Rehabilitation Admission Research Articles

Conception and development of Self-Management indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project

Context Although self-management is linked to reduced secondary health complications (SHCs) and enhanced overall quality of life post-spinal cord injury or disease (SCI/D), it is poorly integrated into the current rehabilitation process. Promoting self-management and assuring equity in care delivery is critical. Herein, we describe the selection of Self-Management structure, process and outcome indicators for adults with SCI/D in the first 18 months after rehabilitation admission. Methods Experts in self-management across Canada completed the following tasks: (1) defined the Self-Management construct; (2) conducted a systematic search of available outcomes and their psychometric properties; and (3) created a Driver diagram summarizing available evidence related to Self-Management. Facilitated meetings allowed development and selection following rapid-cycle evaluations of proposed structure, process and outcome indicators. Results The structure indicator is the proportion of staff with appropriate education and training in self-management principles. The process indicator is the proportion of SCI/D inpatients who have received a self-management assessment related to specific patient self-management goal(s) within 30 days of admission. The outcome indicator is the Skill and Technique Acquisition, and Self-Monitoring and Insight subscores of the modified Health Education Impact Questionnaire. Conclusion The structure indicator will heighten awareness among administrators and policy makers regarding the need to provide staff with ongoing training related to promoting self-management skill acquisition. Successful implementation of the Self-Management process and outcome indicators will promote self-management education and skill acquisition as a rehabilitation priority, allow for personalization of skills related to the individual’s self-management goal(s), and empower individuals with SCI/D to manage their health and daily activities while successfully integrating into the community.

Development of Reaching, Grasping & Manipulation indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project

Objective To describe the development of structure, process, and outcome indicators aimed to advance the quality of Reaching, Grasping & Manipulation (RG&M) rehabilitation for Canadians living with spinal cord injury or disease (SCI/D). Method Upper extremity rehabilitation experts developed a framework of indicators for evaluation of RG&M rehabilitation quality. A systematic search of the literature identified potential upper extremity indicators that influence RG&M outcomes. A Driver diagram summarized factors influencing upper extremity outcomes to inform the selection of structure and process indicators. Psychometric properties, clinical utility, and feasibility of potential upper extremity measures were considered when selecting outcome indicators. Results The selected structure indicator is the number of occupational and physical therapists with specialized certification, education, training and/or work experience in upper extremity therapy related to RG&M at a given SCI/D rehabilitation center. The process indicator is the total hours of upper extremity therapies related to RG&M and the proportion of this time allocated to neurorestorative therapy for each individual with tetraplegia receiving therapy. The outcome indicators are the Graded Redefined Assessment of Strength, Sensation and Prehension (GRASSP) strength and Spinal Cord Independence Measure III (SCIM III) Self-Care subscores implemented at rehabilitation admission and discharge, and SCIM III Self-Care subscore only at 18 months post-admission. Conclusion The selected indicators align with current practice, will direct the timing of routine assessments, and enhance the volume and quality of RG&M therapy delivered, with the aim to ultimately increase the proportion of individuals with tetraplegia achieving improved upper extremity function by 18 months post-rehabilitation.

Development of employment indicators to advance the quality of spinal cord injury rehabilitation care: SCI-High Project

Context Employment and Return to Work (RTW) rates following spinal cord injury/disease (SCI/D) are low due to individual and impairments characteristics, secondary health conditions, social and environmental barriers, prior work experience, workplace supports and resources, and physical or psychosocial work demands. To improve RTW, the SCI-High Project team developed a set of Employment structure, process, and outcome indicators for adults with SCI/D in the first 18 months after rehabilitation admission. Methods A pan-Canadian Working Group of diverse stakeholders: (1) defined the Employment construct; (2) conducted a systematic search of available outcomes measures; (3) constructed a Driver diagram summarizing factors associated with employment. Subsequent facilitated meetings allowed for the creation of structure and process indicators, and the selection of outcome indicators. Results The structure indicator is the proportion of SCI/D rehabilitation programs with an employment resource center. The process indicator is the proportion of SCI/D rehabilitation inpatients who receive an employment assessment during inpatient rehabilitation. The intermediary and final outcome measures are the Readiness for Return-to-Work Scale (RRTW) and Work Productivity and Activity Impairment (WPAI). Scale A of the RRTW for those who are unemployed and Scale B of RRTW and WPAI will be used for those who are employed. Conclusion This framework of Employment indicators intends to support the RTW needs of persons with SCI/D by ensuring that rehabilitation professionals provide opportunities to explore RTW within the first 18 months after rehab admission. Increased employment rates have the potential to enhance the wellbeing, health, and longevity of individuals with SCI/D.

Development of community participation indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project

Context Community participation following spinal cord injury/disease (SCI/D) can be challenging due to associated primary impairments and secondary health conditions as well as difficulties navigating both the built and social-emotional environment. To improve the quality of SCI/D rehabilitation care to optimize community participation, the SCI-High Project developed a set of structure, process and outcome indicators for adults with SCI/D in the first 18 months after rehabilitation admission. Methods A pan-Canadian Working Group of diverse stakeholders: (1) defined the community participation construct; (2) conducted a systematic review of available outcomes and their psychometric properties; (3) constructed a Driver diagram summarizing available evidence associated with community participation; and (4) prepared a process map. Facilitated meetings allowed selection and review of a set of structure, process and outcome indicators. Results The structure indicator is the proportion of SCI/D rehabilitation programs with availability of transition living setting/independent living unit. The process indicators are the proportion of SCI/D rehabilitation inpatients who experienced: (a) a therapeutic community outing prior to rehabilitation discharge; and, (b) those who received a pass to go home for the weekend. The intermediary and final outcome measures are the Moorong Self-Efficacy Scale and the Reintegration to Normal Living Index. Conclusion The proposed indicators have the potential to inform whether inpatient rehabilitation for persons with SCI/D can improve self-efficacy and lead to high levels of community participation post-rehabilitation discharge.

Robotic-assisted total hip arthroplasty: an economic analysis.

Aim: To evaluate 90-day episode-of-care (EOC) resource consumption in robotic-assisted total hip arthroplasty (RATHA) versus manual total hip arthroplasty (mTHA). Methods: THA procedures were identified in Medicare 100% data. After propensity score matching 1:5, 938 RATHA and 4,670mTHA caseswere included. 90-day EOC cost, index costs, length of stayand post-index rehabilitation utilization were assessed. Results: RATHA patients were significantly less likely to have post-index inpatient rehabilitation or skilled nursing facilityadmissions and used fewer home health agencyvisits, compared with mTHA patients. Total 90-day EOC costs for RATHA patients were found to be US$785 less than thoseof mTHA patients (p=0.0095). Conclusion: RATHA was associated with an overall lower 90-day EOC cost when compared with mTHA. The savings associated withRATHA were driven by reduced utilization and cost of post-index rehabilitation services.

Challenges and Lessons Learned for Acute Inpatient Rehabilitation of Persons With COVID-19: Clinical Presentation, Assessment, Needs, and Services Utilization.

ObjectiveThe aim of the study was to present: (1) physiatric care delivery amid the SARS-CoV-2 pandemic, (2) challenges, (3) data from the first cohort of post–COVID-19 inpatient rehabilitation facility patients, and (4) lessons learned by a research consortium of New York and New Jersey rehabilitation institutions.DesignFor this clinical descriptive retrospective study, data were extracted from post–COVID-19 patient records treated at a research consortium of New York and New Jersey rehabilitation inpatient rehabilitation facilities (May 1–June 30, 2020) to characterize admission criteria, physical space, precautions, bed numbers, staffing, employee wellness, leadership, and family communication. For comparison, data from the Uniform Data System and eRehabData databases were analyzed. The research consortium of New York and New Jersey rehabilitation members discussed experiences and lessons learned.ResultsThe COVID-19 patients (N = 320) were treated during the study period. Most patients were male, average age of 61.9 yrs, and 40.9% were White. The average acute care length of stay before inpatient rehabilitation facility admission was 24.5 days; mean length of stay at inpatient rehabilitation facilities was 15.2 days. The rehabilitation research consortium of New York and New Jersey rehabilitation institutions reported a greater proportion of COVID-19 patients discharged to home compared with prepandemic data. Some institutions reported higher changes in functional scores during rehabilitation admission, compared with prepandemic data.ConclusionsThe COVID-19 pandemic acutely affected patient care and overall institutional operations. The research consortium of New York and New Jersey rehabilitation institutions responded dynamically to bed expansions/contractions, staff deployment, and innovations that facilitated safe and effective patient care.

Rehabilitation length of stay and functional improvement among patients with traumatic spinal cord injury.

Retrospective cohort study. Investigate the association between rehabilitation length of stay (LOS) and motor FIM® (mFIM) between rehabilitation admission and discharge among patients with traumatic spinal cord injury (SCI). Seventeen SCI Model Systems (SCIMS) centers in the United States. A total of 3386 patients with traumatic SCI enrolled in the SCIMS Database from 2011 to 2018. The main outcome measure was the mean change in mFIM (12 items) between rehabilitation admission and discharge by twelve neurological categories (C1-C4 American Spinal Injury Association impairment scale (AIS) A-B, AIS C, AIS D, and C5-C8 AIS A-B, AIS C, AIS D, and T1-T10 AIS A-B, AIS C, AIS D, and T11-S3 AIS A-B, C, D). Linear regression models were applied to estimate changes across rehabilitation LOS groups (shortest LOS, quarter2, quarter3, and longest LOS) after adjusting for covariables for each neurological category. The mean age of study patients was 44.5 years. Patients were predominantly men (78.5%), non-Hispanic white (64.8%), and had private insurance (57.1%). The median LOS was 42 days across the entire sample. Longer LOS was associated with a higher mFIM score compared to the shortest LOS among patients with C1-C4 AIS D; C5-C8 AIS D; T1-T10 AIS A-B; and T11-S3 AIS A-B, C, and D after adjusting for demographics and clinical characteristics. Among patients with C1-C4 AIS D; C5-C8 AIS D; T1-T10 AIS A-B; and T11-S3 AIS A-B, C, and D injuries, those with longer rehabilitation stays tended to have more motor function improvement.

Associations between inappropriate medication use and (instrumental) activities of daily living in geriatric rehabilitation inpatients: RESORTstudy.

Inappropriate medication use can affect functional independence in older adults. The aim of the study is to examine associations between potentially inappropriate medication use and Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in geriatric rehabilitation inpatients. A longitudinal, prospective, observational study was undertaken at a teaching hospital. Potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) were measured at acute admission, and at admission and discharge from geriatric rehabilitation. Associations between PIM and PPO use and ADL and IADL scores were examined at admission to geriatric rehabilitation, discharge and 3-month post-discharge. A total of 693 inpatients were included. At the 3-month post-discharge, PPOs were associated with lower IADL scores (incident rate ratio = 0.868, 95% CI 0.776-0.972). There were no significant associations between PIMs and PPOs use at admission to geriatric rehabilitation with longitudinal changes of ADLs and IADLs from geriatric rehabilitation admission to 3-month post-discharge Renal PIMs were associated with higher IADL scores at 3-month post-discharge (incidence rate ratio = 1.750, 95% CI 1.238-2.474). At 3-month post-discharge, PPOs involving vaccinations were associated with a lower IADL score (incident risk ratio = 0.844, 95% CI 0.754-0.944). Inappropriate medication use involving PPOs was associated with lower IADL scores at 3-month post-discharge from geriatric rehabilitation but not with ADL scores. Greater attention is needed in reducing PPOs in geriatric rehabilitation inpatients that can potentially impact IADLs. In the community, health professionals need to be vigilant about assessing how older patients' physical functioning may be affected by inappropriate medication prescribing.

Prognostic factors of functional outcome in post-acute stroke in the rehabilitation unit

This retrospective study aimed to determine which factors, such as cognition, motor recovery, swallowing function, and bladder and bowel functions, significantly predicted independence in the activities of daily living (ADL) at hospital discharge in a domestic population of patients experiencing post-acute stroke who received in-hospital rehabilitation. We reviewed medical records that were retrieved from the Integrated Medical Database, National Taiwan University Hospital (NTUH-iMD) of 3000 patients who suffered from stroke and were admitted to NTUH from 2014 to 2017. The main outcome measure was independence in the basic ADL (modified Barthel index [mBI]) at discharge. Regression analyses were used to identify prognostic factors for the basic ADL (mBI). The total mBI improved from 40.7±33.0 to 63.1±34.1 in eligible 2538 patients during their hospital stay. The baseline daily activity function (R2 change=0.042) was the most important prognostic factor associated with independence at discharge, followed by dependence in sitting up (R2 change=0.014), impaired sitting balance (R2 change=0.010), the Brunnstrom stage of hemiplegic lower limb (R2 change=0.006), and the presence of bladder incontinence (R2 change=0.006) assessed by physician upon rehabilitation admission (R2=0.53, p<0.05). Dependency in sitting up, impaired sitting balance, and the presence of urinary incontinence were negative prognostic factors of ADL independence at discharge (p<0.05). By contrast, the Brunnstrom stage of hemiplegic lower limb and baseline mBI scores at rehabilitation admission were positive prognostic factors of ADL independence at discharge (p<0.05). Baseline ADL function was the most important prognostic factor of functional independence in post-acute stroke. Moreover, the activity limitation of dependency on sitting up and motor function impairment of hemiplegic lower limb prognosticated functional independence.

Patient characteristics predicting attendance for elective in-patient treatment of substance use disorder.

Consumption of alcohol and other drugs constitutes a significant health burden. Treatment access is poor, and a number of barriers are recognised. The objective of this retrospective cohort study is to examine patient characteristics of those attending/not attending for elective in-patient withdrawal management (IWM). Records of all elective admissions for IWM between 1 March and 30 June 2019 were reviewed. Data were extracted on attendance, age, substance(s) used, pre-arranged rehabilitation admissions following discharge, wait time, legal issues and child welfare agency involvement. Of 274 planned admissions, 193 (70%) attended. Attendance was predicted by residential treatment planned after withdrawal management and older age. People using amphetamines were less likely to attend. There are low attendance rates for elective IWM. Patient characteristics predicting lower attendance include younger age, amphetamine use and not planning rehabilitation. Further research is required to improve attendance.

Health Policy and Health Services Delivery in the Era of COVID-19.

Health Policy and Health Services Delivery in the Era of COVID-19.

A seven\xa0week observational analysis of clinical activities in a North Italian orthopaedic hospital during the second wave of SARS-CoV-2 pandemic: far from usual volumes, but different from the first wave

PurposeWe previously described the radical changes occurred in an orthopaedic hospital in Milan (Italy) during the first SARS-CoV-2 pandemic outbreak. Currently, during the second wave, the situation is still far from normality. Here we describe the changes that took place, and are still ongoing, in the clinical practice.MethodsNumber and type of admissions, outpatients activity, ER and urgent procedures in SARS-CoV-2 negative and positive patients have been analyzed over seven weeks (October 26th–December 13th, 2020) and compared with the correspondent period in 2019 and the same timeframe during the first wave (February 24th–April 10th).Results2019 vs. 2020: Overall admissions decreased by 39.8%; however, while admissions for elective surgery dropped by 42.0%, urgent surgeries increased by 117.0%. Rehabilitation admissions declined by 85.2%. White and green priority ER consultations declined by 41.6% and 52.0%, respectively; yellow and red increased by 766.7% and 400.0%, respectively.Second vs. first wave: Overall admissions increased by 58.6% with a smoother decrement in weekly admissions than during the first wave.Disparity of acute admissions vs. rehabilitation expanded: Acute cases increased by 63.6% while rehabilitation cases decreased by 8.7%. Admissions to triage procedures increased by 72.3%.ConclusionsActivity levels are far from normality during the second COVID-19 wave. Elective surgery and outpatients-related activities are still strongly limited compared to 2019 while the number of urgent cases treated increased consistently. SARS-CoV-2 positive emergencies are slightly higher than during the first wave. These important changes are expected to impact on health service and hospital budget for long.

788 Is Dysphagia a Marker for Obstructive Sleep Apnea (OSA) in Traumatic Brain Injury (TBI) Patients: A VA TBI Model System Study

Abstract Introduction Recent work has highlighted prevalent obstructive not central sleep apnea following traumatic brain injury (TBI). Treatment of comorbid OSA may facilitate neurologic recovery but widespread screening is limited. Mixed support exists for the presence of dysphagia as a biomarker of OSA in the general population and stroke patients. Dysphagia is common following TBI; however, no study has examined the relation between OSA and dysphagia in this cohort. Leveraging data from a recent six-center clinical trial of OSA and TBI during inpatient rehabilitation, this secondary analysis examined the association between OSA severity indices and proxy measures of dysphagia. Methods Level 1 polysomnography (PSG) was used to assess OSA (AHI ≥ 5 and ≥ 15) during inpatient rehabilitation for the overall sample (N=248; 203 male; 60.6% severe injury) evaluated at a median of 120.6 days post-TBI and subset ≤ 60 days post-injury. Dysphagia was approximated as the presence of a PEG tube and/or a modified texture diet (MTD) on the day of PSG. Chi square and Fisher’s Exact tests were utilized for group comparisons. Results As previously reported, OSA in this cohort was prevalent (68.2% (n=169) at AHI ≥ 5 and 33.5% (n=83) AHI ≥ 15) with predominantly obstructive events. 27.4% (n=68) met criteria for dysphagia combining proxy measures (34 peg; 49 MTD). No significant difference was found for presence of dysphagia across OSA severity cutoffs (AHI ≥ 5 &amp; 15; p=0.1029 &amp; 0.5959). When examining OSA across the individual proxy measures, persons without a peg tube were significantly more likely to have OSA at AHI ≥ 5 (62.5% vs 5.65%; p=0.0003) and AHI ≥ 15 (31.05% vs 2.42%; p=0.0353). When examining participants less than 60 days post-TBI, the group differences remained. Conclusion The incidence of dysphagia in TBI patients, as indexed by a modified diet or presence of a feeding tube, was not elevated in those with OSA. Sample bias (for undergoing Level 1 PSG and improvement facilitating inpatient rehabilitation admission) may have contributed to findings. Finally, future work with more sensitive indices of dysphagia is needed to accurately evaluate this association. Support (if any) PCORI (CER-1511–33005), NIIDLRR (90DPTB0004)

Clinical Significance of Middle Cerebellar Peduncle Ischemia After Translabyrinthine Vestibular Schwannoma Resection.

To assess clinical symptoms, signs, and radiographic evolution of middle cerebellar peduncle (MCP) diffusion restriction (DR) abnormalities following vestibular schwannoma (VS) resection. Retrospective chart and imaging review. Tertiary-referral neurotology and neurosurgery practice. All consecutive patients who underwent translabyrinthine VS resection over a 2-year period (August 2017-May 2019). Translabyrinthine craniotomy for VS resection. Magnetic resonance imaging (MRI) obtained on postoperative day 1 were reviewed for DR within the pons and cerebellum, with 3 months follow-up MRI to assess for evolution of these vascular changes. Of the 31 patients who met inclusion criteria, MRI demonstrated MCP DR consistent with acute ischemia in 29% (9/31). Of those, two showed corresponding T2 signal abnormalities on follow up MRI consistent with cerebrovascular accident (CVA) within the MCP. Both had severe gait ataxia and dysmetria requiring acute rehabilitation admission and significantly larger tumors (p = 0.02). The remaining seven were asymptomatic, and DR abnormality resolved without lasting radiographic changes. Brainstem compression was present in 100% of patients with postoperative MCP DR (mean MCP ipsilateral:contralateral ratio 0.59 ± 0.19), and 68.1% of those without (mean MCP ratio 0.71 ± 0.25), a difference that was not statistically significant (p = 0.14). In the two patients with CVA, MCP asymmetry persisted, whereas the asymmetry resolved in all others. Asymptomatic acute MCP ischemia discovered incidentally does not require intervention. However, when the ischemic area is large and patients are symptomatic, especially if an acute rehabilitation admission is required, surgeons should suspect true CVA.

Reassessment of Poststroke Dysphagia in Rehabilitation Facility Results in Reduction in Diet Restrictions

Background: Dysphagia assessment in postacute stroke patients can decrease the incidence of complications like malnutrition, dehydration, and aspiration pneumonia. It also helps to avoid unnecessary diet restrictions. The aim of this study is to verify if regular reassessment of dysphagia would change the diet management of postacute stroke patients in rehabilitation settings. Methods: This single-center retrospective study included 63 patients referred to an inpatient neurological rehabilitation center between 2018–2019. A standardized clinical swallowing evaluation and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) were performed. Diet level according to Functional Oral Intake Scale (FOIS) was evaluated. As the primary endpoint, the FOIS values based on diagnostic procedures were assessed at hospital discharge, rehabilitation admission, and after FEES. Results: 19 women (30%) and 44 men (70%), with a mean age of 75 y (SD ± 10.08), were enrolled. The intergroup ANOVA revealed significant differences (p < 0.001) between dietary prescriptions in an acute care setting and following clinical and endoscopic reassessment in the rehabilitation center. Diet recommendations changed in 41 of 63 (65%) enrolled patients (p < 0.001). Conclusion: Instrumental diagnostic by FEES during the early convalescence period of stroke patients leads to clinically relevant changes to diet restrictions and lower rates of pneumonia. Our findings underline the need for regular and qualitative dysphagia diagnostics in stroke patients participating in neurological rehabilitation.

Evaluation of the PRADO home discharge support programme for orthopaedic surgery in 2018

BackgroundBetween 2015 and 2017, nearly 80,000 hospital stays in orthopaedic surgery were entered into a home discharge support programme (PRADO) offered by the statutory health insurance system. The objective of this study was to assess the impact of the PRADO programme on enrolled stays in orthopaedic surgery over the last three years. HypothesisThe home discharge support programme used in orthopaedic surgery shortens hospital stays and decreases the rate of readmission within 30days. Material and methodsThe home discharge support programme PRADO was evaluated both quantitatively and qualitatively. The quantitative study used a multicentre retrospective cohort design with matching to controls identified in the national healthcare database. All hospital stays entered into the home discharge support programme between January 2015 and December 2017 were enrolled in the study. Follow-up was 6months after discharge. The main outcome measure was the rate of readmission within 30days after discharge. The secondary outcome measures were emergency department visits, admission to rehabilitation, mean stay duration, visits to recommended healthcare professionals, medication consumption, and total healthcare expenditure at 6months. The statistical analysis used the per protocol approach. The qualitative study involved semi-structured individual and group interviews designed to investigate adhesion of the professionals and their perceptions of programme implementation, funding, and costs. ResultsOf 82,202 stays in the programme, 71,761 (87%) were matched and included in the analysis. Characteristics were comparable between the programme stays and the control stays. The programme stays had a significant reduction in the number of all-cause ambulatory and non-ambulatory readmissions (4.5% vs. 4.9%, p<0.0001 and 3.9% vs. 4.2%, p=0.0009, respectively). Emergency department visits and rehabilitation admissions within 30days were significantly less common in the programme group than in the control group (mean values, 2.1% vs. 2.3%, p=0.01 and 3.4% vs. 8.4%, p≤0.0001, respectively). Mean stay length was not significantly different between the two groups. Visits to recommended healthcare professionals occurred significantly more often and earlier in the programme group. The delivery of analgesics and heparin was significantly higher in the programme group, whereas no difference occurred in the delivery of antibiotics. Mean total health expenditures at 6months were lower in the programme group (2248 € vs. 2485 €). The success of the PRADO programme was dependent on leadership from the medical staff within the institution and on assistance provided by the hospital throughout its implementation. The criteria for patient eligibility to the programme were not routinely shared by or clear to the healthcare staff. DiscussionThe PRADO programme effectively improves the care of orthopaedic surgery patients and raises the issue of whether some admissions to rehabilitation may be unnecessary. Level of evidenceIII; comparative retrospective study.

Complications During the Inpatient Rehabilitation Period in Neurological Subjects

Objective To explore common complications in people with neurological conditions during rehabilitation admission. Methods: All neurological subjects, including those with stroke, spinal cord injury (SCI), and traumatic brain injury, who were admitted for intensive and less-intensive rehabilitation programs during January to December 2012 were recruited. Both avoidable and unavoidable complications and related factors were assessed. Results: Among 1146 subjects, 65% was male with a mean age of 54.5 years. Almost 90% were admitted for intensive rehabilitation. The common avoidable complications that occurred were urinary tract infection (UTI) (12.8%), musculoskeletal pain (7.0%), neuropathic pain (2.3%), pneumonia (1.5%), and pressure injury (1.2%). Spasticity, which is an unavoidable complication, occurred in 2.1% of subjects. Older age, male gender, diagnosis of SCI, and longer stay were important factors related to complications. Conclusions: Most of the common complications during rehabilitation were avoidable complications, especially UTI and pain. A heightened level of awareness and vigilance should be exercised in older male subjects, those with prolonged hospital stay, and those with a diagnosis of SCI.

Functional outcomes in the inpatient rehabilitation setting following severe COVID-19 infection.

ObjectiveTo characterize the functional impairments of a cohort of patients undergoing inpatient rehabilitation after surviving severe COVID-19 illness, in order to better understand the ongoing needs of this patient population.MethodsThis study consisted of a retrospective chart review of consecutive patients hospitalized for COVID-19 and admitted to a regional inpatient rehabilitation hospital from April 29th to May 22nd, 2020. Patient demographics, clinical characteristics and complications from acute hospitalization were examined. Measures of fall risk (Berg Balance Scale), endurance (6 Minute Walk Test), gait speed (10 Meter Walk Test), mobility (transfer and ambulation independence), cognition, speech and swallowing (American Speech and Hearing Association National Outcomes Measurement System Functional Communication Measures) were assessed at rehabilitation admission and discharge.ResultsThe study population included 29 patients and was 70% male, 58.6% white and with a mean age of 59.5. The mean length of acute hospitalization was 32.2 days with a mean of 18.7 days intubated. Patients spent a mean of 16.7 days in inpatient rehabilitation and 90% were discharged home. Patients demonstrated significant improvement from admission to discharge in measures of fall risk, endurance, gait speed, mobility, cognition, speech and swallowing, (p< 0.05). At discharge, a significant portion of the population continued to deficits in cognition (attention 37%; memory 28%; problem solving 28%), balance (55%) and gait speed (97%).ConclusionPatients admitted to inpatient rehabilitation after hospitalization with COVID-19 demonstrated deficits in mobility, cognition, speech and swallowing at admission and improved significantly in all of these domains by discharge. However, a significant number of patients exhibited residual deficits at discharge highlighting the post-acute care needs of this patient population.

Opioid Prescribing and Utilization During Acute Inpatient Rehabilitation Admissions.

More than 1 billion opioid prescriptions were written between 2014 and 2018 in the United States [1] to treat the acute, subacute, and, in some cases, chronic pain experienced by millions of Americans. These prescriptions were also a significant driver of opioid-related morbidity and mortality as opioid-related overdose deaths accounted for more than half of all drug-related overdose deaths during that same time [2]. Patients with disabilities are among those who suffer from acute and chronic pain and may be especially vulnerable to opioid use, misuse, and overdose-related injury [3, 4]. Patients with disability-related conditions, including spinal cord injury, brain injury, amputations, and strokes, are often treated by physical medicine and rehabilitation (PM&R) physicians who are responsible for managing their complex and sometimes chronic pain. Pain management during an acute inpatient rehabilitation facility (IRF) admission initially continues the acute hospital regimen and is...

Patient Sleep Quality in Acute Inpatient Rehabilitation.

Sleep is an important component of neurorehabilitation. This study evaluates sleep quality in the acute inpatient rehabilitation setting and is the first to compare sleep quality in acute rehabilitation versus the acute care hospital and home settings. To assess patient sleep quality in the acute inpatient rehabilitation setting. Cross-sectional survey study. Acute inpatient rehabilitation unit. Seventy-three patients admitted to the acute rehabilitation unit participated in the study. A validated sleep questionnaire was provided on admission regarding sleep at home and in the acute care hospital. The questionnaire was repeated on discharge from the acute rehabilitation unit regarding sleep during their rehabilitation admission. Visual analog scale of sleep depth, falling asleep, number of awakenings, percentage of time awake, and quality of sleep were obtained through use of the Richards-Campbell Sleep Questionnaire. These values were averaged to obtain "overall sleep perception." An additional question on environmental noise was added. Scores ranged from 0 for "worst sleep possible" to 100 for "best sleep possible." Patients reported significantly better sleep in all domains and overall in the acute rehabilitation unit compared to the acute care hospital, with the exception of percentage of time awake. Patients also reported significantly better sleep depth but worse noise in the acute rehabilitation unit when compared to home. Similarly, patients reported significantly better sleep in all domains and overall at home in comparison to the acute care hospital with the exception of percentage of time awake. Patient in the acute rehabilitation unit experience sleep quality that matches their experience at home and exceeds that in the hospital.