Role Of Inpatient Rehabilitation Research Articles

(056) Role of inpatient Rehabilitation in Managing Delirium: A Review

(056) Role of inpatient Rehabilitation in Managing Delirium: A Review

Heart transplantation and the role of inpatient rehabilitation: A narrative review.

Heart transplantation is a definitive treatment option for patients with end-stage heart failure. Medical and functional complications are common after this procedure, and rehabilitation is often needed postoperatively. Physiatrists caring for persons who have received a donor heart must appreciate the surgical background, the physiologic changes expected, as well as the potential medical complications for which they are at risk after heart transplantation. This review summarizes various topics in heart transplantation including the history of the procedure, exercise physiology and functional outcomes, postoperative medical therapy, medical complications, and special considerations for inpatient rehabilitation in this patient population.

The Role of Inpatient Rehabilitation After Pediatric Epilepsy Surgery for Refractory Epilepsy

Epilepsy surgery reduces seizure burden and antiepileptic use while improving quality of life. Neuroplasticity and rehabilitation aid in recovery after epilepsy surgery. We aimed to examine the impact and role of inpatient rehabilitation after epilepsy surgery in pediatric patients with refractory epilepsy. A retrospective chart review examined patients aged 0–18 years old undergoing epilepsy surgery for refractory epilepsy at our institution between 2012 and 2018, with subsequent admission to inpatient rehabilitation. Demographic, clinical, neurocognitive, and functional outcomes were measured. Thirty-six patients were included: 17 male (47.2%) and 19 female (52.8%). Mean age was 9.3 years (SD 5.2, range 1.1–18.9). The most common procedures were hemispherectomy (13, 36.1%) and lobectomy (12, 33.3%). The mean duration of rehabilitation was 16.2 days (SD 9.2, range 6–42). WeeFIMR scores improved after rehabilitation (65.6 vs. 49.3, p 0.05), and procedure type (p < 0.02), with more independent patients undergoing lobectomy compared with hemispherectomy. Admission and discharge WeeFIMR scores were higher in those functionally independent compared with those functionally dependent at last follow-up (p < 0.01 for all subscores). No difference in change in WeeFIMR was seen between those functionally independent vs. dependent at last follow-up (p < 0.11). Postoperative inpatient rehabilitation after pediatric epilepsy surgery is associated with functional improvement in self-care, mobility, and cognition, but may be influenced by age or procedure type.

Discharge from the acute hospital: trauma patients' perceptions of care.

Objective The involvement of orthopaedic trauma patients in the decision-making regarding discharge destination from the acute hospital and their perceptions of the care following discharge are poorly understood. The aim of the present study was to investigate orthopaedic trauma patient experiences of discharge from the acute hospital and transition back into the community. Methods The present qualitative study performed in-depth interviews, between October 2012 and November 2013, with patients aged 18-64 years with lower limb trauma. Thematic analysis was used to derive important themes. Results Ninety-four patients were interviewed, including 35 discharged to in-patient rehabilitation. Key themes that emerged include variable involvement in decision-making regarding discharge, lack of information and follow-up care on discharge and varying opinions regarding in-patient rehabilitation. Readiness for discharge from in-patient rehabilitation also differed widely among patients, with patients often reporting being ready for discharge before the planned discharge date and feeling frustration at the need to stay in in-patient care. There was also a difference in patients' perception of the factors leading to recovery, with patients discharged to rehabilitation more commonly reporting external factors, such as rehabilitation providers and physiotherapy. Conclusion The insights provided by the participants in the present study will help us improve our discharge practice, especially the need to address the concerns of inadequate information provision regarding discharge and the role of in-patient rehabilitation. What is known about the topic? There is no current literature describing trauma patient involvement in decision-making regarding discharge from the acute hospital and the perception of how this decision (and destination choice; e.g. home or in-patient rehabilitation) affects their outcome. What does this paper add? The present large qualitative study provides information on patients' opinion of discharge from the acute hospital following trauma and how this could be improved from their perception. Patients are especially concerned with the lack of information provided to them on discharge, their lack of involvement and understanding of the choices made with regard to their discharge and describe concerns regarding their follow-up care. There is also a feeling from the patients that they are ready to leave rehabilitation before their actual planned discharge date, a concept that needs further investigation. What are the implications for practitioners? The patient insights gained by the present study will lead to a change in discharge practice, including increased involvement of the patient in the decision-making in terms of discharge from both the acute and rehabilitation hospitals and a raised awareness of the need to provide written information and follow-up telephone calls to patients following discharge. Further research into many aspects of patient discharge from the acute hospital should be considered, including the use of rehabilitation prediction tools to ensure patient involvement in decision-making and a discharge and/or follow-up coordinator to ensure patients are aware of how to access information after discharge.

Poster 274 The Effects of Prolonged Hospitalizations on Service Dogs and the Role of Inpatient Rehabilitation: A Case Report

Poster 274 The Effects of Prolonged Hospitalizations on Service Dogs and the Role of Inpatient Rehabilitation: A Case Report

Inpatient Rehabilitation in Persons With Multiple Myeloma-Associated Fractures: An Analysis of 8 Consecutive Inpatient Admissions

As a result of the aging of the U.S. population and diagnostic advancements, the incidence of cancer has risen from 400 per 100,000 in 1975 to 475 per 100,000 in 2005. With early identification and treatment, however, the 5-year mortality for all cancers has decreased dramatically from 65% in the 1950s to 35% today [1]. The increased incidence and survivorship have heightened the interest in cancer rehabilitation, from management of neuromuscular complications and musculoskeletal pain to guiding cancer treatments based on anticipated impact on function. The issue of residual performance is especially pertinent because many people with early-stage cancers can look forward to a normal or near-normal life expectancy [2]. Understanding the pathology and stage of disease at presentation is crucial to maximize patient performance and quality of life (QOL) [3]. Specifically, hematologic malignancies in the United States account for 10% of all new cancers. Multiple myeloma (MM) represents 15% of those hematologic cancers, with an annual incidence of approximately 4 per 100,000 to 6 per 100,000 new diagnoses in the United States each year [4]. Given the myriad of complications resulting from MM and its treatment, including fracture, one might assume that many patients require inpatient rehabilitation at some point during the course of their disease. However, limited information is available on the role of inpatient rehabilitation in persons with MM. The purpose of this article is to provide insight into the common impairments, medical complications and management, and functional outcomes based on 8 consecutive cases of persons with MM and pathological fractures who were cared for at an inpatient rehabilitation unit.

Rehabilitation and the long-term outcomes of persons with trauma-related amputations

Objective: To examine the long-term outcomes of persons undergoing trauma-related amputations, and to explore factors affecting their physical, social, and mental health and the role of inpatient rehabilitation in improving such outcomes.Design: Abstracted medical records and interview data sought for a retrospective cohort of persons who had undergone a lower-limb trauma-related amputation.Participants: Patients identified with a principal or secondary diagnosis of a trauma-related amputation to the lower extremity at the University of Maryland Shock Trauma Center between 1984 and 1994. Patients with spinal cord injury or traumatic brain injury were excluded.Results: Of 146 patients who had trauma-related amputations to the lower limb at the University of Maryland Shock Trauma Center during the study period, nearly 9% died during the acute admission and 3.5% died after discharge. About 87% of all trauma-related amputations involved males, and roughly three quarters involved white persons. About 80% of all amputations occurred before age 40. The health profile of traumatic amputee subjects interviewed in the study (n = 78, 68% response rate) was systematically lower than that of the general US population for all SF-36 scores. The differences in profiles were largest among SF-36 scales sensitive to differences in physical health status, particularly physical functioning, role limitations due to physical health, and bodily pain. About one fourth of persons with a trauma-related amputation reported ongoing severe problems with the residual limb, including phantom pain, wounds, and sores. The number of inpatient rehabilitation nights significantly improved the ability of patients with amputation to function in their physical roles, increased vitality, and reduced bodily pain. Inpatient rehabilitation was also significantly correlated with improved vocational outcomes.Conclusions: These findings suggest a substantial effect of inpatient rehabilitation in improving long-term outcomes of persons with trauma-related amputations.

Rehabilitation and the long-term outcomes of persons with trauma-related amputations

Pezzin LE, Dillingham TR, MacKenzie EJ. Rehabilitation and the long-term outcomes of persons with trauma-related amputations. Arch Phys Med Rehabil 2000;81:292-300. Objective: To examine the long-term outcomes of persons undergoing trauma-related amputations, and to explore factors affecting their physical, social, and mental health and the role of inpatient rehabilitation in improving such outcomes. Design: Abstracted medical records and interview data sought for a retrospective cohort of persons who had undergone a lower-limb trauma-related amputation. Participants: Patients identified with a principal or secondary diagnosis of a trauma-related amputation to the lower extremity at the University of Maryland Shock Trauma Center between 1984 and 1994. Patients with spinal cord injury or traumatic brain injury were excluded. Results: Of 146 patients who had trauma-related amputations to the lower limb at the University of Maryland Shock Trauma Center during the study period, nearly 9% died during the acute admission and 3.5% died after discharge. About 87% of all trauma-related amputations involved males, and roughly three quarters involved white persons. About 80% of all amputations occurred before age 40. The health profile of traumatic amputee subjects interviewed in the study (n = 78, 68% response rate) was systematically lower than that of the general US population for all SF-36 scores. The differences in profiles were largest among SF-36 scales sensitive to differences in physical health status, particularly physical functioning, role limitations due to physical health, and bodily pain. About one fourth of persons with a trauma-related amputation reported ongoing severe problems with the residual limb, including phantom pain, wounds, and sores. The number of inpatient rehabilitation nights significantly improved the ability of patients with amputation to function in their physical roles, increased vitality, and reduced bodily pain. Inpatient rehabilitation was also significantly correlated with improved vocational outcomes. Conclusions: These findings suggest a substantial effect of inpatient rehabilitation in improving long-term outcomes of persons with trauma-related amputations. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation