Acute Inpatient Rehabilitation Research Articles

Feasibility of a Mindfulness and Pain Management Group in an Acute Rehabilitation Setting

<h3>Research Objectives</h3> To report the feasibility of a Mindfulness and Pain Management group for adults in acute inpatient rehabilitation, share details on the novel intervention, and the results of an exploratory analysis. <h3>Design</h3> Retrospective chart review. <h3>Setting</h3> Inpatient rehabilitation facility. <h3>Participants</h3> Adults receiving rehabilitation after orthopedic, amputee, spinal cord injury, cancer, or stroke, who report pain. <h3>Interventions</h3> 45-minute, 4-part, Mindfulness and Pain Management group led by a clinical psychologist and physical therapist. <h3>Main Outcome Measures</h3> The Mindfulness and Pain Management Survey (MPMS) which assesses any prior knowledge/use of mindfulness and pain management strategies and the likelihood to utilize strategies learned. The Numerical Rating Scale of Pain (NRS) assesses pain levels on a 0-10 scale. The NRS was administered to participants pre and post the intervention. <h3>Results</h3> Over 6-months, 22 pain management groups took place, with 53 participants total. Recruitment was continuous. Of the 53, 57.8% were female, the mean age of the group was 65.45(14.75). The most common diagnostic group was the orthopedic population (54.7%) and the most common location of the pain was the leg (29.7%). The means and standard deviations were calculated for the NRS, both pre and post the group session. The pre-group NRS were 5.13(2.50) and the post-group NRS were 4.45(2.66). The paired samples t-test revealed a statistically significant average difference, t52=3.648, p <h3>Conclusions</h3> The findings demonstrate the feasibility of implementing a Mindfulness and Pain Management Group in an acute rehabilitation setting. Also, findings suggests potential effect on pain reduction, however we suggest more research to examine the efficacy of this group. <h3>Author(s) Disclosures</h3> All authors have nothing to disclose.

Sleep Quality in An Acute Inpatient Rehabilitation Setting: The Importance of Prior Sleep Disorders

<h3>Research Objectives</h3> To assess whether demographic and clinical factors might impact sleep quality during inpatient stay in a rehabilitation setting. <h3>Design</h3> In this prospective study, patients were assessed for their sleep quality at admission and discharge. <h3>Setting</h3> Patients admitted in the acute inpatient rehabilitation unit of Casa Colina Hospital and Centers for Healthcare (Pomona, California) were included in the study. <h3>Participants</h3> Thirty five patients participated to this study (age=61±16 years old; BMI=30±7kg/m2; 18 females, 18 Caucasians). <h3>Interventions</h3> None. <h3>Main Outcome Measures</h3> The Pittsburg Sleep Quality Index (PSQI) was administered as primary outcome. Demographic and clinical data were collected as covariates (i.e., age, BMI, gender, race, cause of hospitalization, pre-hospital setting and prior diagnosis of sleep disorders). The level of anxiety and depression were also assessed using Beck Anxiety Inventory (BAI) and Patient Health Questionnaire-9 (PHQ-9). <h3>Results</h3> The average length of hospitalization was 18±8 days. Cause of hospitalization included stroke (20%), spinal cord injury (28%), orthopedic (28%) and other diagnosis (23%). In this sample, 22% had a sleep disorder diagnosis (mostly sleep apnea) and 60% came from an acute care unit. ANOVAs with repeated measures were performed on the outcome measure (PSQI) controlling for BMI and age. Among the demographic and clinical variables considered, the presence of sleep disorders had an effect on changes in PSQI total scores. The PSQI decreased significantly in patients with prior diagnosis of sleep disorders. The pre-hospital setting trended toward statistical significance only for the group without sleep disorders. The initial level of anxiety or depression did not have an effect on the PSQI scores. However, changes in BAI and PHQ-9 total scores were related to changes in PSQI. Finally, our dataset did not reveal an effect of race or gender. <h3>Conclusions</h3> Prior sleep disorders diagnoses factors has an impact on sleep quality during hospitalization. These results identify high-risk patient characteristics that impact sleep hygiene which will be taken into consideration in developing an intervention for improving inpatient sleep hygiene. <h3>Author(s) Disclosures</h3> The authors have nothing to declare.

A Multi-site Feasibility and Validation Study of Visual Signs and Symptoms Screen (V-SASS)

<h3>Research Objectives</h3> To investigate the feasibility and validity of the V-SASS, a tool for clinicians to easily identify vision function and functional visual deficits and facilitate appropriate referrals and intervention. <h3>Design</h3> Prospective, multi-site study conducted across four states (California, Texas, Illinois, and Minnesota) and six facilities. <h3>Setting</h3> Acute care hospital (22%), inpatient rehabilitation (36.9%), and outpatient rehabilitation (41.1%). <h3>Participants</h3> 141 participants with new onset stroke, average age 61.8 years old, 51.4% male, 48.6% female; 56.4% white, 28.6% Black/African American, 9% Hispanic and 6% Asian/Pacific Islander. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Validation and feasibility of the V-SASS. <h3>Results</h3> The three domains of the V-SASS, inclusive of visual complaints, and static and functional observations, were assessed respectively. In the vision complaint domain, 70.5% of participants identified vision symptoms. 52.6% of the participants were observed to have vision symptoms in the static observation domain. In the final domain, functional observations, 31.9% of the participants exhibited signs of visual dysfunction. Each domain is further subdivided by chief signs and symptoms relative to the topic. Nineteen individuals were confirmed to have been seen by a vision specialist. Of these, 100% had either a vision function (60.0%) or functional vision (80.0%) deficit. 52.6% were found to have both a vision function and functional vision deficit. Feasibility of the V-SASS addressed by various elements, including ease of administration, likability of screen arrangement, confidence in use, and overall recommendations of the V-SASS. All areas addressed were in favor of the V-SASS (all above 75%). Frustration while using the V-SASS was also captured with 24.8% indicating some level of frustration. <h3>Conclusions</h3> The three domains of the V-SASS identified vision signs and symptoms, with prevalence rates (70.5%) consistent with the literature (Rowe et al., 2019). Validity of the V-SASS was confirmed (100% of participants who screened positive were found to have vision deficits by a vision specialist). The V-SASS demonstrates feasibility in multiple clinical and geographic settings, though future research to further investigate robustness is warranted. <h3>Author(s) Disclosures</h3> N/A.

Organizational Capacity Among Hospitals in Medicare and Commercial Bundled Payments

Hospitals must strategically build organizational capacities to succeed in bundled payment arrangements. Given differences between Medicare and commercial arrangements, capacities may vary between hospitals in Medicare vs both Medicare and commercial bundled payment programs. This study compared organizational capacities between these 2 hospital groups. National survey of American Hospital Association (AHA) member hospitals with experience in bundled payment programs. We analyzed data from October 31, 2017, to April 30, 2018, collected from AHA member hospitals with bundled payment experience in only Medicare (Medicare-only hospitals) or in both Medicare and commercial insurers (multipayer hospitals). Survey questions examined capacity in 4 areas: (1) physician performance feedback, (2) care management, (3) postacute care provider utilization, and (4) health information technology. Our sample included 114 hospitals reporting experience in Medicare or commercial bundled payment programs. Both Medicare-only and multipayer hospitals reported high organizational capacities in performance measurement of physician-level quality and cost feedback and in incorporation of health information technology. More multipayer hospitals reported high capacity for coordinating hospital to postacute care settings (88% vs 52%). Although nearly all hospitals in both groups reported formalized relationships with skilled nursing facilities (98%), fewer hospitals reported such relationships with long-term acute care hospitals (83%) and inpatient rehabilitation facilities (80%). Although they have similar capacity in a number of areas, Medicare-only and multipayer hospitals differed with respect to other aspects of organizational capacity.

Improving PM&R Resident Knowledge and Confidence About Autonomic Dysreflexia in Inpatient Spinal Cord Injury Patients

Research Objectives To improve Physical Medicine & Rehabilitation (PMR) resident medical knowledge and confidence in diagnosing and treating Autonomic Dysreflexia (AD) in Spinal Cord Injury patients admitted to an acute inpatient rehabilitation unit. Design Pre-test-post-test design. Setting MR Residency Program at an academic medical center. Participants 24 PM&R residents. Interventions Residents received simulation training on AD in 4 different clinical presentations using separate high-fidelity manikins in a small (3-4) group setting followed by 1 hour of didactic session on AD on a separate date. Main Outcome Measures Resident confidence on diagnosis and treatment of AD measured using a pre- and post-test survey. Responses were scored using Likert scale with 1 being “not at all confident” and 5 being “very confident”. Results For the six PGY-2 residents, a comparison of survey results before simulation and after simulation yielded significant increases in the confidence of their responses to each question asked (except the question regarding understanding of the pathophysiology of autonomic dysreflexia). In a post simulation comparison of survey responses between PGY-2 residents and senior resident there was no significant difference in the confidence of responses between the different resident levels. Conclusions Our study demonstrates the benefits of utilizing simulation training to improve clinical confidence through simulated application of trainee medical knowledge. The lack of significant difference in confidence level in the post stimulation survey responses between PGY-2 and senior residents highlights the value of simulation training for new trainees in orienting them to medical management of AD. High-fidelity manikins are an innovative and interactive educational tool that should be used to augment standard didactic and bedside teaching. Author(s) Disclosures None. To improve Physical Medicine & Rehabilitation (PMR) resident medical knowledge and confidence in diagnosing and treating Autonomic Dysreflexia (AD) in Spinal Cord Injury patients admitted to an acute inpatient rehabilitation unit. Pre-test-post-test design. MR Residency Program at an academic medical center. 24 PM&R residents. Residents received simulation training on AD in 4 different clinical presentations using separate high-fidelity manikins in a small (3-4) group setting followed by 1 hour of didactic session on AD on a separate date. Resident confidence on diagnosis and treatment of AD measured using a pre- and post-test survey. Responses were scored using Likert scale with 1 being “not at all confident” and 5 being “very confident”. For the six PGY-2 residents, a comparison of survey results before simulation and after simulation yielded significant increases in the confidence of their responses to each question asked (except the question regarding understanding of the pathophysiology of autonomic dysreflexia). In a post simulation comparison of survey responses between PGY-2 residents and senior resident there was no significant difference in the confidence of responses between the different resident levels. Our study demonstrates the benefits of utilizing simulation training to improve clinical confidence through simulated application of trainee medical knowledge. The lack of significant difference in confidence level in the post stimulation survey responses between PGY-2 and senior residents highlights the value of simulation training for new trainees in orienting them to medical management of AD. High-fidelity manikins are an innovative and interactive educational tool that should be used to augment standard didactic and bedside teaching.

Executive Function Predicts Mobility and Balance in Stroke Rehabilitation: A Cohort Study

<h3>Research Objectives</h3> To investigate the effect of executive function on mobility and balance in acute stroke rehabilitation. <h3>Design</h3> This was a cohort study with outcomes assessed at admission and discharge. <h3>Setting</h3> Data were extracted from electronic medical records of an acute inpatient rehabilitation unit at a large, urban, academic medical center. <h3>Participants</h3> Participants were 266 adults with stroke admitted to the inpatient rehabilitation unit between 2012 and 2016. Participants were a subgroup of a larger cohort (n=408) who completed the Symbol Digit Modalities Test (SDMT), a measure of executive function. <h3>Interventions</h3> This was an observational study of rehabilitation outcomes. <h3>Main Outcome Measures</h3> The primary outcomes were the baseline-adjusted discharge scores of the Functional Independence Measure mobility subscale and the Berg Balance Scale. The primary predictor was executive function as measured by the SDMT, administered at admission. Covariates considered included sex, age, stroke severity, days post stroke, length of stay, lesion type, comorbidities, and lesion side. The FIM Cognitive subscale was included in each model to distinguish between executive function and general cognitive function. <h3>Results</h3> The SDMT was a significant predictor of baseline-adjusted mobility at discharge (B=0.14; 95% CI=0.08-0.20, standardized b=.24). Other significant predictors included age, sex, and length of stay. The SDMT was a significant predictor of baseline-adjusted balance at discharge (B=0.17, 95%CI=0.03-0.30, standardized b=.12). Other significant predictors included age. FIM Cognitive scores were not significant predictors of mobility or balance. <h3>Conclusions</h3> Executive function is a factor in mobility gains during inpatient rehabilitation for stroke, though the association is modest. Rehabilitation professions should consider the impact on mobility. Cognitive rehabilitation addressing executive function may aid in mobility progress. Executive function contributes to improvements in balance, but the contributions are small. <h3>Author(s) Disclosures</h3> The authors have no conflicts to disclose.

Palliative Rehabilitation in Acute Inpatient Rehabilitation: Prognostic Factors and Functional Outcomes in Patients with Cancer.

Prognosis has a vital role for patients with cancer undergoing palliative rehabilitation in acute inpatient rehabilitation. This study aimed to identify the proportion of patients who survived <2 months after discharge and the associated prognostic factors. This was a secondary analysis of a retrospective study of 163 consecutive patients admitted to acute inpatient rehabilitation from September 1, 2017, to February 28, 2018 at a cancer center. Baseline demographics, clinical characteristics, and putative prognostic factors, including Activity Measure for Post-Acute Care (AM-PAC) functional scores, were analyzed. Of 163 patients, 27 (17%; 95% CI, 11-23) died within 60 days of discharge. These patients were more likely to be male (OR = 2.83; 95% CI, 1.16-6.92; P = .017); have longer hospital stays (OR = 1.02; 95% CI, 1-1.04; P = .015); receive ≥ weekly packed red blood cell (OR = 5.31; 95% CI, 1.86-15.1; P = .003) or platelet (OR = 4.57; 95% CI, 1.44-14.5; P = .014) transfusions; have lower AM-PAC daily activity scores upon discharge (OR = 0.90; 95% CI, 0.83-0.97; P = .006); and have lower AM-PAC basic mobility scores upon admission (OR = 0.91; 95% CI, 0.85-0.98; P = .018) and discharge (OR = 0.88; 95% CI, 0.82-0.94; P = <.001). Multivariate analysis showed that the male sex (OR = 2.71; 95% CI, 1.03-7.15; P = .037) was independently associated with ≤2 months survival, whereas AM-PAC basic mobility score at admission of >33 (OR = 0.24, 95% CI, 0.07-0.79; P = .022) was less likely. Approximately 1 in 6 patients who completed acute inpatient rehabilitation died within 2 months of discharge, had poorer baseline functional status, and were less likely to regain function than those who lived longer.

Abstract 227: Acute Inpatient Rehabilitation And Social Determinants Of Health Are Associated With Functional Recovery Patterns At 12 Months Relative To Hospital Discharge From Cardiac Arrest.

Introduction: Cardiac arrest (CA) survivors have significant impairments and poor functional outcomes at hospital discharge. We assessed if discharge disposition to acute inpatient rehabilitation after CA-related hospitalization is associated with improved functional recovery at 12 months relative to alternative acute care hospital discharge dispositions. Methods: Adults with the return of spontaneous circulation after in-hospital or out-of-hospital CA between 2/1/2016- 1/31/2020 admitted to intensive care units in a single tertiary care center were enrolled in an observational, prospective cohort study. A series of logistic regressions were used to assess acute inpatient rehabilitation associations with good functional recovery patterns, defined as persistent Modified Rankin Score (mRS) 0-2, or absence of any worsening of mRS at 12 months relative to discharge mRS. The model included demographics, individual and structural-level Social Determinants of Health, and pertinent clinical characteristics. Results: Of 201 included patients (24% Hispanic and 19% Black; average age 56±16 years; 40% women), 63% (n=127) reported good functional recovery pattern. Patients who went to acute inpatient rehabilitation were significantly more likely to experience good recovery pattern (54.3% vs 37.8% with poor recovery pattern, p&lt;0.01). In a multivariable model, acute inpatient rehabilitation was significantly associated with a good recovery pattern when compared to other discharge dispositions (home with out-patient rehabilitation services (odds ratio (OR), 0.3; CI, 0.1-0.8; p = 0.02), and skilled nursing facility (OR, 0.2; CI, 0.1-0.6; p&lt;0.01). SDOH including minority race/ethnicity, poor insurance, premorbid unemployment, no carepartner or spouse, and patients with longer hospital length of stay had independent and significant associations with poor functional recovery patterns. Conclusions: Acute inpatient rehabilitation was associated with a good functional recovery pattern 12 months after hospital discharge from CA. Social determinants of health have an independent effect on the functional recovery patterns and should be systematically collected for future outcome-based studies.

Multiplex array analysis of serum cytokines offers minimal predictive value for cognitive function in the subacute phase after stroke.

The effects of inflammation on post-stroke cognitive function are still unclear. This study investigated the correlation between the Th17-related cytokines in peripheral blood and post-stroke cognitive function after ischemic stroke in the subacute phase. A retrospective cohort study. Academic acute inpatient rehabilitation facility. One hundred and fourteen patients with first ischemic stroke were categorized as the poor cognitive recovery group (n = 58) or good cognitive recovery group (n = 56) based on their cognitive MRFS efficiency. All subjects received routine physical, occupational, and speech-language pathology therapy. Serum cytokines/chemokine (IL-1 β, IL-2, IL-4, IL-5, IL-6, IL-9, IL-10, IL-12p70, IL-13, IL-15, IL-17A, IL-17E, IL-17F, IL-21, IL-22, IL-23, IL-27, IL-28A, IL-31, IL-33, GM-CSF, IFN-γ, MIP-3 α, TNF-α, and TNF-β) levels were measured in duplicate using Human Th17 magnetic bead panel and multiplex array analysis (Luminex-200 system). The primary functional outcome was a gain in functional independence measure (FIM) cognitive subscore at discharge. The secondary outcome measures were FIM total score at discharge, length of stay in the hospital, and discharge destination. Cognitive Montebello Rehabilitation Factor Score (MRFS) and cognitive MRFS efficiency were calculated. Demographic and clinical characteristics were obtained from the medical record. The good cognitive recovery group had an interesting trend of higher IL-13 than the poor cognitive recovery group (good cognitive recovery group 257.82 ± 268.76 vs. poor cognitive recovery group 191.67 ± 201.82, p = 0.049, unit: pg/ml). However, Pearson's correlation analysis showed no significant correlation between cytokine levels and gain of cognition, cognitive MRFS, or cognitive MRFS efficiency. Receiver operating characteristic (ROC) analysis of cytokines also suggested a low accuracy of prediction as a predictor for post-stroke cognitive recovery improvement. Our preliminary findings suggested that the level of serum cytokines had minimal predictive value for the recovery of cognitive function during the subacute inpatient rehabilitation after stroke.

CLOT IN TRANSIT: THE ROLE OF POINT-OF-CARE ULTRASOUND IN EARLY DIAGNOSIS AND IMPROVED OUTCOMES

CLOT IN TRANSIT: THE ROLE OF POINT-OF-CARE ULTRASOUND IN EARLY DIAGNOSIS AND IMPROVED OUTCOMES

The role of acute in-patient rehabilitation on short-term outcomes after liver transplantation: A systematic review of the literature and expert panel recommendations.

The indication and surgical complexity of orthotopic liver transplantation underscore the need for strategies to optimize the recovery for transplant recipients. We conducted a systematic review aimed at identifying, evaluating, and synthesizing the evidence examining the effect of in-patient rehabilitation for liver transplant recipients and provide related practice recommendations. Health research databases were systematically reviewed for studies that included adults who received liver transplantation and participated in acute, post-transplant rehabilitation. Postoperative morbidity, mortality, length of hospital stay, length of intensive care unit stay, and other markers of surgical recovery were extracted. Practice recommendations are provided by an international panel using GRADE. Twelve studies were included in the review (including 3901 participants). Rehabilitation interventions varied widely in design and composition; however, details regarding intervention delivery were poorly described in general. The quality of evidence was rated as very low largely owing to "very serious" imprecision, poor reporting, and limited data from comparative studies. Overall, the studies suggest that in-patient rehabilitation for recipients of liver transplantation is safe, tolerable, and feasible, and may benefit functional outcomes. Two practice recommendations related to in-patient rehabilitation following LT were yielded from this review: (1) it is safe, tolerable, and feasible; and (2) it improves postoperative functional outcomes. Each of the recommendations are weak and supported by low quality of evidence. No recommendation could be made related to benefits or harms for clinical, physiological, and other outcomes. Adequately powered and high quality randomized controlled trials are urgently needed in this area.

We Got Your Back: Evaluating Recovery Following Spinal Cord Injury After High-Voltage Electric Burns.

Delayed spinal cord injury (SCI) is a relatively rare consequence of high voltage electrical burns, but it holds significant implications for patient quality of life. Due to the uncommon nature of delayed SCI and variable time of onset following injury, providers are currently unable to provide a prognosis for functional recovery and optimize a therapy process tailored to treat this patient populace. In this study, we aim to better map the pattern of recovery in these patients to better inform future rehabilitation practices. A retrospective chart review of five patients who experienced delayed SCI secondary to an electrical burn was conducted. The majority of patients displayed an upward trajectory in motor function following acute hospitalization and inpatient rehabilitation, with four of the five patients able to achieve complete motor strength in multiple extremities. In addition, rehabilitation was shown to have a noticeable impact in improving functional independence in tasks related to nursing. In conclusion, the clinical and functional outcomes of these delayed SCI patients point to the need for multidisciplinary management following injury and highlight the importance of early rehabilitation in regaining function.

A-150 Cognitive Impairment in Patients with Infratentorial Stroke Undergoing Acute Stroke Rehabilitation

Abstract Objective: Brainstem, pontine, and cerebellar (infratentorial) stroke has been associated with motor and cranial nerve dysfunction. However, case reports and clinical observations suggest that cognitive impairment may be present. Acute inpatient stroke rehabilitation is a critical time to implement cognitive interventions; however, intervention opportunities may be missed if rehabilitation providers are unaware of cognitive dysfunction and do not assess for deficits in patients with infratentorial strokes. Our objective was to evaluate cognition in individuals with infratentorial strokes undergoing acute inpatient rehabilitation. Method: Participants were recruited as part of an ongoing clinical trial on an acute inpatient rehabilitation unit. Participants (N=7; Median age=69 years (range 53-88); Median education=16 years (range: 6-20); 4 female) with recent onset infratentorial stroke were administered the Tablet-based Cognitive Assessment Tool on admission to the unit. Performance was evaluated via normative comparison (impairment defined as ≤1.5 SD below the normative mean) and by direct comparison to participants with supratentorial strokes (N=17) using Mann-Whitney U tests. Results: Participants with infratentorial stroke demonstrated impairment across tasks of attention/working memory, set-shifting, and inhibition (Median age-normed z-score ranged from -2.35 to -3.86). No statistically significant differences were observed between patients with infratentorial and supratentorial strokes on any cognitive tasks (all p’s&amp;gt;.25). Conclusions: In acute inpatient rehabilitation, infratentorial stroke may cause impairment in attention, working memory and executive functioning similar to the impairment seen in patients with supratentorial stroke. Although follow-up analyses with larger samples are warranted, results suggest that early identification and intervention for cognitive deficits should be part of rehabilitation for patients with infratentorial strokes.

Utility of the AM-PAC "6 Clicks" Basic Mobility and Daily Activity Short Forms to Determine Discharge Destination in an Acute Stroke Population.

The American Heart Association and American Stroke Association recommend early identification of level of rehabilitative care as a priority after stroke. To evaluate the utility of the Activity Measure for Post-Acute Care (AM-PAC) "6 Clicks" Daily Activity and Basic Mobility forms to determine the next level of rehabilitation after hospitalization for adults with stroke. Retrospective cohort design using medical records from 2015 to 2016. Major urban hospital. Patients admitted to the stroke service, with a confirmed stroke, who were seen by a physical or occupational therapist; who had a 6 Clicks Basic Mobility or Daily Activity score at initial evaluation; and who were discharged to home, an acute inpatient rehabilitation facility (IRF), or a subacute skilled nursing facility (SNF). Length of stay and discharge destination. Seven hundred four participants (M age = 68.28 yr; 51.21% female) were included. Analysis of variance and receiver operating characteristic curves were performed. Daily Activity scores were highest for home discharge, lower for IRF discharge, and lowest for SNF discharge; Basic Mobility showed a similar pattern. Cutoff values distinguishing home from further inpatient rehabilitation were 44.50 for Basic Mobility and 39.40 for Daily Activity scores (area under the curve [AUC] = .82 for both forms), with scores of 34.59 (AUC = 0.64) and 31.32 (AUC = 0.67) separating IRF from SNF, respectively. Therapists should incorporate 6 Clicks scores into their discharge planning. What This Article Adds: This research demonstrates the utility of an outcome measure in the acute care setting that assists in planning discharge destination for patients with stroke.

Characteristics and Outcomes of COVID-19 Survivors Requiring Inpatient Rehabilitation: A Comparison of Two Waves.

Many survivors of severe or critical COVID-19 have required rehabilitation during the pandemic. The primary objective was to compare characteristics and outcomes of survivors of severe or critical COVID-19 admitted to the inpatient rehabilitation facility during the first two waves of the pandemic. Our secondary objective was to identify the factors contributing to functional dependence on admission, discharge, and length of stay. This is a retrospective cohort study of 138 patients admitted to an inpatient rehabilitation facility in two waves after hospitalization for severe or critical COVID-19 illness between April 1, 2020, and May 3, 2021. Inpatient rehabilitation facility patients in wave 2 had significantly greater functional independence (GG scores) on admission (52; interquartile range, 44-58 vs 41; interquartile range, 28-52), lower incidence of dysphagia and anemia. The patients in both waves experienced similar functional improvement efficiencies with a median GG score change of 3.6 per day and similar discharge GG scores. Neurological sequela (odds ratio, 0.12; P < 0.001) and anemia (odds ratio, 1.35; P < 0.002) were identified as independent predictors of functional independence on admission. Patients with functional deficits after COVID-19 should be considered for acute inpatient rehabilitation as both patient cohorts benefited from their inpatient rehabilitation facility stays with similar length of stays (11-12 days) and discharge to home rates (88%-90%).

Minimal clinically important difference of the Berg Balance Scale and comfortable walking speed in patients with acute stroke: A multicenter, prospective, longitudinal study

Objective To determine the minimal clinically important difference between the Berg Balance Scale and comfortable walking speed in acute-phase stroke patients. Design Multicenter, prospective, longitudinal study. Setting Inpatient acute stroke rehabilitation. Subjects Seventy-five patients with acute stroke, mean (SD) age 71.7 (12.2) years. Intervention Inpatients with acute stroke were assessed with the Berg Balance Scale and comfortable walking speed before and after rehabilitation. Physiotherapy was conducted to improve balance and gait over a 2-week period: an average of 40 min/day on weekdays and 20 min/day on weekends and holidays. Main measures The patients’ Berg Balance Scale, comfortable walking speed, Global Rating of Change scale (patient-rated and physiotherapist-rated), and motor score of the Functional Independence Measure were obtained. Minimal clinically important differences were estimated using both anchor- (receiver operating characteristic curves and change difference) and distribution-based approaches (minimal detectable change and 0.5× the change score [SD]). Results The baseline scores were 31.2 (18.9) for the Berg Balance Scale and 0.79 (0.35) m/s for comfortable walking speed. The minimal clinically important difference in the Berg Balance Scale was 6.5–12.5 points by the anchor-based approach and 2.3–4.9 points by the distribution-based approach. The minimal clinically important difference in comfortable walking speed was 0.18–0.25 m/s by the anchor-based and 0.13–0.15 m/s by the distribution-based approach. Conclusions A change of 6.5–12.5 points in the Berg Balance Scale and 0.18–0.25 m/s in the comfortable walking speed is required in these measurements’ anchor-based minimal clinically important differences to be beyond measurement error, and to be perceptible by both patients and clinicians.

Determining school reintegration needs of acquired brain injury patient through the use of a novel school simulation rubric.

Determining when a child returns to school after an acquired brain injury is difficult to assess. Many factors affect a successful hospital-to-school reintegration. The hospital school simulation allowed the Acute Pediatric Inpatient Rehabilitation Unit (IRU) interdisciplinary team to assess how the patient was functioning at specific stages of the patient healing process to target goals that explicitly helped the patient safely reintegrate into school. A patient with an acquired brain injury (ABI) participated in a hospital school simulation where a novel school simulation rubric (SSR) tool was used to evaluate completion of specific activities the patient would experience in a traditional classroom. Results were shared with the IRU team so accommodations and modifications could be made to the IRU school recommendations letter based on the results of the final SSR. Preliminary results were found to benefit the patient as they reintegrated back to school. This study highlights the need for ongoing communication between hospital providers and educational personnel to provide patients with academic supports for school reintegration.

Getting on the Same Page: A Quality Improvement Project to Enhance Nurse-to-Resident Communications and Reduce Overnight Sleep Interruptions.

Many residency programs utilize "home call" residents who answer hospital communications and place orders from home. Often, residents are required to live nearby and arrive in-person if needed. Residents work normal daytime work hours while on home call, which can last several nights. This disrupts sleep and creates the potential for increased resident fatigue and patient safety issues. To implement and evaluate a novel program to reduce non-urgent overnight pages from nurses to home call physical medicine and rehabilitation (PM&R) residents between 11 pm and 6 am. At an inpatient acute rehabilitation unit in a tertiary care university teaching hospital, we implemented a 2-step prospective quality improvement study with interventions derived from nurse-physician meetings implemented 9 months apart in 2018 and 2019. The first intervention was a centralized nightly handoff sheet. The second intervention was to display suggested PRN medication lists in resident workrooms. The primary outcome measure was the percentage of nights with non-urgent pages between 11 pm and 6 am. Tracking urgent pages and 7-10 am emergent pages were used as balancing measures. A total of 1835 text-based nursing pages (366 pre- and 1469 post-intervention) were received and categorized by content, urgency, and timing over a 17-month period. Post-intervention, there was a stable 25% decrease in nighttime non-urgent pages. The most common hour to be paged shifted from 11 pm to 8 pm. Pain, constipation, insomnia, and nausea were the most common complaints overnight. By characterizing and studying nighttime pages, residents collaborated with nighttime nursing staff through structured meetings to reduce non-urgent nighttime pages for more than 1 year.

Empowerment, Communication, and Navigating Care: The Experience of Persons With Spinal Cord Injury From Acute Hospitalization to Inpatient Rehabilitation.

BackgroundSpinal cord injury (SCI) results in long-term functional impairments that significantly impact participation and role in the community. Newly injured persons are often reintroduced to the community with significant deficits in knowledge, including how to access and navigate community resources and supports. This warrants a better understanding of the patient experience of in-hospital care and discharge planning to ensure individuals with SCI are best supported during transitions in care and while living in the community.ObjectiveTo explore the lived experience of persons with acute SCI and their perceptions of care, focusing on the initial hospital experiences to inpatient rehabilitation.MethodsA phenomenological research study was conducted using semi-structured interviews. Eligible participants had differing etiologies of SCI (including non-traumatic and traumatic SCI), were over the age of 18 at the time of initial care, and experienced acute hospital and inpatient rehabilitation at an Alberta-based institution within the last 10 years. One-on-one interviews took place between March and June 2021 over telephone or virtual platforms (Zoom). Interview transcripts, and field notes developed the text, which underwent hermeneutic analysis to develop central themes.ResultsThe present study included 10 participants living with an SCI in Alberta, Canada. Most participants (80%) were male. Participants' age ranged from 24 to 69 years. The median years since initial SCI was 3 years. Interviews lasted 45–75 min. Seven participants identified as having a traumatic SCI injury and three identified as having a non-traumatic SCI. The interplay between empowerment and disempowerment emerged as the core theme, permeating participants' meanings and perceptions. Three main themes emerged from the interviews regarding the perceptions of the SCI patient experience. Each theme represents a perception central to their inpatient experience: desire to enhance functional independence to empower confidence and self-management; need for effective communication with healthcare providers to support recovery; and navigating appropriate care supports to enhance preparedness for discharge and returning home.ConclusionThis study demonstrates the significant need to enhance education of person/family-centered SCI care, foster positive communication between care recipients and care providers, and facilitate better in-hospital access to appropriate navigation and wayfinding supports.

0597 The Relationship Between Sleep Quality and Functional Outcomes Following Acute Stroke and Inpatient Rehabilitation

Abstract Introduction There is mounting evidence that sleep plays an important role in the rehabilitation and recovery process following acute stroke. Following acute care, many patients with stroke are admitted to inpatient rehabilitation facilities (IRFs), where they undergo intensive, interdisciplinary therapy to recover or relearn functional skills to minimize long-term disability. The role and impact of sleep in this early stage of stroke rehabilitation, however, is poorly understood. The purpose of this study is to investigate the relationship between sleep quality and clinical outcomes in the IRF setting following acute stroke. Methods Patients wore a collection of wearable sensors to measure sleep and wake throughout their IRF stay. Linear mixed-effect models (LMEMs) were built to determine the relationship between functional outcomes and sleep quality. Independent variables were total sleep time (TST) and sleep efficiency (SE) derived from wearable sensors, calculated between two clinical measures. Dependent variables included scores from repeated measures of the 6-Minute Walk Test (6MWT), 10-Meter Walk Test (10MWT), Berg Balance Scale (BBS), and Action Research Arm Test (ARAT). Covariates included demographics such as age and stroke type. Results Fifty-three individuals with stroke (age: 58.26±15.57 years; BMI: 28.27±6.16 kg/m2) consented to participate during their IRF program within 7 days of admission. All individuals were recruited from a single-site IRF between July 2020 and August 2021. The average length of stay was 17.85±6.99 days. There were no significant differences in TST between the first three nights and the last three nights (5.1±1.9 hours vs. 5.2±2.0 hours) or SE (67.8±17.7% vs. 69.0±17.8%). The greater standard deviation of TST was associated with lower 6MWT scores (R2=0.77, beta=−0.48, p=0.06), while the greater standard deviation of SE was associated with lower 10MWT scores (R2=0.80, beta=−0.20, p=0.18). Conclusion Our preliminary findings indicate that greater variability in TST and SE are associated with walking endurance and mobility recovery. Future analyses will investigate additional measures of sleep and activity in IRF settings and their relationship with patient outcomes. This work can inform novel sleep interventions to optimize post-stroke recovery. Support (If Any) This work is supported by the Eunice Kennedy Shriver National Institute of Child Health &amp; Human Development (NIH R01HD097786-01A1).