Inpatient Rehabilitation Facility Research Articles

The contributions of survey-based versus administrative measures of socioeconomic status in predicting type of post-acute care for hospitalized Medicare beneficiaries.

To assess and compare the associations between socioeconomic status (SES) measures from two sources (claims vs. survey data) and the type of post-acute care (PAC) locations following hospital discharge. This observational study included Medicare Fee-for-Service (FFS) beneficiaries age 65.5 years or older who participated in the Medicare Current Beneficiary Survey (MCBS) and were hospitalized in 2006-2011. Multiple data sets were used including: Area Deprivation Index; Medicare Cost Reports, Provider of Services files, and Area Health Resource File. Multinomial regression models estimated associations between beneficiary's SES and PAC type. SES measures came from surveys (income and education) and administrative records (dual enrollment and area deprivation). PAC types included home with self-care, home health agency, skilled nursing facility (SNF), or inpatient rehabilitation facility. Low income and dual enrollment were associated with higher SNF use while living in a deprived area was associated with lower SNF use and higher use of home with self-care. Dual enrollment and area deprivation were associated with the largest differences. If policies to modify payment based on SES are considered, administrative measures (dual enrollment and area deprivation) rather than survey measures (education and income) may be sufficient.

Eculizumab Use in a Temporarily Dialysis-Dependent Patient With Shiga Toxin-Producing Escherichia Coli Hemolytic Uremic Syndrome With Neurological Complications.

Shiga toxin-producing Escherichia coli hemolytic uremic syndrome (STEC-HUS) is the most common cause of acute renal failure in children, and it is associated with thrombocytopenia and hemolytic anemia. Although this disease primarily affects the kidney, it can also contribute to cellular damage in other organ systems, such as the CNS. Eculizumab is a monoclonal antibody that binds to complement proteins to prevent complement-mediated intravascular hemolysis in atypical HUS. In STEC-HUS, complement activation also occurs by Shiga toxin, and previous cases of eculizumab use in the setting of neurological involvement have been shown to be successful. We report the successful use of eculizumab in the setting of typical STEC-HUS-induced neurological symptoms including seizure, altered mental status, and left arm weakness. The patient also experienced concomitant renal failure requiring dose adjustment for hemodialysis. Following 2 doses of eculizumab, our patient was discharged to an inpatient rehabilitation facility with resolution of her renal injury, seizures, and altered mentation without adverse effects from eculizumab throughout the admission. Based on our case study, it appears that eculizumab may be given during or between hemodialysis without dose adjustment.

Social Support and Living Situation of Older Adults With Hip-Fracture: A Retrospective Cohort Study

Sustaining a hip-fracture is a life-changing event negatively affecting older adults. Although, social support is a known determinant of health outcomes, the relationship between social support and living situation of older adults with hip fracture remains under researched. For this study social support is conceptualized using the Finfgeld-Connett framework, where social support is seen as being composed of emotional and instrumental support. The objectives were to examine the relationship between two domains of social support and living situation: 1) after discharge; 2) 3-months after discharge; and 3) 6-months after discharge from an inpatient rehabilitation facility in a sample of older adults with hip fracture. Emotional support was measured as frequency of interaction with someone one week prior to hip fracture, whereas instrumental support was measured as help received in instrumental activities of daily living. Logistic regression was performed to examine the association between social support and living situation. Majority of study participants (N=139) were older (mean age 81.31), female (77.70%), had no cognitive impairment (68.35%), were not married (58.99%), and lived with someone (51.80%) in their own house (71.95%). Older adults with more emotional support were more likely to be discharged home, however little can be said about the effect of the association (OR 6.80, 95% CI 1.08, 22.31, P<.001). Persons receiving more instrumental support had less odds of living at home 3-months (OR 0.41, 95% CI 0.21, 0.78; P=.007) and 6-months after discharge (OR 0.59, 95% CI 0.38, 0.91, P=0.017). Social support is important for older adults during recovery.

Functional Status Across Post-Acute Settings is Associated With 30-Day and 90-Day Hospital Readmissions.

To examine the association between cocalibrated functional scores across post-acute care settings and the subsequent risk of hospital readmission. Retrospective cohort study. We analyzed 781,021 fee-for-service Medicare beneficiaries discharged to either inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), or home health agencies (HHA) after an acute hospital stay for stroke (N= 143,277), lower extremity joint replacements (512,577), and hip/femur fracture (125,167) between January 1, 2013, and August 31,2014. Functional items from IRF-PAI, MDS, and OASIS were categorized into self-care and mobility domains. We cocalibrated admission functional scores across post-acute settings and divided scores into 4 functional levels using quartiles (Q1-Q4, with Q4 representing the most independent function). The primary outcomes were 30-day and 90-day hospital readmissions (yes/no) after an initial post-acute stay. Patients who were more dependent in self-care and mobility at the initial post-acute setting were significantly more likely to experience hospital readmission [eg, hazard ratios of 30-day readmission in stroke: 1.54 (95% confidence interval [CI] 1.47-1.61), 1.18 (95% CI 1.14-1.23), and 1.12 (95% CI 1.08-1.16) for Q1, Q2 and Q3, compared to Q4]. We found similar results for risk of 90-day hospital readmission across impairment conditions. Patients who were more functionally dependent at the initial post-acute setting had a higher risk to readmit to the hospitals after discharging from the post-acute setting for 30 and 90days, compared with patients who were more functionally independent. This finding is consistent across impairment conditions and post-acute settings. Future research should determine effective strategies of maintaining and facilitating functional performance across post-acute settings to optimize long-term patient outcomes.

For-Profit and Not-for-Profit Inpatient Rehabilitation in Traumatic Brain Injury: Analysis of Demographics and Outcomes

ObjectiveTo describe differences in characteristics and outcomes of patients with traumatic brain injury by inpatient rehabilitation facility (IRF) profit status. DesignRetrospective database review using the Uniform Data System for Medical Rehabilitation. SettingIRFs. ParticipantsIndividual discharges (N=53,630) from 877 distinct rehabilitation facilities for calendar years 2016 through 2018. InterventionNot applicable. Main Outcome MeasuresPatient demographic data (age, race, primary payer source), admission and discharge FIM, FIM gain, length of stay efficiency, acute hospital readmission from for-profit and not-for-profit IRFs within 30 days, and community discharges by facility profit status. ResultsPatients at for-profit facilities were significantly older (69.69 vs 64.12 years), with lower admission FIM scores (52 vs 57), shorter lengths of stay (13 vs 15 days), and higher discharge FIM scores (88 vs 86); for-profit facilities had higher rates of community discharges (76.8% vs 74.6%) but also had higher rates of readmission (10.3% vs 9.9%). ConclusionsThe finding that for-profit facilities admit older patients who are reportedly less functional on admission and more functional on discharge, with higher rates of community discharge but higher readmission rates than not-for-profit facilities is an unexpected and potentially anomalous finding. In general, older, less functional patients who stay for shorter periods of time would not necessarily be expected to make greater functional gains. These differences should be further studied to determine if differences in patient selection, coding and/or billing, or other unreported factors underlie these differences.

The Physical Abilities and Mobility Scale as a New Measure of Functional Progress in the PICU

AbstractAssessing functional motor changes and their relationship to discharge needs in the pediatric intensive care unit (PICU) population is difficult given challenges quantifying small functional gains with current tools. Therefore, we compared the Physical Abilities and Mobility Scale (PAMS) to the Functional Status Scale (FSS) in PICU patients to assess correlation and differences and association with discharge needs. This study was a retrospective chart review of all patients (2–18 years old) admitted to the PICU and cardiac PICU for over 9 months who received early mobility services, including PAMS and FSS scoring. Correlation between scales, relationship of scores to disposition, and logistic regression model of changes in PAMS in relation to disposition were determined. Data were obtained for 122 patients. PAMS and FSS scores strongly negatively correlated (Spearman's ρ = − 0.85), but with a nonlinear relationship, as the PAMS more readily differentiated among patients with higher functional status. The median FSS at discharge was 12.5 for those recommended an inpatient rehabilitation facility (IRF) (n = 24), versus 9 for those recommended discharge home (n = 83, Δ 3.5, 95% confidence interval [CI]: 1–6, around one-tenth of FSS scale). The corresponding median PAMS were 42 and 66 (Δ 24, 95% CI: 10–30, one-fourth of PAMS scale). Although not statistically significant, a logistic regression model was consistent with patients who showed modest change in PAMS across hospitalization but persistent deficits (PAMS &lt; 60) were more likely to be recommended an IRF. The PAMS correlates to the FSS, but appears more sensitive to small functional changes, especially in higher functioning patients. It may be useful in prognosticating discharge needs.

Predictors of Acute Transfer and Mortality Within 6 Months From Admission to an Inpatient Rehabilitation Facility for Patients With Brain Tumors

ObjectiveTo obtain useful information for clinicians in evaluating patients with brain tumors for transfer to and subsequent care in inpatient rehabilitation facilities (IRFs). DesignRetrospective chart review. SettingInpatient rehabilitation facility. ParticipantsA total of 208 adults with either initial or recurrent brain tumors who were admitted to an IRF between January 2017 and December 2018 after an acute hospitalization. InterventionsNone Main Outcome MeasuresTransfer from an IRF to an acute care hospital and mortality within 6 months from admission to an IRF. ResultsOf the 208 patients who met inclusion criteria, 20.2% were transferred to an acute care hospital during the IRF stay, which was associated with prior chemotherapy, steroid use, and laterality of tumor. In total, 36.9% of patients with brain tumors died within 6 months of an IRF admission that was associated with recurrent tumor diagnosis, prior chemotherapy, prior neurosurgical intervention, prior neurostimulant use, use of steroids, isocitrate dehydrogenase and O6-methyl-guanyl-methyl-transferase biomarkers, and laterality and location of tumor. ConclusionsPatients with brain tumors have a notable potential for acute hospital transfer and mortality within 6 months of IRF stay, with several tumor- and treatment-related risk factors. This information can help identify functional goals, identify high risk patients, enable closer clinical monitoring, and facilitate focused care discussions at IRFs.

Skilled Nursing and Inpatient Rehabilitation Facility Use by Medicare Fee-for-Service Beneficiaries Discharged Home After a Stroke: Findings From the COMPASS Trial

ObjectivesTo examine the effect of a comprehensive transitional care model on the use of skilled nursing facility (SNF) and inpatient rehabilitation facility (IRF) care in the 12 months after acute care discharge home following stroke; and to identify predictors of experiencing a SNF or IRF admission following discharge home after stroke. DesignCluster randomized pragmatic trial SettingForty-one acute care hospitals in North Carolina. Participants2262 Medicare fee-for-service beneficiaries with transient ischemic attack or stroke discharged home. The sample was 80.3% White and 52.1% female, with a mean (SD) age of 74.9 (10.2) years and a mean ± SD National Institutes of Health stroke scale score of 2.3 (3.7). InterventionComprehensive transitional care model (COMPASS-TC), which consisted of a 2-day follow-up phone call from the postacute care coordinator and 14-day in-person visit with the postacute care coordinator and advanced practice provider. Main Outcome MeasuresTime to first SNF or IRF and SNF or IRF admission (yes/no) in the 12 months following discharge home. All analyses utilized multivariable mixed models including a hospital-specific random effect to account for the non-independence of measures within hospital. Intent to treat analyses using Cox proportional hazards regression assessed the effect of COMPASS-TC on time to SNF/IRF admission. Logistic regression was used to identify clinical and non-clinical predictors of SNF/IRF admission. ResultsOnly 34% of patients in the intervention arm received COMPASS-TC per protocol. COMPASS-TC was not associated with a reduced hazard of a SNF/ IRF admission in the 12 months post-discharge (hazard ratio, 1.20, with a range of 0.95-1.52) compared to usual care. This estimate was robust to additional covariate adjustment (hazard ratio, 1.23) (0.93-1.64). Both clinical and non-clinical factors (ie, insurance, geography) were predictors of SNF/IRF use. ConclusionsCOMPASS-TC was not consistently incorporated into real-world clinical practice. The use of a comprehensive transitional care model for patients discharged home after stroke was not associated with SNF or IRF admissions in a 12-month follow-up period. Non-clinical factors predictive of SNF/IRF use suggest potential issues with access to this type of care.

Characteristics, Outcomes, and Long-Term Survival of Patients With Heart Failure Undergoing Inpatient Cardiac Rehabilitation

ObjectiveTo investigate the association of cardiac rehabilitation (CR) participation with all-cause mortality after a hospitalization for heart failure (HF) and to describe the characteristics and functional and clinical outcomes of HF patients undergoing inpatient CR. DesignMulticenter cohort study. The association between CR participation and all-cause mortality from discharge from the acute care setting was assessed using Cox regression analysis adjusting for established prognostic factors. SettingSix inpatient rehabilitation facilities. ParticipantsA total of 3219 patients with HF admitted to inpatient CR between January 2013 and December 2016. Of these patients, 1455 had been transferred directly from acute care hospitals after a hospitalization for HF (CR-group 1) and 1764 had been admitted from the community due to worsening functional disability or worsening clinical conditions (CR-group 2). Serving as a control group were 633 patients not referred to CR after a hospitalization for HF served as control group (non–CR group). InterventionsCardiac rehabilitation. Main Outcome MeasuresLong-term mortality. Secondary outcomes were: (1) change in functional capacity, as assessed by change in 6-minute walking distance from admission to discharge; (2) clinical outcomes of the index inpatient rehabilitation admission, including in-hospital mortality and unplanned readmission to the acute care. ResultsCompared with the non–CR group, the adjusted hazard ratios of mortality at 1, 3, and 5 years for CR-group 1 patients were 0.82 (range, 0.68-0.97), 0.81 (range, 0.71-0.93), and 0.80 (range, 0.70-0.91). The 6-minute walking distance increased from 230-292 meters (P<.001), and 43.4% of the patients gained >50 m improvement. Overall, 2.5% of the patients died in hospital and 4.7% of the patients experienced unplanned readmissions to acute care, with significant differences between group 1 and group 2. ConclusionsOur data show that inpatient CR is effective in improving functional capacity and suggest that inpatient CR provided in the earliest period after a hospitalization for HF is associated with long-term improved survival.

A Comprehensive Strategy to Pain Management for Cancer Patients in an Inpatient Rehabilitation Facility.

Cancer pain has been shown to have a significant negative impact on health-related quality of life (HRQoL) for people experiencing it. This is also true for patients admitted to inpatient rehabilitation facilities (IRFs). An interdisciplinary approach is often needed to fully address a person's pain to help them attain maximum functional independence and to ensure a safe discharge home. Improving a patient's performance status in an IRF may also be a crucial determinant in their ability to continue receiving treatment for their cancer. However, if a person is determined to no longer be a candidate for aggressive, disease modulating treatment, IRFs can also be utilized to help patients and family's transition to comfort directed care with palliative or hospice services. This article will discuss the interventions of the multidisciplinary inpatient rehabilitation team to address a person's pain.

Abstract 1122‐000131: Acute Ischemic Stroke Patients Receiving Reperfusion Therapy Do Not Have Worse 90‐Day Outcomes After Delirium

Introduction : Post‐stroke delirium (PSD) is associated with increased mortality and worse long‐term functional outcomes. Patients who receive reperfusion therapies in the hospital are frequently kept from regular sleep‐wake cycles the first 24 hrs after treatment, and this disruption could lead to an increase in PSD. In this study, we evaluate the effect of PSD on immediate and long‐term outcomes in AIS patients receiving reperfusion therapies. Methods : Between September 2019 and June 2021, patients diagnosed with AIS within 48 hrs of stroke onset were prospectively evaluated for PSD using the Confusion Assessment Method (CAM)‐ICU daily for the first eight days of their hospital stay. Patients with severe stroke and expected mortality within the first month at the time of admission or with severe aphasia unable to follow commands were excluded. Reperfusion therapies were defined as any IV thrombolytic, IA thrombolytic, or mechanical thrombectomy (MT). The primary outcome was considered a 90‐day mRS score of 0–2. Results : Of 179 patients assessed with the CAM‐ICU, 89 (49.7%) had PSD. We identified 94 patients that had undergone one or both reperfusion therapies; 52 (55.3%) had delirium. Patients who received tPa had a higher risk for delirium (42 vs 29, p = 0.04), but no difference was observed with MT (Table 1). Patients with PSD had a longer hospital length of stay and a higher median admission NIHSS. Patients with delirium who received tPA were more likely to be discharged to inpatient rehabilitation facilities than home (p‐value 0.004, OR 10.1 95%CI 2.1,48). No significant difference was found in 90‐day mRs scores of 0–2 in those with or without PSD. Conclusions : AIS patients with PSD after reperfusion therapy had no significant difference in 90‐day good outcomes despite having longer hospital admissions and being less likely to be discharged home. Further evaluation into how reperfusion therapies convey protection to patients is necessary.

Time at home among nonvalvular atrial fibrillation patients treated with non-vitamin K antagonist oral anticoagulants versus warfarin

Abstract Background Clinical trials and real-world database studies have shown the benefits of non-vitamin K antagonist oral anticoagulants (NOACs) compared to warfarin; however, measures of functional outcomes are critical in evaluating a patient's quality of life. Previous measures of time spent out of hospital in a home setting and time spent receiving disease-related care among non-valvular atrial fibrillation (NVAF) patients are lacking in the current literature. Purpose This analysis was based on the previously published ARISTOPHANES study, and used multiple data sources to evaluate the amount of time spent at a patient's home among NVAF patients who were prescribed NOACs versus warfarin. Methods This retrospective observational study used US data from CMS Medicare and four commercial databases to select adult NVAF patients who initiated apixaban, dabigatran, rivaroxaban, or warfarin (01JAN2013–30SEP2015). Time at home and time at home without external AF-related care were measured during the 180 days after the index date (OAC prescription). Time at home was defined as days from index date without any of the following: an inpatient, skilled nursing facility or nursing facility, hospice, or inpatient rehabilitation facility admission. Time at home and without external AF-related care was defined as days away from home and days with a claim for bleeding, stroke/systemic embolism, AF, or an INR test. Each day a claim was observed was counted as one day. In each database, three 1:1 NOAC-warfarin propensity-score-matched (PSM) cohorts were created before pooling the results. After PSM, a subgroup of patients who were alive and had ≥180 days of follow-up was created. Poisson regression was conducted in each NOAC-warfarin matched cohort to compare time at home and time at home without external AF-related care. Results After matching, a total of 100,977 apixaban-warfarin, 36,990 dabigatran-warfarin, and 125,068 rivaroxaban-warfarin patient pairs were selected. Of those patients, 38–46% had 180 days of follow-up available. Across treatment cohorts, approximately 75% of patients were at home for the 180-day follow-up. Apixaban, dabigatran, and rivaroxaban patients had 1.3, 0.9, and 0.8 more days at home, respectively, compared to warfarin patients. Patients treated with apixaban had 13.4 more days at home without AF-related care compared to warfarin, while dabigatran and rivaroxaban had 11.6 and 11.7 more days at home without AF-related care compared to warfarin. A greater proportion of warfarin patients than NOAC patients had an INR test (81–82% vs 14–21%), and days with INR testing were the main driver for external AF-related care for warfarin patients. Conclusion Among NVAF patients treated with OACs, NOACs were associated with a longer time at home and time at home without external AF-related care compared to warfarin. These results can help inform healthcare providers and patients regarding the impact of NOAC treatment in NVAF patients. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Bristol-Myers Squibb Company and Pfizer Inc.

Time at home among nonvalvular atrial fibrillation patients treated with non-vitamin K antagonist oral anticoagulants: an ARISTOPHANES analysis

Abstract Background Patient-centered outcomes, such as home time, are becoming increasingly important quality-of-life measures. There are limited data on the impact of oral anticoagulants (OACs) on home time among patients with non-valvular atrial fibrillation. Purpose This analysis, based on the previously published ARISTOPHANES study, used five US insurance claims databases (CMS Medicare and four commercial databases) to compare home time among NVAF patients who were prescribed non-vitamin K antagonist OACs (NOACs). Methods Adult NVAF patients who were newly prescribed apixaban, dabigatran, or rivaroxaban (01JAN2013–30SEP2015) were selected. Time at home was calculated as the number of days from the index date (NOAC prescription) without any of the following: an inpatient, skilled nursing facility (SNF) or nursing facility, hospice, or inpatient rehabilitation facility admission. Time at home and without external AF-related care was defined as days from index date without any events from the home time endpoint or any days with a claim for bleeding, stroke/systemic embolism (S/SE), AF, or an INR test. Time at home and without external AF-related care were measured during the 180 days of follow-up; patients were required to have been alive and have 180 days of follow-up post index. In each database, three 1:1 NOAC-NOAC propensity-score-matched (PSM) cohorts were created before combining the databases. For each NOAC-NOAC matched cohort, Poisson regression was conducted to compare time at home and time at home without external AF-related care. Results After PSM, 37,314 apixaban-dabigatran, 107,236 apixaban-rivaroxaban, and 37,693 rivaroxaban-dabigatran patient pairs were created of which 37–44% had 180 days of follow-up available. Across the NOAC cohorts, approximately 21–25% of patients had an admission to a hospital, SNF, nursing facility, rehabilitation center, or hospice during the 180-day follow-up. The time at home was generally consistent between the NOAC cohorts (177 days); however, apixaban patients had 0.5 more days at home compared to rivaroxaban patients. Across all NOAC cohorts, 7–8% had a claim for a S/SE, 11–15% had a claim for bleeding, and 15–22% had an INR test, while 87–89% of all patients had an AF-claim during the 180-day follow-up. Patients prescribed apixaban had 1 more day at home without external AF-related care compared to dabigatran, and 1.5 more days at home without external AF-related care compared to rivaroxaban. Dabigatran had &amp;lt;1 more day at home without external AF-related care compared to rivaroxaban. Conclusion Among NVAF patients treated with NOACs, there were small differences in the time at home and time at home without external AF-related care during the first 6 months of NOAC treatment. As NVAF is a chronic condition, it is important to understand the impact of NOAC treatment on these patient-centered outcomes. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Bristol-Myers Squibb Company and Pfizer Inc.

The Effectiveness of Physical, Occupational, and Speech Therapy in the Treatment of Patients With COVID-19 in the Inpatient Rehabilitation Setting

Purpose The novel coronavirus disease (COVID-19) has resulted in prolonged hospitalizations due to complications of moderate-to-severe COVID-19, leaving many with significant debilitation and functional impairment. The purpose of this research study is to demonstrate the effectiveness of physical, occupational, and speech therapy in the treatment of individuals recovering from COVID-19 in the inpatient rehabilitation setting. Method An observational pretest–posttest study of patients diagnosed with COVID-19 admitted to Adventist HealthCare Rehabilitation was conducted. Results from the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF PAI), the Six-Minute Walk Test (6MWT), the Modified Barthel Index–Shah Version (mBI), the Orientation Log, and the Cognitive Log were collected and analyzed utilizing a paired t test. Results Statistically significant improvements ( p &lt; .05) in IRF PAI ( p = 2.02 × 10 −14 ), 6MWT ( p = 2.29 × 10 −9 ), mBI ( p = 5.95 × 10 −9 ), Orientation Log ( p = 1.81 × 10 −2 ), and Cognitive Log ( p = 9.21 × 10 −4 ) scores demonstrate that physical, occupational, and speech therapy improved the mobility, self-care, and cognitive performance of individuals recovering from COVID-19 at the inpatient rehabilitation level of care. Conclusions These findings can be used to impact the appropriate progression of patients through the health care continuum. As treatment of COVID-19 continues to evolve, ongoing research in this area of practice is warranted to continue to demonstrate the role of rehabilitation in the recovery process.

Outpatient surgery for the inpatient: an introduction to postacute care.

This article considers how postacute care (PAC) facilities such as skilled nursing facilities, inpatient rehabilitation facilities and long-term care hospitals could represent an opportunity for outpatient surgical facilities to improve patient care. In order to understand how these facilities interact with outpatient surgical services, it is first necessary to understand the types of facilities that provide PAC. The significant costs associated with PAC have led to some proposed regulatory changes. Evidence examining postacute costs following total joint replacement has indicated that these costs may be decreased with cooperative efforts between perioperative physicians and PAC facilities. However, the lack of currently published data on the interaction between outpatient surgery and inpatient PAC facilities creates a need to explore how greater cooperation between these types of facilities could lead to improvements in patient care. PAC facilities are inpatient facilities focused on the rehabilitation of patients recovering from an acute illness or surgical intervention. This article seeks to provide ambulatory practitioners a fundamental understanding of PAC as a starting point for future collaborative efforts with PAC facilities; improving care for patients referred to and from PAC facilities for outpatient surgical care.

ECTRIMS 2021 – ePoster

Introduction: COVID-19 induced longitudinal extensive myelitis (LEM) is an extremely rare clinical manifestation. Aims and Methods: In this case study, we report a woman of LEM which appeared fifteen days after COVID-19 infection. Results: A 39-year-old woman, suffering from gradually increased weakness and severe pain at lower limbs and urinary retention was admitted to the emergency department. She was diagnosed with COVID-19 infection 15 days ago and fully recovered from respiratory symptoms. Her initial neurological examination showed loss of muscular strength in right lower limb 1/5 and left lower limb 2/5, hyperreflexia in the lower limbs and generalized allodynia. All modalities of sensation were diminished at the T10 segmental level. Her nasopharyngeal and oropharyngeal swab for polymerase chain reaction (PCR) to detect SARS-CoV-2 was positive. Cerebrospinal fluid (CSF) showed pleocytosis (whitecell count 110/mm3 ) with mostly polymorphonuclear leukocytes (90%), elevated protein (67 mg/dl) and normal glucose (78 mg/dl;concurrent serum glucose level was 96 mg/dl). Serology for SARS-CoV2 in CSF demonstrated infection (anti-SARS-CoV-2 IgG: 5.47 (negative<1). The other serum and CSF tests were negative for differential diagnosis of acute transverse myelitis. Electromyography (EMG) showed normal motor and sensory nerve conduction velocity in the upper and lower limbs. The somatosensory evoked potention test (SEP) determined prolonged latency of bilateral tibial nerve cortical responses with low-amplitudes. Cervical and thoracic MRI demonstrated a long segment of T2 hyperintensities within the central cord extending from C2-C3 level to T10 level. The patient was treated with methylprednisolone 1 g/d IV for five days. Because of her progressed neurological condition, the patient received five sessions of plasma exchange and additionally methylprednisolone 1 g IV was given for another ten days. The patient was discharged to an inpatient rehabilitation facility without any clinical improvement. Conclusions: Acute transverse myelitis have been reported during respiratory diseases due to SARS-CoV-2. Otherwise, the clinical manifestation of LEM induced by COVID-19 seen during infection is very rare. To the best of our knowledge, our case is the second one of LEM induced by COVID-19 confirmed by CSF antibody. This case remarks the importance of recognition and early treatment of LEM during COVID-19 infection.

The Role of Physical Therapy Following CAR T-Cell Therapy: A Case Report

Background: Diffuse large B-cell lymphoma (DLBCL) affects 7 out of 100 000 people in the United States every year. Chimeric antigen receptor (CAR) T-cell therapy is approved by the Food and Drug Administration to treat patients with relapsed/refractory DLBCL who have not responded to 2 prior lines of therapy. CAR T-cell therapy can lead to debilitating side effects necessitating rehabilitation intervention. Case Description: This case report details a 38-year-old woman with refractory DLBCL who received CAR T-cell therapy. The patient experienced grade 2 cytokine release syndrome and grade 4 immune effector cell-associated neurotoxicity syndrome, which resulted in, among other symptoms, lower extremity paraplegia. Upon medical stabilization, the patient was referred to physical therapy. Outcomes: The patient participated in acute care rehabilitation for 8 weeks and progressed significantly toward her prior level of function before being discharged to an inpatient rehabilitation facility. Upon discharge, the patient was able to ambulate with a rolling walker, a knee orthosis, and supervision for safety and had initiated stair training. Discussion/Conclusion: Physical therapists need to understand and recognize the range of side effects that can occur following CAR T-cell therapy. As more patients receive CAR T-cell therapy to treat malignancies, acute care oncology units will undoubtedly be challenged with patients exhibiting severe side effects. Physical therapists are well trained to address physical impairments resulting from CAR T-cell therapy's side effects and will play a vital role in these patients' interdisciplinary care.

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.

Epidermis Taping to Address Pain and Medication Usage in Patients with Amputation in an Inpatient Rehabilitation Setting

Research Objectives Pain management after lower limb amputation is medically challenging. Beyond prescription medication, evidence to support non-pharmacological intervention to reduce pain post-amputation is limited. We intended to explore the use of epidermis Kinesiotape (KT), a non-pharmacological pain management technique, to reduce residual limb pain (RLP), phantom limb pain (PLP), and pharmacological pain medication use for patients with lower limb amputation during an inpatient rehabilitation facility (IRF). Design Observational. Setting Large, urban IRF. Participants Patients admitted to IRF within 3 months of lower limb amputation. Interventions Patients admitted to IPR following a lower limb amputation received KT at day 4 of admission. KT was re-applied every 3 to 4 days. Main Outcome Measures Pain visual analog scale (VAS) scores for RLP and PLP and pain medication use was recorded daily throughout IPR length of stay. Results 25 patients (9 female, 16 male; 13 below knee amputation, 8 above knee amputation, 1 through knee amputation, 2 bilateral below knee amputations, 1 multiple amputations) with average IRF stay of 14 days completed the KT protocol. Daily pain decreased on average from admission to discharge (RLP: 2.15±3.03, PLP 1.5±2.85). Pain medication dose decreased for 64% of patients prescribed morphine, 28% of patients prescribed acetaminophen, and 16% of patients prescribed gabapentin. No adverse events occurred due to KT. Conclusions The small reduction in pain following acute lower limb amputation suggests KT may be a viable non-pharmacological treatment for patients during IRF. Future studies should consider the use of a control group to differentiate impact of KT from spontaneous recovery. Author(s) Disclosures No disclosures to make by any author connected to this poster. Pain management after lower limb amputation is medically challenging. Beyond prescription medication, evidence to support non-pharmacological intervention to reduce pain post-amputation is limited. We intended to explore the use of epidermis Kinesiotape (KT), a non-pharmacological pain management technique, to reduce residual limb pain (RLP), phantom limb pain (PLP), and pharmacological pain medication use for patients with lower limb amputation during an inpatient rehabilitation facility (IRF). Observational. Large, urban IRF. Patients admitted to IRF within 3 months of lower limb amputation. Patients admitted to IPR following a lower limb amputation received KT at day 4 of admission. KT was re-applied every 3 to 4 days. Pain visual analog scale (VAS) scores for RLP and PLP and pain medication use was recorded daily throughout IPR length of stay. 25 patients (9 female, 16 male; 13 below knee amputation, 8 above knee amputation, 1 through knee amputation, 2 bilateral below knee amputations, 1 multiple amputations) with average IRF stay of 14 days completed the KT protocol. Daily pain decreased on average from admission to discharge (RLP: 2.15±3.03, PLP 1.5±2.85). Pain medication dose decreased for 64% of patients prescribed morphine, 28% of patients prescribed acetaminophen, and 16% of patients prescribed gabapentin. No adverse events occurred due to KT. The small reduction in pain following acute lower limb amputation suggests KT may be a viable non-pharmacological treatment for patients during IRF. Future studies should consider the use of a control group to differentiate impact of KT from spontaneous recovery.

Factors Associated with Unsuccessful Admissions to Inpatient Rehabilitation Facilities Among Older Adults With Traumatic Brain Injury

Research Objectives Older adults comprise a growing proportion of patients with TBI in inpatient rehabilitation facilities (IRF). However, concerns about their tolerance of rehabilitation-intensive IRF care remain. Centers for Medicare & Medicaid defined ‘short stays’ (Length of stay (LOS) < 3 days) and ‘short-stay transfers’ (transfers to an institutional setting with a shorter than expected LOS) suggest a limited benefit from an IRF admission. Our objective is to examine the relationship between age, chronic conditions, functional status, and the odds of an ‘unsuccessful IRF admission’ among older adults with TBI. Design In this retrospective cohort study we used Medicare administrative data linked to the National Trauma Data Bank via a Bayesian record linkage algorithm to examine the relationship between age, chronic conditions, functional status, and an ‘unsuccessful IRF admission.’ We used a two-level hierarchical logistic regression model, adjusting for demographics, injury characteristics, and facility effects. Setting U.S. Inpatient Rehabilitation Facilities. Participants Medicare fee-for-service beneficiaries hospitalized with TBI between 2011 and 2015. Interventions N/A. Main Outcome Measures Unsuccessful IRF admission (‘short stays’ or ‘short-stay transfers’). Results Cognitive function in the lowest quartile (OR:2.5 (1.0, 6.3), or motor function in the lowest two quartiles (OR:3.1(1.4, 7.1), OR:6.2 (2.4, 15.6)) were associated with higher odds of an ‘unsuccessful IRF admission’ compared to the highest quartile of each domain. The model differentiated ‘unsuccessful IRF admissions’ (AUC:0.74 (0.69, 0.80), however, 46% of those in cognitive quartile 1, and 52% of those in motor quartiles 1 and 2 were able to discharge home. Conclusions Among older adults with TBI, significant impairments in cognitive and motor function are associated with increased risk of an ‘unsuccessful IRF admission’. Factors unaccounted for in our models, potentially acute management characteristics, may help to differentiate those who are unlikely to benefit from IRF care. Author(s) Disclosures Co-Author Roee Gutman has served as an expert witness for Johnson & Johnson. The authors have no other conflicts of interest to report. Older adults comprise a growing proportion of patients with TBI in inpatient rehabilitation facilities (IRF). However, concerns about their tolerance of rehabilitation-intensive IRF care remain. Centers for Medicare & Medicaid defined ‘short stays’ (Length of stay (LOS) < 3 days) and ‘short-stay transfers’ (transfers to an institutional setting with a shorter than expected LOS) suggest a limited benefit from an IRF admission. Our objective is to examine the relationship between age, chronic conditions, functional status, and the odds of an ‘unsuccessful IRF admission’ among older adults with TBI. In this retrospective cohort study we used Medicare administrative data linked to the National Trauma Data Bank via a Bayesian record linkage algorithm to examine the relationship between age, chronic conditions, functional status, and an ‘unsuccessful IRF admission.’ We used a two-level hierarchical logistic regression model, adjusting for demographics, injury characteristics, and facility effects. U.S. Inpatient Rehabilitation Facilities. Medicare fee-for-service beneficiaries hospitalized with TBI between 2011 and 2015. N/A. Unsuccessful IRF admission (‘short stays’ or ‘short-stay transfers’). Cognitive function in the lowest quartile (OR:2.5 (1.0, 6.3), or motor function in the lowest two quartiles (OR:3.1(1.4, 7.1), OR:6.2 (2.4, 15.6)) were associated with higher odds of an ‘unsuccessful IRF admission’ compared to the highest quartile of each domain. The model differentiated ‘unsuccessful IRF admissions’ (AUC:0.74 (0.69, 0.80), however, 46% of those in cognitive quartile 1, and 52% of those in motor quartiles 1 and 2 were able to discharge home. Among older adults with TBI, significant impairments in cognitive and motor function are associated with increased risk of an ‘unsuccessful IRF admission’. Factors unaccounted for in our models, potentially acute management characteristics, may help to differentiate those who are unlikely to benefit from IRF care.