Physical Therapy Referrals Research Articles

Patterns of Physical Therapy Referral and Subsequent Attendance Among Childhood Cancer Survivors with Chemotherapy-Induced Peripheral Neuropathy at a Regional Childhood Cancer Survivorship Clinic

ObjectivesChildhood cancer survivors are at risk for chemotherapy-induced peripheral neuropathy (CIPN). Physical therapy (PT) improves CIPN symptoms, but little is known about survivors’ PT utilization. We described characteristics of survivors with ≥ grade 2 CIPN, investigated PT referral and attendance, and described characteristics of survivors who attended and did not attend PT. MethodsChildhood cancer survivors <21 years old at cancer diagnosis and ≥2 years posttherapy, living in the United States, evaluated at a regional survivorship clinic were included in this retrospective analysis if they had motor CIPN. Symptomatic CIPN (≥grade 2 by Common Terminology Criteria for Adverse Events) and PT referral/attendance were tabulated. Patient characteristics from the medical record, and neighborhood characteristics (retrieved using survivors’ zip code from the National Neighborhood Data Archive) were described by group. ResultsAmong 91 survivors with CIPN (median 17.5 years old, 8.1 years postcancer diagnosis, 45.1% female), 35 (38.5%) had ≥ grade 2 CIPN. Survivors with ≥ grade 2 CIPN were 28.6% female, and 45.7% were <13 years old. Twenty-four (68.6%) survivors with ≥ grade 2 CIPN agreed to PT referral, and 15 (42.9%) attended PT. Among survivors who attended PT, 73.3% were <13 years old. Neighborhood characteristics of survivors included median percentage of adults without a high school diploma (6.7% PT attendees, 12.5% nonattendees), median percentage of adults who are foreign-born (11.5% PT attendees, 16.4% nonattendees), and median percentage of households with an annual income of <$15,000 (3.2% PT attendees, 6.5% nonattendees). ConclusionsWhile 68.6% of survivors with ≥ grade 2 CIPN were referred to PT, only 42.9% attended. Studies to better understand barriers to PT attendance and interventions to improve attendance are needed, especially in older survivors. Implications for Nursing PracticeNurses can play a key role in survivor education and care coordination to help optimize PT attendance.

Treatment of Stress Urinary Incontinence: Does Race Matter?

The importance of this study was to examine treatment patterns and surgical complications for stress urinary incontinence (SUI). The aim of this study was to describe the treatment of SUI and associated complications in a racially and ethnically diverse population. This was a retrospective cohort study of patients with a new diagnosis of SUI. We identified patients who received treatment with a pessary, pelvic floor physical therapy, or surgery. Surgical complications were abstracted. Logistic regression was used to examine the association between race/ethnicity and treatment, as well as surgical complications. A total of 67,187 patients with a new diagnosis of SUI were included. The population was predominately Hispanic (47.5%) followed by White, Asian, Black, Native Hawaiian/Pacific Islander, and American Indian/Alaska Native. Comparing no treatment to any treatment, all racial/ethnic groups, except American Indian/Alaska Native, had decreased odds of receiving treatment compared with White women. Hispanic and Native Hawaiian/Pacific Islander women had increased odds of referral for pelvic floor physical therapy compared with White women. All racial/ethnic groups, except for American Indian/Alaska Native women, had decreased odds of receiving a sling procedure compared with White women. When these racial/ethnic minority groups did receive treatment, it was more likely to be conservative treatment compared with White women. There were no significant differences in individual surgical complications. Racial minority women were 20-50% less likely to undergo a sling procedure, commonly posited as the gold standard surgical treatment. Racial minority women were 40-100% more likely to receive conservative management and 20-50% less likely to receive any treatment compared with White women.

Preventing New Injuries after Upper Extremity Fracture in Older Adults: Opportunities in Orthopaedics and Physical Therapy Referrals

Preventing New Injuries after Upper Extremity Fracture in Older Adults: Opportunities in Orthopaedics and Physical Therapy Referrals

Prevalence of Pain and Its Relationship with Age and Sex among Patients in Saudi Arabia.

Studies investigating the prevalence of patients with pain referred for physical therapy in Saudi Arabia are scarce. This study aimed to estimate the period prevalence of pain that led to referrals for physical therapy and to evaluate the association between pain and patient age and sex. This retrospective study used data from the electronic health record system of a hospital for adult patients referred for physical therapy. In total, 7426 (26.0%) patients (mean (±SD) age, 51.4 ± 15.0 years) experienced pain, the majority of whom were female (65.8%). The back (30.7%) was the most commonly reported pain region, followed by the neck (13.2%), shoulders (12.1%), and knees (11.8%). The referring physician(s) identified pain in a specific body region in 5894 of the 7426 (79.4%) patients. A moderate correlation was found between sex and pain region (Cramer's V = 0.151, p < 0.001) and between age group and pain region (Cramer's V = 0.10, p < 0.001). Pain was prevalent among adult patients referred for physical therapy and was moderately associated with sex and age. Further research examining the prevalence of pain and its risk factors in a larger, representative sample of the population is warranted.

ADHERENCE TO INTERVENTIONS AT A FALL CLINIC: PRELIMINARY DESCRIPTIVE DATA FROM A SINGLE ACADEMIC INSTITUTION

Abstract Background Falls and fall-related injuries are major public health concerns. Approximately 50 billion dollars are spent on annual medical costs related to falls. Fall prevention is a priority for promoting active and healthy aging in older adults. Fall prevention clinics enable focused evaluation, identification, and treatment of modifiable risk factors, specifically for falls; however, their effectiveness is dependent upon patient adherence to preventive interventions. Methods We analyzed patients aged &amp;gt; 65 years who visited our fall clinic between February 2021 and February 2023. We took an interdisciplinary approach to improve adherence to recommendations, including follow-up phone calls by a dedicated nurse to confirm adherence, nurse-directed interventions such as Tai Chi sessions, and home environment assessments by a social worker. Results 48 patients were included in this analysis, with a mean age of 84 (65-99), and 85% were female. Fall-specific risk factors identified included impairment of strength, gait, or balance (96%); use of fall-risk-increasing medications (54%); problems with feet affecting gait (40%); visual impairment (29%); and postural hypotension (6%). The adherence rates for our interventions were 48% for physical therapy referrals, 28% for podiatry referrals, 36% for ophthalmology referrals, 47% for other referrals, 75% for vitamin D prescriptions, and 50% for assistive device prescriptions. Conclusions There is room for improvement in adherence to referrals. A larger sample size and longer follow-up period are required to investigate factors related to non-adherence. The delivery of both verbal and written recommendations, the identification of each patient’s barriers, and same-day referrals may help improve adherence.

Geriatric assessment-guided interventions for older adults with multiple myeloma: A feasibility and acceptability study

IntroductionGeriatric assessment (GA)-guided supportive care programs have been successful in improving treatment outcomes for older adults with solid-organ cancers. This study aimed to evaluate the feasibility of a GA-guided supportive care program among older adults treated for multiple myeloma (MM). Materials and MethodsThe study utilized an existing registry of adults with plasma cell disorders at the University of North Carolina. Patients with MM, aged 60 or older, and having a GA-identified deficit in one or more problem area were offered referrals to supportive care resources during routine visits. Problem areas included physical function deficits, polypharmacy, and anxiety or depression. Patients with physical function deficits were offered referral to physical therapy (PT), those with polypharmacy to an Oncology Clinical Pharmacist Practitioner (CPP), and those with mental health symptoms to the Comprehensive Cancer Support Program (CCSP). ResultsOf the 58 individuals identified as having at least one deficit on the GA, PT was the most commonly identified relevant resource (79%), followed by CPP visits (57%). Among individuals that were offered referral(s) to at least one new supportive care resource, the acceptance rate was 50%. Referral acceptance rates were highest among those recommended for a CPP visit (55% of those approached) and lowest for CCSP (0%). DiscussionThe study examined the feasibility and acceptability of a referral program for supportive care resources among older adults with MM who have deficits on GA. The most commonly identified deficit was physical functioning, followed by polypharmacy and mental health. The study found that physical interventions and referrals to CPPs were the most accepted interventions. However, the low proportion of patients who accepted physical therapy referrals indicates the need for tailored and more personalized approaches. Further research is needed to explore the feasibility and impact of supportive care referral programs for older adults with MM.

Chronic Sufferers and Environmental Conditions

Environmental conditions are associated with the onset of pain or the recurrence of symptoms of chronic sufferers either with musculoskeletal pathologies or neurological diseases. Recent research has indicated that physiotherapy also appears to be helpful in dealing with the symptoms of climate change. The purpose of this study was to investigate how temperature and precipitation are associated with referrals for physical therapy. All the data were collected retrospectively for three years, 2020–2022. A total of 2164 referrals were studied, 78% of which were female cases. Our results highlighted that (a) referrals with musculoskeletal problems are associated with the weather indicators of temperature and precipitation, (b) this relation was found to be stronger for females, and (c) there were slightly differentiated trends between them and those with neurological problems. These results suggest that low temperatures and high precipitation are strongly associated with increased referrals for chronic musculoskeletal pain and that females are more vulnerable to precipitation. Moreover, the increased number of referrals with chronic neurological problems was found to be associated with extreme temperatures. Considering these findings, rehabilitation centers and healthcare systems have the opportunity to immediately provide reliable and qualitative services, guided always by the safety and maximum relief of chronic sufferers.

Incidence, Radiologic and Dosimetric Parameters Associated with Radiation Induced Breast Lymphedema

Radiation induced breast lymphedema (BL) is an underreported but common finding. This study aimed to report the incidence of clinical BL and investigate the radiologic and dosimetric parameters associated with higher risk of BL. This IRB approved study included women with breast cancer who underwent breast conservative surgery followed by adjuvant radiation therapy between 2019 and 2021 at our institution. We reviewed the eligible patients' charts for incidence of clinical BL resulting in symptoms and requiring physical therapy referral. Thickness of the skin at defined center and bottom points of the breast was measured for patient' baseline and follow up mammograms. Dosimetric parameters were imported from patients' radiation plans including mean, maximum doses, and volumes receiving 20, 30, 40, & 50 Gy (V20, V30, V40, & V50), of the whole breast (WB), breast_eval (BE), and breast skin (BS) (defined as the superficial 5 mm of the skin). A chi-square test was used to test the association between clinical BL and radiation treatment regimens and beam energies and the association of skin thicknesses between those who had clinical BL and those who did not. A Wilcoxon rank sum test was used to test the association of the dosimetric parameters with clinical BL. We identified 268 patients who were eligible for the study. After chart and radiologic review, 119 patients had complete records available and were included in this study. Twenty-nine patients (24.4%) of the patients presented with symptomatic BL. Most patients (68%) received hypofractionated (42.56 Gy with or without 10 Gy boost), while 25% received conventional and 7% received ultra-hypofractionated radiotherapy. There was no association between the fractionation and incidence of BL (p = 0.4). There was no association between breast size and BL (mean 1065 cc vs 1232 cc, p = 0.35). There was significant association between BL and BS V30 (142cc vs 162 cc, p = 0.02), and BS V40 (82 cc vs 102 cc, p = 0.02), and a trend towards significant association with BS V20 (172cc vs. 193cc, p = 0.08), BS V50 (8 cc vs. 16 cc, p = 0.06). There was no significant association between BL and BS mean dose (36.9 Gy vs 39 Gy p = 0.11), or BS max dose (53.9 Gy vs 54.1 Gy, p = 0.21). None of the dosimetric parameters of WB and BE had significant association with clinical BL. Utilizing ROC analysis, there was significant association between clinical BL and the change of baseline mammogram breast skin thickness and skin thickness at 6 months follow up mammograms (+13 mm center point p = 0.04, +9 mm bottom point p<0.5), and at 12 months mammograms (+15 mm center point p<0.5, +11 mm bottom point p<0.5). Almost 1 in 4 women experienced radiation induced BL in our cohort. BS V30 & V40 are significantly associated with higher risk of BL. There was significant association between increased skin thickening in 6- and 12-months follow up mammograms and BL. Further analysis will follow to assess the association between surgical and clinical characteristics and BL.

Reducing Physical Therapy Consults for Patients With High Functional Mobility in the Acute Medical Inpatient Setting: A Difference-in-Difference Analysis

ObjectiveTo evaluate the effectiveness of clinical decision support for reducing misallocation of physical therapy (PT) consults. DesignA prospective quasi-experimental study. Between October 2018 and November 2021, routinely documented data on functional status and physical therapy referrals were collected from electronic medical records. SettingHospital Medicine and General Internal Medicine service lines at a large quaternary academic medical center. Participants20,810 adult patients hospitalized on any of the included treatment (hospital medicine) or control (general internal medicine) service lines. Main Outcome MeasureThe primary outcome was “change in proportion of misallocated PT consults” measured as likelihood of PT consults for patients admitted with high functional mobility scores. Changes in the primary outcome from the pre-intervention to post-intervention period were compared in the control and treatment groups using propensity score–weighted difference-in-differences multivariable logit regression adjusting for clinically relevant covariates. InterventionThe intervention period was measured for 20 months and consisted of a clinical decision support tool embedded in the daily note templates for hospital medicine providers. The tool provided education on patient mobility scores and their relation to need for PT consult. The tool was rolled out without any further announcements or education. ResultsOur cohort included 20,810 unique admissions (mean age 58.9, 55% women, 83% Black). Post-intervention, the likelihood of PT referrals for patients with high baseline mobility (AM-PAC >18) decreased by 7.3% (P<.001) for the treatment group compared with control, adjusted for age, sex, race, ethnicity, length-of-stay, and mobility change. ConclusionMobility score-based clinical decision support can decrease unneeded PT consults in the inpatient setting. This could help allocate therapy time for at-risk patients while also having a positive effect on health care systems.

The Impact of Physical Therapy After Lumbar Fusion Surgery.

Retrospective Cohort. To determine if outcomes varied between patients based on physical therapy (PT) attendance after lumbar fusion surgery. The literature has been mixed regarding the efficacy of postoperative PT to improve disability and back pain, as measured by patient-reported outcome measures. Given the prevalence of PT referrals and lack of high-quality evidence, there is a need for additional studies investigating the efficacy of PT after lumbar fusion surgery to aid in developing robust clinical guidelines. We retrospectively identified patients receiving lumbar fusion surgery by current procedural terminology codes and separated them into 2 groups based on whether PT was prescribed. Electronic medical records were reviewed for patient and surgical characteristics, PT utilization, and surgical outcomes. Patient-reported outcome measures (PROMs) were identified and compared preoperatively, at 90 days postoperatively and one year postoperatively. The two groups had similar patient characteristics and comorbidities and demonstrated no significant differences between readmission, complication, and revision rates after surgery. Patients that attended PT had significantly more fused levels (1.41 ± 0.64 vs. 1.32 ± 0.54, P =0.027), longer operative durations (234 ± 96.4 vs. 215 ± 86.1min, P =0.012), and longer postoperative hospital stays (3.35 ± 1.68 vs. 3.00 ± 1.49 days, P =0.004). All groups improved similarly by Oswestry Disability Index, short form-12 physical and mental health subsets, and back and leg pain by Visual Analog Scale at 90-day and 1-year follow-up. Our data suggest that physical therapy does not significantly impact PROMs after lumbar fusion surgery. Given the lack of data suggesting clear benefit of PT after lumbar fusion, surgeons should consider more strict criteria when recommending physical therapy to their patients after lumbar fusion surgery. Level-Ⅲ.

Should isolated superolateral Hoffa's fat pad edema identified by MRI be reported or ignored in adolescent patients?

Background and objectiveThe presence of superolateral Hoffa's fat pad (SHFP) edema is associated with several morphometric measurements related to patellar alignment and trochlear morphology. Our aim is to evaluate management implications in adolescent patients with isolated superolateral Hoffa's fat pad edema on MRI. Materials and methodsRetrospective review of 117 adolescents with knee MRI (mean 14.8 years old) with isolated superolateral Hoffa's fat pad edema. Patients with edema were separated into two groups based on the number of MRI axial slices involved with edema: group 1 (G1) of 27 patients with 1 slice vs group 2 (G2) of 90 patients with 2 or more slices. A comparison control group was used (45 patients who had normal MRI knees). Data points included % referral for physical therapy (PT) or surgery, Hoffa's fat pad edema, tibial tubercle-trochlear groove (TT-TG) distance and lateral trochlear inclination (LTI) angle. Fisher's exact and independent t-tests, ANOVA and regression models were used for statistical analysis. ResultsThere is statistically significant difference between Hoffa's fat pad edema patients and control regarding PT referral with G1: 70%, G2: 76%, and control: 53% (p = 0.03). There is statistically significant difference between these groups regarding TT-TG measurements with higher values in edema groups; G1: 11.9 mm±4.1, G2 13 mm ±4.1, and control 8.7 mm±3.6, (p = 0.001). There was a statistically significant association between edema and increased TT-TG distance (p = 0.001) but not LTI angle (p = 0.2). ConclusionMRI identification of isolated superolateral Hoffa's fat pad edema is positively associated with TT-TG distance and its presence is associated with higher referral rates to physical therapy for patella maltracking.

139 Reducing Physical Therapy Consults for Patients with High Functional Mobility in the Acute Medical Inpatient Setting: A Difference-in-Differences Analysis

OBJECTIVES/GOALS: Physical therapy (PT) is key for treating functional decline that inpatients experience but is a constrained resource in hospital settings. The Activity Measure Post-Acute Care (AM-PAC) score is a mobility measurement tool that has been used to define misallocation of PT. We aim to optimize PT referrals using AM-PAC-based clinical decision support . METHODS/STUDY POPULATION: We conducted a prospective study of patients admitted to University of Chicago Medical Center. AM-PAC scores were assessed by nursing staff every 12 hours. Clinical decision support was designed using validated AM-PAC cutoffs (&gt; 18, a predictor of discharge to home). The tool was embedded in hospital medicine note templates, requiring providers to indicate PT referral status based on current AM-PAC scores. The primary outcome, unskilled consult , was defined as PT referral for patients with AM-PAC &gt; 18. Data were collected for one year prior to implementation and one year after implementation for intervention (hospital medicine) and control (general internal medicine) services. Difference in differences analysis was used to assess the association between the intervention and unskilled consults. RESULTS/ANTICIPATED RESULTS: Between October 2018 and March 2021, 18,241 admissions were eligible for the study. Compared to preintervention, there was a lower rate of referral to PT for patients with high AM-PAC mobility scores in the post-intervention period [18.5% vs 16.6%; X2(1) = 7.02; p &lt; 0.01]. In the postintervention time period, the control group experienced a 2.6% increase in unskilled consults while the intervention group experienced a 2.3% decrease, a difference in differences of 4.9% (95% CI -0.07–-0.03 for difference in differences) controlling for age sex, race, LOS, and change in mobility. Compared to preintervention, there was no statistically significant difference in mean change in mobility score post-intervention for either group. DISCUSSION/SIGNIFICANCE: Our results suggest that clinical decision support can decrease unskilled PT consults. Many functionally independent patients can mobilize with nursing or other mobilization staff. Hospitals should consider mobility score-based decision support to prioritize PT for impaired and at-risk patients.

The Implementation of a Return-to-Play Protocol with Standardized Physical Therapy Referrals in a Collegiate Football Program: PT's Role in Return-to-Play, A Clinical Commentary.

Level V.

Health Literacy and Adherence to Clinical Recommendations in Head and Neck Cancer

After definitive cancer treatment, survivors of head and neck cancer (HNC) are commonly recommended to participate in therapies aimed at reducing the burden of treatment-related side effects. In this study, we evaluated whether adherence to referral to physical therapy (PT) and speech-language pathology therapy (SLPT) is related to patient health literacy (HL). This is a retrospective cohort analysis of patients attending a multidisciplinary HNC survivorship clinic between 2017 and 2019. HL was measured using the Brief Health Literacy Screen, with scores below 10 indicating inadequate HL. Chi-square and logistic regression were used to evaluate the association between HL and adherence to PT or SLPT referral. From the overall cohort (N = 454), 80 patients (18%) had inadequate HL. Compared to those with adequate HL, patients with inadequate HL were significantly less likely to complete initial PT evaluation (74% vs. 58%, p = .034) but were not significantly less likely to complete initial SLPT evaluation (70% vs. 61%, p = .37). After adjusting for age, primary tumor site, and treatment stage, we found that patients with inadequate HL were half as likely to follow up for initial PT evaluation (odds ratio 0.45, p = .032). Overall, inadequate HL is associated with reduced adherence to PT but is not associated with adherence to SLPT among HNC survivors. These results highlight the clinical importance of HL and underscore the need for interventions to facilitate adherence to treatment for patients with inadequate HL. [HLRP: Health Literacy Research and Practice. 2023;7(1):e52-e60.].

Clinical Decision Trees to Guide Physical Therapy Management of Persons with Huntington's Disease.

In 2020, our group published physical therapy clinical practice guidelines (CPG) for people with Huntington's disease (HD). The guideline recommendations were categorized according to six primary movement impairment classifications. To facilitate implementation of this CPG, we have developed guideline-based algorithms for physical therapy assessments and interventions and recommendations for therapists to overcome barriers to CPG implementation for people with HD. We conducted a literature review of papers that evaluated physical therapy interventions in individuals with HD (n = 26) to identify assessments for each of the primary movement impairment classifications, and then searched for papers (n = 28) that reported their clinometric/psychometric properties in HD. Assessments were evaluated using modified Movement Disorder Society Committee on Rating Scales criteria and other relevant criteria. We identified a "core set" of physical therapy assessments for persons with HD, including the Six Minute Walk Test, Timed Up and Go Test, Berg Balance Scale, and the Medical Outcomes Study Short Form 36 (SF-36). We then developed guideline-based decision trees to assist in decision making and implementation of the CPG into practice for persons with HD across the continuum of care. Finally, we developed strategies for overcoming barriers to implementation, such as seeking specialized training in HD, engaging caretakers or family members to help the person with HD to exercise, and establishing clinical pathways that support early physical therapy referrals. Knowledge translation documents such as this are essential to promoting implementation of the physical therapy CPGs into clinical practice.

Effects of an electronic health record-based mobility assessment and automated referral for inpatient physical therapy on patient outcomes: A quasi-experimental study.

To assess the effectiveness of a hospital physical therapy (PT) referral triggered by scores on a mobility assessment embedded in the electronic health record (EHR) and completed by nursing staff on hospital admission. EHR and billing data from 12 acute care hospitals in a western Pennsylvania health system (January 2017-February 2018) and 11 acute care hospitals in a northeastern Ohio health system (August 2019-July 2021). We utilized a regression discontinuity design to compare patients admitted to PA hospitals with stroke who reached the mobility score threshold for an EHR-PT referral (treatment) to those who did not (control). Outcomes were hospital length of stay (LOS) and 30-day readmission or mortality. Control variables included demographics, insurance, income, and comorbidities. Hospital systems with EHR-PT referrals were also compared to those without (OH hospitals as alternative control). Subgroup analyses based on age were also conducted. We identified adult patients with a primary or secondary diagnosis of stroke and mobility assessments completed by nursing (n=4859 in PA hospitals, n=1749 in OH hospitals) who completed their inpatient stay. In the PA hospitals, patients with EHR-PT referrals had an 11.4 percentage-point decrease in their 30-day readmission or mortality rates (95% CI -0.57, -0.01) relative to the control. This effect was not observed in the OH hospitals for 30-day readmission (β=0.01; 95% CI -0.25, 0.26). Adults over 60 years old with EHR-PT referrals in PA had a 26.2 percentage-point (95% CI -0.88, -0.19) decreased risk of readmission or mortality compared to those without. Unclear relationships exist between EHR-PT referrals and hospital LOS in PA. Health systems should consider methodologies to facilitate early acute care hospital PT referrals informed by mobility assessments.

Stair climbing: A time efficient and cost effective exercise protocol for fitness in young healthy females

Background:&#x0D; Physical therapy intervention is a substantial regime in prevention and management of postpartum complications including both systemic and psychological illnesses.&#x0D; Purpose:&#x0D; It is to determine the frequency of physical therapy referrals during postpartum period in Pakistan in addition to frequency of mothers attending physical therapy sessions as well as the most commonly reported complains after delivery.&#x0D; Method:&#x0D; It was a cross sectional study conducted in twin cities of Pakistan. Data was collected from 384 mothers in their postpartum period through a self-structured questionnaire after taking verbal and written consent. It inquired whether the subject was aware of physical therapy, referred for physical therapy, and attended physical therapy sessions in addition to the most commonly reported complain amongst mothers in the postpartum period. Data collected was kept confidential.&#x0D; Results:&#x0D; The mean age of participants was 25.76±4.09. Out of 384 women, only 138(35.9%) reported to have awareness regarding physical therapy and merely 89(23.2%) were actually referred for physical therapy in postpartum period and attended the sessions. Back pain and urinary incontinence were amongst the most commonly reported complains in postpartum period.&#x0D; Conclusion:&#x0D; It is concluded that the rate of referral to physical therapy is very low in a developing country like Pakistan irrespective of any complications faced by mothers in postpartum period. Furthermore, females who did consult a physical therapist after referral got lost to follow-ups.

A Comparison of Minimally Invasive Achilles Repair Techniques on Functional Outcome and Failure Rates

Category: Sports; Ankle Introduction/Purpose: The incidence of Achilles tendon ruptures (ATR) is 21.5 per 100,000 people, making it the most common tendon rupture of the lower extremity. Repair methods consist of the traditional open, indirect repair with suture anchors (Midsubstance SpeedBridge, MSB), or jig-assisted technique (Percutaneous Achilles Repair System, PARS) with MSB; the latter two being minimally invasive. Early mobilization is crucial for restoration of tendon strength and function. The available literature shows minimally invasive techniques allow early weight-bearing but lacks the direct comparison of the techniques on clinical recovery duration and patient outcomes. The purpose of the study was to compare safety (i.e., risk of re-rupture) and efficiency (i.e., days to medical clearance) between the traditional open, MSB, and PARS with MSB techniques for ATR repair. Methods: This retrospective study used the CPT code 27650 and yielded 103 patients that underwent a primary ATR between 2017 to 2021 that were managed by three fellowship-trained orthopedic surgeons. After excluding chronic tendinopathy, revisions, patients lost to follow up or non-compliance, 41 acutely injured patients remained. Patients were followed until medical clearance or they reached Maximal Medical Improvement (MMI). The chart review included complications (e.g., infection, healing issues, nerve issues, re-rupture), referral to physical therapy (PT), days non-weight bearing (NWB), physical exam findings, and patient compliance with recommendations. Continuous variables were examined using one-way ANOVAs, one-way ANCOVAs, Independent-Samples Median Tests, or Kruskall-Wallis H Tests for age, body mass index (BMI), recovery duration, days NWB, and days until PT referral. Chi-square tests or Fisher's Exact tests were performed to compare proportions for sex, and complications. Bonferroni adjustments were performed for post hoc testing. Results: 41 patients (39.7 +- 24 years old; 38 males; 7 females) and BMI of 30.3 +- 6.1 kg/m2 underwent an ATR repair. There were no significant differences between groups for re-rupture rates (none reported), complications (P = 0.245), age (P = 0.497), or BMI (P = 0.908). There were significant differences in recovery duration (P = 0.004) and days NWB (P = 0.001). After controlling for days NWB, recovery duration was significantly different between groups [F(2,41) = 6.098, P = 0.005; partial h2 = 0234]. Recovery duration for PARS (119.2 +- 44.0 days) was significantly quicker than both open (169.4 +- 41.6 days; P = 0.019) and MSB (167.2 +- 31.2 days; P = 0.009), but no differences between open and MSB (P = 1.00). Conclusion: The PARS with MSB method had a much shorter recovery duration with clearance occurring 50 days faster than other techniques. It is possible the PARS with MSB technique allowed for earlier mobilization which contributed to an accelerated recovery. Non-weight bearing days and early initiation of PT could be a factor in recovery duration and warrants further exploration. Future prospective research with a more homogenous patient population with a focus on early rehabilitation will provide greater insight.

Improving Mobility Practices of Critically Ill Children.

This quality improvement project aimed to improve mobility practices in a pediatric intensive care unit. Three interventions were implemented: a staff-developed mobility progression guideline (including patient mobility phase identification using animal images), physical therapy (PT), and occupational therapy (OT) referrals for all patients with expected hospitalizations of more than 3 days, and the use of activity goal posters. The frequency of mobility activities performed, the number of PT and OT referrals and nurses' confidence in mobilizing patients were compared before and after project implementation. Improvements occurred in the median number of daily mobility activities per patient encounter (1.5-4.0), number of PT and OT referrals (43% and 61% increase, respectively), and nurses' confidence in mobilizing patients (69% of clinical nurses agreed their confidence in mobilizing patients improved after protocol implementation). Implementation of an interprofessional mobility quality improvement project improved mobility practices in the pediatric intensive care unit.

Activity Measure for Post-Acute Care “6-Clicks” Basic Mobility Scores Predict Discharge Destination After Acute Care Hospitalization in Select Patient Groups: A Retrospective, Observational Study

ObjectivesTo establish cutoff scores for the Activity Measure for Post-Acute Care “6-Clicks” standardized Basic Mobility scores (sBMSs) for predicting discharge destination after acute care hospitalization for diagnostic subgroups within an acute care population and to evaluate the need for a second score to improve predictive ability. DesignRetrospective, observational design. SettingMajor medical center in metropolitan area. ParticipantsElectronic medical records of 1696 adult patients (>18 years) admitted to acute care from January to October 2018. Records were stratified by orthopedic, cardiac, pulmonary, stroke, and other neurological diagnoses (N=1696). Interventions: None Main Outcome MeasurePhysical therapists scored patients’ sBMSs after referral for physical therapy and prior to discharge. Receiver operating characteristic curves delineated sBMS cutoff scores distinguishing various pairings of home, home with services, inpatient rehabilitation, or skilled nursing facility discharges. First and second sBMSs were compared with percentage change of the area under the curve and inferential statistics. ResultsHome vs institution cutoff score was 42.88 for combined sample, pulmonary and neurological cases. The cutoff score for orthopedic diagnoses score was 41.46. Cardiac and stroke model quality invalidated cutoff scores. Home without services vs skilled nursing discharges and home with services vs skilled nursing discharges were predicted with varying cutoff scores per diagnosis. sBMS cutoff scores collected closer to discharge were either the same or higher than first cutoffs, with varying effects on predictive ability. ConclusionssBMSs can help decide institution vs home discharge and finer distinctions among discharge settings for some diagnostic groups. A single sBMS may provide sufficient assistance with discharge destination decisions but timing of scoring and diagnostic group may influence cutoff score selection.