Inpatient Rehabilitation Setting Research Articles

Clinical and Demographic Factors Associated with Receiving an Opioid Prescription following Admission to the Pediatric Intensive Care Unit.

Opioids are commonly used to treat pain in the pediatric intensive care unit (PICU), and many children receive opioid prescription(s) at discharge. The frequency of opioid prescriptions at discharge and associations with individual characteristics and clinical factors are unknown. This study aimed to identify (1) the number of children who receive an opioid prescription at PICU discharge and (2) the demographic and clinical factors associated with receiving an opioid prescription. Data were collected via the electronic medical record. The sample was 3345 children (birth to 18 years) admitted to the PICU and discharged to home or an inpatient rehabilitation setting. In total, 23.7% of children were prescribed an opioid at discharge. There were group differences in who received opioid prescriptions (yes/no) related to PICU diagnosis, length of hospital stay, number of days on mechanical ventilation, number of previous hospitalizations, organ dysfunction score, and admission type (surgical versus non-surgical). Binary logistic regression models examined predictors of opioid prescription at discharge for the total sample and diagnostic subgroups. Older age and surgical admission type were the most consistent predictors of receiving an opioid prescription. Future research should examine prescription usage patterns and how use of opioids is associated with pain and functional outcomes over time.

Using Co-Design To Develop A Hospital-Based Vocational Rehabilitation Intervention For Adults With Acquired Brain Injury

<h3>Research Objectives</h3> Although recommendations are for vocational rehabilitation to commence soon after injury, there are acknowledged challenges to commencing this activity during hospitalisation, when clinical goals are more often centred on basic activities (such as self-care and mobility). This study aimed to develop a vocational rehabilitation intervention for people who have suffered brain injury, that is suitable for delivery in an inpatient rehabilitation setting. <h3>Design</h3> Using an action-research design, this study followed a participatory, intervention mapping approach to develop and pilot the intervention. <h3>Setting</h3> Specialist inpatient brain injury rehabilitation unit, Melbourne, Australia. <h3>Participants</h3> Stakeholder participants included n=14 allied health clinicians (including occupational therapists, speech and language therapists, physiotherapists, clinical and neuropsychologists and social workers) who worked in collaboration with researchers (n=2) to co-design the vocational rehabilitation intervention process. An open invitation was extended to clinicians to participate in the intervention mapping process. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Systematic literature review identified the barriers and enablers to providing work-focussed interventions in the inpatient setting. Qualitative focus groups and document review were used iteratively to identify intervention objectives and outcomes, before intervention strategies were developed and trialed. <h3>Results</h3> Early vocational rehabilitation interventions should be delivered in partnership with the patient, clinicians, family and their social network (inclusive of the workplace). A comprehensive, five phase program was developed: (i) orientation to the worker role, (ii) building awareness of work activities, (iii) improving core work skills, (iv) improving job-specific skills, (v) discharge planning from the program. <h3>Conclusions</h3> Co design offered an excellent opportunity to develop an intervention which supported an interdisciplinary team to embed vocational rehabilitation into usual hospital-based rehabilitation. <h3>Author(s) Disclosures</h3> Study is funded by the Transport Accident Commission through the small grants scheme. Natasha Lannin is supported by the Australian Heart Foundation Future Leader Fellowship (102055).

Assessing Bilateral Upper Extremity Integration using the Bilateral Task Assessment

<h3>Research Objectives</h3> To investigate the validity and reliability of the Bilateral Task Assessment (BTA) in the inpatient rehabilitation (IP rehab) setting. <h3>Design</h3> Study on psychometric properties. <h3>Setting</h3> An urban, inpatient rehabilitation facility. <h3>Participants</h3> Inpatient rehabilitation consumers assessment results. <h3>Interventions</h3> The BTA was administered by occupational therapists to 3,962 individuals in IP rehab. Psychometric analysis consisted of Cronbach's alpha and item-to-total correlations to determine internal consistency, a correlation analysis to assess concurrent validity, factor analysis to determine dimensionality, and item response theory to compute scores and assess test difficulty. <h3>Main Outcome Measures</h3> Validity, inter-rater/test-retest reliability, and internal consistency of the Bilateral Task Assessment. <h3>Results</h3> The scoring standard (.93) and times score (.86) indicates that both variables have good internal consistency. Factor analysis indicates a large effect size for BTA task scores and moderate effect size for BTA times. The additional analyses of the rating scale data confirmed the high internal consistency (.93) and high ITT correlations ranging from .86 - .90. The concurrent validity analysis found significant correlations with seven other measures of upper extremity function. Confirmatory factor analysis indicated that the BTA is a unidimensional measure (1-factor RMSEA = .06, CFI = .99). IRT analysis determined that the measure is most accurate for logit scores around -.40. <h3>Conclusions</h3> This study determined that the BTA demonstrated strong psychometric qualities and that it can be more widely used within occupational therapy practice to assess bilateral integration in stroke survivors. The BTA is a valid and consistent measure that can support BUE integration in occupational performance through assessment in a more functional context. <h3>Author(s) Disclosures</h3> The authors have nothing to disclose.

Integrating Lived Experience Into Rehabilitation Clinical Trial Design: A Framework For Success

<h3>Research Objectives</h3> To propose an evidence-based, best-practice framework for lived experience and community engagement in clinical trials testing rehabilitation interventions. <h3>Design</h3> This project applied a mixed-method and iterative process. Commencing first with a scoping review of available policies and processes, we then undertook a consultation and development process with key stakeholders. Facilitated group discussion and triangulation of findings supported the development of a structured framework that included both principles of conduct as well as practical processes. <h3>Setting</h3> Trials will be conducted in both inpatient and ambulatory rehabilitation settings, and therefore the engagement framework was conceptually developed with people with lived experience (PWLE) across this continuum. <h3>Participants</h3> Key stakeholders were PWLE and carers, research academics and Consumer Health Forum (Australia's leading advocate on consumer health care issues). <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> To better understand the issues affecting meaningful engagement as well as implementation and strategies that can be applied, evidence was drawn from multiple sources. The method included content analysis of published policies, frameworks and guidelines specific to engaging PWLE, evidence-focused review of proposed elements using a focus group method, and consultative discussion. Methods were applied for data collection and analysis so as to ensure triangulation of results. <h3>Results</h3> Clinical trials were acknowledged to be a specialist design, and formal training in clinical trial methodology was seen to be critical, irrespective of the level of participation sought by PWLE. To ensure equality and effective involvement, engagement in trial design, governance, enrolment and data collection, dissemination and translation were acknowledged. Formal training, remuneration and compensation, and principles for ensuring accessible communication form key process recommendations. Pilot testing demonstrated the successful application of the framework to support active partnership of PWLE in rehabilitation trials. <h3>Conclusions</h3> This study produced an effective method for meaningful community stakeholder engagement to ensure clinical trial designs remain rigorous, research teams are able to maximise participant benefit while minimising participant burden, and trial results are readily translated so as to optimise adoption in clinical practice. <h3>Author(s) Disclosures</h3> The authors declare no conflicts of interest.

Development of a 30-Day Readmission Risk Calculator for the Inpatient Rehabilitation Setting.

Readmission to acute care from the inpatient rehabilitation facility (IRF) setting is potentially preventable and an important target of quality improvement and cost savings. The objective of this study was to develop a risk calculator to predict 30-day all-cause readmissions from the IRF setting. Retrospective database analysis using the Uniform Data System for Medical Rehabilitation (UDSMR) from 2015 through2019. In total, 956 US inpatient rehabilitation facilities and 1,849,768 IRF discharges comprising patients from 14 impairment groups. Logistic regression models were developed to calculate risk-standardized 30-day all-cause hospital readmission rates for patients admitted to an IRF. Models for each impairment group were assessed using 12 common clinical and demographic variables and all but 4 models included various special variables. Models were assessed for discrimination (c-statistics), calibration (calibration plots), and internal validation (bootstrapping). A readmission risk scoring system was created for each impairment group population and was graphically validated. The mean age of the cohort was 68.7 (15.2) years, 50.7% were women, and 78.3% were Caucasian. Medicare was the primary payer for 73.1% of the study population. The final models for each impairment group included between 4 and 13 total predictor variables. Model c-statistics ranged from 0.65 to 0.70. There was good calibration represented for most models up to a readmission risk of 30%. Internal validation of the models using bootstrap samples revealed little bias. Point systems for determining risk of 30-day readmission were developed for each impairment group. Multivariable risk factor algorithms based upon administrative data were developed to assess 30-day readmission risk for patients admitted from IRF. This report represents the development of a readmission risk calculator for the IRF setting, which could be instrumental in identifying high risk populations for readmission and targeting resources towards a diverse group of IRF impairment groups.

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

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

Clinician perspectives on the implementation of inpatient cycling-based exergames for children with cerebral palsy: A qualitative study

ABSTRACT Objective To understand the perspectives of key stakeholder clinicians in implementing inpatient cycling-based exergames for children with cerebral palsy (CP) into pediatric rehabilitation. Methods Sixteen clinicians (nurses, physiotherapists, recreational therapists) that participated in a study exploring the feasibility of implementing cycling-based exergames for inpatient children with CP were interviewed. Clinicians’ responses were coded using the Theoretical Domains Framework (TDF). Beliefs were generated from each response and relevant domains were identified. Results Ten domains from the TDF were identified as relevant. Key enablers to clinician participation in future implementation included revision of clinician roles and responsibilities, the belief that children with CP will benefit from exergames, and the belief in potential applicability to other pediatric populations. Barriers included clinician limited time and exergame responsibilities not aligning with perceived clinician roles. Conclusions This study identifies key barriers and enablers that future inpatient pediatric rehabilitation settings should consider when incorporating exergames into rehabilitation practice.

A scabies outbreak in an inpatient rehabilitation setting

BackgroundScabies is a skin infection transmitted by close person-to-person contact. Crusted scabies is a more severe type which is more contagious. Delayed diagnosis of scabies could lead to an outbreak. MethodsThe outbreak occurred at a 435-bed academic medical center with 76 inpatient rehabilitation beds. The index patient was incarcerated and admitted to our hospital in February 2022. The patient developed crusted scabies after steroids treatment. ResultsThe patient was treated with oral ivermectin (200 mcg/kg, maximum dose 15 mg) and topical permethrin 5%. All units were followed for 6 weeks since diagnosis of the index patient. A total of 46 healthcare workers (20 nurses and 26 physical therapists) were exposed. Twenty-nine presented symptoms and were treated with ivermectin and permethrin or only ivermectin. No physicians, other patients, or prison guards were affected. There was no secondary household transmission of those exposed healthcare workers. ConclusionsScabies is highly contagious in high-risk patients. Early diagnosis and effective infection control are of vital importance.

Evaluation of physical health in an in-patient psychiatric rehabilitation setting

BackgroundThe mortality gap between patients with and without serious mental illness (SMI) is around 15–20 years. Here, we aim to identify some of the factors contributing to that gap via poor physical health and sub-optimal medical management. MethodsWe report the results of a detailed cross-sectional study of physical health parameters in an in-patient rehabilitation population in Scotland, including a consideration of concordance with guidelines and comparisons to healthy populations. ResultsData was collected from 57 of all 62 in-patients. 42% were obese (compared to 28% of the population), 84% were smokers (vs 16%), 16% were hypertensive, 22% had raised HbA1c, 50% had raised cholesterol, 47% had QRISK >10%. 68% agreed to a full physical health review, 65% agreed to flu vaccination. Completed screening uptake compared to the Scottish population was low: Cervical (30% vs 69%), Bowel (8% vs 64%), Breast (23% vs 72%), Abdominal Aortic Aneurysm (0% vs 78%). Patients generally had up to date recorded weight (100%), blood pressure (98.2%), heart rate (98.2%) and lipids (89.4%), but not ECG's (61.4%) or Diabetes screening (59.6%). Following review, 17 referrals were made to medics/surgeons, 29 to broader specialties, 24 medications were started, 9 stopped and 27 changed: most commonly statins (12 patients), vitamin D (8 patients) and hypoglycemics (5 patients). ConclusionsThe findings highlight cardiovascular risk factors and cancer screening as specific areas to target for improving poor physical health in populations with SMI. Patients are often willing to engage but specific ways to lower the barriers to screening and treatment are required.

Prevalence of frailty and frailty outcomes within the inpatient rehabilitation setting: use of routinely collected electronic health information.

Frailty within the older adult rehabilitation population is relatively under-explored. We aimed to derive a frailty index (FI) from electronic routinely collected data to determine frailty prevalence, and to assess its ability to predict adverse outcomes in the rehabilitation setting. A FI was derived and retrospectively applied to electronically recorded health information of older adults admitted for inpatient rehabilitation. For analysis, subjects were allocated into frailty score (FS) groups (0-5). Primary outcome was a six-month hospitalistion rate, and other outcomes were: mortality, entrance into long-term care (LTC) at one year, length of stay (LOS), 30- and 90-day hospitalistions. Univariate and multivariable logistic regressions analysed associations between frailty and outcomes. One hundred and sixty-two patient electronic notes were reviewed. Mean (SD) age was 86 (8.2) years, 147 (90.7%) were considered frail (FS>0.25). The most frail group (FS 5) had higher risk of six-month hospitalisations (OR=6.19; 95%CI=1.82, 21.13; p=0.004). A higher frailty score was associated with shorter LOS compared to lowest frailty scores (15.7 days vs 25.4 days; p=0.04). No relationship was found with shorter-term outcomes. Prevalence of frailty is high in the rehabilitation setting. Association of frailty with shorter LOS and lack of association found with shorter-term outcomes warrant further study.

Opioid Utilization and Management in the Setting of Stewardship During Inpatient Rehab Care.

BackgroundOpioid utilization and management in an inpatient rehabilitation setting have not been widely described, despite the unique opportunities that exist in this setting to support opioid stewardship across transitions in care. We aimed to characterize opioid utilization and management by interprofessional teams across a large, inpatient rehabilitation setting after incorporation of opioid stewardship principles by pharmacists as part of their daily practice.Patients and methodsThis was a retrospective chart review at Toronto Rehab, University Health Network, Toronto, Canada. Patients with admission orders for any opioid from November 2017 to February 2018 were included. Complex continuing care and palliative care patients were excluded. Descriptive statistics were primarily used to describe the data as well as univariate linear regression to compare associations with milligram morphine equivalent (MME) reduction.ResultsA total of 448 patients were included. A reduction in total daily MME was seen in 49% (n=219) of the patients during their inpatient stay, with 73% (n=159) of these patients having a reduction of ≥50%. Sixty-nine percent (n=311) of the patients received an opioid prescription at discharge, with most scheduled (90%, n=98) with a supply of less than 30 days. Rehabilitation length of stay was correlated with a MME decrease during rehab (p<0.01), suggesting that longer lengths of stay contributed to a greater reduction in MME. Patients with chronic opioid use prior to acute care admission (p=0.01), and those who started extended-release opioids during acute care (p=0.02) were significantly less likely to discontinue opioids during rehab stay.ConclusionOpioid utilization and management in the setting of opioid stewardship across inpatient rehab and transitions of care were characterized. Opportunities exist for further quality improvement initiatives within inpatient rehabilitation and acute care settings to identify and support patients with complex pain management needs.

Is environmental enrichment useful for stroke and other non-progressive brain injury? A Cochrane Review summary with commentary.

Stroke and other traumatic brain injuries are the leading causes of global disability in adults. Environmental enrichment for neurological diseases is a relatively new concept within rehabilitation. These are interventions to enhance the level of somatic and social stimulation by providing an engaging environment. To assess the effects of environmental enrichment on well-being, functional recovery, activity levels and quality of life in people who have stroke or non-progressive brain injury. Multiple global databases were searched on 26 October 2020. Aim was to include only the randomized controlled trials that compared environmental enrichment with standard services. A single RCT study with 53 participants with stroke was included. It compared the environmental enrichment (physical, cognitive and social activities such as reading material, board and card games, gaming technology, music, artwork, and computer with Internet) with standard services in an inpatient rehabilitation setting. The evidence was of very low quality and follow up was of 3 months only. The current data are inconclusive and there is a need for well-designed large-scale trials to study the role of environmental enrichment in the functional recovery of neurological diseases.

A survey of pediatric neuropsychologists serving inpatient rehabilitation, Part II: billing, time allocation and tracking, and professional identity and perceptions

ABSTRACT Professional challenges have been documented in broad surveys of neuropsychologists. While previous surveyors have included pediatric neuropsychologists, few, if any, have specifically examined practices among those who primarily work in pediatric inpatient rehabilitation settings. Therefore, the aim of this study was to survey neuropsychologists in this setting. Thirty neuropsychologists from the U.S. and one from Canada that work in inpatient pediatric rehabilitation participated in an online survey. Most respondents (83.3%) billed for their inpatient time. Sixty-four percent indicated that payor type (private vs. public) affected services a moderate amount to a lot; this was primarily due to payor’s influence on length of stay. Most providers had productivity expectations (66.7%). Among those that had productivity expectations, three-quarters used “hours billed;” 37.5% were solely or additionally tracked by relative value units (RVUs). The majority of respondents conducted some type of clinical data collection, usually for research purposes. With respect to professional identity, most respondents indicated positivity about their role. The top challenges endorsed were related to workload/ability to meet the patients’ needs and billing/productivity. Issues related to billing and payor may influence aspects of pediatric inpatient rehabilitation neuropsychological care. Managing challenges related to billing and the time demands associated with providing inpatient services were top concerns for many respondents. Most sites surveyed were involved in data collection, usually for research purposes; increased data collection efforts are needed to aid with program development and evaluation and to demonstrate the added value of neuropsychological services from a patient care perspective.

Foodservice systems and mealtime models in rehabilitation: Scoping review.

To describe current foodservice systems and mealtime care utilized in the rehabilitation setting. A secondary aim was to identify commonly used outcome measures in foodservice research in the rehabilitation setting. A scoping review. PubMed, CINAHL, Scopus, Embase, PsycINFO and Cochrane were searched until January 2022. The review was conducted according to Joanna Briggs Institute's methodology for scoping reviews. Included studies were conducted in the inpatient rehabilitation setting, adult population ≥18 years old and provided a description of at least one element of the foodservice system, food and menu, waste and/or eating environment. Of 5882 articles screened, 37 articles were included, reporting 31 unique studies. Most rehabilitation units had cook-fresh production methods (50%), used decentralized bulk delivery methods (67%) had a communal dining room (67%) and had a 3-week menu cycle (71%). Mealtime care was predominantly provided by nursing staff, however few studies reported on specific activities. Nutritional intake was a key outcome measure across included studies (43%), with only six papers reporting on rehabilitation outcomes. Of the intervention studies (n=9), all were aimed at improving nutritional intake through menu or mealtime care modifications; few (n = 3) studied changes in rehabilitation outcomes. This scoping review identified a considerable lack of reporting of foodservice and mealtime care systems used in rehabilitation settings in the available literature. Further investigation is required to understand what models of mealtime care are provided to patients and to understand the impact of changes to foodservice and mealtime systems on patient outcomes. No patient or public contribution was necessary for this review.

The Impact of an Evidence-Informed Spinal Cord Injury Activities of Daily Living Education Manual (SADL-eM): Protocol for a Randomized Controlled Trial.

BackgroundSpinal cord injury (SCI) is a catastrophic injury associated with functional loss and life-threatening complications. Many people with SCI in the Gaza Strip of Palestine are discharged from inpatient rehabilitation to the community while still lacking many daily life skills. This randomized controlled trial (RCT) seeks to test the impact of the Spinal Cord Injury Activities of Daily Living Education Manual (SADL-eM)—an evidence-based occupational therapy patient educational intervention—on rehabilitation outcomes.ObjectiveThe proposed trial aims to evaluate the SADL-eM intervention compared with standard treatment among people with SCI.MethodsThis is a parallel RCT with two study arms: intervention and control. A total of 90 patients treated in inpatient rehabilitation settings will be randomly allocated to two study groups. Both groups will receive standard care. The intervention group will also use the SADL-eM with their treating occupational therapist during rehabilitation. The SADL-eM is a comprehensive activities of daily living (ADL) educational tool that was codeveloped with people with SCI and stakeholders across Gaza. The self-report version of the Spinal Cord Independence Measure will be used on admission (ie, baseline measure) and after 6 weeks as the primary outcome measure. Secondary outcomes include the third version of the Spinal Cord Independence Measure, the Private Religiousness Practices Scale, the Organizational Religiousness Short-Form, additional ADL domains covered by the education manual, and adherence to the intervention. The effect of the intervention will be determined using repeated-measures analysis of variance.ResultsThis study will be conducted from April 2021 through December 2022, with results expected to be available in January 2023.ConclusionsIf the SADL-eM is demonstrated as clinically effective, this will have significant implications for occupational therapy interventions in low- and middle-income countries.Trial RegistrationClinicalTrials.gov NCT04735887; https://clinicaltrials.gov/ct2/show/NCT04735887

Physical Rehabilitation Before and After Lung Transplantation for COVID-19 ARDS: A Case Report.

To describe the functional trajectory and physical rehabilitation of an individual who underwent lung transplantation for COVID-19 acute respiratory distress syndrome (ARDS). A previously healthy 60-year-old man admitted to critical care pre-transplantation and followed six months post-transplant. Physical rehabilitation in the critical care, acute ward and in-patient rehabilitation settings. Despite a successful surgery, a long and complex acute care admission contributed to a slow and variable functional recovery. Significant functional limitations and physical frailty were present in the early post-transplant period. Little is known of the effects of COVID-19 superimposed upon lung transplantation on muscle function, exercise capacity, and physical activity. Future research should include case series to further understand the functional deficits and trajectory of recovery in this emerging clinical population. Standard core outcome measures should be identified for this population to enable synthesis of findings and inform short- and long-term rehabilitation strategies.

What are the predictors of TOMM failure in clinical TBI populations? A retrospective analysis.

To determine base rates of invalid performance on the Test of Memory Malingering (TOMM) in patients with traumatic brain injury (TBI) undertaking rehabilitation who were referred for clinical assessment, and the factors contributing to TOMM failure. Retrospective file review of consecutive TBI referrals for neuropsychological assessment over seven years. TOMM failure was conventionally defined as performance <45/50 on Trial 2 or Retention Trial. Demographic, injury, financial compensation, occupational, and medical variables were collected. Four hundred and ninety one TBI cases (Median age = 40 years [IQR = 26-52], 79% male, 82%severe TBI) were identified. Overall, 48 cases (9.78%) failed the TOMM. Logistic regression analyses revealed that use of an interpreter during the assessment (adjusted odds ratio [aOR] = 8.25, 95%CI = 3.96-17.18), outpatient setting (aOR = 4.80, 95%CI = 1.87-12.31) and post-injury psychological distress (aOR = 2.77, 95%CI = 1.35-5.70) were significant multivariate predictors of TOMM failure. The TOMM failure rate for interpreter cases was 49% (21/43) in the outpatient setting vs. 7% (2/30) in the inpatient setting. By comparison, 9% (21/230) of non-interpreter outpatient cases failed the TOMM vs. 2% (4/188) of inpatient cases. TOMM failure very rarely occurs in clinical assessment of TBI patients in the inpatient rehabilitation setting. It is more common in the outpatient setting, particularly in non-English-speaking people requiring an interpreter. The findings reinforce the importance of routinely administering stand-alone performance validity tests in assessments of clinical TBI populations, particularly in outpatient settings, to ensure that neuropsychological test results can be interpreted with a high degree of confidence.

Early Physical Rehabilitation in Frail Patients Undergoing Coronary Artery Bypass Surgery

To date, there are insufficient data on the concept of exploring rehabilitation potential in older patients with frailty syndrome, while developing strategies to improve outcomes after cardiac surgery and reducing the number of postoperative complications remains a relevant topic. Aim. To assess safety and feasibility of early physical rehabilitation in frail patients undergoing coronary artery bypass grafting (CABG). Material and methods. The study included 49 patients with stable coronary artery disease (CAD) admitted for elective CABG with cardiopulmonary bypass (CPB). Patients were randomized into two groups according to the approach to physical rehabilitation: in the early rehabilitation group (n=22), treadmill workouts were conducted starting from the 7th postoperative day and continued at the second stage of inpatient rehabilitation. Patients in the control group (n=27) had no treadmill training. In the inpatient rehabilitation setting, the incidence and the type of complications were assessed; on the 6th day and 21-23 days after CABG, the results of the cardiopulmonary exercise testing (CPET) were analyzed. Results and discussion. The groups were similar in baseline intraoperative characteristics. Postoperative complications occurred in 18% of patients in the early rehabilitation group and in 48% of patients in the control group (p=0.037). In the group of patients with early rehabilitation, the rate of postoperative complications decreased by 4 times compared to the control group (OR – 0.24; 95% CI – 0.06-0.896). Peak oxygen consumption (p=0.03) and exercise tolerance (p=0.03) were significantly higher in the group of patients with the early rehabilitation according to CPET conducted three weeks after the surgery. At the present stage, it seems optimal to shift the start of physical rehabilitation in postoperative period to the earlier dates. Minimizing the patient’s immobilization period helps to optimize the course of the postoperative period. Conclusion. Early rehabilitation in the postoperative period of CABG in patients with frailty is associated with lower incidence of postoperative complications and improvements in physical capacity of patients by the end of the hospital stay

Health care interpreter use in an inpatient rehabilitation setting: examining patterns of use and associated clinical outcomes

Purpose Professional interpreters can improve healthcare quality and outcomes when there is language discordance between patients and health care providers. Multidisciplinary rehabilitation relies on nuanced communication; however, the use of interpreters in rehabilitation is underexplored. This study aimed to examine patterns of health care interpreter use in an inpatient rehabilitation setting. Methods A retrospective cohort study was conducted including patients admitted for subacute rehabilitation during 2019–2020 identified as having limited English proficiency. Patterns of interpreter use (professional and “ad hoc”) and rehabilitation outcomes were evaluated via medical record review. Results Eighty-five participants were included. During inpatient rehabilitation (median 17 [12–28] days), most clinical interactions (95%) occurred without an interpreter present. Patterns of interpreter use were variable; with greater use of ad hoc versus professional interpreters (received by 60% versus 49% of the cohort, respectively). Those who interacted with a professional interpreter had a longer length-of-stay, larger Functional Independence Measure (FIM) gain, and lower rate of hospital readmission six months post-discharge. The number of professional interpreter sessions correlated positively with FIM gain. Conclusions Access to professional interpreters in inpatient rehabilitation was variable, with some patients having no or minimal access. These findings provide preliminary evidence that professional interpreter use may be associated with clinical rehabilitation outcomes. Implications for rehabilitation Professional health care interpreters can be used to overcome language barriers in rehabilitation. In an inpatient rehabilitation setting, professional interpreters appeared to be underutilized, with many patients having no or minimal access to interpreters. Use of ad hoc, untrained interpreters and informal communication strategies was common during rehabilitation. Use of professional interpreters appeared to be associated with favorable rehabilitation outcomes.

Assessment of Walking Speed and Distance Post-Stroke Increases After Providing a Theory-Based Toolkit.

Background and Purpose:While underutilized, poststroke administration of the 10-m walk test (10mWT) and 6-minute walk test (6MWT) can improve care and is considered best practice. We aimed to evaluate provision of a toolkit designed to increase use of these tests by physical therapists (PTs).Methods:In a before-and-after study, 54 PTs and professional leaders in 9 hospitals were provided a toolkit and access to a clinical expert over a 5-month period. The toolkit comprised a guide, smartphone app, and video, and described how to set up walkways, implement learning sessions, administer walk tests, and interpret and apply test results clinically. The proportion of hospital visits for which each walk test score was documented at least once (based on abstracted health records of ambulatory patients) were compared over 8-month periods pre- and post-intervention using generalized mixed models.Results:Data from 347 and 375 pre- and postintervention hospital visits, respectively, were analyzed. Compared with preintervention, the odds of implementing the 10mWT were 12 times greater (odds ratio [OR] = 12.4, 95% confidence interval [CI] 5.8, 26.3), and of implementing the 6MWT were approximately 4 times greater (OR = 3.9, 95% CI 2.3, 6.7), post-intervention, after adjusting for hospital setting, ambulation ability, presence of aphasia and cognitive impairment, and provider-level clustering. Unadjusted change in the percentage of visits for which the 10mWT/6MWT was documented at least once was smallest in acute care settings (2.0/3.8%), and largest in inpatient and outpatient rehabilitation settings (28.0/19.9% and 29.4/23.4%, respectively).Discussion and Conclusions:Providing a comprehensive toolkit to hospitals with professional leaders likely contributed to increasing 10mWT and 6MWT administration during inpatient and outpatient stroke rehabilitation.Video available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A390).