Acute Physical Therapy Research Articles

Increasing Functional Measurement Tool Utilization by Acute Physical Therapists

Background: At an acute academic medical center, an electronic medical record (EMR) clarity report revealed that proper documentation of a functional measurement tool during acute physical therapy (PT) initial evaluation and reevaluation sessions occurred only 12% of the time. A formal quality improvement project was initiated to correct this gap in recommended best practice. Objective: To increase utilization and documentation of functional measurement tools in acute PT evaluation and reevaluation sessions from baseline of 12% to 100% based on the APTA recommendations for best standard of care in clinical practice. Methods: This quality improvement project involved acute PT staff and faculty in an academic medical center assessing a gap in best practice. Barriers to best clinical practice were assessed and targeted interventions included education and awareness of baseline performance compared with expectations, streamlining usability of the EMR documentation flowsheet and creating resources to address gaps in knowledge, performance, or access to available functional tools. Data were collected at project initiation, midterm, and after final interventions through manual chart reviews, EMR clarity reports, and a custom PT staff survey. Results: Documentation of functional measurements tools improved from the baseline of 12% to 89.5% after full project interventions. Follow-up survey results indicated that PTs' perception of providing the highest quality of care increased by 29 percentage points, from 71% to 100%. Improved diversity of tool usage was also noted. Of the tools documented, Activity Measure for Post-Acute Care (AMPAC) functional measurement tool was selected 90% of the time at baseline and dropped to 66% post-intervention, allowing for a 24% increase in diversity of tool selection. Conclusions: Accurate discovery of the primary and secondary factors impacting tool use with targeted interventions yielded a 7.5-fold improvement (from 12% to 89.5%) in performance and documentation of functional measurement tools during PT evaluation and reevaluation sessions in the acute care setting. The project also highlighted limitations of education alone in effectively promoting adherence to best practice standards. The increased utilization and documentation of functional measurement tools has improved PT practice in this academic medical center through more objective detection of functional changes across the continuum. It should also promote targeted PT interventions, which should improve PT effectiveness and potentially even impact hospital length of stay.

Effects of Acute Physical Therapy Services on Individuals with Acute Decompensated Heart Failure

<h3>Research Objectives</h3> 1) To describe the characteristics of patients admitted with acute decompensated heart failure (ADHF) that are referred to Acute Physical Therapy Services (APTS), 2) To determine if there were significant differences in initial and discharge measurements using four functional outcome measures (five minute walk test [5mWT], modified 30 second chair rise test [30CRT], six-minute walk test [6MWT], and timed up and go test [TUG], 3) To determine if patients' discharge performance could be predicted from initial performance. <h3>Design</h3> Prospective, pre and post, cohort study. <h3>Setting</h3> Academic hospital. <h3>Participants</h3> All subjects (N=102) were admitted patients with admitting diagnosis of acute decompensated heart failure and were refereed to APTS. <h3>Interventions</h3> The intervention was APTS (therapeutic exercises, transfer training, gait training, balance retraining, and patient education). Each subject received as needed intervention in each session due to limited activity tolerance, lasting between 30 to 60 minutes or as tolerated. <h3>Main Outcome Measures</h3> 6MWT to measure aerobic capacity; 5mWT to measure gait speed; TUG to assess falls, 30CRT to measure leg strength, and GROC to measure perceived progress at discharge. <h3>Results</h3> At initial evaluation, all FOM showed marked functional limitations (mean 5mWT=.723 meter/seconds; mean 30CRT=7.8 repetitions; mean 6MWT=525 feet; mean TUG=22.21 seconds). At discharge evaluation, all FOM showed significant improvement at p≤ .0005 (mean 5mWT=.795 meter/seconds; mean 30CRT=9.35 repetitions; mean 6MWT=635.65 feet; mean TUG=20.694 seconds). Significant mean differences (p≤ .001) were found in 30CRT (1.68 repetitions), in 6MWT (110.45 feet), and in TUG (-2.16 seconds), when compared the initial and discharge measurements. All initial scores were able to significantly predict discharge measurements at p≤ .005. <h3>Conclusions</h3> This study found profound functional limitations in those admitted with ADHF. During hospitalization, those subjects who received APTS made significant improvements in all four FOM. In addition, FOM at discharge can be predicted using initial admission scores. Lastly, the findings of this study add support to the effectiveness of APTS in maximizing medical management for patients admitted with ADHF. <h3>Author(s) Disclosures</h3> All authors have no conflict of interest to disclose.

Acute Care Physical Therapy Practice Analysis Identifies the Need for a Core Outcome Measurement Set

Purpose: This study's primary objective is to determine the current use of outcome measures (OMs) by physical therapists practicing in acute care settings. Secondarily, this study aims to establish whether physical therapists support the development of a core OM set for use in acute care settings. Methods: An investigator-developed online survey (Qualtrics) was distributed to acute care physical therapy stakeholders, including practicing clinicians, educators, and administrators. The survey contained 4 sections with 28 questions: (1) acute care physical therapy practice patterns; (2) use of OMs in practice; (3) the development of a core OM set; and (4) demographic, education, and experience in the physical therapy profession. Descriptive statistics were used to assess response frequency and rationale for the use of specific OMs. Results: A convenience sample of 170 acute physical therapy stakeholders completed the survey. Respondents represented 38 states, with most respondents (n = 153; 90%) practicing in one or more acute care specialty areas. The majority of respondents (n = 145; 83%) reported using an OM more than 50% of the time in their practice. Physical function was the main construct (n = 163; 96%) respondents assessed with an OM. Acute care physical therapists primarily used OMs to track response to interventions (n = 134; 79%) and develop a care plan (n = 91; 54%). Length of time required to complete an OM and its clinical utility were the most common rationales for selecting an OM (n = 150, 88%; n = 147, 86%, respectively). Strong support was found for developing a core OM set for acute physical therapist practice (n = 147; 86%). The preferred methods for the organization of a core OM set, in rank order, were by diagnosis, International Classification of Functioning, Disability, and Health (ICF) framework, domains of health, and settings/location. Conclusion: Most physical therapists participating in this study of practice in acute care reported using OMs in their daily practice. This survey confirms the desire to develop a core OM set with high clinical utility for use in acute care settings.

Acute Rehabilitation in the COVID-19 Pandemic: A Case Report of Physical Therapy Perspectives From the Front Line

Abstract Severe acute respiratory syndrome coronavirus (SARS-CoV-2) or COVID-19 has grown to become a global pandemic. Although much has been learned about the virus, the complete impact is still not fully understood. This highly infectious pathogen can cause multiple complications in infected individuals, leading to impairments and functional limitations. To date, there has been limited literature available to describe the rehabilitation needs of patients with COVID-19. New York City (NYC) was initially identified as the United States epicenter, where various health system faced unique considerations when managing patients with COVID-19. The purpose of this article was to share the clinical perspectives of the acute physical therapy (PT) team working in one of the large health system in NYC. The report will describe the role PT played in the evaluation, assessment, and treatment of patients with COVID-19 as they navigated the acute hospital setting.

Acute Physical Therapy Competency for Identifying Appropriate Patients for a Physical Therapist Assistant's Caseload

Background: At an academic medical center, physical therapist assistants (PTAs) were observed spending increased time reviewing charts and collaborating with the physical therapists (PTs) about inappropriate patient caseloads. Objective: To develop staff competency through a standardized process for the identification of appropriate patients for a PTA caseload utilizing the APTA's PTA Direction Algorithm and improve PT/PTA relationships in the acute care setting. Design: Mixed-methods prospective study. Methods: Study consisted of acute care PT staff in an academic medical center using the PTA Direction Algorithm with data collected, pre- and posttraining of the PT staff in the algorithm, and the Mann-Whitney U test was used to determine statistical differences. Focus groups with the PTAs were conducted pre- and posttraining of the PT staff. Results: Data were collected from the 2 participating PTA staff for a period of 294 total worked hours both for the pre- and posttraining periods. For the pretraining period, data were collected between April 1, 2018, and April 28, 2018, for 28 days with 302 patient care encounters. The posttraining period occurred between July 1, 2018, and August 11, 2018, for 42 days with 307 patient care encounters. The PTAs' daily average pretraining of 10.79 patient encounters, 40.71 minutes for chart reviews, and 12.89 minutes for PT/PTA collaboration decreased posttraining, to a daily average of 7.31 patient encounters, 6.43 minutes for chart reviews, and 6.76 minutes for PT/PTA collaboration. PTAs spent significantly less time in daily average reviewing of charts posttraining (mean = 6.43, SD 10.98, compared with the pretraining (mean = 40.71, SD 38.96, U = 186.500, P &lt; .001). Collaboration times also significantly decreased posttraining (mean = 6.76, SD 11.14), compared with pretraining (mean = 12.89, SD 11.54, U = 371.00, P = .007); however, the average number of daily encounters unfavorably decreased in the posttraining (mean = 7.31, SD 5.13), compared with the pretraining period (mean = 10.79, SD 5.06, U = 398.5, P = .022). Limitations: Small number of participants in one academic medical center. Conclusions: The PTA Direction Algorithm tool used in establishing staff competency provided the mechanism for developing a standardized process, significantly improving chart review time, and PT/PTA relationships in the acute care setting.

A Simple Tool Using AM-PAC “6-Clicks” to Measure Value Added in Acute Care Physical Therapy: The Therapy Value Quotient

Background and Purpose: Acute physical therapy practitioners and leaders continue to search for a practical method to measure value. The purpose of this case report is to introduce the Therapy Value Quotient and its simple yet effective use of Activity Measure for Post-Acute Care Inpatient Mobility Short Form, also known as “6-Clicks,” and common payroll data to measure changes in value added to patient care. Case Description: Health care service value should be measured by outcomes produced divided by the cost of services to produce those outcomes. Although acute physical therapy practice continues to progress toward consistent outcome measurement, widespread application of outcomes to quantify value is rare. This lack of value measurement leaves acute care practitioners' value measured primarily in terms of how many units or visits a therapist can code in a certain number of hours worked. Unfortunately, quantities of units or visits are not synonymous with value. Acute care managers and practitioners need a viable and easy-to-use tool that requires minimal data entry and uses existing, easily accessible payroll and electronic health record data. Outcomes: The goal of this project was to create a value calculation with commonly used systems (payroll, electronic health record) data and Activity Measure for Post-Acute Care Inpatient Mobility Short Form data to quantify value. Minimizing manual data entry decreases errors and improves real-time calculations. The purposely minimized design of the equation allows clinicians and managers freedom to create highest-value processes that achieve the maximal value added. Discussion: The Therapy Value Quotient can help managers and clinicians investigate and measure value-adding tactics while improving care delivery and efficiency instead of simply increasing the number of procedures per hour worked.

Acute Physical Therapy and Length of Hospital Stay Following Lumbar Discectomy and Lumbar Fusion: A Retrospective Analysis

Purpose: Lumbar fusion and discectomy are commonly performed spinal surgical procedures. Factors associated with post-surgical length of hospital stay (LOS) have not been investigated. The purpose of this study was to evaluate factors, including utilization of acute physical therapy intervention (APTI), that were associated with LOS following lumbar discectomy or fusion. Method: A retrospective medical record review was conducted for 100 patients who underwent lumbar discectomy or fusion between December 1, 2007 and December 1, 2009. We tested for correlations of APTI, patient and surgery characteristics with LOS. Results: Age, number of surgical levels, functional dependency and number of acute physical therapy visits all yielded significant bivariate correlation to LOS. The dichotomous variables, type of surgery, sex, and discharge placement level were related to significant differences in LOS. These variables were included in a linear regression model to test for unique contributions of variance of these factors to LOS. Follow-up analysis tested the unique contributions of APTI and functional dependency to variability in LOS. Conclusion: Increased LOS is associated with greater age, greater number of pathological levels, fusion, greater functional dependency, discharge status to a care facility, male sex, and more physical therapy visits. While this study design cannot distinguish the impact of APTI on LOS, it suggests factors that may guide identification of patients likely to have a longer LOS.

Improving the Care of Patients who have Difficulty Weaning from the Ventilator in the Acute Care Setting

Purpose: Our physical therapists aspired to provide effective, evidence-based examination and interventions for patients who have difficulty weaning from ventilation in order to maximize function. Process: Acute physical therapy staff identified areas where improvements were needed, the challenges encountered when treatments are being provided for this patient population, and the goals for this project as well as potential solutions. Physical therapy staff was surveyed to discern their comfort level with progression of mobility with patients using ventilators. A survey of other healthcare team members was completed to ascertain their perception of physical therapy's role when treating this patient population. Hospitals similar to ours were contacted to determine what standards of care these facilities utilized, and a literature search was completed. Post-implementation surveys were completed by the physical therapy staff and other healthcare team members. Outcomes: An algorithm and a standard of care were developed to provide guidance to therapists for examination and interventions. An informational handout on ventilator settings and terminology was completed. Summary: We describe a quality improvement project for patients who have difficulty weaning from the ventilator in the acute care setting. We are hopeful that our experience and process may be helpful to other facilities undertaking a similar project.

Future of Acute Physical Therapy

Future of Acute Physical Therapy

Acute Physical Therapy Management for a Patient with Maffucciʼs Syndrome Following Modified Internal Hemipelvectomy and Reconstruction with Saddle Prosthesis: A Case Report

Acute Physical Therapy Management for a Patient with Maffucciʼs Syndrome Following Modified Internal Hemipelvectomy and Reconstruction with Saddle Prosthesis: A Case Report

What Patient Attributes Are Associated With Thoughts of Suing a Physician?

Fishbain DA, Bruns D, Disorbio JM, Lewis JE. What patient attributes are associated with thoughts of suing a physician? Objective To address a neglected research area: the attributes of rehabilitation patients associated with “thoughts of suing a physician” (S-MD). Design The S-MD statement “I am thinking about suing one of my doctors” was administered to 2264 people, along with the Battery for Health Improvement (BHI 2). Items predictive of S-MD were identified. Setting Acute physical therapy, work hardening programs, chronic pain programs, physician offices, and vocational rehabilitation programs. Participants Participants included 777 rehabilitation patients and 1487 nonpatient community-dwellers. Interventions Not applicable. Main Outcome Measures We used a multivariate analysis of variance to determine which of the 18 BHI 2 scales predicted the S-MD statement. Items from the scales found to be predictive, plus other variables, were then used in a chi-square analysis that compared people who wished to sue with those who did not. We then used a stepwise regression analysis with significant items from the prior analyses to build a model for predicting a potential S-MD patient. Results The highest percentage (11.5%) of patients affirming the S-MD statement were those involved in workers’ compensation and personal injury litigation, compared with only 1.9% of community-living subjects. Stepwise regression of BHI 2 variables produced a 13-variable model explaining 38.04% of the variance. A logistic regression of demographic variables (eg, education, ethnicity, litigiousness) explained 20% of the variance. Conclusions Anger ( P<.001), mistrust ( P<.001), a focus on compensation ( P<.001), addiction ( P<.001), severe childhood punishments ( P<.001), having attended college ( P<.001), and other patient variables were associated with thoughts of suing a physician.

Functional outcomes of lobar and double lung transplant recipients

Purpose: The Living Lobar Transplant (LLT) procedure was pioneered at the University of Southern California (USC) to meet a growing need for lung transplantation. The purpose of this retrospective case-series study was to compare acute physical therapy (PT) functional outcomes of LLT vs. cadaveric double lung transplant (DLT) recipients over a six year period at USC University Hospital.

Acute Physical Therapy for Cerebral Vascular Accident : A Prevention Point of View

Acute Physical Therapy for Cerebral Vascular Accident : A Prevention Point of View