Inpatient Rehabilitation Patients Research Articles

Examination of pain comorbid diagnoses in the inpatient rehabilitation population across all impairment groups.

Pain is common in inpatient rehabilitation patients; however, the prevalence of pain diagnoses in this population is not well-defined. This study examines comorbid pain diagnoses in inpatient rehabilitation patients across impairment groups. Adult inpatient rehabilitation patients discharged from January 2016 through December 2019 were identified in the Uniform Data System for Medical Rehabilitation® database using a literature-established framework containing ICD-10-CM pain diagnoses. Demographic data, clinical data, and pain diagnoses were compared across the 17 rehabilitation impairment groups. Of 1,925,002 patients identified, 1,347,239 (70.0%) had at least one ICD-10 pain diagnosis. Over half of all patients in each impairment group had at least one pain diagnosis. The most common pain diagnoses were limb/extremity and joint pain, with variation between impairment groups. Female sex and being in the arthritis, major multiple trauma, and pain syndrome impairment groups were associated with a greater odds of a pain diagnosis. Over half of all patients in each rehabilitation impairment group have a pain diagnosis, which varies between impairment groups. Due to the high prevalence of pain diagnoses, a new focus on pain management in inpatient rehabilitation patients is needed. Rehabilitation outcomes may also be affected by pain.

Decreased bed mobility function is associated with post-discharge mortality for cancer patients in inpatient rehabilitation.

The establishment of rehabilitation goals for hospitalized cancer patients depends on accurate medical prognosis and matching goals to clinical timelines. Current tools for estimating prognosis are limited. We hypothesized that bed mobility is a predictor of mortality in cancer patients admitted to inpatient rehabilitation. In a retrospective cohort of 187 subjects with non-neurologic cancer admitted to inpatient rehabilitation, Functional Independence Measure (FIM) scores and 6-month mortality were analyzed. In the cohort, survival rate was 71% at 6 months. In univariate analysis, discharge bed mobility score (OR = 0.75, 95%CI = 0.61 to 0.90, p = 0.003), bed mobility FIM gain (OR = 0.66, 95%CI = 0.51 to 0.85, p = 0.002), and bed mobility FIM efficiency (OR = 0.011, 95%CI = 0.00032 to 0.21, p = 0.006) were inversely associated with 6-month mortality after discharge from IRF. In multivariate analysis with additional motor FIM items, only bed mobility (OR = 0.73, 95%CI = 0.54 to 0.97, p = 0.029) and grooming (OR = 0.79, 95% CI = 0.63 to 0.99, p = 0.041) were independently associated with mortality. Lower discharge and lower change in bed mobility FIM scores are associated with mortality in cancer patients in inpatient rehabilitation. Bed mobility could serve as a clinical tool for estimating medical prognosis in hospitalized cancer patients and should be validated in prospective studies.

National Disability Insurance Scheme timeframes and functional outcomes for inpatient rehabilitation patients: a 5-year retrospective audit.

Objective The aim of this study was to compare National Disability Insurance Scheme (NDIS) timeframes and functional outcomes for a patient population managed in an inpatient hospital rehabilitation unit. Methods A retrospective hospital audit was undertaken of adult patients admitted to a tertiary-level, regional inpatient rehabilitation unit between January 2017 and December 2021 who were either referred, or not, to the NDIS. A hospital NDIS patient database, Australasian Rehabilitation Outcome Centre episode data, and patient medical records were analysed. The main outcome measures included actual rehabilitation length of stay versus expected length of stay, and Functional Independence Measure (FIM) efficiency for all inpatients, with NDIS timeframes analysed for the NDIS-referred patient subgroup. Results Rehabilitation inpatients referred for NDIS services significantly exceeded expected rehabilitation length of stay compared to those not referred to the NDIS. Furthermore, expected length of stay was significantly exceeded for those patients who required implementation of a NDIS plan to safely transition from hospital. FIM efficiency was significantly lower for patients referred to the NDIS. Recent improvement in timeframes for being accepted as a NDIS participant did not reduce length of stay. Conclusions NDIS timeframes for rehabilitation inpatients incur a significant opportunity cost for the provision of efficient inpatient rehabilitation services that are unaccounted for in current benchmarking performance standards.

Feasibility and Safety of Early Post-COVID-19 High-Intensity Gait Training: A Pilot Study.

The feasibility and safety of rehabilitation interventions for individuals recovering from COVID-19 after the acute stage is not well understood. This pilot study aims to provide a preliminary investigation of the feasibility and safety of providing high-intensity gait training (HIT) with a targeted cardiovascular intensity of 70-85% of the age-predicted maximum heart rate (HRmax) for individuals undergoing rehabilitation post-COVID-19. Consecutive patients who were medically cleared for HIT were invited to participate in the study. Participants practiced walking in varied contexts (treadmill, overground, and stairs), aiming to spend as much time as possible within their target cardiovascular intensity zone during scheduled physical therapy (PT) sessions. Training characteristics and adverse events were collected to determine the feasibility and safety of HIT. The severity of adverse events was graded on a 1-5 scale according to the Common Terminology Criteria for Adverse Events. The participants (n = 20) took a mean of 2093 (±619) steps per PT session. The average peak heart rate during PT sessions was 81.1% (±9.4) of HRmax, and 30.1% (±21.0) of the session time was spent at heart rates ≥ 70% HRmax. Mild adverse events (grade 1) occurred in <5% of the sessions, and no intervention-requiring or life-threatening adverse events (grade 2-5) occurred. This pilot study provides preliminary evidence that HIT may be feasible and safe during inpatient rehabilitation for patients post-COVID-19 following medical clearance.

Blood pressure trajectory of inpatient stroke rehabilitation patients from the Determining Optimal Post-Stroke Exercise (DOSE) trial over the first 12 months post-stroke.

High blood pressure (BP) is the primary risk factor for recurrent strokes. Despite established clinical guidelines, some stroke survivors exhibit uncontrolled BP over the first 12 months post-stroke. Furthermore, research on BP trajectories in stroke survivors admitted to inpatient rehabilitation hospitals is limited. Exercise is recommended to reduce BP after stroke. However, the effect of high repetition gait training at aerobic intensities (>40% heart rate reserve; HRR) during inpatient rehabilitation on BP is unclear. We aimed to determine the effect of an aerobic gait training intervention on BP trajectory over the first 12 months post-stroke. This is a secondary analysis of the Determining Optimal Post-Stroke Exercise (DOSE) trial. Participants with stroke admitted to inpatient rehabilitation hospitals were recruited and randomized to usual care (n = 24), DOSE1 (n = 25; >2,000 steps, 40-60% HRR for >30 min/session, 20 sessions over 4 weeks), or DOSE2 (n = 25; additional DOSE1 session/day) groups. Resting BP [systolic (SBP) and diastolic (DBP)] was measured at baseline (inpatient rehabilitation admission), post-intervention (near inpatient discharge), 6- and 12-month post-stroke. Linear mixed-effects models were used to examine the effects of group and time (weeks post-stroke) on SBP, DBP and hypertension (≥140/90 mmHg; ≥130/80 mmHg, if diabetic), controlling for age, stroke type, and baseline history of hypertension. No effect of intervention group on SBP, DBP, or hypertension was observed. BP increased from baseline to 12-month post-stroke for SBP (from [mean ± standard deviation] 121.8 ± 15.0 to 131.8 ± 17.8 mmHg) and for DBP (74.4 ± 9.8 to 78.5 ± 10.1 mmHg). The proportion of hypertensive participants increased from 20.8% (n = 15/72) to 32.8% (n = 19/58). These increases in BP were statistically significant: an effect [estimation (95%CI), value of p] of time was observed on SBP [0.19 (0.12-0.26) mmHg/week, p < 0.001], DBP [0.09 (0.05-0.14) mmHg/week, p < 0.001], and hypertension [OR (95%CI): 1.03 (1.01-1.05), p = 0.010]. A baseline history of hypertension was associated with higher SBP by 13.45 (8.73-18.17) mmHg, higher DBP by 5.57 (2.02-9.12) mmHg, and 42.22 (6.60-270.08) times the odds of being hypertensive at each timepoint, compared to those without. Blood pressure increased after inpatient rehabilitation over the first 12 months post-stroke, especially among those with a history of hypertension. The 4-week aerobic gait training intervention did not influence this trajectory.

No One-Size-Fits-All: A Qualitative Study of Patient Experience in Inpatient Rehabilitation

Abstract Date Presented 04/22/2023 Patient experience is increasingly being acknowledged as an important quality indicator in health care. Nevertheless, there is a lack of understanding of this construct. This qualitative study sought to understand the lived experiences of patients in inpatient rehabilitation and the factors that are most influential in this experience. Research findings increase understanding of the patient experience and perceived influential factors. This is crucial to providing patient-centered care. Primary Author and Speaker: Mirline Milien Additional Authors and Speakers: Megan Bewernitz Contributing Authors: Katherine Stallings, Mary Ellen Young

Frequency, Characteristics, and Risk Factors for Falls at an Inpatient Cancer Rehabilitation Unit.

Falls in the hospital can lead to adverse events, including injuries. Studies have shown that patients with cancer and those undergoing inpatient rehabilitation (IPR) are at higher risk for falls. Therefore, we measured the frequency, degree of harm, and characteristics of patients who fell in an inpatient cancer rehabilitation unit. A retrospective review was conducted on inpatient cancer rehabilitation patients admitted from January 2012 to February 2016. Fall frequency, degree of harm, fall circumstances, cancer type, patient's fall risk score on the basis of the MD Anderson Cancer Center Adult Inpatient Fall Risk Assessment Tool (MAIFRAT), length of stay, and risk factors were evaluated for patients. There were 72 out of 1,571 unique individual falls (4.6%), with a falls incidence of 3.76 falls per 1,000 patient-days. Most fallers (86%) suffered no harm. Risk factors for falls included presence of patient-controlled analgesia pump (P = .03), pump such as insulin or wound vacuum-assisted closure (P < .01), nasogastric, gastric, or chest tube (P = .05), and higher MAIFRAT score (P < .01). The fallers were younger (62 v 66; P = .04), had a longer IPR stay (13 v 9; P = .03), and had a lower Charlson comorbidity index (6 v 8; P < .01). The frequency and degree of harm for falls in the IPR unit were less than previous studies, which suggests that mobilization for these patients with cancer is safe. The presence of certain medical devices may contribute to fall risk, and more research is needed to better prevent falls in this higher-risk subgroup.

Inpatient rehabilitation patients are more active during rehabilitation times and days than non-rehabilitation times and days: An observational study

Introduction: The effectiveness of inpatient rehabilitation services has been well supported. However, patients receiving inpatient rehabilitation may be physically inactive outside of therapy. The primary objectives were to determine differences in activity levels between rehabilitation time and non-rehabilitation time and rehabilitation day and non-rehabilitation day during inpatient rehabilitation stay. The secondary objective was to determine differences among rehabilitation services. Methods: In all, 50 participants wore an ActiGraph GT9X Link on their non-dominant wrist during their inpatient rehabilitation stay. Results: We found significant differences in total activity counts between rehabilitation time and non-rehabilitation time ( z = 6.15, p &lt; 0.001) and between rehabilitation day and non-rehabilitation day ( z = 5.82, p &lt; 0.001). We found significant differences in total activity counts between occupational therapy and physical therapy ( z = 5.71, p &lt; 0.001), occupational therapy and speech-language pathology ( z = 3.41, p &lt; 0.001), and physical therapy and speech-language pathology ( z = 3.07, p = 0.002). The degrees of all differences were large. Conclusion: To increase the activity levels during non-rehabilitation times and days, patients receiving inpatient rehabilitation may benefit from strategies which increase activity levels such as an individualized program that can be safely and independently performed outside of rehabilitation sessions.

Comparison of Functional Outcomes After Acute Inpatient Rehabilitation After Acquired Brain Injury Before and During the COVID-19 Pandemic.

The objective of this study was to characterize and compare functional outcomes of acquired brain injury patients in an inpatient rehabilitation facility in the year before (April 2019-March 2020) and during the first year (April 2020-March 2021) of the COVID-19 pandemic, when the most drastic changes in the delivery of health care occurred. In this retrospective single-center chart review study, functional outcomes, based on the Center for Medicare and Medicaid Services Inpatient Rehabilitation Facility-Patient Assessment Instrument, were obtained and analyzed for patients in acute inpatient rehabilitation with acquired brain injury. Data from 1330 patients were included for analysis. Functional outcomes of average self-care, bed mobility, and transfer scores were statistically, but not clinically, different between groups. More patients in the pandemic group were discharged home (prepandemic n = 454 [65.4%]; pandemic n = 461 [72.6%]; P = 0.011), although they had significantly longer lengths of stay (prepandemic median = 14.0 [interquartile range = 9.0-23.0]; pandemic = 16.0 [10.0-23.0]; P = 0.037). Despite the impact of hospital policies due to the COVID-19 pandemic, similar functional outcomes were obtained for those with acquired brain injury after inpatient rehabilitation.

COMPARING INPATIENT REHABILITATION AND HOME-BASED REHABILITATION PRACTICES FOLLOWING ACUTE STROKE: A PROSPECTIVE CONTROLLED STUDY

OBJECTIVE: The aim of this study is to evaluate whether home-based rehabilitation (HBR) is as effective as inpatient rehabilitation in patients with acute stroke as well as to identify patients at increased risk of mortality/morbidity during rehabilitation.MATERIAL AND METHODS: The present study included 64 patients with acute stroke who were referred from the neurology service and intensive care units to an inpatient rehabilitation unit (n=28) or HBR programs (n=36). Brunnstrom motor stages, Functional Independence Measure and Stroke Impact Scale scores of all patients were recorded before treatment and 12 weeks after therapy. Evaluation parameters were compared between 2 groups. The presence of any morbidity/mortality that developed during rehabilitation period were recorded. Afterward, all the patients were divided into 3 groups as inpatient, HBR and patients with mortality/morbidity and evaluation parameters before therapy were compared among the groups.RESULTS: At third month, while there was no significant change in all quality of life subscales following HBR, the improvement in all quality of life subscales following inpatient rehabilitation, except for the memory and emotion subscales were significant. At the end of 12th week; 5 (13.90%) of the 36 patients were died, and another 5 (13.90%) had developed a new cerebrovascular disease in HBR group. The memory, communication and emotion subscales scores of 10 patients with mortality/morbidity were significantly lower than the patients without mortality/morbidity in other 2 groups.CONCLUSIONS: To better manage difficult clinical encounters, the physician needs to well identify acute stroke patients who will be referred to inpatient rehabilitation or home exercise group. When choosing a rehabilitation program, physicians may also consider the mortality/morbidity related to memory, communication and emotional scores.

Feasibility of Problem-Solving Training During Inpatient Rehabilitation in Patients With Stroke.

Stroke survivors report feeling unprepared to manage challenges that arise during the transition from hospital to home. Cultivating problem-solving skills before discharge may better prepare patients for the transition home. To determine the feasibility of a protocol to deliver Problem-Solving Training (PST) to stroke survivors during inpatient rehabilitation to increase goal achievement. Single-group feasibility study. Academic and county hospital inpatient rehabilitation units. Adult patients with stroke and planned discharge home. Up to six PST sessions over 2 to 3 wk followed by 3 mo of mobile health boosters. Of 17 eligible participants, 15 consented and 11 completed three or more PST sessions. Six participants used electronic boosters, achieving at least one goal postdischarge. Participants reported high satisfaction with PST (Client Satisfaction Questionnaire-8 M score = 29.3, SD = 4.4; range = 8-32), moderate depression at baseline (eight-item Patient Health Questionnaire [PHQ-8] score, M = 11.0, SD = 6.1; range = 0-27), mild depression at 3 mo postdischarge (PHQ-8 score, M = 8.3, SD = 5.5), moderately high self-efficacy at baseline (General Self-Efficacy Scale [GSE] score, M = 31.1, SD = 7.3; range = 10-40), and a self-efficacy increase at 3 mo postdischarge (GSE score, M = 34.1, SD = 4.2). PST among patients with stroke during inpatient rehabilitation was feasible, and participants demonstrated improvements in clinical outcomes and goal attainment. Barriers to participation and adherence should be addressed in future studies. What This Article Adds: Teaching patients problem-solving skills early after a stroke using a metacognitive strategy is feasible and may decrease depression and increase self-efficacy while fostering independent goal setting and problem solving.

Frequency and Characteristics of Medical Complications in Rehabilitation Settings: A Scoping Review.

To synthesize the available evidence on medical complications occurring in adult patients in subacute inpatient rehabilitation, and to describe the impact on subacute length of stay and readmission to acute care. Scoping review. Adult patients, within the inpatient rehabilitation environment, who experienced medical complications, clinical deterioration and/or the requirement of transfer to acute care. A systematic search of MEDLINE and CINAHL electronic databases was undertaken to identify primary research studies published in English and French between 2000 and 2021. Study reporting followed the standards indicated by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist (PRISMA-ScR). A total of 47 studies were identified for inclusion. Key results included differences in the type and frequency of complications according to admission type, the proportion of patients experiencing at least 1 complication, and complications associated with transfer to acute care. Patients admitted for inpatient rehabilitation are at high risk of medical complications and may not be medically stable during their admission, requiring care by clinicians with expertise in functional rehabilitation, and ongoing management by members of the multidisciplinary team with expertise in acute general medicine, infectious diseases and recognition and response to clinical deterioration.

Development and Validation of a Nomogram to Predict Hemiplegic Shoulder Pain in Patients With Stroke: A Retrospective Cohort Study

ObjectiveThe development and validation of a nomogram for the individualized prediction of hemiplegic shoulder pain (HSP) during the inpatient rehabilitation of patients with stroke. DesignRetrospective cohort study. SettingThe rehabilitation department at a tertiary hospital. ParticipantsA total of 376 patients (N=376) with stroke admitted to inpatient rehabilitation from January 2018 to April 2021 were included in this study. InterventionsNot applicable. Main Outcome MeasuresThe outcome measure was shoulder pain on the patients’ hemiplegic side occurring at rest or with movement during hospitalization. ResultsAmong the 376 patients with stroke, 113 (30.05%) developed HSP. Five independent predictors were included in the nomogram: subluxation, Brunnstrom stage, hand edema, spasticity, and sensory disturbance. The nomogram was a good predictor, with a C-index of 0.85 (95% confidence interval, 0.81-0.89) and corrected C-index of 0.84. The Homer-Lemeshow test (χ2=13.854, P=.086) and calibration plot suggested good calibration ability of the nomogram. The optimal cutoff value for the predicted probability of HSP was 0.30 (sensitivity, 0.73; specificity, 0.83). Moreover, the decision curve analysis revealed that the nomogram would add net clinical benefits if the threshold possibility of HSP risk was from 5%-88%. ConclusionsOur nomogram could accurately predict HSP, which may help clinicians accurately quantify the HSP risk in individuals and implement early interventions.

Individuals Receiving Inpatient Rehabilitation Show the Highest Objectively Measured Physical Activity Level During OT

Abstract Date Presented 04/01/2022 Many patients in inpatient rehabilitation may spend too much time being sedentary. According to our findings of objectively measured physical activity levels, individuals receiving inpatient rehabilitation were most physically active during OT but were more sedentary during nonrehabilitation times and days. Therapists should consider implementing individualized therapy plans for patients to perform independently and safely without a therapist present during inpatient rehabilitation. Primary Author and Speaker: Young Joo Kim Additional Authors and Speakers: Carley Overman, Anne E. Dickerson, Xiangming Fang, Heather Panczykowski

Changes in functional independence after inpatient rehabilitation in patients with spinal cord injury: A simultaneous evaluation of prognostic factors

Objective This study aimed to investigate the improvements of functional independence following inpatient rehabilitation and compare those improvements between different levels and severities of Spinal Cord Injury (SCI). Prognostic factors affecting the patient’s outcomes were also studied. Settings Rofeideh Rehabilitation Hospital. Outcome Measures Spinal Cord Independence Measure version III (SCIM III), and Functional Independence Measure (FIM). Method In this retrospective cohort study, 180 patients with SCI were enrolled to record their functional independence upon admission and discharge, and the changes were compared between different levels and severities of injury using non-parametric tests. The prognostic factors of outcomes were studied by generalized estimating equation (GEE) analysis. Results The independence changes were significant for all the severities (American Spinal Injury Association Impairment Scale (AIS)) and levels of injury except for the patients with AIS A and B at upper cervical levels (P < 0.05). The level of injury, AIS, Length of Stay (LOS), and pressure ulcer had a significant prognostic value on patient’s outcomes. Furthermore, there was a significant difference between different levels of injury with the same AIS grade in functional improvement (P < 0.05), while there was a significant difference between AIS groups with the same level of injury only at upper and middle cervical lesions (P < 0.05). Conclusion Recording the values of functional independence before and after rehabilitation in individuals with SCI can help clinicians approximately expect the outcomes of future patients. Moreover, a deeper study of the prognostic factors can provide a more logical expectation of rehabilitation outcomes.

Relationship Between Cachexia and the Functional Progress of Patients With Cancer in Inpatient Rehabilitation.

Although inpatient rehabilitation can improve functional independence in patients with cancer, the role of cachexia in this population is unknown. Our objectives were to:1) Establish prevalence of cachexia in a cohort of cancer patients receiving inpatient rehabilitation and its association with demographic and oncological history.2) Determine the relationship between the presence of cachexia and functional recovery and whether these patients in inpatient rehabilitation have a distinct prognosis. This is a retrospective cohort study of 250 patients over 330 admissions to an inpatient rehabilitation facility. Body weight loss threshold and Weight Loss Grading Scale identified patients with and without cachexia. Main outcomes were functional independence measure scores, discharge destination, and 6-mo survival. Prevalence of cachexia in inpatient rehabilitation was 59% using consensus body weight loss criteria, and 77% of cancer patients had a Weight Loss Grading Scale score greater than 0. Patients with and without cachexia had similar motor and cognitive gains, although patients with severe cachexia had more limited functional gains ( P < 0.05) and increased odds of acute care return ( P < 0.01). Patients with a Weight Loss Grading Scale score of 4 had decreased survival at 6 mos ( P < 0.05) compared with noncachectic patients. These data suggest that there is a relationship between cachexia and recovery for cancer patients that should be further studied in rehabilitation settings.

Patients' Health Literacy in Rehabilitation: Comparison between the Estimation of Patients and Health Care Professionals.

The term health literacy (HL) comprises the handling of health information and disease-specific and generic self-management skills, especially relevant for patients with chronic conditions. Health care professionals (HCPs) should correctly identify patients’ communication needs and their HL levels. Therefore, the aims of the study were (1) to determine inpatient medical rehabilitation patients’ HL based on self-assessment, (2) to evaluate changes from admission to discharge, (3) to identify HCPs estimation of patients’ HL, and (4) to compare the estimated patient HL by patients and HCPs. A combined cross-sectional and longitudinal study was conducted in an orthopedic rehabilitation center in Germany. The multidimensional Health Literacy Questionnaire (HLQ) was filled in by patients (admission, discharge). An adapted version was administered to HCPs (n = 32) in order to assess HL of individual patients. Data from 287 patients were used for the longitudinal analysis, and comparison was based on n = 278 cases with at least two HL estimations. The results showed a significant increase in HL in five of nine scales with small effect sizes. Moreover, HCPs mostly provided higher scores than patients, and agreement was poor to fair. Differences between the HL estimation might lead to communication problems, and communication training could be useful.

Sex and Racial/Ethnic Differences in Within-Stay Readmissions During Inpatient Rehabilitation Among Patients With Traumatic Brain Injury.

The aim of the study was to determine the association of sex and race/ethnicity with acute hospital readmissions ("within-stay readmissions") during inpatient rehabilitation facility care versus patients discharged home without a within-stay readmission among traumatic brain injury patients. The study used a secondary analysis ( N = 210,440) of Uniform Data System for Medical Rehabilitation data using multiple logistic regression. Within-stay readmissions occurred for 11.79% of female and 11.77% of male traumatic brain injury patients. Sex-specific models identified insurance, comorbidities, and complications factored differently in likelihood of within-stay readmissions among female than male patients but association of all other factors were similar per group. Within-stay readmissions differences were more pronounced by race/ethnicity: White, 11.63%; Black, 11.32%; Hispanic/Latino, 9.78%; and other, 10.61%. Descriptive bivariate analysis identified racial/ethnic patients with within-stay readmissions had greater days from traumatic brain injury to inpatient rehabilitation facility admission (White, 17.66; Black, 21.70; Hispanic/Latino, 23.81; other, 20.66) and lower admission cognitive and motor function. Factors differed across models predicting within-stay readmissions for race/ethnic groups; age, admission motor and cognitive function, complications, and length of stay were consistent across groups. This study demonstrates disparities by race/ethnicity for inpatient rehabilitation facility within-stay readmissions among traumatic brain injury patients and factors predictive of this potentially preventable outcome by sex and race/ethnicity. Findings could inform care planning and quality improvement efforts for TBI patients.

A Total Performance Score for Inpatient Rehabilitation Facilities: Stakeholder Perspectives

<h3>Research Objectives</h3> - To identify quality domains rehabilitation stakeholders consider the most important - To identify the percentage of an Inpatient Rehabilitation Total Performance Score that should represent the voice of the patient or their family - To identify the percentage of an Inpatient Rehabilitation Total Performance Score that should reflect what happened during the inpatient rehabilitation stay versus after the stay. <h3>Design</h3> We conducted a two-stage on-line survey of rehabilitation stakeholders. <h3>Setting</h3> The surveys was completed on-line. <h3>Participants</h3> To date, 29 respondents completed both surveys. Respondents were former inpatient rehabilitation patients, patient advocates, rehabilitation clinicians, rehabilitation researchers. <h3>Interventions</h3> Not Applicable. <h3>Main Outcome Measures</h3> Rating of quality measure domains, percentage of a inpatient rehabilitation Total Performance Score that should represent the patient's voice, percentage of a inpatient rehabilitation Total Performance Score that should reflect care during the inpatient stay. <h3>Results</h3> To date, 29 individuals completed both surveys (72% response rate), including 17 former patients and advocates and 12 clinicians, administrators, and researchers. When presented with the Donabedian model, respondents slightly favored outcome measures compared to process and structure measures. Among the 22 quality measure topics described, respondents considered the most important quality measures to be: discharge to the community, goal setting, discharge planning, functional assessment and goals, Improvement in mobility, new or worsened pressure ulcers/injuries (undesirable outcome). When asked what percentage of a Total Performance Score should represent the voice of the patient or their family, the mode was 30%. When asked what percentage of a Total Performance Score should reflect what happened during the inpatient rehabilitation stay versus after the stay, the mode was 75%. <h3>Conclusions</h3> Survey respondents supported quality measures in all three domains of the Donabedian model, slightly favoring outcome measures compared to process and structure measures. Respondents indicated that the patient's voice is important to consider in a inpatient rehabilitation Total Performance Score (mode = 30% weight) and indicated that care during the inpatient setting should be weighted more (mode = 75%) than the post-discharge (mode = 25%) time frame. <h3>Author(s) Disclosures</h3> Funding: RTI International

Abstract WMP43: Optimizing Therapy Intensity For Inpatient Stroke Rehabilitation: A Linear Programming Model For Cost

Background: Although the best practice guidelines in Canada recommended that stroke patients in inpatient rehabilitation receive a minimum of 3 hours of therapy 5 days per week, very few patients receive this amount of therapy as the national average is 90 minutes of therapy 5 days a week. Administrators have stated that is not feasible to provide the best practice amounts of therapy due to budget constraints. Therefore, the purpose of this study was to develop a linear programming model which assessed the feasibility of meeting Canadian guidelines for therapy amount in inpatient stroke rehabilitation. Methods: A linear programming model was developed based upon previously published works on the impacts of increasing therapy amount to the Canadian best practices. The objective function was to minimize cost. Decision variables included the hours of physiotherapy, occupational therapy, and speech-language pathology a moderate patient receives. Constraints included minimum and maximum hours of therapy, the relationship between therapy amount of length of stay, and the therapy time ratios Results: The optimal solution found that cost, when minimized with moderate patients, were provided with 1.2, 1.2, and 0.6 hours of physiotherapy, occupational therapy, and speech-language pathology respectively. This results in a 24.3-day length of stay. The total modeled cost was $18,253.55 per moderate patient. Based upon this model, the current Canadian average length of stay and therapy amount costs an additional $1,470.13 per moderate patient compared to the model solution. Conclusion: This work demonstrates that providing the best practice amount of therapy to patients may result in cost savings due to the reduction in length of stay, contradicting the commonly held notion that providing more therapy is not feasible from a financial point of view.