Skilled Nursing and Inpatient Rehabilitation Facility Use by Medicare Fee-for-Service Beneficiaries Discharged Home After a Stroke: Findings From the COMPASS Trial

ObjectivesTo examine the effect of a comprehensive transitional care model on the use of skilled nursing facility (SNF) and inpatient rehabilitation facility (IRF) care in the 12 months after acute care discharge home following stroke; and to identify predictors of experiencing a SNF or IRF admission following discharge home after stroke.DesignCluster randomized pragmatic trialSettingForty-one acute care hospitals in North Carolina.Participants2262 Medicare fee-for-service beneficiaries with transient ischemic attack or stroke discharged home. The sample was 80.3% White and 52.1% female, with a mean (SD) age of 74.9 (10.2) years and a mean ± SD National Institutes of Health stroke scale score of 2.3 (3.7).InterventionComprehensive transitional care model (COMPASS-TC), which consisted of a 2-day follow-up phone call from the postacute care coordinator and 14-day in-person visit with the postacute care coordinator and advanced practice provider.Main Outcome MeasuresTime to first SNF or IRF and SNF or IRF admission (yes/no) in the 12 months following discharge home. All analyses utilized multivariable mixed models including a hospital-specific random effect to account for the non-independence of measures within hospital. Intent to treat analyses using Cox proportional hazards regression assessed the effect of COMPASS-TC on time to SNF/IRF admission. Logistic regression was used to identify clinical and non-clinical predictors of SNF/IRF admission.ResultsOnly 34% of patients in the intervention arm received COMPASS-TC per protocol. COMPASS-TC was not associated with a reduced hazard of a SNF/ IRF admission in the 12 months post-discharge (hazard ratio, 1.20, with a range of 0.95-1.52) compared to usual care. This estimate was robust to additional covariate adjustment (hazard ratio, 1.23) (0.93-1.64). Both clinical and non-clinical factors (ie, insurance, geography) were predictors of SNF/IRF use.ConclusionsCOMPASS-TC was not consistently incorporated into real-world clinical practice. The use of a comprehensive transitional care model for patients discharged home after stroke was not associated with SNF or IRF admissions in a 12-month follow-up period. Non-clinical factors predictive of SNF/IRF use suggest potential issues with access to this type of care.     

Health information seeking by women with physical disabilities: A qualitative analysis

BackgroundHealth information seeking is critical to medical decision-making and optimal health. Although researchers have begun to explore how people with disabilities search for health information, no studies have investigated health information seeking by women with physical disabilities.ObjectiveThe purpose of this qualitative study was to examine the health information seeking experiences of women with physical disabilities.MethodWe conducted a series of semi-structured, online focus group meetings with 21 women with disabilities. Sessions were recorded and transcribed, and data were analyzed using conventional content analysis.ResultsTwo broad themes emerged: 1) pathways to information on general health; sexual and reproductive health; as well as bowel, bladder, and other pelvic health issues; and 2) perceived facilitators and barriers to obtaining health information. Information pathways differed by the type of information sought. Internet was a commonly used resource, with a high value placed on social media interaction among peers. Self-advocacy emerged as a prominent facilitator of health information seeking. Barriers identified were lack of disability-related education, limited accessibility, and providers’ negative attitudes.ConclusionThis is the first known in-depth qualitative exploration of health information seeking by women with disabilities. Study findings revealed pathways to information commonly used by women with disabilities. The study also identified notable gaps and challenges to health information seeking including the need for improved provider education and training. Findings highlight the importance of the availability and accessibility of high quality, health-related information essential for the health and well-being of women with disabilities.     

Effectiveness of Mirror Therapy for Phantom Limb Pain: A Systematic Review and Meta-analysis

ObjectiveTo evaluate the effectiveness of mirror therapy (MT) for phantom limb pain (PLP).Data SourcesPubMed, EMBASE, Ovid MEDLINE, Scopus, Cochrane Library, Physiotherapy Evidence Database, CNKI, and WanFang Data were used to search for studies published up to March 31, 2021.Study SelectionRandomized controlled trials (RCTs) comparing the pain intensity of MT for PLP were performed. A total of 2094 articles were found. Among them, 10 were eligible for the final analysis.Data ExtractionThe quality of the RCTs was assessed using the Physiotherapy Evidence Database (PEDro) scale by 2 independent reviewers. Outcome data were pooled according to follow-up intervals (1, 3, 6, and 12mo). Duration times were used as a basis for distinguishing subgroups. The primary evaluation was by visual analog scale. The PEDro scale was used to assess the methodological quality of studies.Data SynthesisMeta-analysis revealed a statistically significant decrease in pain in the MT group vs the control group within 1 month (I²=0%; standardized mean difference [SMD]=?0.46, 95% confidence interval [CI], ?0.79 to ?0.13; P = .007). The patients with pain for longer than 1 year benefited more from MT (I²=0%; SMD=?0.46; 95% CI, ?0.85 to ?0.07; P = .02).ConclusionsMT has beneficial effects for patients with PLP in the short-term, as evidenced by their improved pain scores. There was no evidence that MT had a long-term effect, but that may be a product of limited data. For patients with long-term PLP, MT may be an effective treatment.     

First-Time Lumbar Medial Branch Radiofrequency Ablation: Patient-Reported Outcomes Measurement Information System as a Metric of Outcome

ObjectiveTo investigate the ability of Patient-Reported Outcomes Measurement Information System (PROMIS) to capture the therapeutic effect of first-time medial branch radiofrequency ablation (RFA).DesignBefore-after trial.SettingSingle academic spine center.ParticipantsPatients who underwent first-time medial branch RFA for lumbar facet joint pain identified by dual comparative medial branch block with ≥80% pain relief between January 1, 2015 and September 1, 2019 were identified using procedural billing codes. Charts were reviewed manually to confirm accuracy and strict adherence to the 80% pain relief threshold for each medial branch block. Thirty-nine patients met the criteria and were included in this study (N=39).InterventionsMedial branch RFA.Main Outcome MeasuresPROMIS score domains of Depression, Pain Interference, and Physical Function collected pre- and post RFA were compared. Pretreatment scores were within 6 weeks prior to the first medial branch block. Posttreatment scores were between 5 weeks and 6 months after RFA. Paired-sample t test analyses were used to calculate responsiveness to treatment, with significance assigned as P<.05 prior to acquiring data. Effect size was calculated using Cohen's d.ResultsPROMIS domains of Pain Interference and Physical Function demonstrated a statistically significant improvement (P=.004 and P=.017, respectively). The PROMIS domain of Depression did not demonstrate a statistically significant change (P=.12). The effect size was medium (d=?0.43) for Pain Interference, small/medium (d=0.31) for Physical Function, and small (d=-0.12) for Depression.ConclusionsMedial branch RFA as a treatment for lumbar facet syndrome is associated with a statistical improvement in PROMIS domains of Physical Function and Pain Interference.