Inpatient Rehabilitation Patients Research Articles

Sarcopenia Is Associated With Reduced Function on Admission to Rehabilitation in Patients With Diabetes.

This work aims to estimate the prevalence of sarcopenia and to investigate the association between sarcopenia and functional performance in patients with and without diabetes admitted for inpatient rehabilitation. Consecutive patients admitted to the subacute inpatient rehabilitation unit at St Vincent's Hospital Melbourne, Australia (November 2016 to March 2020) were prospectively recruited into this cross-sectional study. Sarcopenia was diagnosed using the European Working Group on Sarcopenia in Older People 2018 algorithm. Participants' functional performance was measured by the total Functional Independence Measure, motor Functional Independence Measure, and the Short Physical Performance Battery. The association between sarcopenia and functional performance was investigated using quantile regression. Of 300 participants, 49 (16%) had a history of diabetes and 44 (14.7%) were diagnosed with sarcopenia. No significant difference in the prevalence of sarcopenia between patients with or without diabetes was identified (11/49, 22.5% vs 33/251, 13.2%, P = .12). In patients with diabetes, those with sarcopenia had significantly reduced functional performance compared to those without sarcopenia on Functional Independence Measure, motor Functional Independence Measure, and the Short Physical Performance Battery, whereas in patients without diabetes no significant difference between patients with and without sarcopenia were identified for either functional performance measure (all P values for interaction < .005). The diagnosis of sarcopenia was associated with a reduced functional performance on admission to inpatient rehabilitation in patients with diabetes, but not in those without diabetes. Further investigation is needed into the progress of patients with dual diagnoses of diabetes and sarcopenia in inpatient rehabilitation.

Feasibility and user-experience of virtual reality in neuropsychological assessment following stroke

ABSTRACT Virtual Reality (VR) offers the possibility to assess cognitive functioning in a dynamic environment resembling daily life. In this cross-sectional study, we used two user interfaces, namely non-immersive VR by using a computer monitor (CM) and immersive VR by using a head-mounted display (HMD). We investigated (1) potential differences in feasibility, user-experience, and a potential preference for one user interface over another between stroke patients and healthy controls; (2) potential differences in feasibility, user-experience, and preference between patients referred for inpatient rehabilitation care and patients referred for outpatient rehabilitation care; and (3) potential demographic and clinical characteristics that were related to patients’ preference for one user interface over another. Stroke patients (n = 88) and healthy controls (n = 66) performed a VR-task with a CM and HMD. Both user interfaces were feasible to use, irrespective of clinical referral (in- or outpatient rehabilitation care). Patients reported an enhanced feeling of engagement, transportation, flow, and presence, but more negative side effects when tested with a HMD, compared to a CM. The majority of stroke patients had no preference for one user interface over the other, yet younger patients tended to prefer a HMD. VR seems highly feasible in stroke patients.

Readmission to Acute Care During Inpatient Rehabilitation for Patients with Traumatic Brain Injury

Readmission to Acute Care During Inpatient Rehabilitation for Patients with Traumatic Brain Injury

Title: Predictors of Functional Cognitive Gains During Inpatient Rehabilitation for Patients with Traumatic Brain Injury

Identify patient characteristics that predict cognitive improvement during inpatient rehabilitation after traumatic brain injury (TBI).

Use of a Cluster of Outcome Measures to Predict Discharge Disposition For Stroke Patients in Inpatient Rehabilitation

Use of a Cluster of Outcome Measures to Predict Discharge Disposition For Stroke Patients in Inpatient Rehabilitation

Unexpressed psychosocial needs in cancer patients at the beginning of inpatient rehabilitation: a qualitative analysis

Objective Cancer patients often need professional help to alleviate their psychosocial distress. However, not all patients express their needs. In this study, we explored possible barriers to patients’ expressing needs, contents of needs difficult to express, and conditions facilitating expressing needs. Methods We conducted semi-structured interviews with 29 oncological inpatient rehabilitation patients, 7 members of self-help groups, and 10 health professionals. We analyzed data with structuring content analysis. Results Fear of stigmatization and difficulties in the physician-patient-relationship were the most critical expression barriers reported. Sexuality deemed to be one of the most challenging themes for patients. Changes in the physician’s behavior and sufficient resources were mentioned as the main facilitating conditions. Our results indicate a wide diversity within the barriers and topics, but a general consistency between patients and health professionals. Conclusion This study provides evidence for the existence of a variety of barriers to cancer patients’ expressing their needs. Practice Implications Health professionals should be aware of the different possible expression barriers to facilitate patient communication.

Supervised Exercise Training in Patients with Chronic Thromboembolic Pulmonary Hypertension as Early Follow-Up Treatment after Pulmonary Endarterectomy: A Prospective Cohort Study

Background: Data on exercise training in chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary endarterectomy (PEA) as well as data on clinical and haemodynamic changes shortly after PEA are lacking. Objective: The objective of this prospective study was to analyse the safety, feasibility, and the effectiveness of combined supervised inpatient rehabilitation in patients with CTEPH directly after PEA. Methods: CTEPH patients started a 19-week rehabilitation program (3 weeks as inpatients and continued at home for another 16 weeks) with supervised exercise training as follow-up treatment shortly after PEA. Haemodynamics were assessed by right heart catheterisation before PEA and 22 weeks after PEA. Non-invasive assessments as transthoracic echocardiography and 6-min walking distance (6MWD) were performed before PEA and after 3 (that is, beginning of rehabilitation), 6, and 22 weeks following PEA. Adverse events were recorded throughout the study. Results: Forty-five CTEPH patients were included (49% female, 57.6 ± 12.4 years old, 60% WHO functional class III). Rehabilitation was started 3.3 ± 0.9 weeks after PEA. Exercise training was well tolerated in all patients without severe side effects. Haemodynamics measured by right heart catheterisation significantly improved from pre-PEA to 22 weeks post-PEA in cardiac output (+1.2 ± 1.5 L/min, 33.4%, p = 0.001) and mean pulmonary arterial pressure (–19 ± 13 mm Hg, –39.6%, p < 0.0001). Right heart size measured by echocardiography, 6MWD, quality of life, and oxygen saturation significantly improved not only within the first 3 weeks after PEA but also during the following 19 weeks of exercise training. Conclusions: Supervised exercise training was feasible as early follow-up treatment after PEA. Further controlled studies are needed to discriminate the effects of PEA and early follow-up rehabilitation. Trial Registration: The study was registered at clinicaltrials.gov (NCT01393327) on July 13, 2011. The study start date was January 2010, and completion date was December 2013.

Nutrition and hydration management among stroke patients in inpatient rehabilitation: a best practice implementation project.

In 2012 in Australia, stroke was the cause of 11 791 deaths and affected the lives of over 420 000 survivors. Survivors experience significant physical and cognitive deficits; and accumulate a 43% risk of subsequent stroke. Effective evidence-based management of stroke is essential. The Stroke Foundation released Clinical Guidelines for Stroke Management in 2017. Within these guidelines, nutrition and hydration are recognized as important aspects of poststroke management. Audit criteria drawn from the guidelines focussed on the role of multidisciplinary screening, assessment, monitoring and treatment of dehydration and malnutrition; as well as provision of nutrition education and counselling relating to secondary prevention of stroke. The implementation team included dietetics, medical and nursing staff. The project was completed in the stroke unit at Hampstead Rehabilitation Centre (Adelaide, South Australia). To determine current compliance with Australian Clinical Guidelines of Stroke Management 2017, specifically those relating to nutrition, hydration and secondary prevention. To engage a multidisciplinary team to develop and implement strategies promoting best practice care for stroke survivors. The project utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System audit tool for baseline and follow-up audit, and the Getting Research into Practice feedback tool to facilitate practice change. Postimplementation audit results demonstrated improvement in four criteria: Criterion 3 - Nondysphagic stroke patients with confirmed malnutrition or at risk for malnutrition are offered oral nutrition supplements, Criterion 4 - Stroke patients who are malnourished or at risk of malnutrition are referred to a Dietitian for individualized medical nutrition therapy, Criterion 5 - The hydration status of stroke patients is assessed, monitored and managed throughout their hospital admission, Criterion 6 - Stroke survivors are referred to a Dietitian for the provision of individualized dietary advice which incorporates secondary prevention strategies. Criterion 7 (A collaborative goal setting approach which includes the stroke survivor, their families and carers and the rehabilitation care team is implemented) remained consistent at 100% compliance. Although Criteria 5 and 6 improved during the project, they remained below 75% compliance therefore, offer ongoing opportunity for development. Criterion 1 (Stroke patients are screened for malnutrition upon admission using a validated malnutrition screening tool) and Criterion 2 (Stroke patients are rescreened for malnutrition weekly using a validated malnutrition screening tool) were affected by a change from written to electronic medical records therefore, the results did not accurately reflect the intervention. The current project successfully increased knowledge of nutrition and hydration management for stroke survivors and more closely aligned inpatient management with best practice guidelines to improve health outcomes. It highlighted areas of focus moving forward and has prompted ongoing work for sustaining evidence-based practice change.

Medical complications during inpatient rehabilitation in patients with ischemic stroke in a tertiary care hospital in Nepal

Background: Complications are common in patients with ischemic stroke and hinder successful rehabilitation. Timely identification and management of complications are key factors in the management of patients with ischemic stroke.&#x0D; Objectives: The aim of this study is to find the occurrence of different types of complications in patients admitted with the diagnosis of ischemic stroke and to find the risk factors associated with the occurrence of complications.&#x0D; Methodology: The study is a cross sectional descriptive study. A total of 96 patients with ischemic stroke admitted to the Department of Neurology of Kathmandu Medical College Teaching Hospital over a period of six months (July 2018 to December 2018) were recruited. Data was recorded according to a designed proforma and analysed using Statistical Package for the Social Sciences version 20.&#x0D; Results: The age group ranged from 25 to 91 years with the mean age of 64.36 years and 50 (52.1%)patients were male. A total of 62 (64.6%) patients developed at least one complication during hospital stay. Pneumonia and urinary tract infection were the most common complications occurring in 22(22.9%) patients. The occurrence of complications was positively correlated with National Institutes of Health Stroke Scale and Glasgow Coma Scale.&#x0D; Conclusion: Pneumonia and urinary tract infection were the most common complications in our study and were similar to those quoted in the western literature. Severity of stroke had positive correlations with occurrence of complications.

0729 Sleep Apnea Diagnosis And Severity And Their Impact On Cognition After TBI: A VA TBI Model Systems Study

Abstract Introduction For persons with moderate-to-severe traumatic brain injury (TBI), chronic cognitive impairment contributes to long term disability. Health comorbidities may contribute to the neurologic burden in TBI. Indeed, obstructive sleep apnea (OSA) is associated with neuropathological and cognitive changes. The objective of this study was to examine the relationship between OSA and cognition after TBI. Methods Participants were prior inpatient rehabilitation patients drawn from the Tampa VA TBI Model Systems longitudinal study. Post-discharge interviews occurred 2 to 6 years post-TBI. Participants reported whether they were diagnosed with OSA and completed the Brief Test of Adult Cognition by Telephone (BTACT) which measures recall, working memory, processing speed, fluency, and reasoning. Participants with polysomnography (PSG) were separately analyzed to examine the impact of sleep apnea severity (i.e., Apnea-Hypopnea Index [AHI]) on cognition. Results Participants (N=104) were mostly male (95.2%), age M=37.7 (SD=12.5), Education M=13.6 years (SD=2.1), and 45.2% were diagnosed with OSA. Participants with and without OSA did not differ by age, education, gender, or time since injury at time of BTACT (ps &amp;gt; .05). ANCOVAs were conducted examining OSA diagnosis on BTACT subscale scores, covarying TBI severity level, but results did not reach statistical significance (ps &amp;gt; .05). A subset of participants with OSA had PSG (n=27), AHI score quartiles = 6.7/10.4/21.6. Higher AHI was associated with poorer reasoning (Spearman ρ = -0.45, p = .019). Nonsignificant results were found for word recall (Spearman ρ = -0.35, p = .074) and processing speed (Spearman ρ = -0.36, p = .069). Conclusion Severity of sleep apnea may influence aspects of cognition among persons with TBI, although these results are preliminary and need replication with a larger and more representative sample. Support This work was supported by the Veterans Health Administration Central Office VA TBI Model Systems Program of Research and subcontract from General Dynamics Information Technology [W91YTZ-13-C-0015, HT0014-19-C-0004] from the Defense and Veterans Brain Injury Center (DVBIC); and from the United States Department of Veterans Affairs [W81XWH-13-2-0095]; and from the United States Department of Defense Congressionally Directed Medical Research Programs; and from the Patient Centered Outcomes Research Institute (PCORI) [CER-1511-33005].

Practical Considerations for Implementing Virtual Care in Physical Medicine and Rehabilitation: For the Pandemic and Beyond.

This article outlines a practical approach to quickly implementing virtual care for physiatrists. This skill is relevant not only during times of a pandemic, when face to face care is impossible, but is also valuable when caring for patients who have physical, financial, logistic, or other challenges to on-site care. Key themes covered in this article include selecting appropriate virtual care platforms, consenting patients for virtual care and conducting successful virtual visits. It also reviews strategies for performing virtual physical examinations and engaging learners in virtual care.

Comparison of functional recovery and outcome at discharge from subacute inpatient rehabilitation in patients with right or left stroke with and without contralateral spatial neglect.

To compare to what extent the presence of contralateral spatial neglect affects functional recovery and outcome among patients with right or left stroke after subacute inpatient rehabilitation. Observational cohort study comparing functional improvement and outcome. The same admission data-set was used as in part 1 of this study. Right and left stroke rehabilitants with equally mild neglect and those without neglect (a total of 4 subgroups) all improved proportionally as much, but those with neglect, irrespective of stroke side needed a longer stay in inpatient rehabilitation. At discharge, total disability did not differ significantly between the 2 neglect subgroups, but those with left stroke had significantly lower Functional Independence Measure cognitive sub-score and score in communication. Rehabilitants with neglect, irrespective of stroke side had higher motor, cognitive and total disability and were more often institutionalized than those without neglect. Mild neglect did not impair recovery after right or left stroke, but rehabilitants with neglect were more disabled and needed a longer rehabilitation inpatient stay than those without neglect.

Predicting admission to post-acute inpatient rehabilitation in patients with acute stroke.

To identify predictors of admission to post-acute inpatient rehabilitation settings follow-ing acute care for stroke survivors in Taiwan. Prospective observation study. Stroke survivors (n = 558) admitted to acute care wards for inpatient rehabilitation (62% male; mean age 60.0 ± 12.2 years). The primary outcome was whether survivors were admitted to post-acute inpatient rehabilitation settings after discharge from acute care wards. Logistic regression model was adopted to examine the predictors of admission to post-acute inpatient rehabilitation. A receiver operating characteristic curve was drawn to compute the ability of the predictors to discriminate the outcome. Multivariate analysis results indicated Activity Measure Post-Acute Care "6-Clicks" Basic Mobility score to be the only significant predictor of admission to post-acute inpatient rehabilitation (odds ratio = 0.44, 95% confidence interval: 0.34-0.56). Receiver operating characteristic curve analysis results indicated that the cut-off point for Basic Mobility was 13 (standardized score: 33.99). This yielded a sensitivity value of 0.98 and a specificity value of 0.96 for determining the admission to post-acute inpatient rehabilitation. Activity Measure Post-Acute Care "6-Clicks" Basic Mobility subscale scores at admission for acute care can predict admission to post-acute inpatient rehabilitation for stroke survivors in Taiwan. This tool can aid clinicians in formulating adequate discharge plans at an early stage, and thus improve the quality of care.

The Short Physical Performance Battery (ASSESSMENT)

The Short Physical Performance Battery (ASSESSMENT)

Discharge Disposition After Anterior Cervical Discectomy and Fusion

Age and comorbidity burden of patients going anterior cervical discectomy and fusion (ACDF) have increased significantly over the past 2 decades, resulting in increased expenditures. Non-home discharge after ACDF contributes to increased direct and indirect costs of postoperative care. The purpose of this study was to identify independent prognostic factors for discharge disposition in patients undergoing ACDF. A retrospective review was conducted at 5 medical centers to identify patients undergoing ACDF for degenerative conditions. The primary outcome was non-home discharge. Additional outcomes considered included discharge to rehabilitation and home discharge with services. Bivariate and multivariable analyses were used to identify independent prognostic factors for non-home discharge. Of 2070 patients undergoing ACDF, 114 (5.5%) had non-home discharge and 63 (3.0%) had discharge to inpatient rehabilitation. Factors independently associated with non-home discharge included older age, marital status, Medicare insurance, Medicaid insurance, previous spine surgery, myelopathy, preoperative comorbidities (hemiplegia/paraplegia, congestive heart failure, cerebrovascular accident), anemia, and leukocytosis. C-statistic for the overall model was 0.85. Results were relatively similar for patients younger than the age of 65 years as well as for discharge to inpatient rehabilitation and discharge home with services. Numerous sociodemographic and clinical characteristics influence the risk of non-home discharge and discharge to inpatient rehabilitation in patients undergoing ACDF. Policy makers and payers should consider these factors when determining appropriate preoperative adjustment for risk-based reimbursements.

Changes and interactions of physical activity in patients with occupational respiratory diseases after a behavioral exercise intervention: A study protocol

Introduction: An active lifestyle represents a challenge for patients with chronic respiratory diseases because of pathophysiological alterations which lead to reduced physical activity (PA). Patients fall into a downward spiral of deconditioning with increased symptoms and reduced PA. Various studies suggest that a higher PA level in these subjects increases quality of life and reduces risk of hospital admissions and mortality, so that the long-term maintenance of PA in these patients is an important aim in disease management. As ordinary fitness training during inpatient rehabilitation seems to be insufficient, behavior changes promise long-term success. Methods and analysis: The objective of this longitudinal analysis is to investigate various physiological and psychological determinants of PA in patients with occupational respiratory diseases. The randomized controlled trial will examine the effects of a behavioral exercise intervention during inpatient pulmonary rehabilitation (PR) on the basis of objective (by ActigraphGT3x+®) and subjective physical activity measured 4 weeks before the start of the rehabilitation and 2, 6 and 12 months after rehabilitation. In addition, psychological determinants such as anxiety, depression and self-efficacy, will be investigated. Participants were randomized in an intervention group (IG) and control group (CG). The IG participated in a behavioral exercise intervention of 9 sessions, in addition to the regular PR. The CG received standard PR over 4 weeks. The behavioral exercise intervention is based on a theoretical framework of various behavior change models in order to maintain or increase PA with the help of volitional and motivational strategies including knowledge transfer, goal setting, action planning and barrier management. Every session consists of theoretical and practical elements to enable participants to pursue an active lifestyle. Conclusion: The purpose of the current study (a randomized controlled trial) is to examine the effectiveness of a behavioral exercise intervention during an inpatient rehabilitation of patients with occupational respiratory diseases on several outcomes, for example, physical activity and mental health. Thus, the results will contribute to optimize a sustainable disease management.

Managing Palliative Patients in Inpatient Rehabilitation Through a Short Stay Family Training Program.

Retrospective Analysis of a Quality Improvement Program. To describe the development, implementation, and outcomes of an inpatient rehabilitation-based Short Stay Family Training (SSFT) program for patients with life-limiting conditions. Patients with terminal illnesses often have functional limitations that prohibit discharge home after hospitalization, but their condition limits their ability to participate in rehabilitation in an inpatient setting. After a needs assessment, an interdisciplinary team developed an SSFT program to empower patients, caregivers, and family members by giving them the tools to be independent in caring for a patient with a life-limiting condition. Patients qualifying for the program were tracked in terms of acute care physical therapy and occupational therapy discharge recommendations, diagnosis, inpatient rehabilitation unit length of stay (LoS), caregiver involvement, and discharge location. Data were retrospectively analyzed from patients over the first 16 months. Since program implementation, 30 patients and their family members participated in the program. Overall, these patients experienced decreased LoS, increased discharge to home, and increased palliative care involvement in the plan of care. Short Stay Family Training is a viable alternative to traditional inpatient rehabilitation to allow patients with life-limiting conditions to discharge home safely with caregiver support.

Use of Wearable Tech to Increase Physical Activity in Inpatient Rehabilitation for Patients With Chronic Pain

Use of Wearable Tech to Increase Physical Activity in Inpatient Rehabilitation for Patients With Chronic Pain

Development and Validation of the Occupational Self-Assessment-Short Form (OSA-SF).

The Occupational Self-Assessment, Version 2.2 (OSA 2.2), is a client-centered measure of clients' perceived occupational competence and value. The OSA 2.2 has previously demonstrated good structural validity and internal consistency; however, the administration length could deter therapists from using this assessment in acute care and acute inpatient rehabilitation. To evaluate reliability and validity of the OSA 2.2 in acute care and acute inpatient rehabilitation and to develop and validate the OSA-Short Form (OSA-SF). We performed a descriptive psychometric analysis using the Rasch analytic approach. The data were collected in acute care and acute inpatient rehabilitation. Our convenience sample consisted of 86 patients in acute care and acute inpatient rehabilitation. Participants rated their perceived occupational competence and value by completing the OSA 2.2. We examined psychometric properties of the OSA 2.2 and OSA-SF using a partial credit Rasch model. The 21-item OSA 2.2 was reduced to a 12-item OSA-SF through iterative removal of items on the basis of item-misfit statistics. The OSA-SF demonstrated adequate rating scale functioning, dimensionality, item and person goodness of fit, item targeting, item hierarchies, and item and person separation. Findings indicate that the OSA-SF is a valid and reliable measure that can guide client-centered goal setting and intervention planning for adults receiving acute care and acute inpatient rehabilitation. The OSA 2.2 and the OSA-SF offer a client-centered approach to evaluating patients' self-reported ability and ratings of the importance of performing everyday occupations. These assessments can guide client-centered goal setting in acute care and acute inpatient rehabilitation.

Intervention for Increasing Vitamin D Supplementation in a Deficient Rehabilitation Population: Outcomes of a Quality Improvement Initiative.

Vitamin D deficiency (VDD) is highly prevalent and increases the risk of osteoporosis, falls, and fractures. Patients in acute inpatient rehabilitation have several risk factors for VDD, the adverse effects of which may hinder long-term functional gain. To evaluate the prevalence of and risk factors for VDD in patients admitted to acute inpatient rehabilitation and to evaluate the efficacy of a standardized vitamin D screening and supplementation protocol. Prospective cohort study as part of a quality improvement initiative. An academic, freestanding acute inpatient rehabilitation hospital. Patients consecutively admitted over a 4-month period between November 2014 and February 2015 (n=128 pre-intervention and n=129 post-intervention). Universal screening of vitamin D level on admission followed by utilization of a standard supplementation protocol. Vitamin D insufficiency (VDI) and VDD prevalence along with screening, and supplementation rates. Preintervention, 10.2% of patients were screened for VDD, with 23.1% VDI and 46.2% VDD. Postintervention, 89.9% were screened, with 31.9% VDI and 47.4% VDD. 6.3% of all patients were supplemented on vitamin D preintervention compared to 53.5% postintervention. In multivariate analyses, the odds of VDD was significantly associated with African American race (OR 7.30, 95% CI, 1.56-34.20, P = .12) and age younger than 65 (OR 13.62 95% CI, 2.51-73.83, P = .002). Diagnoses in the "other neurologic" category were associated with decreased odds of VDD (OR 0.01, 95% CI, 0.001-0.193, P = .002). Given the high prevalence of VDD in an acute inpatient rehabilitation hospital, a routine screening and standardized supplementation protocol may improve quality of care. III.