Inpatient Rehabilitation Unit Research Articles

Regional Public Health Response to Emerging Carbapenamase-Producing Organisms in Central Florida, 2019

Background: Detection of unusual carbapenemase-producing organisms (CPOs) in a healthcare facility may signify broader regional spread. During investigation of a VIM-producing Pseudomonas aeruginosa (VIM-CRPA) outbreak in a long-term acute-care hospital in central Florida, enhanced surveillance identified VIM-CRPA from multiple facilities, denoting potential regional emergence. We evaluated infection control and performed screening for CPOs in skilled nursing facilities (SNFs) across the region to identify potential CPO reservoirs and improve practices. Methods: All SNFs in 2 central Florida counties were offered a facility-wide point-prevalence survey (PPS) for CPOs and a nonregulatory infection control consultation. PPSs were conducted using a PCR-based screening method; specimens with a carbapenemase gene detected were cultured to identify the organisms. Infection control assessments focused on direct observations of hand hygiene (HH), environmental cleaning, and the sink splash zone. Thoroughness of environmental cleaning was evaluated using fluorescent markers applied to 6 standardized high-touch surfaces in at least 2 rooms per facility. Results: Overall, 21 (48%) SNFs in the 2-county region participated; 18 conducted PPS. Bed size ranged from 40 to 391, 5 (24%) facilities were ventilator-capable SNFs (vSNFs), and 12 had short-stay inpatient rehabilitation units. Of 1,338 residents approached, 649 agreed to rectal screening, and 14 (2.2%) carried CPOs. CPO-colonized residents were from the ventilator-capable units of 3 vSNFs (KPC-CRE=7; KPC-CRPA=1) and from short-stay units of 2 additional facilities (VIM-CRPA, n = 5; KPC-CRE, n = 1). Among the 5 facilities where CPO colonization was identified, the prevalence ranged from 1.1% in a short-stay unit to 16.1% in a ventilator unit. All facilities had access to soap and water in resident bathrooms; 14 (67%) had alcohol-based hand rubs accessible. Overall, mean facility HH adherence was 52% (range, 37%–66%; mean observations per facility = 106) (Fig. 1). We observed the use of non–EPA-registered disinfectants and cross contamination from dirty to clean areas during environmental cleaning; the overall surface cleaning rate was 46% (n = 178 rooms); only 1 room had all 6 markers removed. Resident supplies were frequently stored in the sink splash zone. Conclusions: A regional assessment conducted in response to emergence of VIM-CRPA identified a relatively low CPO prevalence at participating SNFs; CPOs were primarily identified in vSNFs and among short-stay residents. Across facilities, we observed low adherence to core infection control practices that could facilitate spread of CPOs and other resistant organisms. In this region, targeting ventilator and short-stay units of SNFs for surveillance and infection control efforts may have the greatest prevention impact.Funding: NoneDisclosures: None

A novel program of self-administration of medications within an acute inpatient rehabilitation unit

Introduction:Self-administration of medications (SAM) is a critical component of independent living in the face of chronic illnesses. The current local practice, where nurses manage all aspects of inpatient medication administration, has significant limitations in promoting this important activity post-discharge. Inpatient SAM is considered novel in Singapore. In this paper, we aim to describe the process of establishing a SAM program in a local rehabilitation inpatient ward.Materials and methods:In 2016, a multidisciplinary workgroup was formed in a local general hospital to develop a SAM protocol to empower participants to better self-manage their medications post-discharge through a series of graduated assessments and targeted education. The program started as a pilot in April 2017, and was eventually expanded to all rehabilitation wards within the hospital. Medication errors and near-misses were tracked, and surveys targeting participating patients and staff were given at the end of each encounter.Results:As of 31 December 2019, 160 patients were enrolled into the SAM program. Of these, 75, 63 and 22 patients were in SAM 1, SAM 2 and SAM 3 (tiers representing differing independence levels), respectively, at discharge. There were no medication errors. One near-miss was reported. The program was well-received by both patients and staff.Conclusions:We present a novel and viable protocol for the inpatient selection and assessment of patients, with the aim of supporting safe SAM post-discharge through educational empowerment and early identification of barriers with interventions.

Psychiatric morbidity and its correlates among primary family caregivers of individuals diagnosed with schizophrenia in Taiwan

Background Caregiving for patients with schizophrenia is often challenging and may increase the risk of psychiatric morbidity among primary family caregivers. However, the associated factors of psychiatric morbidity among caregivers have not been fully investigated. Aims This study aimed to screen psychiatric morbidity and its correlates among primary family caregivers of persons with schizophrenia receiving inpatient psychiatric rehabilitation services. Methods A cross-sectional, correlational design was used. A total of 184 Taiwanese primary family caregivers in inpatient psychiatric rehabilitation units participated in the study. Descriptive statistics, Chi-square tests, independent t-tests, and a stepwise binary logistic regression analysis were performed to examine the association among primary family caregivers’ psychiatric morbidity and primary family caregivers’ sociodemographic characteristics and mutuality and patients’ sociodemographic and clinical characteristics. Results The prevalence of psychiatric morbidity among primary family caregivers was 48.4%. Unemployment, lower mutuality, additional dependents in need of care, and caring for patients with more psychiatric hospitalizations were the most significant factors for psychiatric morbidity among primary family caregivers. Conclusion Mental healthcare professionals should recognize patients and their primary family caregivers as a unit of care. Primary family caregivers must receive increased assistance, including supportive resources and therapeutic interventions, to reduce psychiatric morbidity.

Clostridium difficile Infection Reservoirs Within an Acute Rehabilitation Environment.

Clostridium difficile infection is a common hospital-associated infection spread via patient contact or contaminated environments. The risk for spread of C difficile may be greater in inpatient rehabilitation units than in some hospital units as patients are not confined to their rooms and often share equipment. Environmental disinfection is challenging in shared medical equipment, especially in equipment with complex designs. The study aimed to examine the presence of C difficile spores within an acute rehabilitation environment and to evaluate disinfection effectiveness. Cultures were performed on 28 rehabilitation rooms, 28 rehabilitation floor surfaces, and 80 shared devices and equipment. Two disinfection interventions were implemented, and environmental cultures then were repeated postintervention. Environmental cultures positive for CD spores were rehabilitation rooms (1/28), rehabilitation floors (13/28), and wheelchairs (3/20). After the implementation of new disinfection methods, repeat cultures were obtained and produced negative results. Nonsporicidal disinfectant was not effective on hospital floors. Sporicidal disinfection of the floor is important when rates of C difficile infection are increased. Wheelchairs are complex devices and difficult to properly clean. The hospital purchased an ultraviolent device for wheelchair cleaning with a subsequent reduction in spores on repeat cultures. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. Upon completion of this article, the reader should be able to: (1) Recognize the impact of Clostridium difficile infections on the healthcare system; (2) Describe potential reservoirs of Clostridium difficile in the inpatient rehabilitation environment; and (3) Discuss interventions that may be implemented to reduce the reservoirs of Clostridium difficile on the rehabilitation unit. Advanced. The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Feasibility and acceptability of the multicontext approach for individuals with acquired brain injury in acute inpatient rehabilitation: A single case series

ABSTRACT The Multicontext (MC) approach, a metacognitive intervention designed to improve awareness, strategy use, and executive functioning, may be beneficial for individuals with acquired brain injury (ABI) undergoing acute inpatient rehabilitation. The goal of this study was to provide evidence of feasibility and acceptability of the MC approach and to explore clinical outcomes. A case series of eight individuals with acquired brain injury and at least mild executive functioning impairment were recruited from an acute inpatient rehabilitation unit. The MC approach – involving guided questioning and patient self-generation of strategies practiced across everyday functional cognitive tasks – was implemented within routine occupational therapy. Occupational therapists implemented the MC approach with high adherence to the treatment protocol. Therapists’ perceived challenges were the time constraints of inpatient rehabilitation as well as client factors. Participants rated the MC approach as highly satisfying and engaging. They described subjective improvements in their ability to use executive functioning strategies. The MC approach was associated with improvement in awareness, strategy use, and executive functioning at the conclusion of treatment. The MC approach may be a beneficial intervention for individuals with acquired brain injury and executive dysfunction undergoing acute inpatient rehabilitation. Further evaluation with larger samples in controlled trials is warranted. Trial registration: ClinicalTrials.gov identifier: NCT04363645..

Nurses Beliefs, Attitudes, and Perception Related to Work in Inpatient Stroke Rehabilitation Unit, a qualitative Study

Objective: This Study aims to explore Nurses beliefs, attitudes and perception related to work in inpatient stroke rehabilitation Unit. Background: Role of the nurses in the rehabilitation process has increased dramatically for last two decades. Many attempts have been done to identify the role of the nurses in the Inpatient stroke rehabilitation units, they concluded that nurses are involved as an essential part of the rehabilitation process, however, their contribution to improving patient's outcomes is poorly understood and refined. Design: hermeneutic phenomenology, qualitative approach. Methods: The data were collected by using a semi-structured interview, using open-ended questions then the major themes Transcribed for thematic analysis. Results: Two Main categories were identified; the experience of nurses in Stroke rehabilitation units and the challenges in nursing contribution in stroke units, and the recommended strategies to enhance the role of the nurses in stroke rehab units. Conclusion/Relevance to clinical practice: The study provided an evidence that nurses believe in themselves as an effective team member in stroke rehabilitation, and they are enjoying while helping patients to recover to allow them to reintegrate and adapt to their new life situations. However, this study showed a lot of obstacles that minimize the contribution of nursing in stroke rehabilitation units. The future nursing rehab role should also be developed to meet the post-discharge needs and the emerging rehabilitation services and technologies, moreover, nurses have to clear and specify their specific bedside care and interventions. Nurses have to adopt new knowledge and competencies in collaboration with other disciplines such as occupational therapies, physical therapy, and speech therapy, to upgrade their assessment and intervention skills that enable the nurses to provide systematic and therapeutic feedback about the patient progress and the proper interventions that needed to reflects that on the functional abilities on discharge.

Predicting Falls Using the Stroke Assessment of Fall Risk Tool.

Falls in the inpatient stroke population are common, resulting in increased morbidity and slow rehabilitation progress. Falls may result from stroke-specific neurologic deficits; however, assessment of these deficits is lacking in many fall screening tools. To compare the ability to predict falls of the Stroke Assessment of Fall Risk (SAFR) tool, which includes items related to stroke-specific neurologic deficits, and the commonly used Morse Fall Scale, which does not include these items. Prospective cohort study. Inpatient tertiary stroke rehabilitation unit. Patients (N = 220) with acute stroke. Falls were captured by the medical records from January 2017 to September 2018. Logistic regression analysis evaluated both screening tools for predicting falls by calculating sensitivity, specificity, area under the receiver operating characteristic (AUC-ROC) curve, and odds ratio (OR). We compared SAFR and Morse mean scores between fallers and non-fallers using t-tests. Forty-eight (21.8%) patients experienced ≥1 fall. SAFR, but not Morse, scores showed a statistically significant difference between fallers and non-fallers (P = .001 vs P = .24, respectively). Higher SAFR score was associated with higher odds of falls (OR 1.36, 95% CI [1.12, 1.64]), whereas Morse was not (OR 1.04, 95% CI [0.97, 1.12]). SAFR showed a statistically significant difference in hemi-neglect between fallers and non-fallers (P = .03). Sensitivity and specificity of SAFR were 47.9% and 76.7%, vs 45.8% and 68.0% for Morse, respectively. SAFR positive predictive value and negative predictive value were 36.5% and 84.1%, respectively, similar to Morse (28.6% and 81.8%). The AUC-ROC was 0.65 for SAFR and 0.56 for Morse. SAFR was significantly associated with fall risk and had better discrimination between fallers and non-fallers than Morse. The neurologic-specific hemi-neglect component of SAFR, a component not present on the Morse, was a fall risk factor. Further research evaluating the predictive value of fall scales that include neurologic deficits is needed.

Prevention of Candida Auris Outbreak

Background Candida auris (C. auris) is an emerging, multidrug-resistant fungus. Because of the difficulty of identification of this organism and its ability to spread through patient contact and environmental contamination, healthcare settings are experiencing outbreaks with this organism. Methods The Health Department (HD) contacted Infection Prevention (IP) regarding an admitted patient who had been exposed to C. auris during a hospitalization at another facility. The patient had been admitted for 5 days without isolation. The HD requested we isolate and screen the patient for C. auris. The patient was found to be colonized with C. auris. An exposure investigation was implemented. Because part of the patient's stay was on an Inpatient Rehabilitation unit, we categorized exposure risks to high and low. Patients at high risk were placed on Contact Isolation in a private room whereas patients at low risk were placed on modified Contact Isolation and were cohorted. Additionally, all affected areas were disinfected with bleach. Patients transferred from our facility to our sister facilities were screened. Patients discharged prior to screening were flagged in our IP software to be identified upon readmit for isolation and screening. We also partnered with the HD and other facilities where our patients were transferred for prevention of spread. Results A total of 104 patients were determined to be exposed. Thirty-one patients were screened with no new cases identified. Other exposed patients who were discharged from our hospital screened elsewhere were found to be negative. Conclusions Having adequate laboratory technology to identify this organism is critical to the interruption of spread. Timely notification of a potential case is important to decrease the scope of exposure. Practicing effective hand hygiene and daily environmental disinfection with an agent that has activity against C. auris are also key strategies to prevent the spread of this significant organism. Candida auris (C. auris) is an emerging, multidrug-resistant fungus. Because of the difficulty of identification of this organism and its ability to spread through patient contact and environmental contamination, healthcare settings are experiencing outbreaks with this organism. The Health Department (HD) contacted Infection Prevention (IP) regarding an admitted patient who had been exposed to C. auris during a hospitalization at another facility. The patient had been admitted for 5 days without isolation. The HD requested we isolate and screen the patient for C. auris. The patient was found to be colonized with C. auris. An exposure investigation was implemented. Because part of the patient's stay was on an Inpatient Rehabilitation unit, we categorized exposure risks to high and low. Patients at high risk were placed on Contact Isolation in a private room whereas patients at low risk were placed on modified Contact Isolation and were cohorted. Additionally, all affected areas were disinfected with bleach. Patients transferred from our facility to our sister facilities were screened. Patients discharged prior to screening were flagged in our IP software to be identified upon readmit for isolation and screening. We also partnered with the HD and other facilities where our patients were transferred for prevention of spread. A total of 104 patients were determined to be exposed. Thirty-one patients were screened with no new cases identified. Other exposed patients who were discharged from our hospital screened elsewhere were found to be negative. Having adequate laboratory technology to identify this organism is critical to the interruption of spread. Timely notification of a potential case is important to decrease the scope of exposure. Practicing effective hand hygiene and daily environmental disinfection with an agent that has activity against C. auris are also key strategies to prevent the spread of this significant organism.

Inpatient rehabilitation outcomes in neoplastic spinal cord compression vs. traumatic spinal cord injury

Objective: To compare neurological and functional outcomes, and complications of patients with neoplastic vs traumatic spinal cord injury (SCI) after in-patient rehabilitation. Design: This study is a retrospective analysis. Setting: In-patient rehabilitation unit of a tertiary research hospital. Participants: A total of 252 patients with a SCI were included; 43 with neoplastic SCI (mean age: 60.9 ± 15.7 years, 60.5% were males) and 209 with traumatic SCI (mean age: 43.1 ± 16.8 years, 71.3% were males). Outcome measures: Comparisons were made of demographic characteristics, etiology, American Spinal Injury Association (ASIA) impairment scale, functional independence measurement (FIM) and Functional Ambulation Categories (FAC) scores, length of stay (LOS), bladder independence, medical comorbidities and complications in both groups. Results: Patients with neoplastic SCI were significantly older than those with traumatic SCI (P < 0.01). No difference was present between the groups in terms of sex and lesion level (P > 0.05). Incomplete SCI was significantly higher in the neoplastic group when compared with the traumatic group (P < 0.01). The LOS was significantly shorter in the neoplastic group than traumatic group (34.8 ± 41.03 vs. 60.02 ± 53.1, P < 0.01). There were no differences in the admission FIM scores (69.3 ± 24.7 vs. 58.7 ± 18.9, P > 0.05), discharge FIM scores (82.1 ± 25.1 vs. 74.02 ± 23.3, P > 0.05) and FIM efficiencies (0.43 ± 0.72 vs. 0.36 ± 0.51, P > 0.05) for the neoplastic and traumatic groups, respectively. However, neoplastic SCI patients demonstrated lower FIM gains compared to traumatic patients (12.9 ± 11.9 vs. 15.4 ± 15.2, P < 0.05). During rehabilitation, urinary tract infection (48.4% vs. 69.4%) and decubitus ulcer (11.6% vs. 35.9%) were significantly more common in the traumatic group than the neoplastic group (P < 0.05). Conclusion: Neoplastic SCI patients who commonly present at rehabilitation units exhibit different characteristics from traumatic SCI patients but the rehabilitation results are similar. Similar functional development can be achieved in a shorter period of time with inpatient rehabilitation in the neoplastic SCI group.

The prevalence of sarcopenia in middle‐aged and older patients in post‐acute inpatient rehabilitation: a cross‐sectional study

AbstractBackgroundDespite the recommendation of European Working Group on Sarcopenia in Older People 2 (EWGSOP2) consensus statement not to exclude patients younger than 65 years, the prevalence of sarcopenia has not been investigated in younger post‐acute inpatient rehabilitation population. The objectives of this study were to: estimate the prevalence of sarcopenia in post‐acute inpatient rehabilitation population; compare the prevalence of sarcopenia in patients above and below 65 years. MethodsThis cross‐sectional observational study recruited adult patients admitted to an inpatient rehabilitation unit at a metropolitan tertiary referral hospital in Melbourne, Australia. Participants' sarcopenia status was determined using the EWGSOP2 algorithm based on grip strength and muscle mass.ResultsBetween November 2016 and January 2019, 203 participants were enrolled. Participants' broad diagnostic streams included musculoskeletal, neurologic, spinal, cardiac, amputee, and deconditioning. The overall prevalence of sarcopenia was 18% [95% confidence interval (CI) 13% to 24%]. The prevalence of sarcopenia in patients younger than 65 was 14% (95% CI 8% to 22%), and the prevalence in patients 65 and older was 23% (95% CI 15% to 32%), risk difference of 9% (95% CI: −1.2% to 20%; P = 0.1). With incorporation of these results into the most recent meta‐analysis of sarcopenia in inpatient rehabilitation, the mean pooled prevalence of sarcopenia was 47% (95% CI 23% to 71%). Stratified by age, patients with sarcopenia had significantly longer preceding length of stay in the acute hospital (P = 0.015).ConclusionsThe overall estimated prevalence of sarcopenia in patients admitted to inpatient rehabilitation was 18%, and the estimated prevalence of sarcopenia in patients younger than 65 was 14%.

GripBMI – A fast and simple sarcopenia screening tool in post acute inpatient rehabilitation

Sarcopenia is prevalent in post acute inpatient rehabilitation. An easy to administer screening test may improve identification of sarcopenia in this population, which may promote its early detection and treatment. THE AIMS OF THIS STUDY WERE: a) To investigate clinical utility of SARC-F as a European Working Group on Sarcopenia in Older People2 (EWGSOP2) recommended tool for sarcopenia case finding in post acute inpatient rehabilitation. b) To develop an easy and pragmatic screening test for sarcopenia in healthcare settings with limited ability to measure the patients' muscle mass for confirmation of the sarcopenia diagnosis. This cross-sectional study with prospective data collection recruited patients admitted to a general inpatient rehabilitation unit in a metropolitan tertiary referral hospital in Australia. Participant's true sarcopenia status was ascertained, as per EWGSOP2, from their grip strength and muscle mass. Two SARC-F questionnaires were administered, for participants' current and, by recall, premorbid status. To develop GripBMI screening tool, BMI test positivity cut off was established on training sample and validated in conjunction with the established grip strength cut off on validation sample using area under the Receiver Operating Curve (ROC) analysis. True prevalence of sarcopenia in 277 participants (median age 64 years (IQR 53-72), 52% male) was 14% (95%CI 11%-19%). Screening utility of SARC-F positive status at the time of admission for sarcopenia had ROC of 0.50, and of premorbid SARC-F positive status had ROC of 0.51. Out of 42 participants positive on the GripBMI screen, 33 had sarcopenia, and out of 235 participants negative on the GripBMI screen, 7 participants had sarcopenia, resulting in GripBMI ROC area 0.89, sensitivity 83%, specificity 96%, positive predictive value 79%, negative predictive value 97%, diagnostic odds ratio 119 (95% CI 42-338). The GripBMI screening tool uses the combination of EWGSOP2 recommended low grip strength cut offs and Body Mass Index of less than 25 as a positive screening test for sarcopenia. It may assist in promoting early detection and management of sarcopenia in post acute inpatient rehabilitation.

Cognitive recovery of children and adolescents with moderate to severe TBI during inpatient rehabilitation

Objective Traumatic brain injury (TBI) is the leading cause of morbidity and mortality in children and adolescents. This study examines the early cognitive-linguistic recovery of pediatric patients who sustained TBI and required inpatient rehabilitation and investigates the contribution of various demographic, clinical, and preinjury factors to recovery. Methods A retrospective chart review of children and adolescents, ages 3–20 years, admitted to an inpatient rehabilitation unit. Acute outcomes were assessed at admission and discharge using the WeeFIM and CALS. Premorbid measures of behavioral and emotional functioning were also collected. Results One hundred and one children and adolescents (mean age = 12.31, SD = 4.46) diagnosed with TBI requiring inpatient rehabilitation were included. Patients displayed significant improvements on cognitive-linguistic skills and functional independence between admission and discharge, with medium to large effect sizes. Premorbid behavioral-emotional functioning was not found to be associated with early cognitive recovery. Conclusion Results suggest that significant functional improvements can be expected for pediatric patients with TBI during inpatient rehabilitation. Consistent with previous literature, injury severity was significantly related to acute outcomes. In conjunction with the WeeFIM, the CALS appears to be a meaningful complement for assessing and monitoring cognitive-linguistic skills during inpatient rehabilitation. Implications for Rehabiliation Our study provides support for the utility of the CALS to assess cognitive recovery during inpatient rehabilitation following moderate to severe TBI. Injury severity and not pre-injury functioning or demographic variables was related to worse scores on the CALS at discharge. Using a measure sensitive to change over admission, such as the CALS, can inform treatment planning.

A Comparison of the Armeo to Tabletop-assisted Therapy Exercises as Supplemental Interventions in Acute Stroke Rehabilitation: A Randomized Single Blind Study.

To evaluate the feasibility of an additional therapeutic upper limb exercise (ULE) intervention in early phase post-stroke rehabilitation and to assess outcomes of therapy using the Armeo Spring (ARMEO) versus Therapist-assisted Table Top (TAT) interventions. Randomized, single-blind trial. Stroke acute inpatient rehabilitation unit. Forty-five participants early after first stroke, Fugl-Meyer Assessment (FMA) score >8, Modified Ashworth score (MAS) of <3. Participants were randomized to TAT or ARMEO ULE in addition to the required 3 hours of 1:1 standard of care provided in an inpatient rehabilitation facility (IRF). Completed number of treatments; withdrawals; serious/adverse events; Functional Independence Measure (FIM) motor; FIM efficiency; FMA; MAS; elbow active (A) and passive (P) range of motion (ROM); and therapist effort measured by the Modified Borg Rating of Perceived Exertion Scale (RPE). Post-intervention FIM and FMA scores increased but did not demonstrate any statistically significant differences between the intervention groups (P = .585, .962, partial n2 = .001, .001, respectively). There were no statistically significant differences in post-intervention MAS elbow flexion and extension (P = .332, .252, partial n2 = .009, .007, respectively) and A/P ROM elbow extension between training groups (P = .841, .731, partial n2 = .001, .003, respectively). There was a statistically significant difference in post-intervention A/P ROM elbow flexion between groups (P = .031, .018, partial n2 = .123, .146). Post-intervention RPE did not show any statistically significant differences between the training groups (P = .128, partial n2 = .063). Total elbow range showed larger adjusted mean gains for the ARMEO. No serious adverse events were reported. This study demonstrates that additional therapeutic ULE in the early phase of post-stroke inpatient rehabilitation is feasible and that both interventions showed positive changes in selected outcomes.

COVID-19: planning for the aftermath to manage the aftershocks.

COVID-19: planning for the aftermath to manage the aftershocks.

Physiotherapists’ role during hospital-to-home transition for older adults with hip fracture and mobility limitation: A research protocol

Introduction Functional deficits such as gait speed, muscle strength or reduced activities in daily living after discharge are predictors for hospital readmission for older adults with hip fractures. However, physiotherapists (PTs) who are inherently mobility experts, do not actively participate during the hospital-to-home transition of older adults with hip fractures in the developing countries, including Nigeria. This qualitative study aims to describe and explore how PTs working within inpatient rehabilitation units prepare older adults (≥60 years) with a hip fracture for transfer to their home in the community. Methods We will adopt Sally Thorne’s Interpretive Description approach to purposively select 25 PTs with 5-years experience of participating in discharging older adults with hip fractures from inpatient rehabilitation-to-home. Data collection will include (a) semi-structured, one-on-one interviews with PTs, (b) discharge summaries of two older adults, and (c) final focus group discussion with PTs. We will ask the physiotherapists to provide discharge summaries of two older adults - one that they described as a “difficult” case and one that they described as an “easy” case during inpatient rehabilitation-to-home transition. Data will be analyzed employing Sally Thorne’s “borrowing techniques”- content and thematic analysis for the patients’ discharge summaries and PT interviews, respectively.

Stroke from Prospective Acute Inpatient Rehabilitation Data: Functional Outcomes Using the Functional Independence Measure

Objectives: Stroke is a second leading cause of mortality and results often to severely lasting disability in worldwide. We studied the long-term effects of rehabilitation after stroke as a key factor in improving the quality of life, due to the reason that Mongolia has one of highest rates of ischemic heart disease. The aim of this study was to evaluate functional outcomes of all patients admitted to an inpatient rehabilitation unit in a tertiary hospital using Functional Independence Measure (FIM), and analyze factors that are associated significantly with progression of discharge functional scores and higher functional gains. Methods: In this longitudinal study over a two-month period, functional data for 104 patients admitted consecutively to the Stroke Center at Third State Central Hospital inpatient rehabilitation unit in Mongolia were charted into a custom designed rehabilitation database. The primary outcome measures were the discharge total FIM scores, FIM gain and FIM efficiency. Multiple linear regression analysis were used to identify independent variables associated with better discharge FIM scores and FIM gain. Results: The mean age was 56.3 ±11.6 years and 55.7% of the patients were male. Ischemic stroke (28.8%) followed by hemorrhagic stroke (71.2%) were more common diagnoses. The average rehabilitation length of stay was 9.3 ± 2.2 days. The mean admission total FIM score was 42.3 ± 20.7 and the mean discharge total FIM score was 61.3 ± 24.6, with this gain being highly significant (P &lt; 0.001). The mean FIM gain was 18.6 ± 17.4 and FIM efficiency was 2.1 ± 1.0 points per day. Factors associated with better functional outcomes were higher admission motor and cognitive FIM scores, male gender and a longer rehabilitation length of stay. Conclusions: The FIM is an easy-to-use, standardized and robust general measure of functional disability. The total FIM scores of all patients, participated in this study, significantly improved. Moreover, longer rehabilitation LOS resulted in a negative effect on discharge FIM scores. To our knowledge, this study is the first study that examines the stroke rehabilitation using FIM scores as the primary outcome measure in Mongolia.

Clinical and epidemiological analysis of severe traumatic brain injury: the role of nutritional support to the injured with a prolonged state of impaired consciousness

Relevance. Patients with prolonged impaired consciousness due to traumatic brain injury are the most difficult category of patients in inpatient medical rehabilitation units. Despite the experience gained in managing this complex category of patients, the problem of nutrition status and trophological insufficiency, as well as practical issues regarding the organization of optimal nutrition at this stage of medical rehabilitation remain unresolved.Intention. To study the role of nutritional support for patients with long-term impaired consciousness on the basis of a clinical and epidemiological analysis of severe traumatic brain injury.Methodology.The data of an epidemiological analysis of traumatic brain injuries and features of ongoing nutritional support in patients with long-term impaired consciousness are presented, based on a study of domestic and foreign publications from 2005 to 2019.Results and Discussion. Timely and adequate nutritional support optimizes the structural-functional and metabolic systems of the body, adaptive reserves interfere with rapidly progressive depletion and chronic catabolic processes, contribute to positive changes in the functional state of the brain, reduce infectious complications, and increase the effectiveness of rehabilitation measures and the rate of recovery of consciousness.Conclusion. The analysis revealed the ambiguity of the interpreted data on clinical recommendations and approaches to the use of nutritional support in patients with long-term impaired consciousness due to traumatic brain injury. Considering the fact that in most cases such patients need continuous long-term comprehensive rehabilitation measures, accompanied by significant energy costs of the body, an essential component of the rehabilitation process, in our opinion, is the inclusion of adequate nutritional support that prevents fast-progressing exhaustion and chronic catabolic processes. In this regard, such an urgent task is to optimize the algorithms of nutritional support in patients with long-term impaired consciousness after a traumatic brain injury, the solution of which will improve the functional state of the brain and, therefore, the rehabilitation prognosis and quality of their life.

How is carer strain related to the recovery of stroke survivors with right hemisphere dysfunction? Implications for practice

Aim Right hemisphere strokes are associated with neuro-behavioural impairments including hemi-inattention, impulsiveness and anosognosia, which can impede stroke recovery and adversely affect carer health. This study explored the impact of associated impairments on carer strain and depression through a mixed methods approach. Method Fifty-one carer-survivor dyads were recruited from inpatient rehabilitation units and followed-up for 6 months. Validated measures assessed survivors’ physical and cognitive function and carers’ strain and depression levels. Survey methods captured qualitative experiences of the caring role. Data collection occurred at baseline, discharge, 6 weeks post-discharge and 6 months. Multilevel-modelling and thematic data analysis, were employed. Results Carer strain median scores were within normal ranges of the Caregiver Strain Index scale. Carer strain was positively linked to carer depression, number of carers’ concerns reported and survivors’ anosognosia levels. Carer strain was negatively linked to the survivors’ functional and cognitive abilities. Carers’ experiences differed qualitatively with caring concerns increasing over time. Conclusion Carer strain worsens with increases in significant concerns about the rehabilitation process and poor survivor functioning skills, which potentially increase risk of depression in carers. Consequently, improving right-hemisphere stroke survivors’ recovery and nurturing the carer-survivor relationship are likely to enhance overall outcomes and caring experiences. IMPLICATIONS FOR REHABILITATION In the context of right hemisphere stroke: Carer assessment should be comprehensive and include a measure of perceived ability to care. Less strained carers tend to report fewer caring concerns and have lower depression levels. Education, training and practical support should be tailored to carer identified needs, abilities and the caring context.

Discharge to inpatient care facilities following hip fracture surgery: incidence, risk factors, and 30-day post-discharge outcomes.

Discharge to an inpatient care facility (skilled-care or rehabilitation) has been shown to be associated with adverse outcomes following elective total joint arthroplasties. Current evidence with regard to hip fracture surgeries remains limited. The 2015-2016 ACS-NSQIP database was used to query for patients undergoing total hip arthroplasty, hemiarthroplasty and open reduction internal fixation for hip fractures. A total of 15,655 patients undergoing hip fracture surgery were retrieved from the database. Inpatient facility discharge included discharges to skilled-care facilities and inpatient rehabilitation units. Multi-variate regression analysis was used to assess for differences in 30-day post-discharge outcomes between home-discharge versus inpatient care facility discharge, while adjusting for baseline differences between the 2 study populations. A total of 12,568 (80.3%) patients were discharged to an inpatient care facility. Discharge to an inpatient care facility was associated with higher odds of any complication (OR 2.03 [95% CI, 1.61-2.55]; p < 0.001), wound complications (OR 1.79 [95% CI, 1.10-2.91]; p = 0.019), cardiac complications (OR 4.49 [95% CI, 1.40-14.40]; p = 0.012), respiratory complication (OR 2.29 [95% CI, 1.39-3.77]; p = 0.001), stroke (OR 7.67 [95% CI, 1.05-56.29]; p = 0.045, urinary tract infections (OR 2.30 [95% CI, 1.52-3.48]; p < 0.001), unplanned re-operations (OR 1.37 [95% CI, 1.03-1.82]; p = 0.029) and readmissions (OR 1.38 [95% CI, 1.16-1.63]; p < 0.001) following discharge. Discharge to inpatient care facilities versus home following hip fracture surgery is associated with higher odds of post-discharge complications, re-operations and readmissions. These results stress the importance of careful patient selection prior to discharge to inpatient care facilities to minimise the risk of complications.

Standardized Outcome Measures in Stroke Rehabilitation and Falls After Discharge: A Cohort Study.

Individuals with stroke discharged from inpatient rehabilitation units (IRUs) are at increased risk for falls. In IRUs, standardized outcome measures (SOMs) have been used to predict falls, but the results have been mixed. To examine the relationship between SOMs and the risk of falls in individuals with stroke within 6 months of discharge from an IRU. Prospective cohort study with 6-month follow-up. IRU that was part of a large, urban academic medical center. Individuals with stroke who underwent rehabilitation. Self-reported falls within 6 months of discharge. The study included 105 participants who were discharged to their homes after inpatient rehabilitation and who responded to a 6-month follow-up (57% response rate) phone call. Twenty-nine participants (28%) reported falling. Significant odds ratios (ORs), adjusted for age, sex, and stroke severity, were found for the following measures: Berg Balance Scale (OR 0.95, 95% confidence interval [CI] 0.92-0.99), Activity Measure for Post-Acute Care basic mobility (OR 0.89, 95% CI 0.81-0.97), Motricity Index (OR 0.96, 95% CI 0.94-0.98), Functional Independence Measure mobility subscale (OR 0.89, 95% CI 0.80-0.98), and Trunk Control Test (OR 0.97, 95% CI 0.95-0.99). Areas under the curve ranged from .64 to .71. In samples of 82 to 90 patients who could complete the tests, gait speed, the Functional Reach Test, the 6-minute Walk Test, and Timed Up and Go did not result in significant ORs. At discharge, SOMs were associated with the odds of falls within 6 months. The multifactorial nature of falls will continue to make prediction challenging but SOMs can be helpful. Lower extremity strength deserves more attention as a risk factor.