Management Of Functional Impairment Research Articles

Improving measurement of functional status among older adults in primary care: A pilot study.

Despite its importance for clinical care and outcomes among older adults, functional status-the ability to perform basic activities of daily living (ADLs) and instrumental ADLs (IADLs)-is seldom routinely measured in primary care settings. The objective of this study was to pilot test a person-centered, interprofessional intervention to improve identification and management of functional impairment among older adults in Veterans Affairs (VA) primary care practices. The four-component intervention included (1) an interprofessional educational session; (2) routine, standardized functional status measurement among patients aged ≥75; (3) annual screening by nurses using a standardized instrument and follow-up assessment by primary care providers; and (4) electronic tools and templates to facilitate increased identification and improved management of functional impairment. Surveys, semi-structured interviews, and electronic health record data were used to measure implementation outcomes (appropriateness, acceptability and satisfaction, feasibility, fidelity, adoption/reach, sustainability). We analyzed qualitative interviews using rapid qualitative analysis. During the study period, all 959 eligible patients were screened (100% reach), of whom 7.3% (n = 58) reported difficulty or needing help with ≥1 ADL and 11.8% (n = 113) reported difficulty or needing help with ≥1 IADL. In a chart review among a subset of 50 patients with functional impairment, 78% percent of clinician notes for the visit when screening was completed had content related to function, and 48% of patients had referrals ordered to address impairments (e.g., physical therapy) within 1 week. Clinicians highly rated the quality of the educational session and reported increased ability to measure and communicate about function. Clinicians and patients reported that the intervention was appropriate, acceptable, and feasible to complete, even during the COVID pandemic. These findings suggest that this intervention is a promising approach to improve identification and management of functional impairment for older patients in primary care. Broader implementation and evaluation of this intervention is currently underway.

Unmet needs in the management of functional impairment in patients with chronic pain: a multinational survey.

Background: A survey of European Pain Federation 2019 attendees was conducted to identify unmet needs in chronic pain patients. Materials & methods: Four questions were asked focusing on functional impairment in chronic pain, including who are at increased risk and ways to better identify and manage these patients. Results: In total143 respondents indicated that key issues were lack of knowledge, lack of resources/time to assess and manage chronic painand lack of sufficient tools to identify patients at risk for functional impairment. Education and training of primary care physicians, simplified guidelines and practical tools for assessmentand use of multidisciplinary teams to treat chronic pain were recommended. Conclusion: There are many unmet needs in the management of functional impairment in chronic pain patients.

Promoting assessment and management of function through navigation: opportunities to bridge oncology and rehabilitation systems of care.

Recent calls from oncology providers and cancer policy forums advocate for improved connections between rehabilitation services and cancer care delivery. Traditionally, this intersection has occurred when patients present with overt disability related to cancer treatment and is driven by reactive approaches to care. A growing body of evidence suggests that a proactive approach to functional screening and assessment encourages the identification and management of functional impairment and morbidity earlier in the cancer care continuum and contributes to better outcomes. A clinical pathway that prompts screening and referral to rehabilitation services in an expedited manner is needed. Cancer patient navigators provide care coordination through the duration of medical treatment, survivorship, and end-of-life. This article presents a framework for navigation workflows to support functional assessment and provide early triage pathways to the rehabilitation system of care. We provide a case example of novel approach to patient navigation from a Southeastern United States community cancer center that uses a patient navigator with a rehabilitation background to serve in this role. An overview of the position skills, functional assessment and referral pathways, and perspective on quality improvements related to this approach are described. The use of rehabilitation providers beyond traditional clinical roles should be further explored. Their expertise in functional assessment and interpretation could foster improvements in cancer care delivery and outcomes for survivors in both the short and long term.

Minimizing Disability from Graft-Versus-Host Disease

Graft-versus-host disease (GVHD) is a complication of hematopoietic stem cell transplantation which can result in significant disability. Any organ system may be affected, and as a result, a wide variety of functional impairments may occur. Rehabiliation services can improve patient outcomes and quality of life, but an understanding of the underlying disease process is necessary. There have been few studies published recently regarding the management of functional impairments in GVHD patients. The National Institutes of Health Consensus Development Project on Criteria in Chronic Graft-versus-Host Disease is an ongoing project begun in 2005 and most recently updated in 2014; however, these data have not yet been used to assess the management of disability in this population. The treatment of functional impairments from GVHD remains largely annectdotal and based around experiences from similar diseases; however, rehabilitation interventions should still be considered for patients with significant disease burden.

Socioeconomics viewpoint: the need for an update of the clinical practice guideline on cataract.

In June 1994, the Agency for Health Care Policy and Research (AHCPR), Washington, DC, called a meeting to hear opinions on the need for a reconstituted panel to revise the recently published clinical practice guideline Cataract in Adults: Management of Functional Impairment. The need and timing of a revision depend essentially on the answer to two questions: (1) Are there serious flaws in the previous panel's work that would necessitate a re-review? or (2) Is there new scientific information that can be critically assessed that would substantially alter the recommendations of the guideline? It is important to consider these questions with care because any revision is likely to be both costly and time-consuming.