Inpatient Rehabilitation Hospital Research Articles

Transition between inpatient rehabilitation and National Disability Insurance Scheme for Traumatic Brain Injury and Spinal Cord Injury.

ObjectiveTo understand the pathway and diverse levels of functional impairment for people with traumatic brain injury (TBI) and spinal cord injury (SCI) as they transition from inpatient rehabilitation (IR) hospital setting to ongoing care and support under the National Disability Insurance Scheme (NDIS) in Australia.
 ApproachThe Australasian Rehabilitation Outcomes Centre (AROC) has data on almost every inpatient rehabilitation episode of care since 2002, including TBI and SCI. AROC data is de-identified with a statistical linkage key (SLK-581). The NDIS dataset contains identified administrative data on participants of the scheme from which the SLK-581 was derived. Datasets were restricted to TBI and SCI records and the SLK with key dates used to link records together. The linkage was done in multiple passes with different levels of information with each link being validated using secondary information relating to date of injury, date of admission and geographical location.
 ResultsOver the period 2012-2019, approximately 2,000 records from AROC episodes were linked to an NDIS participant following data validation and individual review of borderline matches We will compare the functional independence of the individual upon leaving rehabilitation with their need for support under the NDIS. Functional independence in rehabilitation is measured by clinicians using the Functional Independence Measure (FIM), a tool that requires clinicians to be trained and credentialed in its use as it is part of the funding model for IR in Australia. Need for support under the NDIS is measured by the funded supports available to a participant under the plan. We expect to demonstrate a correlation between FIM scores and funded supports and identify and analyse any unexpected results.
 ConclusionThese results will inform resource allocation within the NDIS. This project demonstrates how de-identified research datasets can be linked with administrative datasets to draw new and powerful insights into government service delivery and population health while maintaining privacy. Challenges to accurate linkage can be overcome through iterative and non-deterministic approaches.

Sleep Monitoring during Acute Stroke Rehabilitation: Toward Automated Measurement Using Multimodal Wireless Sensors.

Sleep plays a critical role in stroke recovery. However, there are limited practices to measure sleep for individuals with stroke, thus inhibiting our ability to identify and treat poor sleep quality. Wireless, body-worn sensors offer a solution for continuous sleep monitoring. In this study, we explored the feasibility of (1) collecting overnight biophysical data from patients with subacute stroke using a simple sensor system and (2) constructing machine-learned algorithms to detect sleep stages. Ten individuals with stroke in an inpatient rehabilitation hospital wore two wireless sensors during a single night of sleep. Polysomnography served as ground truth to classify different sleep stages. A population model, trained on data from multiple patients and tested on data from a separate patient, performed poorly for this limited sample. Personal models trained on data from one patient and tested on separate data from the same patient demonstrated markedly improved performance over population models and research-grade wearable devices to detect sleep/wake. Ultimately, the heterogeneity of biophysical signals after stroke may present a challenge in building generalizable population models. Personal models offer a provisional method to capture high-resolution sleep metrics from simple wearable sensors by leveraging a single night of polysomnography data.

Occupational and Physical Therapists' Use of Intrapersonal and Interpersonal Emotion Regulation Strategies During Patient Interactions: A Qualitative Study.

Occupational and physical therapists' use of intrapersonal and interpersonal emotion regulation strategies may play an important role in building therapeutic relationships, but little is known about how they use these strategies during patient interactions. To understand how therapists use intrapersonal and interpersonal emotion regulation strategies during their patient interactions. This qualitative study consisted of two stages of data collection. In Stage 1, therapists were interviewed regarding how they use emotion regulation strategies in their therapeutic relationships. In Stage 2, patient-therapist dyads were observed during treatment sessions and then interviewed at the end of the therapeutic relationship. Inpatient and outpatient rehabilitation hospitals and clinics in the United Kingdom. In Stage 1, 13 occupational therapists and 9 physical therapists participated; in Stage 2, 14 patient-therapist dyads participated. A semistructured interview guide was used to ask therapists how they use emotion regulation strategies during patient interactions. Therapists used a wide range of interpersonal and intrapersonal emotion regulation strategies that can be categorized in prominent emotion regulation strategy taxonomies. They used these strategies both proactively, in anticipation of emotional events, and reactively, in response to emotional events. Their use helped them to build and maintain the therapeutic relationship and to protect themselves, feel better, and get their jobs done. The ability to regulate one's own and others' emotions is an essential part of therapists' work. In this study, therapists used a wide range of emotion regulation strategies to benefit themselves and their patients. What This Article Adds: This is the first study to identify the specific intrapersonal and interpersonal emotion regulation strategies used by occupational and physical therapists during patient-therapist interactions. This study makes an important contribution to understanding therapists' use of proactive and reactive emotion regulation strategies to build and maintain therapeutic relationships.

Infection prevention and control across the continuum of COVID-19 care: A qualitative study of patients', caregivers' and providers' experiences.

IntroductionHealthcare facilities adopted restrictive visitor policies as a result of the COVID‐19 (COVID) pandemic. Though these measures were necessary to promote the safety of patients, families and healthcare providers, it led to isolation and loneliness amongst acute care inpatients that can undermine patient rehabilitation and recovery. The study objectives were to (1) explore how infection prevention and control (IP&C) measures impacted stakeholders' perceptions of care quality and interactions with others and (2) investigate how these experiences and perceptions varied across stakeholder groups and care settings.MethodsA qualitative descriptive study was conducted. Patients and their families from an inpatient COVID rehabilitation hospital and healthcare providers from an acute or rehabilitation COVID hospital were interviewed between August 2020 and February 2021.ResultsA total of 10 patients, 5 family members and 12 healthcare providers were interviewed. Four major themes were identified: (1) IP&C measures challenged the psychosocial health of all stakeholders across care settings; (2): IP&C measures precipitated a need for greater relational care from HCPs; (3) infection prevention tenets perpetuated COVID‐related stigma that stakeholders experienced across care settings; and (4) technology was used to facilitate human connection when IP&C limited physical presence.ConclusionIP&C measures challenged psychosocial health and maintenance of vital human connections. Loneliness and isolation were felt by all stakeholders due to physical distancing and COVID‐related stigma. Some isolation was mitigated by the relational care provided by HCPs and technological innovations used. The findings of the study underscore the need to balance safety with psychosocial well‐being across care settings and beyond the patient–provider dyad.Patient and Public ContributionThis study was informed by the Patient‐Oriented Research Agenda and developed through consultations with patients and family caregivers to identify priority areas for rehabilitation research. Priority areas identified that informed the current study were (1) the need to focus on the psychosocial aspects of recovery from illness and injury and (2) the importance of exploring patients' recovery experiences and needs across the continuum of care. The study protocol, ethics submission, analysis and manuscript preparation were all informed by healthcare providers with lived experience of working in COVID care settings.

An Interprofessional Education Program for Employees at an Inpatient Rehabilitation Hospital

Abstract Date Presented 04/01/2022 A quality improvement (QI) program called the Educational Program for Interprofessional Collaboration (EPIC) was implemented at an inpatient rehabilitation hospital in Woburn, MA. The purpose of EPIC was to improve employees’ interprofessional collaboration knowledge and skills and to create positive perceptions of working in interprofessional teams. The components of the EPIC program can be transferred to other hospital settings to improve interprofessional collaboration. Primary Author and Speaker: Moriah Boyd

Lessons learned: Characteristics of first-year COVID-19 hospital outbreaks

Background: At the start of the COVID-19 pandemic, the DC Department of Health (DC Health) mandated new case reporting for early outbreak detection: (1) weekly healthcare personnel (HCP) absenteeism line lists indicating staff absent for confirmed or suspected SARS-CoV-2, (2) daily line lists of all SARS-CoV-2–positive inpatients, and (3) hospital contact tracing. Between March 27, 2020, and December 31, 2020, DC Health detected 36 confirmed and 14 suspected hospital outbreaks, of which only 18% (8 confirmed and 1 suspect) were known to the affected hospital. DC Health learned which outbreaks warranted early or aggressive intervention by tracking outbreak characteristics across its jurisdiction. This allowed prioritization of during surges when it was difficult for DC Health and hospital staff to investigate every outbreak. Methods: Potential outbreaks in short-stay and inpatient rehabilitation hospitals were flagged after identifying SARS-CoV-2 hospital-onset (HO) inpatients or staff clusters on line lists. Variables of interest in line lists included specimen collection and hospital admission dates, units or departments, and patient contact. Facility contact tracing by infection preventionists further verified epidemiological links among cases. Outbreak details were systematically tracked in a locally developed REDCap database and were analyzed if they had an initial case, outbreak start date, or an investigation start date in 2020. Frequency procedures, SQL statements, and date calculations were computed using SAS Enterprise Guide version 8.3 software. Results: Confirmed outbreaks had an average of 6.92 (range, 0–32) HCP and 2.58 (range, 0–22) patient cases, with 69% being confirmed-HO cases and 31% probable HO. Moreover, 53% of confirmed outbreaks occurred in the following departments: cardiac, behavioral health, intensive care, and environmental services (EVS)/facilities. All of these departments had recurrent outbreaks. Behavioral health, medical and cardiac units had the highest number of patient cases. On average, confirmed outbreak investigations lasted 24.6 days, with outbreaks prolonged in the ICU (40.25 days) and the medical unit (37.67 days). Top triggers for investigations ultimately classified as confirmed outbreaks were (1) positive symptomatic HCP, (2) confirmed-HO cases, and (3) exposures from positive HCP. Conclusions: The dynamic nature of COVID-19 created challenges in detecting and responding to hospital outbreaks. Developing a low-resource outbreak tracking system helped identify outbreak types and triggers that warranted early or aggressive interventions. Understanding the characteristics of hospital outbreaks was critical for maximizing infection control resources during surges of infectious disease outbreaks, such as COVID-19. Hospitals or local health departments could adapt this system to meet their needs.Funding: NoneDisclosures: None

Predictors of post-hip fracture knee pain in hospitalized older adults with intertrochanteric femoral fracture.

Post-hip fracture knee pain (PHFKP) is an important issue that contributes to reduced gait speed and prolonged hospitalization. Femoral morphology has been reported to contribute to the development of PHFKP, but an independent association has not been confirmed and clinically applicable cutoffs for predicting the development of PHFKP remain unclear. To determine whether femoral morphology and knee extension range of motion limitation are independent factors in PHFKP and to determine cutoffs for predicting the development of PHFKP. Retrospective chart review study. Convalescent inpatient rehabilitation hospital. Patients in a convalescent ward after intertrochanteric femoral fracture surgery. PHFKP development, radiographic femoral morphology (leg length discrepancy and neck-shaft angle), and knee extension range of motion limitation. PHFKP developed in 36 (35%) of the 103 patients enrolled. The PHFKP group had a longer hospital stay (p=.029), greater weight (p=.031), greater knee extension range of motion limitation (p=.001), and more varus neck-shaft angle (p < .001) compared to the non-PHFKP group. Varus neck-shaft angle (odds ratio, 0.85; 95% confidence interval [CI], 0.78-0.92; p < .001) and knee extension range of motion limitation (odds ratio, 1.18; 95% CI, 1.07-1.30; p=.001) were significant factors for PHFKP development. Neck-shaft angle discrepancy and knee extension range of motion limitation demonstrated moderate accuracy in discriminating development of PHFKP according to receiver operating characteristic analysis, with cutoffs of 9.6° and 7.5°, respectively. Areas under the receiver operating characteristic curve were 0.77 (95% CI, 0.66-0.88; p < .001) for neck-shaft angle discrepancy and 0.67 (95% CI, 0.56-0.79; p=.004) for knee extension range of motion limitation. Varus neck-shaft angle and knee extension range of motion limitation were identified as independent predictors of PHFKP. The cutoff for neck-shaft angle may be useful for predicting PHFKP development and to define an acceptable angle of fracture reduction to prevent PHFKP.

Goals and Action Plans Across Time and Place-A Qualitative Study Exploring the Importance of "Context" in Person-Centered Rehabilitation.

BackgroundPerson-centeredness is increasingly addressed in relation to rehabilitation interventions. Collaborative goal setting and action plans are key measures in person-centered rehabilitation. There is a lack of knowledge about how person-centered goals and action plans developed away from the patient's everyday life are experienced by patients after discharge.PurposeThis aim of the study is to explore how patients with rheumatic diseases experience the relevance of goals and action plans after discharge from inpatient rehabilitation hospital stay.MethodsIndividual narrative interviews were conducted with eight patients with rheumatic diseases, aged between 40 and 60. A convenience sampling strategy was applied. Data collection, analysis and interpretation of data were performed within a phenomenological-hermeneutic framework inspired by Paul Ricoeur's interpretative philosophy.ResultsThe analysis derived one core theme, “The relevance of goals and action plans is contextual” and three subthemes: “Admission—a protected bubble,” “Back home—a harsh reality,” and “Need for post-discharge support.”ConclusionThis study indicates that the relevance of goals and action plans to patients with rheumatic diseases is context specific. On the basis of the study, it is suggested that the context should be considered in rehabilitation practice, including the social network of the patients. This is in order to support patients in rehabilitation interventions to manage everyday life with disease after discharge to their own homes. Moreover, the concept of context in person-centered rehabilitation should be reconsidered. The study also concludes that there is a need for further development and research in follow up programs, as it is not clear what may constitute an optimal design of follow up support.

Revisiting Criteria for Emergence From The Minimally Conscious State

<h3>Research Objectives</h3> To determine whether consistent command following (CCF) may be a sign of emergence from the minimally conscious state (MCS). <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> Specialized disorders of consciousness (DoC) program in an inpatient rehabilitation hospital. <h3>Participants</h3> Patients with severe acquired brain injury and DoC. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Time from injury to recovery of CCF and time from injury to emergence from MCS (defined as functional object use [FO] or functional communication [FC] on the Coma Recovery Scale – Revised [CRS-R]) across the first eight weeks of rehabilitation. <h3>Results</h3> Of 214 patients admitted to rehabilitation without CCF, FO, or FC (median [interquartile range, IQR] age: 53 [34, 66] years, male: 134 (62.6%), traumatic etiology: 115 (53.7%), admission CRS-R total score: 10 [7, 13]), 162 (75.7%) recovered CCF and emerged from MCS during the eight-week observation period. Of these, 116 patients (71.6%) recovered CCF either at the same time or after emerging from MCS. Both CCF and emergence from MCS occurred approximately 46 days post-injury. FO and FC were equally likely to be the first observed behavior consistent with emergence from MCS (p <.001). <h3>Conclusions</h3> Most patients admitted to rehabilitation following severe brain injury recovered CCF and emerged from MCS during the first eight weeks of rehabilitation. CCF and emergence from MCS occur at approximately the same time during the recovery course, suggesting that CCF should be included as a criterion signaling emergence from MCS. Including CCF as a criterion for emergence from MCS may improve access to clinical services for patients with DoC, as this suggests capacity for active participation in rehabilitation. <h3>Author(s) Disclosures</h3> The authors declare no relevant conflict of interest.

Virtual Focus Groups for Remote Qualitative Research in Individuals with Brain Injury: Challenges and Lessons Learned

<h3>Research Objectives</h3> To develop, refine, and implement strategies for virtual qualitative research in individuals with brain injury (BI) using the Knowledge to Action Framework. <h3>Design</h3> To design a standard operating procedure (SOP) for remote qualitative data collection in BI populations, we conducted a literature review, adapted the intervention to BI-specific needs, tested adaptations in mock focus groups, and integrated input from local experts. <h3>Setting</h3> Inpatient rehabilitation hospital. <h3>Participants</h3> Brain injury and psychological health investigators. <h3>Interventions</h3> Mock focus groups were conducted and guided by a standard operating procedure manual, technological supports for the virtual platform, and privacy adaptation protocols. <h3>Main Outcome Measures</h3> Debriefing sessions using rigorous probing following the mock focus groups. <h3>Results</h3> An SOP outlining barriers, facilitators, and strategies for remote qualitative data collection in BI populations. Barriers include logistical (e.g. documenting responses in compliance with privacy and confidentiality standards) and technological (e.g. disparities in familiarity with video conferencing) challenges. Facilitators can include participants having experience with virtual platforms. Recommendations include 1) consultation with key stakeholders to identify potential participants and refine strategies, 2) limitation of focus group size to 5-7 participants and designation of an additional team member for technological support, 3) creation of simple, easy to read participant guides that include technical instructions and process descriptions, 4) development of remote-specific protocols to address confidentiality and privacy issues related to participant identification and storage of audio and visual recordings, and 5) obtainment of participant feedback after each focus group to inductively adapt interventions to address the needs of cognitively impaired participants. <h3>Conclusions</h3> Virtual focus groups for remote qualitative data collection in persons with brain injury are a feasible, efficient, and low-cost approach that allows broad participation and enables capture of diverse stakeholder perspectives. <h3>Author(s) Disclosures</h3> Authors reported no disclosures.

Assessing the Impact of Specialized Oral Nutrition Supplementation Use on Wound Healing

Research Objectives Assess utilization and impact of a specialized oral nutrition supplement (ONS) containing arginine, glutamine, and hydroxymethylbutyrate (HMB) on wound healing. Design Retrospective analysis comparing treatment group (51 patients, 161 wounds) receiving standard care plus a specialized ONS for ≥14 days and comparison group (136 patients, 263 wounds) receiving standard care. Between group differences evaluated using t-tests and mixed models with inverse probability weighting. Setting Inpatient rehabilitation hospital. Participants 187 adult patients admitted between 1/2018-12/2019 with ≥1 measured wound and ≥2 wound care nurse assessments. Interventions Specialized oral nutrition supplement administered for 14 days. Main Outcome Measures Wound healing was measured in weekly intervals by decrease in wound surface area (superficial) or volume (non-superficial) in past 1 week. Results While no age differences were reported between groups (50.9 vs 51.0 years, p=1.0), the treatment group had a higher percentage of male patients (90.2% vs 69.9%, p<0.01). Treatment group patients had more wounds (3.3 vs 2.0, p<0.01), lower functional independence measure scores (35.7 vs 40.3, p=0.082), and a higher case mix index (2.3 vs. 2.0, p=0.008) at baseline. Average inpatient stay (44. 8 vs 39.9 days, p=0.36) and wound area at baseline (22.0 vs 13.1 cm2, p=0.18) were higher, but not statistically different, in the treatment group. Treatment group wounds significantly decreased in area (61.0% vs 34.6%, p=0.01) compared to comparison group wounds. The odds of a decrease in wound size were higher in the treatment versus comparison group (OR = 24.1, p<0.01). Conclusions Patients receiving specialized ONS had more wounds and higher acuity level than those in the comparison group but had a significant reduction in wound size. There are several limitations in this retrospective study, including baseline functional and wound size differences. However, these findings support the benefits of specialized ONS in improving wound healing for patients with pre-existing wounds. Author(s) Disclosures KW Kerr, S Sulo and JL Nelson are Abbott employees and stockholders. Study financially supported by Abbott. Assess utilization and impact of a specialized oral nutrition supplement (ONS) containing arginine, glutamine, and hydroxymethylbutyrate (HMB) on wound healing. Retrospective analysis comparing treatment group (51 patients, 161 wounds) receiving standard care plus a specialized ONS for ≥14 days and comparison group (136 patients, 263 wounds) receiving standard care. Between group differences evaluated using t-tests and mixed models with inverse probability weighting. Inpatient rehabilitation hospital. 187 adult patients admitted between 1/2018-12/2019 with ≥1 measured wound and ≥2 wound care nurse assessments. Specialized oral nutrition supplement administered for 14 days. Wound healing was measured in weekly intervals by decrease in wound surface area (superficial) or volume (non-superficial) in past 1 week. While no age differences were reported between groups (50.9 vs 51.0 years, p=1.0), the treatment group had a higher percentage of male patients (90.2% vs 69.9%, p<0.01). Treatment group patients had more wounds (3.3 vs 2.0, p<0.01), lower functional independence measure scores (35.7 vs 40.3, p=0.082), and a higher case mix index (2.3 vs. 2.0, p=0.008) at baseline. Average inpatient stay (44. 8 vs 39.9 days, p=0.36) and wound area at baseline (22.0 vs 13.1 cm2, p=0.18) were higher, but not statistically different, in the treatment group. Treatment group wounds significantly decreased in area (61.0% vs 34.6%, p=0.01) compared to comparison group wounds. The odds of a decrease in wound size were higher in the treatment versus comparison group (OR = 24.1, p<0.01). Patients receiving specialized ONS had more wounds and higher acuity level than those in the comparison group but had a significant reduction in wound size. There are several limitations in this retrospective study, including baseline functional and wound size differences. However, these findings support the benefits of specialized ONS in improving wound healing for patients with pre-existing wounds.

Assessing Decision-Making Capacity in Patients with Acquired Brain Injury: A Toolkit of Ethical Guidelines

<h3>Research Objectives</h3> To improve provider knowledge of the construct of capacity, clarify existing capacity assessment institutional policies, and provide recommendations for conducting capacity assessment. <h3>Design</h3> A semi-structured interview script and Likert scale survey were developed to investigate stakeholder knowledge and perspectives on decision-making capacity. Constant Comparative Method Analysis was conducted to identify themes across and within stakeholder groups. <h3>Setting</h3> Inpatient Rehabilitation Hospital. <h3>Participants</h3> Multidisciplinary stakeholder representatives, including physicians, investigators, hospital administrators, legal counsel, psychologists, case managers, nurses, social workers, caregivers, and patients (N=21), selected by the investigators using purposive sampling. <h3>Interventions</h3> Not Applicable. <h3>Main Outcome Measures</h3> Four thematic areas (i.e. clinical, research, ethical, legal) identified through application of a data reduction procedure. <h3>Results</h3> Ethically, capacity assessment promotes patients' autonomy, dignity, best interests, well-being, values, preferences and goals of care, and allows patients to maintain the right to refuse treatment. Clinically, stakeholders reported that capacity assessment ensures that patient preferences are considered in the plan of care and that unwanted procedures and treatments are prevented. Legally, capacity assessment ensures there is valid informed consent. For research, capacity assessment helps establish a point person to make decisions and allows for decisions to be made regarding patient participation in research studies. Providers identified challenges including lack of time, lack of familiarity with legal statutes, and uncertainty about the multidimensionality of capacity. Investigators identified challenges including tracking proxy/guardian status long-term and lack of consensus between clinical and research teams. Surrogate decision makers identified challenges including lack of direct contact with patients, family discord, and negative impact of personal emotions. For healthcare systems, challenges included incomplete medical records, high staff turnover, and team miscommunication. A provider toolkit for capacity assessment and monitoring was developed based on challenges identified by stakeholder groups and recommendations were proposed for refining institutional policy and procedures. <h3>Conclusions</h3> While stakeholder groups appear to have a general understanding of the concept of capacity, familiarity with specific procedures and regulations is limited. Institutions should provide supportive resources for providers directly involved in assessment of decision-making capacity. <h3>Author(s) Disclosures</h3> No Disclosures.

Computerized social cognitive training in the subacute phase after traumatic brain injury: A quasi-randomized controlled trial

Objectives To assess the usefulness of a computerized tasks module designed for the rehabilitation of social cognition (SC) in acquired brain injury. Methods Quasi-randomized controlled trial (ClinicalTrials.gov:NCT03479970) involving 45 patients with moderate-severe traumatic brain injury (TBI) in a subacute inpatient rehabilitation hospital. The experimental group (n = 28) received treatment with a computerized SC module in combination with a non-SC module. The control group (n = 26) only received a treatment with non-SC module. Results Intragroup comparisons showed that the experimental group had better results for all SC measures, except for International Affective Picture System (IAPS). The control group improved for Facial Expressions of cEmotion-Stimuli and Tests (FEEST) and Moving Shapes Paradigm (MSP), showing no changes with respect to pretreatment in IAPS, MSP and Reading the Mind in the Eyes Test (RMET). Intergroup comparisons did not present differences between the two groups for pretreatment measures. Post-treatment comparison showed that the experimental group obtained better results for RMET than the control group. Conclusion The computerized SC module was useful for the rehabilitation of SC in patients with moderate-severe TBI in the subacute phase. The group that received combined rehabilitative treatment (SC + non-SC) obtained better results for SC than the group that received treatment intended only for non-SC.

Inpatient rehabilitation wheelchair management quality improvement project: Implications for patients with spinal cord injury

Context/Objective: Evaluate hospital fleet wheelchair (WC) requests submitted by physical therapists (PT) for patients with spinal cord injury (SCI) to trial and use during inpatient rehabilitation. Design: Quality improvement project secondary analysis of delivery process and WC trials. Setting: Urban inpatient rehabilitation hospital. Participants: Internal review of 4,371 WC requests narrowed to 750 patients with SCI. Interventions: PTs submitted WC requests between March 25, 2017, and September 30, 2019. Outcome Measures: WC delivery timeframe, level of SCI, type of WC. Results: PTs requested power (28%), and manual WC bases: standard (19.1%), tilt (18.9%), ultralight rigid (18.9%), ultralight folding (13.5%), and recliner (1.6%) respectively. Patients received fleet WCs 49.9% of the time within specified urgency timeframes. A Chi-Square test showed a significant association between WC request urgency and fulfillment within established timeframes (χ 2 = 19.68, P < 0.001, n = 750). Broken down by urgency level: 60.0% low (n = 12), 56.2% medium (n = 244), and 39.9% high (n = 118) received their WC within established timeframes. Patients with cervical level SCI (n = 162) had the highest mean wait time of 8.28 days for power WCs. The second highest wait time was 6.29 days (SD 6.6) for manual ultralight rigid WCs (n = 34). Conclusion: Inpatient fleet WC delivery is critical to patients with SCI. Variation occurs by WC type requested and by the level of injury. Gaps exist in providing appropriate WCs in facility timeframe guidelines by the level of urgency that is within 24 h for high, 3–5 days for medium, and 5–7 days for low.

Clinical and Economic Burden of Out-of-Hospital Cardiac Arrest in US Commercial Insurance Population (2014 to 2019)

Little is known about the economic burden incurred by out-of-hospital cardiac arrest (OHCA) in the US commercial insurance setting. We used IBM MarketScan Commercial Claims and Encounters Database (January 2014 to March 2019) to identify patients hospitalized with OHCA based on the International Classification of Diseases codes. Patients who survived the initial OHCA episode were stratified by prognosis based on discharge setting and classified into mild (discharged home), moderate (skilled nursing facility), severe (inpatient rehabilitation or long-term hospital), and very severe (hospice) prognosis groups, respectively. Patients were followed up for 12 months after discharge for health care resource utilization and medical costs, which were inflated to year 2020. Overall, 23,512 patients with OHCA hospitalization were identified, of whom 14,667 were <65 years and 60.5% were men. The incidence of OHCA per 100,000 was steady in patients <65 years over the years (17.9 in 2014; 17.5 in 2018) but among those ≥65 years, decreased from 139.7 in 2014 to 111.1 in 2018. Total medical costs 12 months after discharge generally increased with severity of prognosis, with an average for the mild, moderate, and severe prognosis group, respectively, estimated to be $52,746, $100,394, and $130,530 among patients <65 years, and $63,194, $65,794, and $70,973 among those ≥65 years. Costs were lower for those with very severe prognosis ($7,102 for <65 years; $2,553 for ≥65 years), possibly due to high mortality. In conclusion, OHCA continues to pose a substantial clinical and economic burden on patients and the US health care system, which increases with the severity of disease prognosis.

Translation of Karnofsky Performance Status (KPS) for use in inpatient cancer rehabilitation.

Better tools are needed to predict functional decline and oncologic prognosis in inpatient cancer rehabilitation. The Karnofky Performance Status (KPS) is a widely used scale of functional performance in oncology, although the scale differs from current rehabilitation terminology. Use of the KPS in inpatient rehabilitation may support a shared method of communication between cancer rehabilitation providers and the primary oncology teams. To establish interrater reliability for translation of the KPS for use in inpatient cancer rehabilitation. Retrospective interrater reliability review. A large inpatient rehabilitation hospital system. Fifty randomized charts were chosen for review from a larger database of all patients admitted to an inpatient cancer rehabilitation program in 2020. Not applicable. The KPS scale was translated into common inpatient rehabilitation grading consistent with the Continuity and Assessment Record and Evaluation (CARE) Item Set to support its use in this specialty area. Additionally, a list of best practice guidelines and scoring instructions were created to assist raters in determining appropriate levels within the scale. Members of the inpatient cancer rehabilitation team scored all patients within the larger database (n=424) throughout 2020. A blinded rater completed retrospective chart reviews to score the 50-chart sample. A two-way random effects model was used to calculate an intraclass correlation coefficient (ICC) for the KPS scores at each of three time points (premorbid, admission, and discharge). The KPS interpretation for rehabilitation proved to be statistically reliable for the 50-chart sample. The premorbid KPS interrater reliability was acceptable (ICC=0.67; 95% confidence interval [CI]: 0.40-0.82), admission KPS reliability was good (ICC=0.88, 95% CI: 0.78-0.93), and discharge reliability was excellent (ICC=0.96; 95% CI: 0.91-0.98). The KPS translation at three time points (premorbid, admission, and discharge) during the inpatient rehabilitation continuum has acceptable interrater reliability.

Collaboration in Animal-Assisted Activities and Animal-Assisted Therapy

Animal Assisted Intervention is a valuable tool in inpatient and outpatient rehabilitation. Conducting goal-directed, therapeutic Animal-Assisted Interventions requires certification, training and collaboration. It is important that Animal Assisted Therapy teams comprised of specially trained dogs and handlers are co-certified to ensure the safety of patients, therapeutic interactions, and beneficial outcomes aligned with rehab goals. Some examples of speech therapy goals and outcomes in AAT are included below. It is preferred to conduct co-treatment sessions with AAT therapists and a second clinician to increase the opportunity for a variety of treatment modalities, to develop collaborative ideas for treatment sessions and to improve socialization opportunities. To collaborate for a successful AAT session, a co-treating therapist must first understand the AAT program and services available specific to the trained animal-handler team. This article outlines the process involved in obtaining and maintaining a skilled facility dog and an Animal Assisted Therapy program in an inpatient rehabilitation hospital. Animal Assisted Therapy has great potential to excite, distract, engage, encourage, and motivate patients. It is a new field, with generalized criteria for practice and limited standard protocols. It is underutilized and often mischaracterized. With more widespread education and advocacy and development of clinical standards and guidelines, AAT could improve the lives of so many people hoping to return to life as they knew it.

Rasch Properties of the Cognitive and Linguistic Scale and Optimization for Outcome Trajectory Modeling in Pediatric Acquired Brain Injury

ObjectivesTo (1) determine if items on the Cognitive and Linguistic Scale (CALS) follow a Rasch distribution and (2) explore the relationship between Rasch-derived Cognitive Ability Estimates and outcome trajectory parameters using a nonlinear mixed-effects modeling approach. DesignRetrospective study. SettingPediatric inpatient rehabilitation hospital. ParticipantsA total of 252 children (N=252) aged of 2-21 years (median, 11.8 [IQR, 6.4-15.9] years) consecutively admitted to an inpatient rehabilitation brain injury unit (2008-2014) for a first inpatient admission after acquired brain injury. InterventionsNot applicable. Main Outcome MeasuresRasch-derived Cognitive Ability Estimates from the CALS and associated outcome trajectory parameters. ResultsThe CALS demonstrates adequate interval-scale properties with removal of scores from the arousal and responsivity items. Rasch-derived Cognitive Ability Estimates were associated with age (β=0.025, P<.001) such that older age was associated with a faster rate of recovery and more complete ultimate recovery. Slower recovery initiation was associated with a less complete overall cognitive recovery (Spearman ρ=−0.31; P<.001). ConclusionsThe Cognitive Ability Estimates derived from the CALS and associated outcome parameters (eg, rate of recovery) may serve as an ideal outcome measure for clinical trials evaluating interventions for acquired brain injury in a pediatric rehabilitation setting.

Dysphagia Characteristics of Patients Post SARS-CoV-2 During Inpatient Rehabilitation

ObjectiveTo investigate dysphagia in patients recovering from SARS-CoV-2 admitted to acute inpatient rehabilitation by summarizing clinical swallow evaluation and videofluoroscopic swallow study findings. DesignRetrospective cohort study. SettingUrban inpatient rehabilitation hospital. ParticipantsThe first inpatients admitted with SARS-CoV-2 (N=40) who participated in a videofluoroscopic swallow study. InterventionsNot applicable. Main Outcome MeasuresPatient characteristics upon admission (duration of intubation, tracheostomy status, comorbidities, videofluoroscopic swallow study (VFSS) completion at previous level of care); admission International Dysphagia Diet level (IDDSI); Mann Assessment of Swallowing Ability (MASA), Functional Oral Intake Scale (FOIS), dysphagia severity rating; penetration aspiration scale (PAS) rated during VFSS; and IDDSI level recommended after completion of VFSS. ResultsTwenty percent of patients had been evaluated by videofluoroscopy in acute care. Nineteen of 37 (51%) individuals were upgraded to IDDSI level 7 regular diet with level 0 thin liquids and achieved a FOIS of 7 after the completion of the VFSS. Five individuals (13%) received a diet downgrade or remained on the same diet recommendations from their admission. Total numerical score (TNS) of less than 170 on the MASA predicted presence of aspiration in 27% of patients (6 of 22). Seventy-two percent of the sample (16 of 22) had a TNS less than 170 but did not demonstrate any instances of aspiration. The odds of patients having a PAS of 3 or greater increased by approximately 15% (odds ratio, 1.15; 95% confidence interval, 1.03-1.27; P=.013). Thus, with each additional day of intubation during acute care stay, there was a 15% greater likelihood of having airway invasion. ConclusionsInstrumental swallow evaluations are imperative to diagnose and treat dysphagia in the post-coronavirus disease population. Because of the heterogeneity of this population, high incidence of prolonged intubation, and limitations of the clinical swallowing evaluation, instrumental assessments need to be performed on a more consistent basis as infection prevention protocols evolve.

Efficacy of an exoskeleton-based physical therapy program for non-ambulatory patients during subacute stroke rehabilitation: a randomized controlled trial

BackgroundIndividuals requiring greater physical assistance to practice walking complete fewer steps in physical therapy during subacute stroke rehabilitation. Powered exoskeletons have been developed to allow repetitious overground gait training for individuals with lower limb weakness. The objective of this study was to determine the efficacy of exoskeleton-based physical therapy training during subacute rehabilitation for walking recovery in non-ambulatory patients with stroke.MethodsAn assessor-blinded randomized controlled trial was conducted at 3 inpatient rehabilitation hospitals. Patients with subacute stroke (< 3 months) who were unable to walk without substantial assistance (Functional Ambulation Category rating of 0 or 1) were randomly assigned to receive exoskeleton-based or standard physical therapy during rehabilitation, until discharge or a maximum of 8 weeks. The experimental protocol replaced 75% of standard physical therapy sessions with individualized exoskeleton-based sessions to increase standing and stepping repetition, with the possibility of weaning off the device. The primary outcome was walking ability, measured using the Functional Ambulation Category. Secondary outcomes were gait speed, distance walked on the 6-Minute Walk Test, days to achieve unassisted gait, lower extremity motor function (Fugl-Meyer Assessment), Berg Balance Scale, Patient Health Questionnaire, Montreal Cognitive Assessment, and 36-Item Short Form Survey, measured post-intervention and after 6 months.ResultsThirty-six patients with stroke (mean 39 days post-stroke) were randomized (Exoskeleton = 19, Usual Care = 17). On intention-to-treat analysis, no significant between-group differences were found in the primary or secondary outcomes at post-intervention or after 6 months. Five participants randomized to the Exoskeleton group did not receive the protocol as planned and thus exploratory as-treated and per-protocol analyses were undertaken. The as-treated analysis found that those adhering to exoskeleton-based physical therapy regained independent walking earlier (p = 0.03) and had greater gait speed (p = 0.04) and 6MWT (p = 0.03) at 6 months; however, these differences were not significant in the per-protocol analysis. No serious adverse events were reported.ConclusionsThis study found that exoskeleton-based physical therapy does not result in greater improvements in walking independence than standard care but can be safely administered at no detriment to patient outcomes.Clinical Trial Registration The Exoskeleton for post-Stroke Recovery of Ambulation (ExStRA) trial was registered at ClinicalTrials.gov (NCT02995265, first registered: December 16, 2016)