists is comparable to that of oncologists despite HT caring for more severely ill oncology patients. From a value perspective, hospitalists facilitating care for hospitalized cancer patients will allow oncologists to maximize ambulatory time and focus on active cancer treatment. [Table: see text]

Use of AM-PAC “6 Click” Scores to Predict Discharge Location Post-hospitalization in Adults With Cardiovascular Disease: A Retrospective Cohort Study

Purpose: Scores on the Activity Measure for Post-Acute Care (AMPAC) 6-Clicks are used in the hospital setting as functional measures to guide care and discharge recommendations. However, limited evidence exists regarding the accuracy of AMPAC 6-Clicks in predicting discharge location for those with cardiovascular disease (CVD). The purpose of this study was to determine the accuracy of AM-PAC 6-Clicks scores to predict discharge to home/self-care from an acute care hospital in adults with CVD. Methods: A retrospective review of medical record data comprised of AM-PAC 6-Clicks basic mobility or daily activity scores at physical or occupational therapy evaluation and discharge was completed. Logistic regression analyses were performed to determine if 6-Clicks scores could predict discharge to home/self-care while controlling for age, insurance type, and length of stay. Receiver operating characteristic curves were created to determine the 6-Clicks scores with the best sensitivity/specificity to determine discharge to home/self-care. Results: Logistic regression models indicated that the basic mobility score at discharge from physical therapy services accounted for 71% of the variance in predicting discharge to home/self-care after controlling for covariates. The best 6-Clicks non-converted cutoff value for accuracy of discharge to home/self-care was 20.50 for daily activity and 18.5 for basic mobility completed at discharge. Conclusions: Basic mobility scores at discharge are significant predictors of discharge to home/self-care in older adults with CVD. Further inpatient rehabilitation services should be considered for patients who score less than 18.5 (converted = 44.5) on the basic mobility or 20.50 (converted = 43.15) on the daily activity measures.

In-hospital Functional Status Assessment (6-Clicks Score) Is Associated with Post-discharge Facility Use In Heart Failure Patients

Introduction Functional status assessment in the HF population has typically relied on self-reported questionnaires like Kansas City Cardiomyopathy Questionnaire (KCCQ). Since 2011, Cleveland Clinic physical therapists have administered an objective, validated measure of physical function—the Activity Measure for Post-Acute Care (PAC) ”6-Clicks”. 6-Clicks assesses ability to turn in bed, sit, transfer from bed to chair, stand, walk, eat, dress, bathe, perform personal care and use the bathroom. Scores range from 6 to 24, with higher scores representing greater functional independence. We characterized the association between 6-clicks score and PAC disposition (home, home care, or SNF) in patients admitted for HF whose relative functional status was moderate (score >12) or better. Establishing if an objective functional status assessment is associated with PAC disposition in HF patients has not been previously described. Understanding factors driving facility use post-discharge may have implications for length of stay, patient satisfaction, health system costs, external quality measures, and efforts to decrease facility usage in the COVID era. Methods/Results In 2019, 772 patients with CHF-DRGs were admitted to the Cleveland Clinic hospitals across Ohio. Patients with 6-clicks Conclusion Lower 6-clicks functional status scores were associated with discharge to SNF in HF patients. Living alone had a trend toward association with facility use but did not meet statistical significance. Given significant overlap in functional status across disposition destinations, however, other factors beyond functional status including family support factor into discharge disposition.

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.

Use of the Activity Measure for Post-Acute Care "6 Clicks" Basic Mobility Inpatient Short Form and National Institutes of Health Stroke Scale to Predict Hospital Discharge Disposition After Stroke.

Therapists in the hospital are charged with making timely discharge recommendations to improve access to rehabilitation after stroke. The objective of this study was to identify the predictive ability of the Activity Measure for Post-Acute Care "6 Clicks" Basic Mobility Inpatient Short Form (6 Clicks mobility) score and the National Institutes of Health Stroke Scale (NIHSS) score for actual hospital discharge disposition after stroke. In this retrospective cohort study, data were collected from an academic hospital in the United States for 1543 patients with acute stroke and a 6 Clicks mobility score. Discharge to home, a skilled nursing facility (SNF), or an inpatient rehabilitation facility (IRF) was the primary outcome. Associations among these outcomes and 6 Clicks mobility and NIHSS scores, alone or together, were tested using multinomial logistic regression, and the predictive ability of these scores was calculated using concordance statistics. A higher 6 Clicks mobility score alone was associated with a decreased odds of actual discharge to an IRF or an SNF. The 6 Clicks mobility score alone was a strong predictor of discharge to home versus an IRF or an SNF. However, predicting discharge to an IRF versus an SNF was stronger when the 6 Clicks mobility score was considered in combination with the NIHSS score, age, sex, and race. The 6 Clicks mobility score alone can guide discharge decision making after stroke, particularly for discharge to home versus an SNF or an IRF. Determining discharge to an SNF versus an IRF could be improved by also considering the NIHSS score, age, sex, and race. Future studies should seek to identify which additional characteristics improve predictability for these separate discharge destinations. The use of outcome measures can improve therapist confidence in making discharge recommendations for people with stroke, can enhance hospital throughput, and can expedite access to rehabilitation, ultimately affecting functional outcomes.

Benefits of an early mobility program for hospitalized cancer patients: A pilot study.

7008 Background: Cancer patients are often hospitalized with complications from cancer and cancer treatment. Many experience a decline in physical functioning which likely contributes to increased length of stay (LOS) and excess days, increased readmissions and decreased patient experience. We aimed to determine whether a mobility program project would improve quality of care and decrease healthcare utilization. Methods: We implemented a mobility aide program on an oncology unit in a large academic medical center between April 2, 2019 to December 31, 2019. The program consisted of nursing evaluation using the Activity Measure for Postacute Care (AMPAC), an ordinal scale ranging from bed rest to ambulating ≥250 feet, was used to quantify mobility. Plan of care was determined in a multidisciplinary manner with physical therapy (PT), nursing and a mobility aide, a medical assistant with enhanced rehabilitation training. Patients were then mobilized two times per day seven days a week. Using descriptive statistics we evaluated the programs impact on excess days, readmissions, changes in mobility and patient experience as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) during this time period compared to the 6 month interval prior to implementation. Results: During the study interval, 988 patients were admitted and received the mobility program. There was a 6% reduction in excess days (p = 0.04). Similarly, readmission rates decreased from 25% to 19% (p = 0.03). Overall 76% of patients wither maintained or improved their mobility score. During this time period HCAHPS scores (willingness to recommend hospital) increased from 63% at baseline to 91% (p = 0.01). Conclusions: Use of this mobility program resulted in a significant decrease in healthcare utilization and improvement in patient experience. This demonstrates that non-PT professionals can mobilize hospitalized cancer patients decreasing the burden of PT and nursing resources. Future work will evaluate the sustainability of the program and evaluate association with healthcare costs.

Validation of the Mandarin Version of the Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" Among Patients in Acute Rehabilitation.

A standardized functional measure that can be used across rehabilitation care settings in Taiwan is urgently needed. To generate a Mandarin version of the Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" for patients in acute care. Mixed-methods study with a cross-sectional design. Acute care wards of three teaching hospitals in Taiwan. A sample of 231 neurological patients in acute care (62.3% female; mean age = 63.2 yr, standard deviation = 14.6). The 6-Clicks consist of three subscales: Basic Mobility, Daily Activity, and Applied Cognition. They were translated into Mandarin, and their internal consistency, test-retest reliability, interrater reliability, and convergent validity were tested. All subscales of the Mandarin version of the 6-Clicks showed good internal consistency (α = .97-.98). Test-retest and interrater reliabilities were excellent for all subscales (intraclass correlation coefficients >.8). Convergent validity was supported by strong correlations of the Basic Mobility and Daily Activity subscales with the Barthel Index (r = .73 and .72, respectively) and between the Applied Cognition subscale and the Montreal Cognitive Assessment (r = .82). Our results provide psychometric evidence supporting the use of the Mandarin version of the 6-Clicks in acute care settings in Taiwan. This study confirms the appropriateness of the use of the Mandarin version of the AM-PAC "6-Clicks" with patients in acute rehabilitation, making it a valuable addition to validated measures available for use by occupational therapists in Taiwan.

Measuring Mobility in Low Functioning Hospital Patients: An AM-PAC Replenishment Project

ObjectiveTo expand an existing validated measure of basic mobility (Activity Measure for Post-Acute Care [AM-PAC]) for patients at the lowest levels of function. DesignItem replenishment for existing item response theory (IRT) derived measure via (1) idea generation and creation of potential new items, (2) item calibration and field testing, and (3) longitudinal pilot test. SettingTwo tertiary acute care hospitals. ParticipantsConsecutive inpatients (N=502) ≥18 years old, with an AM-PAC Inpatient Mobility Short Form (IMSF) raw score ≤15. For the longitudinal pilot test, 8 inpatients were evaluated. ResultsFifteen new AM-PAC items were developed, 2 of which improved mobility measurement at the lower levels of functioning. Specifically, with the 2 new items, the floor effect of the AM-PAC IMSF was reduced by 19%, statistical power and measurement breadth were greater, and there was greater measurement sensitivity in longitudinal pilot testing. ConclusionAdding 2 new items to the AM-PAC IMSF lowered the floor and increased statistical power, measurement breadth, and sensitivity.

Clinically Integrated Physical Therapist Practice in Cancer Care: A New Comprehensive Approach.

Best practice recommendations in cancer care increasingly call for integrated rehabilitation services to address physical impairments and disability. These recommendations have languished primarily due to a lack of pragmatic, generalizable intervention models. This perspective paper proposes a clinically integrated physical therapist (CI-PT) model that enables flexible and scalable services for screening, triage, and intervention addressing functional mobility. The model is based on (1) a CI-PT embedded in cancer care provider clinics, and (2) rehabilitation across the care continuum determined by the patient's level of functional mobility. The CI-PT model includes regular screening of functional mobility in provider clinics via a patient-reported mobility measure-the Activity Measure for Post-Acute Care, a brief physical therapy evaluation tailored to the specific functional needs of the individual-and a tailored, skilled physical therapist intervention based on functional level. The CI-PT model provides a pragmatic, barrier-free, patient-centric, data-driven approach to integrating rehabilitation as part of standard care for survivors of cancer. The model standardizes CI-PT practice and may be sufficiently agile to provide targeted interventions in widely varying cancer settings and populations. Therefore, it may be ideal for wide implementation among outpatient oncological settings. Implementation of this model requires a shared approach to care that includes physical therapists, rehabilitation administrators, cancer care providers, and cancer center administrators.

Long-term functional outcomes after traumatic popliteal artery injury: A 20-year experience.

Traumatic popliteal arterial injury (TPAI) is associated with a risk of both limb loss and long-term morbidity due to prolonged ischemia and the often-associated musculoskeletal injuries. Long-term functional outcome following this injury has not been adequately studied. We evaluated patients with TPAI to determine if there was an improvement in functional outcome over time. We hypothesized that both the initial severity of ischemia and the associated injuries limited the ability of patients to improve functional outcome. Patients with TPAI for 20 years were identified. All patients had at least a 2-year follow-up. Functional outcomes were measured using the Boston University Activity Measure for Post-Acute Care to assess basic mobility (BM) and daily activity (DA). Multiple linear regression, adjusted for age, severity of injury and shock, operative complexity, associated injuries, ischemic time, and length of follow-up were used to identify predictors of functional outcome after TPAI. A total of 214 patients were identified: 123 penetrating (57%) and 91 blunt (43%). Overall mortality was 1.9% (all in-hospital), and amputation occurred in 10%. Of the 210 survivors, follow-up was obtained in 145 patients (69%). Median follow-up was 9.2 years (interquartile range, 5.7-15.7 years). Mean Activity Measure for Post-Acute Care scores for BM and DA were 78 and 75, respectively, both signifying mild impairment (normal, >84). Multiple linear regression failed to identify increasing length of follow-up as a predictor of improved functional outcomes. Only age, lower extremity fracture, and ischemic time were identified as predictors of decreased BM and DA. Increasing age, lower extremity fracture, and prolonged ischemic time worsened long-term functional outcomes. Functional outcome did not improve over time, suggesting that maximal recovery may be achieved within the first 2 years postinjury. Thus, early and effective revascularization remains the only potentially modifiable risk factor for improving functional outcomes following TPAI. Prognostic, level III.

Influence of Vestibular Diagnosis and Management on Recommended Discharge Environment for Hospitalized Inpatients

Purpose: Despite the prevalence of dizziness and vertigo, evidence examining the impact of acute vestibular physical therapy evaluation and intervention for patients reporting these symptoms in the acute care setting is limited. Recent evidence indicates that patients may present with vestibular impairments without obvious symptoms; however, physical therapists are not routinely evaluating for vestibular dysfunction in hospitalized adults. The primary purpose of this study was to determine the influence and feasibility of vestibular physical therapy evaluation and treatment on recommended discharge environment for hospitalized inpatients. Methods: A retrospective chart review was conducted of patients who were referred for vestibular physical therapy evaluation and treatment after not responding to conventional balance intervention during hospitalization. Primary outcome measures included change in recommended discharge environment and time in minutes for the vestibular encounter. Secondary outcomes included the Activity Measure for Post-Acute Care (AM-PAC) Basic Mobility Score and the Johns Hopkins Highest Level of Mobility (JH-HLM) Scale from prior to vestibular encounter and upon discharge. Results: Twenty-two patients who met inclusion criteria were included for analysis. Of the patients evaluated for vestibular impairment, less than 5% had been admitted for symptoms of dizziness. A statistically significant change in recommended discharge environment after the vestibular physical therapy encounter was found (χ2 = 64.86, P &lt; .001), with an associated 54.5% reduction in the number of patients requiring inpatient rehabilitation. Average session duration for all vestibular encounters was—mean (SD) [range]—57.59 (21.19) [30-120] minutes. Significant differences in functional mobility from prior to the vestibular encounter to discharge were found for both the JH-HLM (P = .003) and the AM-PAC (P = .050). Discussion: This study demonstrates that identifying and treating hospitalized patients with vestibular impairments regardless of having a primary admitting diagnosis of vestibular impairment may influence the recommended discharge environment resulting in higher levels of mobility during and after hospitalization. While a higher overall treatment time was required to address vestibular impairments during hospitalization, the significant reduction in patients recommended for inpatient rehabilitation suggests potential for significant health care dollar savings for both the patient and the institution. Further exploration is needed to investigate vestibular intervention and overall reduction in length of stay. Conclusion: By providing a more comprehensive approach to evaluation and assessment, acute care physical therapists can have a profound impact in early identification of vestibular impairments in hospitalized inpatients, thus providing more focused therapy interventions, promoting more rapid improvements in functional mobility, and facilitating discharge to the most appropriate destination.

Occupational therapy for adults with brain tumors in the acute care setting.

The number of adults diagnosed with brain tumors is increasing, as are the survival rates. Neurological impairments from brain tumors can impact activity and participation. Adults with brain tumors benefit from post-acute rehabilitation. However, there is limited evidence from the acute care setting. The purpose of this study was to examine how acute care occupational therapy services were utilized and whether patients made functional gains after receiving occupational therapy services. A retrospective chart review of 153 electronic medical records was completed for patients who received occupational therapy services at a large teaching hospital. Data collected included number of occupational therapy visits, the types of interventions, and patient performance using the Boston University Activity Measure for Post-Acute Care "6 Clicks for Daily Activity" short form (AM-PAC). More than half the patients received one occupational therapy visit (54.2%) with a median length of stay of three days. Most interventions focused on activities of daily living (ADLs). Of those patients who received more than one visit, 67% showed improvements in their AM-PAC scores. Occupational therapy practitioners provided interventions that addressed ADLs, and patients demonstrated gains in functional performance. These findings suggest that patients benefit from occupational therapy services provided in the acute care setting.

Activity Limitations Before and After Specialized Brain Injury Rehabilitation: NIDILRR TBI Model Systems Study

Evaluate characteristics of Activity Measure for Post-Acute Care (AM-PAC) as an outcome measure of activity limitations in individuals with TBI and apply it to evaluate changes in activity limitations in individuals receiving specialized brain injury rehabilitation.

Total Artificial Heart: A Retrospective Descriptive Analysis of Functional Improvement Associated With Postsurgical Rehabilitation

Purpose: To identify rehabilitation course and functional outcomes in patients with an implanted total artificial heart (TAH). Methods: From 2012 to 2015, 10 patients with a TAH implantation at a quaternary care hospital were identified for inclusion. Patients were referred to occupational and physical therapy by the cardiothoracic surgery team. Retrospective data collection included the Boston University Activity Measure for Post-Acute Care (AM-PAC) “6-Clicks” inpatient short form based on the functional status documented weekly. Additional patient factors were reviewed specific to cognition, dysphagia, lymphedema, and skin integrity to obtain a comprehensive understanding of therapy scope. Results: The median acute hospitalization length of stay was 68 days. By the time of discharge, AM-PAC 6-Clicks functional mobility scores improved by 48% and AM-PAC 6-Clicks daily activity scores improved by 40%. Conclusions: Following TAH implantation, patients appear to safely participate in a comprehensive restorative rehabilitation program in the intensive and progressive care units. Patients with a TAH implant showed improvement in their mobility and activity performance by the time of discharge.

Feasibility, safety, and functional recovery after active rehabilitation in critically ill surgical patients

BackgroundThe characteristics of critically ill surgical patients differ from those of medical patients. Few studies have evaluated rehabilitation in surgical intensive care units (SICUs), particularly in non-Western countries and in elderly patients. ObjectiveThe objective of this study was to investigate the rehabilitation characteristics, safety, and functional recovery in non-Western SICU patients. MethodsData from patients who received active rehabilitation in 2016 were retrospectively reviewed. Clinical characteristics, functional recovery, and safety were investigated and compared in patients aged <65 or ≥65 years. Potential safety events were also compared between the two age groups and according to the reason for SICU admission. ResultsData from 157 patients were included in the analysis. The number of patients who were able to stand or walk increased from the beginning of rehabilitation to the time of ICU discharge (from 52 to 102 patients, P < 0.01). The Activity Measure for Post-Acute Care (AM-PAC) score also increased during rehabilitation (from 11.6 to 13.9, P < 0.01). Functional recovery did not differ between the two age groups. During 780 rehabilitation sessions, 23 potential safety events (3.0%) were noted; no significant differences were seen between the two age groups. A significant difference was noted when patients were grouped according to the reason for SICU admission (1.7% in postoperative care patients vs 4.5% in patients admitted for other reasons, P = 0.02). ConclusionsActive rehabilitation in critically ill surgical patients is feasible and safe and resulted in improved mobility, regardless of age. However, the reason for SICU admission should be considered.