Inpatient Rehabilitation Setting Research Articles

Disparities in Physical Therapy Outcomes Based on Race and Ethnicity: A Scoping Review.

This scoping review synthesizes and summarizes the evidence on racial and ethnic disparities in outcomes after physical therapist treatment. Four databases from 2001 through 2021 were searched for articles reporting physical therapy outcomes across racial and ethnic groups. The Arksey and O'Malley's methodological framework was adapted for this scoping review. Two reviewers screened the abstracts and 5 reviewers screened full texts for inclusion. Five reviewers extracted information including study design, diagnoses, setting, outcomes reported, the domains the outcomes measured, and racial and ethnic groups included. To identify disparities, summarized differences in outcomes (better, worse, no difference) for each racial and ethnic group compared to White patients were calculated. Of 1511 abstracts screened, 65 met inclusion criteria, 57 of which were observational designs. All 65 articles included non-Hispanic White patients as the reference group. A majority of the physical therapy outcomes reported by race were for Black patients and/or Hispanic or Latino patients, whereas outcomes for Asian, American Indian, Alaskan Native, and/or Native Hawaiians or Pacific Islander patients were reported infrequently. Most articles reported disparities in health outcomes for patients in the inpatient rehabilitation setting (n = 48) and for adults (n = 59) with neurologic diagnoses (n = 36). Compared to White patients, worse outcomes were reported more frequently for all marginalized racial and ethnic groups after physical therapy, with the exception of marginalized groups having the same or better outcomes for successful post-rehabilitation community discharge. Gaps remain in understanding outcome disparities beyond older adult and neurologic populations as well as for musculoskeletal diagnoses frequently treated by physical therapists. The presence of racial and ethnic disparities in physical therapy outcomes should motivate physical therapists to understand the mechanisms underlying disparities and focus on social and structural drivers of health inequity in their clinical decision-making.

'On-Demand' snack service in a rehabilitation setting: Impact on satisfaction,intake, waste and costs.

To evaluate an 'On-Demand' snack service in a rehabilitation setting for satisfaction, intake, waste and cost. In September 2021, a trial of an 'On-Demand' snack service was conducted on two general rehabilitation wards in a purpose-built rehabilitation hospital. A retrospective comparison of pre-implementation, 1-month and 8-month post-implementation audit data was used to evaluate staff and patient satisfaction, nutritional intake, waste and cost (labour and food). Descriptive and inferential statistical analyses were performed for intake quantitative data and content analysis was conducted for qualitative data. A total of 26 responses from staff and 34 from patients were received. Staff reported higher overall satisfaction with the 'tea-trolley' service (50% vs. 32%; χ2 6.815 [2]; p < 0.05). Patient satisfaction ratings of the original 'tea-trolley' system were higher than the 'On-Demand' snacks system (96% vs. 59%; χ2 41.60 [2]; p < 0.0001). Median daily intake from snack food and drinks was maintained (938 kJ and 6 g protein vs. 925 kJ and 6 g protein) and waste (23.3% vs. 20.9%; p < 0.05) decreased with the 'On-Demand' service. Cost of ordered food was similar ($778.15 'tea-trolley' vs. $746.1 'On-Demand'), however cost of waste ($179.47 'tea-trolley' vs. $128.7 'On-Demand') and labour ($1650.46 'tea-trolley' vs. $926.44 'On-Demand') reduced by 28% and 44%, respectively, with the 'On-Demand' snack service. Implementing an 'On-Demand' snack service in the general inpatient rehabilitation setting resulted in reductions in food waste, foodservice staff labour and waste costs, while intake was maintained. Patient and staff satisfaction decreased warranting further investigation into appropriate implementation methods.

Designing an occupation-based group intervention for adult inpatient rehabilitation: Partnering with clinicians and patients using a nominal group technique design.

Occupation-based interventions use engagement in a person's daily activities to achieve change. There is growing research into the use of occupation-based group interventions in the inpatient rehabilitation setting. It remains unclear whether occupation-based groups offer comparable outcomes to occupation-based interventions delivered individually; this research will precede a clinical trial aimed at comparing these two approaches for improving occupational performance outcomes. This study details the process of co-designing the intervention. Partnering with clinicians and patients in the design of healthcare interventions can promote patient-centred care, enhance uptake, and improve applicability and sustainability of the intervention to that setting. A modified nominal group technique (NGT) design was applied to facilitate two meetings and an electronic survey with an expert panel of clinicians and patients. Twelve participants (n = 4 occupational therapists, n = 1 registered nurse, n = 1 physiotherapist, n = 1 occupational therapy assistant, n = 1 occupational therapy manager, and n = 4 patients) were purposively recruited. A modified approach to the technique's four stages was used: silent generation, round robin, clarification, and voting. Consensus was set at >50%. Qualitative data from group discussions were analysed thematically. All participants agreed the intervention should include patient-centred, goal-directed, practice of daily activities, including breakfast and lunch preparation, domestic tasks, and laundry. Other components that were agreed included where the groups could run, group size, eligibility criteria, and frequency. Key themes from clinicians included needing a goal-directed intervention, focused on progressing towards hospital discharge; time and resource requirements were also discussed. Patients emphasised the importance of building social connections, opportunity to engage in meaningful activity, and the importance of linking participation to patient goals. Through collaboration with clinicians and patients, an occupation-based group intervention considering the available evidence, alongside clinical, experiential, and contextual sources of knowledge was developed; this resulted in an evidence-based, patient-centred, and contextually relevant intervention.

Patients’ perceptions of participating in self-directed activities outside supervised occupational and physiotherapy within inpatient and home-based rehabilitation settings: a qualitative study

Purpose To investigate patients’ perceptions of participating in self-directed activities, outside supervised occupational and physiotherapy, within rehabilitation settings. Methods Semi-structured interviews were undertaken with 16 patients and in three instances, their carers, from three health services in Victoria, Australia, two offering inpatient and one offering home-based rehabilitation care. A thematic analysis was performed using a framework approach. Results Themes identified included the role of the clinicians in encouraging patients and instilling confidence, giving feedback and “just being there”; considerations in program delivery, including different formats, support from peers and relatives, and program familiarity and flexibility; patients’ different intrinsic driving and limiting forces, including following orders, seeing results, desiring autonomy and having an “inner athlete”; and the environment, including functional activities, space, equipment, time and availability. Conclusions Patients and their carers reported positive experiences of participating in self-directed therapy programs within rehabilitation settings, with programs perceived as beneficial in optimising recovery. Patients reported a range of driving and limiting factors in relation to completing self-directed activities. Understanding these factors, relating to the patient, their environment and other people, is critical for clinicians so that they can modify their delivery accordingly, ensuring uptake and sustained implementation of self-directed activities in rehabilitation care.

Idle-Time Exercise: Promoting More-Involved arm use in the Inpatient Rehabilitation Setting after Stroke

Idle-Time Exercise: Promoting More-Involved arm use in the Inpatient Rehabilitation Setting after Stroke

Functional Dry Needling in the Inpatient Rehabilitation Setting: A Feasibility Study and Implementation Review

Functional Dry Needling in the Inpatient Rehabilitation Setting: A Feasibility Study and Implementation Review

Predicting inpatient rehabilitation length of stay for adults with traumatic spinal cord injury

Introduction Most post-injury traumatic spinal cord injury (TSCI) care occurs in the inpatient rehabilitation setting. The inpatient rehabilitation length of stay (R-LOS) has been shown to be a significant predictor of motor function restoration in persons with TSCI. Due to the complexity, and heterogeneity of individuals with TSCI, the R-LOS is challenging to predict at admission. Purpose To identify the main predictors of R-LOS and derive an equation to estimate R-LOS in persons with TSCI. Methods This is a retrospective analysis of data from adults with TSCI from The Rick Hansen Spinal Cord Injury Registry in Alberta, Canada, who received rehabilitation care between May 10, 2005, and January 28, 2020. Multiple linear regression analysis was used to determine significant relationships between R-LOS and measures of participant demographics, length of stay, impairment and injury classification, and comorbidities. Results The analysis included 736 adults with TSCI from an eligible cohort of 1365. The median R-LOS was 65 days (IQR 39–99 days), ranging from 1 to 469 days. Multivariate linear regression analysis identified two significant predictors of R-LOS, total FIM score and the injury classification. This model was used to derive a R-LOS prediction equation, which explained 34% of the variance in R-LOS. Conclusion We developed a simple equation to predict R-LOS based on the level of impairment and total FIM scores in persons with TSCI. These data have implications for health system planning, improvement, and innovation, and provide insights to support further research into the predictors of R-LOS, identification of higher-risk individuals.

Rehabilitation Therapy and Multimorbidity: A Retrospective Cohort Study

Aims Home care rehabilitation therapists can address the functional health needs of those with multimorbidity. This study described individuals with multimorbidity receiving home care rehabilitation therapy and examined the relationship between receipt of rehabilitation therapy and hospital utilization. Methods The cohort included long-stay home care clients experiencing multimorbidity who were discharged from an inpatient rehabilitation setting (N = 5,234) between 2007 and 2015. Multivariable logistic regression was used to examine the association between receipt of rehabilitation therapy and hospitalization. Results Nearly 40% of this cohort had 5+ chronic conditions. Those receiving only rehabilitation therapy were less likely to be readmitted to the hospital (OR = 0.68; 95% CI: 0.51–0.92), and less likely to use emergency services (OR = 0.80; 95% CI: 0.66–0.97) at the 3-month timeframe. Similar trends were observed at the 12-month timeframe. Conclusions Individuals with multimorbidity have complex health needs and home care rehabilitation therapists aid in sustained discharges and influence subsequent health utilization.

Navigating the Challenges of Candida auris Colonization in Rehabilitation Settings.

Candida auris is a highly transmissible yeast that is capable of causing invasive and fatal infections, particularly among persons with underlying medical conditions. Its incidence is rising, especially among patients cared for in post-acute care facilities. Individuals colonized with the yeast may be cared for in inpatient rehabilitation settings, without heightened risk for invasive infection and/or transmission to others, as long as appropriate infection control measures are followed. This article reviews key information for rehabilitation nurses caring for persons with C. auris , including risk factors for infection, the need for contact precautions, appropriate disinfection practices for therapy and diagnostic equipment, and critical components of safe transitions in the care of these patients.

Student‐led activities of daily living group program in a hospital inpatient rehabilitation setting

AbstractIntroductionOccupational therapists have vital roles in inpatient rehabilitation to focus on independence in activities of daily living. Occupational therapy interventions are uniquely designed to address goals of service users and can be delivered individually or in group formats. Group interventions promote service users' mutual support and enable therapists to increase frequency and intensity of service provision. Student‐led programs have become an attractive model, benefiting students while providing positive treatment outcomes for service users. There is an emerging body of literature that explores service users' and students' satisfaction with student‐led group models of practice within inpatient rehabilitation and occupational performance outcomes of service users participating in student‐led programs. This study aimed to explore the satisfaction of service users and students in addition to the self‐reported occupational performance outcomes of a student‐led activities of daily living group program in inpatient rehabilitation.MethodsData from 33 service users and seven students were collected retrospectively. The intervention involved a student‐led activities of daily living group program, consisting of three groups: breakfast, morning tea, and home readiness group. All service users and students completed unique satisfaction surveys at the conclusion of their participation in the student‐led program. Service users completed a self‐reported activities of daily living performance measure pre‐ and post‐program. Findings were reported in descriptive statistics, and pre‐ and post‐program data were compared with the Wilcoxon signed‐rank test.ResultsAll students were satisfied with the student‐led program. Majority of service users were satisfied with all components of the student‐led program. Median scores for self‐reported performance increased significantly following the student‐led program (P &lt; 0.001).ConclusionThis study highlighted that service users and students were satisfied with the service delivery of a student‐led activities of daily living group program. The program was effective in addressing self‐reported performance for service users in inpatient rehabilitation. The findings from this study have potential to inform clinical practice on the implementation of student‐led programs in occupational therapy settings.

Mobility and self-care outcomes in patients with a bariatric comorbidity during inpatient rehabilitation.

First, we describe the characteristics and functional outcomes of obese and bariatric patients in an inpatient rehabilitation facility (IRF). Second, we assessed differences in functional outcomes for bariatric, obese, and standard weight body mass index (BMI) groups. Third, we explored whether these characteristics differ between time periods and diagnostic groups. A retrospective study comparing electronic medical record data collected in 2016 and 2018, using a repeated cross-sectional cohort design. IRF. Individuals ≥18 years of age diagnosed with brain injury, medical complexity, general neurology, orthopedic, spinal cord injury (SCI), and stroke. Participants grouped as standard (BMI <30 kg/m2), obese (BMI 30-39 kg/m2), and bariatric (BMI ≥40 kg/m2) weights. (N = 2015 in 2016, N = 2768 in 2018.) INTERVENTIONS: Patients received standard inpatient rehabilitation. In 2018, clinicians had access to new weight-appropriate equipment. Discharge destination; length of stay (LOS) by BMI group and medical diagnoses; item-specific functional independence measure (FIM) change scores. Sixty-four percent to 67% of all BMI groups achieved a home discharge. The bariatric BMI group had a longer LOS (21 days) than the standard or obese groups. There was a significant interaction in a linear regression analysis between diagnosis and LOS, where LOS was longer in medically complex patients with bariatric BMI (19.3 days compared to 16.1 days) but shorter in bariatric patients with SCI (20.6 days) compared to standard weight patients (26.2 days). In 2018, the bariatric BMI group had greater average FIM change scores for bathing, lower body dressing, toilet transfers, and bed transfers. Patient BMI is associated with LOS in the IRF, although affected by diagnosis. Patients with higher BMIs can make changes in specific individual motor FIM items. For patients with bariatric BMIs, FIM change scores were higher in 2018, possibly due to the use of equipment and facilities designed for higher weight capacities.

A mixed-methods validation of the 15-item English version of the Questionnaire about the Process of Recovery (QPR) in an adult mental health inpatient rehabilitation setting

ABSTRACT Background Recovery is a key outcome within healthcare services and can be assessed using the Questionnaire about the Process of Recovery (QPR). Research indicates good psychometric properties in community samples, but no research has extended this to inpatient settings. The face validity of the QPR has not been assessed. This research aimed to explore the psychometric properties of the QPR in an adult mental health inpatient rehabilitation setting. Method 150 inpatients completed the QPR questionnaire. 10 inpatients participated in a semi-structured interview to assess face and concurrent validity. Results The results indicated a single factor solution was appropriate, explaining 51.4% of the variance. Internal consistency was excellent (α = 0.94). No floor or ceiling effects were observed. Interviews indicated good face and content validity. Discussion Overall, this research supports the use of the 15-item QPR in inpatient rehabilitation settings as all assessed psychometric properties were adequate. Some participants suggested additional aspects of their recovery that the QPR did not cover, supporting the use of the QPR alongside other symptom-specific measures.

31 Characterizing Sociodemographic Factors Associated with the Cognitive and Linguistic Scale (CALS) Among Pediatric Rehabilitation Patients Admitted for Traumatic Brain Injury

Objective:Extant literature suggests significant heterogeneity in recovery trajectories after experiencing a moderate to severe traumatic brain injury (TBI) during childhood (Moran et al., 2016). The Cognitive and Linguistic Scale (CALS) is a promising non-norm-referenced measure designed for serial monitoring within an inpatient rehabilitation setting that may optimize prediction of acute recovery and long-term neuropsychological functioning. To date, the CALS has primarily been examined in the context of injury characteristics such as severity and etiology (e.g., Slomine et al., 2016), and it is unclear what non-injury factors may be relevant to consider. Using archival data gathered from an inpatient pediatric neurorehabilitation program, this study examined associations between the CALS and select sociodemographic factors to better inform the clinical utility of the measure.Participants and Methods:Participants included 56 youth (46% BIPOC, 66% male) aged 2-17 years (M = 12.40, SD = 3.99) who were admitted for moderate to severe TBI to an inpatient rehabilitation program at a regional tertiary care children’s hospital. Data extracted from medical records included demographic information (i.e., age at injury, sex, ethnoracial identity, address, initial Glasgow Coma Scale (GCS) rating, CALS at admission, and full-scale IQ (FSIQ) at discharge. GCS was used as a proxy for injury severity. Residential addresses were geocoded and area-level median income was used as a proxy for familial socioeconomic status (SES). A multiple regression model was utilized to parse the individual contributions of demographic variables) on initial CALS performance while accounting for injury severity. Parallel regression models were used to determine whether patient characteristics moderate the association between initial CALS performance and cognitive functioning at discharge.Results:Preliminary analyses demonstrated that there were no significant associations between GCS and demographic variables, ps &gt; .05. Patient age at injury was significantly associated with CALS total score at admission above and beyond injury severity and other demographic characteristics, t (31) = 2.55, p = .016, such that older age was associated with higher initial CALS scores. Results of moderator analyses between CALS and patient characteristics showed a significant main effect of injury severity, such that higher GCS was associated with higher FSIQ at discharge across models, ps &lt; .05. No significant interactions were identified.Conclusions:These findings provide additional evidence for the generalizability of the CALS and further characterize its associations with non-injury factors, which is important for better understanding aspects that contribute to recovery trajectories and outcomes after moderate to severe TBI. Given the longstanding challenges in regard to the validity of neuropsychological assessment for diverse groups, it is critical to explicitly examine cultural context when considering the clinical utility of a measure. A limitation of the current study is the utilization of broad demographic information due to limited availability of sociocultural data. Future research should examine more granular and culturally-specific variables that may impact CALS performance (e.g., educational attainment, linguistic considerations), beyond using broad-based demographic data as a proxy for sociocultural factors. Another important next step is to utilize serial administrations of the CALS to examine the impact of sociocultural factors on recovery trajectories following TBI.

Multimodal agility-based exercise training (MAT) versus strength and endurance training (SET) to improve multiple sclerosis-related fatigue and fatigability during inpatient rehabilitation: a randomized controlled pilot and feasibility study [ReFEx

BackgroundMultimodal agility-based exercise training (MAT) is a group-based exercise training framework for persons with multiple sclerosis (pwMS) with a potential to impact fatigue and fatigability. In a mixed-methods design, this study evaluated the feasibility of implementing MAT in an inpatient rehabilitation setting and the feasibility of a randomized controlled trial (RCT) study protocol with ‘traditional’ strength and endurance training (SET) as an active control condition. Secondarily, preliminary outcome data was acquired.MethodsPwMS with low to moderate disability and self-reported fatigue were randomly allocated to either MAT or SET when starting inpatient rehabilitation (4–6 weeks). The MAT-participants exercised in a group following a MAT-manual (sessions were gym- (5x/week) and pool-based (3x/week)). SET-participants exercised individually 5x/week on a cycle ergometer, and 3x/week on strength training machines. Feasibility assessments focused on processes, resources, management, time, and scientific domains. Assessed clinical outcomes at admission and discharge included perceived fatigue, motor and cognitive fatigability, cognitive performance, motor function, and balance confidence. Perceived fatigue was reassessed 1, 4, and 12 weeks after discharge. Feasibility was determined regarding predetermined progression criteria.ResultsTwenty-two participants were randomized. Both groups performed the minimum number of sessions (> 18), and retention was adequate (73–91%). SET-participants performed more sessions than MAT-participants (30.8 vs. 22.7) and stayed longer in the facility (34.2 vs. 31.6 days). Non-eligibility of admitted pwMS was high (74% non-eligible), mainly due to high EDSS and inability to attend pool-based sessions. Consequently, recruitment (1.8/month) was slower than the predetermined progression criterium. Baseline assessments took longer than required (only 50% completed within 3 days). Short-term fatigue reduction was similar for both groups. Motor fatigability also improved in both groups, whereas cognitive fatigability deteriorated. In MAT, average improvement in walking endurance (43.9 m) exceeded minimal important change values for individuals (> 26.9 m).ConclusionsProgressing to a definitive RCT necessitates adaptation of eligibility criteria. In the present design it will also be difficult to attain similar dosing of interventions. A multicenter RCT focused only on gym-based MAT might be another option to assess the effect of MAT. The primary outcome measure should be able to measure change in perceived fatigue more robustly.Trial registrationGerman Clinical Trials Register: DRKS00023943, date of registration: 23 September 2021.

Feasibility and outcomes of supplemental gait training by robotic and conventional means in acute stroke rehabilitation

IntroductionPracticality of implementation and dosing of supplemental gait training in an acute stroke inpatient rehabilitation setting are not well studied but can have positive impact on outcomes.ObjectivesTo determine the feasibility of early, intense supplemental gait training in inpatient stroke rehabilitation, compare functional outcomes and the specific mode of delivery.Design and settingAssessor blinded, randomized controlled trial in a tertiary Inpatient Rehabilitation Facility.ParticipantsThirty acute post-stroke patients with unilateral hemiparesis (≥ 18 years of age with a lower limb MAS ≤ 3).InterventionLokomat® or conventional gait training (CGT) in addition to standard mandated therapy time.Main outcome measuresNumber of therapy sessions; adverse events; functional independence measure (FIM motor); functional ambulation category (FAC); passive range of motion (PROM); modified Ashworth scale (MAS); 5 times sit-to-stand (5x-STS); 10-m walk test (10MWT); 2-min walk test (2MWT) were assessed before (pre) and after training (post).ResultsThe desired supplemental therapy was implemented during normal care delivery hours and the patients generally tolerated the sessions well. Both groups improved markedly on several measures; the CGT group obtained nearly 45% more supplemental sessions (12.8) than the Lokomat® group (8.9). Both groups showed greater FIM improvement scores (discharge – admission) than those from a reference group receiving no supplemental therapy. An overarching statistical comparison between methods was skewed towards a differential benefit (but not significant) in the Lokomat® group with medium effect sizes. By observation, the robotic group completed a greater number of steps, on average. These results provide some evidence for Lokomat® being a more efficient tool for gait retraining by providing a more optimal therapy “dose”.ConclusionsWith careful planning, supplemental therapy was possible with minimal intrusion to schedules and was well tolerated. Participants showed meaningful functional improvement with relatively little supplemental therapy over a relatively short time in study.

App-Delivered Cognitive-Behavioral Therapy for Insomnia Among Patients with Comorbid Musculoskeletal Complaints and Insomnia Referred to 4-Week Inpatient Multimodal Rehabilitation: Protocol for a Randomized Clinical Trial.

Insomnia is prevalent among patients receiving treatment for long-term musculoskeletal complaints in inpatient rehabilitation settings. Cognitive-behavioral therapy for insomnia (CBT-I) is effective for improving sleep quality in patients with pain, but a lack of therapists often limits the capacity to use this therapy in rehabilitation programs. The aim of this randomized clinical trial (RCT) is to evaluate the effectiveness of app-delivered CBT-I adjunct to inpatient multimodal rehabilitation for individuals with comorbid musculoskeletal complaints and insomnia, compared with rehabilitation (usual care) only. This RCT has two parallel arms: 1) inpatient multimodal rehabilitation and 2) app-delivered CBT-I adjunct to inpatient multimodal rehabilitation. Patients referred to Unicare Helsefort (Norway) with long-term chronic musculoskeletal complaints are invited to the study. Eligible and consenting participants will be randomized to the intervention and usual care at a ratio of 2:1. Assessments will be carried out at baseline (prior to randomization), 6 weeks (at the end of rehabilitation), 3 months (primary outcome), as well as 6 and 12 months after the rehabilitation. The primary outcome is insomnia severity measured at 3 months. Secondary outcomes include pain intensity, health-related quality of life, fatigue, physical function, work ability, expectations about sick leave length, sick leave, and prescribed medication. Exploratory analyses are planned to identify moderators and mediators of the effect of the app-delivered intervention. This RCT will provide novel knowledge about the effectiveness of app-delivered CBT-I as an adjunct to usual care among patients participating in inpatient multimodal pain rehabilitation. Regardless of the results from this trial, the results will improve our understanding of the utility of dCBT-I in the field of rehabilitation and the importance of adding sleep therapy to this patient group. This trial was prospectively registered in ClinicalTrials.gov October 10, 2022 (ClinicalTrials.gov identifier: NCT05572697).

A technology-focused service within a rehabilitation setting: exploring the experiences and current technology demands of people with disabilities

Purpose To understand and combat the challenges in taking up and implementing technology in rehabilitation settings, the HabITec Lab, a clinical service focused on technology, was piloted for 12-months within a tertiary hospital. This article reports on its preliminary impacts as a clinical service and on clients, including the types of assistive technology (AT) in demand. Materials and Methods Referral and administrative data from 25 individuals who attended the HabITec Lab were collated and analysed using descriptive statistics. For those who attended more than once (n = 12), goal attainment was assessed using the Modified Goal Attainment Measure (MGAM). Post-intervention semi-structured interviews were completed with participants to understand their experience at the HabITec Lab. Interviews were analysed using thematic analysis. Results Most attendees (92%) were undergoing inpatient rehabilitation following a spinal cord injury (SCI). The majority (73%) of goals related to improving entertainment and connection. All participants who completed the MGAM showed improved goal attainment following their HabITec Lab attendance. Qualitative data highlighted appreciation for the service and suggestions for its future. Conclusions This study revealed a high level of demand for support to use AT amongst individuals with SCI, particularly consumer-grade smart devices that could assist communication. This finding may have been influenced by the impacts of the COVID-19 pandemic and frequent lockdowns during this period. This study indicated that the HabITec Lab was able to address important goals for attendees, but also illuminate a new future and trigger enthusiasm about future goals. Attendance was liberating, but resourcing barriers were frustrating. IMPLICATIONS FOR REHABILITATION Dedicated socio-technological spaces such as HabITec are an important way to provide access to expertise and develop consumer knowledge of technology not adequately addressed elsewhere in the rehabilitation continuum. Access to technological support for individuals in the inpatient setting facilitates access to technology in the present and capacity building to foster ongoing use of technology in the future. Dedicated socio-technological spaces should be adequately resourced, funded, staffed and promoted to ensure optimal outcomes. Access to Smart devices within the inpatient rehabilitation setting is critical for people with spinal cord injury to foster communication with family, friends and communities.

Feasibility of ballistic strength training to improve mobility of inpatients with traumatic brain injury

The objective of this study was to investigate the feasibility of ballistic strength training (BST) to improve the mobility of individuals recovering from traumatic brain injury (TBI) in an inpatient rehabilitation centre. Participants had a maximum of eight usual physiotherapy sessions substituted with BST sessions. The feasibility of BST was assessed in terms of recruitment, attendance, adverse events (AEs), and participant acceptability of the intervention. The clinical aspects of feasibility were assessed by recording the ability of participants to complete the exercises and acquire skills. Secondary measures included the 10-metre walk test, the 6-minute walk test, and the Global Rating of Change scale. Fourteen of 22 eligible individuals with TBI in an inpatient rehabilitation centre consented to participate in the study, of whom two were excluded. No intervention-related AEs occurred. Participants attended 97% (71/73) of the total sessions. Participants positively accepted the intervention as rated on a visual analogue scale, M (SD) = 9.2 (0.9). All participants were able to complete the BST exercises. Participants significantly improved comfortable walking speed and walking capacity (p &lt; 0.01). Participants perceived a meaningful change in walking ability. BST appears to be a promising rehabilitation method that may improve the walking outcomes of individuals with TBI in an inpatient rehabilitation setting. Larger-scale clinical trials are warranted.

The Development and Integration of a Safety Officer Role to Facilitate Prevention of COVID-19 Virus Transmission in an Adult Inpatient Rehabilitation Setting Using Collaborative Change Leadership Methodology.

With the onset of the COVID-19 pandemic, a large urban academic hospital responded by creating the temporary role of a "Safety Officer (SO)." The key task of the SO role was to supervise staff donning and doffing personal protective equipment (PPE) and provide real-time feedback on their performance. The support for safe donning and doffing would contribute to staff well-being by reducing their fear of infection transmission. A Collaborative Change Leadership (CCL) approach was used to facilitate the development, implementation, and evaluation of the role. This included an iterative feedback process with clinicians and safety officers to continually refine the role. Feedback indicated value in the initiative as increasing staff confidence about preventing virus transmission, as well as their sense of safety at work. Areas for future improvement included additional communication strategies for interprofessional teams and external partners, as well as planning around logistics to better support the safety officers in performing this new, temporary role. The Safety Officer role was able to help alleviate concerns regarding potential infection transmission and contribute positively to staff well-being.

One Meaning for Two Persons: An Actor-Partner Interdependence Model Analysis of Meaning in Life, Anxiety, and Depression Among Rehabilitation Patients and Caregivers.

Patients and caregivers in the inpatient physical rehabilitation setting are presented with life-changing medical conditions, and their meaning in life can change dramatically. Meaning in life is associated with fewer depressive and anxiety symptoms, but little is known about how they are related interdependently among patients and caregivers. In the current study, we aim to explore their dyadic relationships. Actor-partner interdependence model through structural equation modeling for dyadic analyses. A total of 160 pairs of patients and caregivers recruited from 6 inpatient rehabilitation hospitals in China. Cross-sectional surveys were conducted among pairs of rehabilitation patients and caregivers. The presence of and search for meaning were measured with the Meaning in Life Questionnaire. In 2 separate models, we found that patients' presence of meaning was negatively associated with their own depression (β=-0.61, P < .001) and anxiety (β=-0.55, P < .001), as well as their caregivers' depression (β=-0.32, P < .001) and anxiety (β=-0.31, P < .001). However, the caregivers' presence of meaning was only negatively associated with their own depression (β=-0.25, P < .05) and anxiety (β=-0.21, P < .05). A search for meaning was not significantly associated with depression or anxiety. The results indicate that the anxiety and depressive symptoms of rehabilitation inpatients and caregivers are associated with their own level of presence of meaning. Caregivers' depression and anxiety are interdependently associated with patients' presence of meaning. Clinicians should take dyadic interdependence into consideration when providing psychological services to rehabilitate patients and their caregivers. Meaning-centered interventions can be helpful for the dyads' meaning-making and mental health.