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1.
Janet K. Freburger Dongmei Li Anna M. Johnson Erin P. Fraher 《Archives of physical medicine and rehabilitation》2018,99(6):1077-1089.e7
Objective
To identify predictors of therapist use (any use, continuity of care, timing of care) in the acute care hospital and community (home or outpatient) for patients discharged home after stroke.Design
Retrospective cohort analysis of Medicare claims (2010–2013) linked to hospital-level and county-level data.Setting
Acute care hospital and community.Participants
Patients (N=23,413) who survived the first 30 days at home after being discharged from an acute care hospital after stroke.Interventions
Not applicable.Main Outcome Measures
Physical and occupational therapist use in acute care and community settings; continuity of care across the inpatient and home or the inpatient and outpatient settings; and early therapist use in the home or outpatient setting. Multivariate logistic and multinomial logistic regression analyses were conducted to identify hospital-level, county-level, and sociodemographic characteristics associated with therapist use, continuity, and timing, controlling for clinical characteristics.Results
Seventy-eight percent of patients received therapy in the acute care hospital, but only 40.8% received care in the first 30 days after discharge. Hospital nurse staffing was positively associated with inpatient and outpatient therapist use and continuity of care across settings. Primary care provider supply was associated with inpatient and outpatient therapist use, continuity of care, and early therapist care in the home and outpatient setting. Therapist supply was associated with continuity of care and early therapist use in the community. There was consistent evidence of sociodemographic disparities in therapist use.Conclusions
Therapist use after stroke varies in the community and for specific sociodemographic subgroups and may be underused. Inpatient nurse staffing levels and primary care provider supply were the most consistent predictors of therapist use, continuity of care, and early therapist use. 相似文献2.
Chih-Ying Li Amol Karmarkar Deepak Adhikari Kenneth Ottenbacher Yong-Fang Kuo 《Archives of physical medicine and rehabilitation》2018,99(7):1279-1288.e1
Objective
To investigate the effects of age and sex on 30-, 60-, and 90-day hospital readmission after acute hospital discharge for individuals with traumatic brain injury (TBI).Design
Retrospective cohort study.Setting
Acute hospitals and postacute discharge settings.Participants
Individuals (N=52,877) with Diagnosis Related Group codes of TBI, who were divided into 4 age groups: 18 to 40, 41 to 65, 66 to 75, and ≥76 years.Interventions
Not applicable.Main Outcome Measures
All-cause hospital readmission.Results
Sex differences in 30-, 60-, and 90-day hospital readmission were found among all age groups (P<.05 for all). The largest sex differences in hospital readmission were in the 2 oldest groups (66–75 and ≥76y). For both sexes, the oldest group (≥76y) had the highest adjusted 90-day readmission risk (eg, 90-d readmission: odds ratio, 2.32 [95% confidence interval, 2.01–2.69] for men; odds ratio, 1.96 [95% confidence interval, 1.59–2.43] for women). Among those readmitted within 90 days, the youngest group (18–40y) had the highest cumulative readmission percentage (35% for both sexes) within the first week of hospital discharge.Conclusions
Age and sex were significantly associated with hospital readmission during the first 90 days postdischarge in our TBI sample. Specifically, those aged 66 to 75 or ≥76 years had the highest readmission risk over 90 days for both sexes. The findings suggest that clinicians should consider age and sex in discharge planning and for the entire episode of care for the population with TBI. 相似文献3.
Laura Coots Daras Melvin J. Ingber Jessica Carichner Daniel Barch Anne Deutsch Laura M. Smith Alan Levitt Joel Andress 《Archives of physical medicine and rehabilitation》2018,99(6):1049-1059
Objective
To examine facility-level rates of all-cause, unplanned hospital readmissions for 30 days after discharge from inpatient rehabilitation facilities (IRFs).Design
Observational design.Setting
Inpatient rehabilitation facilities.Participants
Medicare fee-for-service beneficiaries (N=567,850 patient-stays).Interventions
Not applicable.Main Outcome Measures
The outcome is all-cause, unplanned hospital readmission rates for IRFs. We adapted previous risk-adjustment and statistical approaches used for acute care hospitals to develop a hierarchical logistic regression model that estimates a risk-standardized readmission rate for each IRF. The IRF risk-adjustment model takes into account patient demographic characteristics, hospital diagnoses and procedure codes, function at IRF admission, comorbidities, and prior hospital utilization. We presented national distributions of observed and risk-standardized readmission rates and estimated confidence intervals to make statistical comparisons relative to the national mean. We also analyzed the number of days from IRF discharge until hospital readmission.Results
The national observed hospital readmission rate by 30 days postdischarge from IRFs was 13.1%. The mean unadjusted readmission rate for IRFs was 12.4%±3.5%, and the mean risk-standardized readmission rate was 13.1%±0.8%. The C-statistic for our risk-adjustment model was .70. Nearly three-quarters of IRFs (73.4%) had readmission rates that were significantly different from the mean. The mean number of days to readmission was 13.0±8.6 days and varied by rehabilitation diagnosis.Conclusions
Our results demonstrate the ability to assess 30-day, all-cause hospital readmission rates postdischarge from IRFs and the ability to discriminate between IRFs with higher- and lower-than-average hospital readmission rates. 相似文献4.
Laura Coots Daras Melvin J. Ingber Anne Deutsch Jennifer Gaudet Hefele Jennifer Perloff 《Archives of physical medicine and rehabilitation》2018,99(6):1060-1066
Objective
To examine whether there are differences in inpatient rehabilitation facilities' (IRFs') all-cause 30-day postdischarge hospital readmission rates vary by organizational characteristics and geographic regions.Design
Observational study.Setting
IRFs.Participants
Medicare fee-for-service beneficiaries discharged from all IRFs nationally in 2013 and 2014 (N = 1166 IRFs).Interventions
Not applicable.Main Outcome Measures
We applied specifications for an existing quality measure adopted by Centers for Medicare & Medicaid Services for public reporting that assesses all-cause unplanned hospital readmission measure for 30 days postdischarge from inpatient rehabilitation. We estimated facility-level observed and risk-standardized readmission rates and then examined variation by several organizational characteristics (facility type, profit status, teaching status, proportion of low-income patients, size) and geographic factors (rural/urban, census division, state).Results
IRFs’ mean risk-standardized hospital readmission rate was 13.00%±0.77%. After controlling for organizational characteristics and practice patterns, we found substantial variation in IRFs' readmission rates: for-profit IRFs had significantly higher readmission rates than did not-for-profit IRFs (P<.001). We also found geographic variation: IRFs in the South Atlantic and South Central census regions had the highest hospital readmission rates than did IRFs in New England that had the lowest rates.Conclusions
Our findings point to variation in quality of care as measured by risk-standardized hospital readmission rates after IRF discharge. Thus, monitoring of readmission outcomes is important to encourage quality improvement in discharge care planning, care transitions, and follow-up. 相似文献5.
Chih-Ying Li Amol Karmarkar Yu-Li Lin Yong-Fang Kuo Kenneth J. Ottenbacher James E. Graham 《Archives of physical medicine and rehabilitation》2018,99(3):598-602.e2
Objective
To investigate the effects of facility-level factors on 30-day unplanned risk-adjusted hospital readmission after discharge from inpatient rehabilitation facilities (IRFs).Design
Study using 100% Medicare claims data, covering 269,306 discharges from 1094 IRFs between October 2010 and September 2011.Setting
IRFs with at least 30 discharges.Participants
A total number of 1094 IRFs (N=269,306) serving Medicare fee-for-service beneficiaries.Interventions
Not applicable.Main Outcome Measures
Risk-standardized readmission rate (RSRR) for 30-day hospital readmission.Results
Profit status was the only provider-level IRF characteristic significantly associated with unplanned readmissions. For-profit IRFs had a significantly higher RSRR (13.26±0.51) than did nonprofit IRFs (13.15±0.47) (P<.001). After controlling for all other facility characteristics (except for accreditation status because of its collinearity with facility type), for-profit IRFs had a 0.1% point higher RSRR than did nonprofit IRFs, and census region was the only significant region-level characteristic, with the South showing the highest RSRR of all regions (type III test, P=.005 for both).Conclusions
Our findings support the inclusion of profit status on the IRF Compare website (a platform including IRF comparators to indicate quality of services). For-profit IRFs had a higher RSRR than did nonprofit IRFs for Medicare beneficiaries. The South had a higher RSRR than did other regions. The RSRR difference between for-profit and nonprofit IRFs could be due to the combined effects of organizational and regional factors. 相似文献6.
7.
Background
Understanding risk factors associated with readmission after lower extremity amputation may indicate targets for reducing readmission.Objective
To evaluate factors associated with all-cause 30-day readmission after lower extremity amputation procedures.Design
Retrospective cohort study.Setting
Inpatient.Patients
A total of 2480 patients who had lower extremity amputations between 2008 and 2014 were selected from national electronic medical record database, Cerner Health Facts.Methods
Univariate analysis of demographics, diagnoses, postoperative medications, and laboratory results were examined. Multivariate logistic regression models were used to identify characteristics independently associated with readmission overall and by amputation location—above the knee (AKA) or below the knee (BKA).Main Outcome Measurement
Readmission within 30 days of discharge.Results
More than one half of patients (1403, 57%) underwent BKA and 1077 (43%) underwent AKA. Readmission within 30 days was 22% (24.1% BKA versus 19.4% AKA, P = .005). In multivariable logistic regression, factors associated with 30-day readmission after any amputation included BKA (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.15-1.74, P = .001), hypertension (OR 1.70, 95% CI 1.33-2.16), surgical-site infections (OR 1.44, 95% CI 1.02-2.04), heart failure (OR 1.39, 95% CI 1.10-1.75), discharge to a skilled nursing facility (OR 1.88, 95% CI 1.41-2.51), and emergency/urgent procedures (OR 1.32, 95% CI 1.04-1.67). At readmission, 13.3% of patients with a BKA required an AKA revision, and 21.3% had a diagnosis of surgical-site infection.Conclusions
Risk factors for readmission after any amputation included cardiac comorbidities, associated postoperative medications, and discharge to a skilled nursing facility. The finding that acute arterial embolism or thrombosis and a BKA during the index admission was highly associated with readmission, combined with the high rates of 30-day conversion to an AKA when readmitted, suggests these patients more often develop stump complications or may be undertreated during the initial hospitalization.Level of Evidence
III 相似文献8.
9.
Samman Shahpar Alex W.K. Wong Susan Keeshin Sarah M. Eickmeyer Patrick Semik Masha Kocherginsky Stacy McCarty 《PM & R》2018,10(9):926-933
Background
Malignant brain tumors cause significant impairments in function because of the nature of the disease. Nevertheless, patients with malignant brain tumors can make functional gains equivalent to those with stroke and traumatic brain injury in the inpatient rehabilitation setting. However, the efficacy of outpatient rehabilitation in this population has received little study.Objective
To determine if an interdisciplinary outpatient rehabilitation program will improve functional outcomes in patients with malignant brain tumors.Design
Nonrandomized prospective longitudinal study.Setting
Six affiliated outpatient sites of one institution.Patients
Forty-nine adults with malignant brain tumors were enrolled.Methods
Patients received interdisciplinary therapy services, with duration determined by the therapist evaluations. The therapists scored the Day Rehabilitation Outcome Scale (DayROS) and Disability Rating Scale (DRS) on admission and discharge. The caregivers filled out the DRS at discharge, 1 month, and 3 months after discharge.Main Outcome Measurements
The primary study outcome measure was the DayROS, which is a functional measure similar to the Functional Independence Measure. DRS was another functional outcome measure assessing basic self-care, dependence on others, and psychosocial adaptability.Results
Forty-six of 49 enrolled patients (94%) completed the day rehabilitation program. The average length of stay was 76.9 days. There was a significant improvement in total DayROS (P < .001), mobility (P < .001), Activities of Daily Living ( P < .001), and communication (P < .001) DayROS subscores from admission to discharge. There were no significant changes over time in the DRS scores. Women had higher DayROS gains (P = .003) and better therapist DRS scores from admission to discharge than men (P = .010).Conclusions
Patients with malignant brain tumors can make functional gains in an interdisciplinary outpatient rehabilitation program. This level of care should be considered in this patient population.Level of Evidence
II 相似文献10.
Tracy M. Mroz Ann Meadow Elizabeth Colantuoni Bruce Leff Jennifer L. Wolff 《Archives of physical medicine and rehabilitation》2018,99(6):1090-1098.e4
Objective
To examine associations between organizational characteristics of home health agencies (eg, profit status, rehabilitation therapy staffing model, size, and rurality) and quality outcomes in Medicare beneficiaries with rehabilitation-sensitive conditions, conditions for which occupational, physical, and/or speech therapy have the potential to improve functioning, prevent or slow substantial decline in functioning, or increase ability to remain at home safely.Design
Retrospective analysis.Setting
Home health agencies.Participants
Fee-for-service beneficiaries (N=1,006,562) admitted to 9250 Medicare-certified home health agencies in 2009.Interventions
Not applicable.Main Outcome Measures
Institutional admission during home health care, community discharge, and institutional admission within 30 days of discharge.Results
Nonprofit (vs for-profit) home health agencies were more likely to discharge beneficiaries to the community (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.13–1.33) and less likely to have beneficiaries incur institutional admissions within 30 days of discharge (OR, .93; 95% CI, .88–.97). Agencies in rural (vs urban) counties were less likely to discharge patients to the community (OR, .83; 95% CI, .77–.90) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.24; 95% CI, 1.18–1.30) and within 30 days of discharge (OR, 1.15; 95% CI, 1.10–1.22). Agencies with contract (vs in-house) therapy staff were less likely to discharge beneficiaries to the community (OR, .79, 95% CI, .70–.91) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.09; 95% CI, 1.03–1.15) and within 30 days of discharge (OR, 1.17; 95% CI, 1.07–1.28).Conclusions
As payers continue to test and implement reimbursement mechanisms that seek to reward value over volume of services, greater attention should be paid to organizational factors that facilitate better coordinated, higher quality home health care for beneficiaries who may benefit from rehabilitation. 相似文献11.
Alexander J. Bajorek Chloe Slocum Richard Goldstein Jacqueline Mix Paulette Niewczyk Colleen M. Ryan Carla Tierney Hendricks Ross Zafonte Jeffrey C. Schneider 《PM & R》2017,9(1):1-7
Background
A significant proportion of burn injury patients are admitted to inpatient rehabilitation facilities (IRFs). There is increasing interest in the use of functional variables, such as cognition, in predicting IRF outcomes. Cognitive impairment is an important cause of disability in the burn injury population, yet its relationship to IRF outcomes has not been studied.Objective
To assess how cognitive function affects rehabilitation outcomes in the burn injury population.Design
Retrospective study.Setting
Inpatient rehabilitation facilities in the United States.Participants
A total of 5347 adults admitted to an IRF with burn injury between 2002 and 2011.Methods or Interventions
Multivariable regression was used to model rehabilitation outcome measures, using the cognitive domain of the Functional Independence Measure (FIM) instrument as the independent variable and controlling for demographic, medical, and facility covariates.Main Outcome Measurements
FIM total gain, readmission to an acute care setting at any time during inpatient rehabilitation, readmission to an acute care setting in the first 3 days of IRF admission, rate of discharge to the community setting, and length of stay efficiency.Results
Cognitive FIM total at admission was a significant predictor of FIM total gain, length of stay efficiency, and acute readmission at 3 days (P < .05). Cognitive FIM total scores did not have an impact on acute care readmission rate or discharge to the community setting.Conclusions
Cognitive status may be an important predictor of rehabilitation outcomes in the burn injury population. Future work is needed to further examine the impact of specific cognitive interventions on rehabilitation outcomes in this population.Level of Evidence
II 相似文献12.
Cameron J.B. Cunningham Heather C. Finlayson William R. Henderson Russell J. O’Connor Andrew Travlos 《PM & R》2018,10(5):494-500
Background
Critical illness polyneuromyopathy (CIPNM) increasingly is recognized as a source of disability in patients requiring intensive care unit (ICU) admission. The prevalence and impact of CIPNM on patients in the rehabilitation setting has not been established.Objectives
To determine the proportion of at-risk rehabilitation inpatients with evidence of CIPNM and the functional sequelae of this disorder.Design
Prospective observational study.Setting
Tertiary academic rehabilitation hospital.Patients
Rehabilitation inpatients with a history of ICU admission for at least 72 hours.Methods
Electrodiagnostic studies were performed to evaluate for axonal neuropathy and/or myopathy in at least one upper and one lower limb.Main Outcome Measurements
The primary outcome was prevalence of CIPNM. Secondary outcomes included Functional Independence Measure (FIM) scores, rehabilitation length of stay (RLOS), and discharge disposition.Results
A total of 33 participants were enrolled; 70% had evidence of CIPNM. Admission FIM score, discharge FIM, FIM gain, and FIM efficiency were 64.1, 89.9, 25.5, and 0.31 in those with CIPNM versus 78.4, 94.6, 16.1, and 0.33 in those without CIPNM, respectively. Average RLOS was 123 days versus 76 days and discharge to home was 57% versus 90% in the CIPNM and non-CIPNM groups, respectively.Conclusions
CIPNM is very common in rehabilitation inpatients with a history of ICU admission. It was associated with a lower functional status at rehabilitation admission, but functional improvement was at a similar rate to those without CIPNM. Longer RLOS stay may be required to achieve the same functional level.Level of Evidence
III 相似文献13.
Suzanne R. O&#x;Brien Ning Zhang 《Archives of physical medicine and rehabilitation》2018,99(1):107-115
Objectives
To determine the association between therapy intensity and discharge outcomes for aged Medicare skilled nursing facilities (SNFs) fee-for-service beneficiaries and to determine the association between therapy intensity and time to community discharge.Design
Retrospective observational design.Setting
SNFs.Participants
Aged Medicare fee-for-service beneficiaries (N=311,338) in 3605 SNFs.Interventions
The total minutes of physical therapy, occupational therapy, and speech therapy per day were divided into intensity groups: high (≥60min); medium-high (45–<60min); medium-low (30–<45min); and low (<30min).Main Outcome Measures
Four discharge outcomes—community, hospitalization, permanent placement, and death—were examined using a multivariate competing hazards model. For those associated with community discharge, a Poisson multivariate model was used to determine whether length of stay differed by intensity.Results
High intensity therapy was associated with more community discharges in comparison to the remaining intensity groups (hazard ratio, .84, .68, and .433 for medium-high, medium-low, and low intensity groups, respectively). More hospitalizations and deaths were found as therapy intensity decreased. Only high intensity therapy was associated with a 2-day shorter length of stay (incident rate ratio, .95).Conclusions
High intensity therapy was associated with desirable discharge outcomes and may shorten SNF length of stay. Despite growing reimbursements to SNFs for rehabilitation services, there may be desirable benefits to beneficiaries who receive high intensity therapy. 相似文献14.
Dawn B. Simpson Monique Breslin Toby Cumming Sam de Zoete Seana L. Gall Matthew Schmidt Coralie English Michele L. Callisaya 《Archives of physical medicine and rehabilitation》2018,99(11):2216-2221.e1
Objective
To examine whether change in rehabilitation environment (hospital or home) and other factors influence time spent sitting upright and walking after stroke.Design
Observational study.Setting
Two inpatient rehabilitation units and community residences following discharge.Participants
Participants (N=34) with stroke were recruited.Main Outcome Measure
An activity monitor was worn continuously for 7 days during the final week in the hospital and the first week at home. Other covariates included mood, fatigue, physical function, pain, and cognition. Linear mixed models were performed to examine the associations between the environment (exposure) and physical activity levels (outcome) in the hospital and at home. Interaction terms between the exposure and other covariates were added to the model to determine whether they modified activity with change in environment.Results
The mean age of participants was 68±13 years and 53% were male. At home, participants spent 45 fewer minutes sitting (95% CI -84.8, -6.1; P=.02), 45 more minutes upright (95% CI 6.1, 84.8; P=.02), and 12 more minutes walking (95% CI 5, 19; P=.001), and completed 724 additional steps (95% CI 199, 1250; P=.01) each day compared to in the hospital. Depression at discharge predicted greater sitting time and less upright time (P=.03 respectively) at home.Conclusions
Environmental change from hospital to home was associated with reduced sitting time and increased the time spent physically active, though depression modified this change. The rehabilitation environment may be a target to reduce sitting and promote physical activity. 相似文献15.
Gardner Yost Laura Coyle Kristen Milkevitch Roy Adair Antone Tatooles Geetha Bhat 《PM & R》2017,9(1):40-45
Background
Left ventricular assist devices (LVADs) have become an increasingly popular and effective means for treating advanced heart failure. LVAD implantation requires extensive surgery and postoperative rehabilitation. The Functional Independence Measure (FIM) has been used to quantify functional gains in numerous patient populations, including those with stroke and spinal cord injury. This study investigated functional improvements in patients undergoing LVAD implantation using the FIM score.Objective
To assess functional improvements in patients with advanced heart failure who underwent LVAD implantation.Design
Retrospective.Setting
Inpatient rehabilitation unit.Subjects
Ninety consecutive patients who received acute inpatient rehabilitation after continuous flow LVAD implantation.Methods
Demographic, laboratory, and functional outcomes data including inpatient rehabilitation unit (IRU) length of stay (LOS), discharge disposition, and FIM score were collected for all patients. Paired t-tests were used to assess change in functional measures and laboratory data.Main Outcome Measures
Primary outcome measures included FIM gain, FIM efficiency, discharge disposition, rates of readmission after discharge from rehabilitation, and LOS in the rehabilitation unit.Results
The FIM gain was statistically significant at 28.4 ± 12.3 (P < .001) and compared favorably with benchmarks for mean FIM gains at our facility (26.4), regionally (21.5), and nationally (22.7) for patients admitted to IRUs with a cardiac diagnosis. FIM efficiency (FIM gain/IRU LOS) was 1.9 ± 1.0 compared with the mean FIM efficiency at our facility (2.2), regionally (2.1), and nationally (2.2). Seventy-four percent (n = 67) of patients were discharged directly home after inpatient rehabilitation, 17% (n = 16) were readmitted to the acute hospital service, and 8% (n = 7) required additional rehabilitation at a subacute rehabilitation facility. The IRU LOS was 16.2 ± 6.9 days.Conclusions
Our study indicates that most patients with an LVAD achieve clinically meaningful functional gains from acute inpatient rehabilitation, with the majority of patients being discharged home. Further studies need to be performed to analyze clinical outcomes after acute inpatient rehabilitation.Level of Evidence
IV 相似文献16.
Penny Goldberg Giorgio Zeppieri Joel Bialosky Charlotte Bocchino Jon van den Boogaard Susan Tillman Terese L. Chmielewski 《Archives of physical medicine and rehabilitation》2018,99(1):43-48
Objective
To compare baseline kinesiophobia levels and their association with health-related quality of life across injury locations.Design
Retrospective cross-sectional study.Setting
Single, large outpatient physical therapy clinic within an academic medical center.Participants
Patients (N=1233) who underwent an initial evaluation for a diagnosis related to musculoskeletal pain and completed the 11-item version of the Tampa Scale for Kinesiophobia (TSK-11) and the Medical Outcomes Study 8-Item Short-Form Health Survey (SF-8) questionnaires within 7 days of their first visit were eligible for inclusion. Three hundred eighty patients were excluded because of missing data or because they were younger than 18 years. A total of 853 patients (mean age, 43.55y; range, 18–94y) were included.Interventions
Not applicable.Main Outcome Measures
Comparison of baseline kinesiophobia levels and their association with health-related quality of life across injury locations in an outpatient physical therapy setting.Results
Separate analysis of variance models compared TSK-11 scores based on involved body region, and Pearson correlation coefficients were used to examine the association between TSK-11 scores and the SF-8 subscales at each body region. TSK-11 scores did not differ by body region (range, 23.9–26.1). Weak to moderate negative correlations existed between kinesiophobia and the SF-8 subscales.Conclusions
Kinesiophobia levels appear elevated and negatively associated with health-related quality of life at initial physical therapy evaluation regardless of injury location. These findings suggest that physical therapists in outpatient orthopedic settings should implement routine kinesiophobia assessment and provide stratified care based on kinesiophobia levels across musculoskeletal conditions. 相似文献17.
Kosuke Kitano Takashi Asakawa Naoto Kamide Keisuke Yorimoto Masaki Yoneda Yutaka Kikuchi Makoto Sawada Tetsuo Komori 《Archives of physical medicine and rehabilitation》2018,99(10):2114-2117
Objective
To verify the effects of structured home-based exercises without supervision by a physical therapist in patients with early-stage amyotrophic lateral sclerosis (ALS).Design
A historical controlled study that is part of a multicenter collaborative study.Setting
Rehabilitation departments at general hospitals and outpatient clinics with a neurology department.Participants
Patients (N=21) with ALS were enrolled and designated as the home-based exercise (Home-EX) group, and they performed unsupervised home-based exercises. As a control group, 84 patients with ALS who underwent supervised exercise with a physical therapist for 6 months were extracted from a database of patients with ALS and matched with the Home-EX group in terms of their basic attributes and clinical features.Intervention
The Home-EX group was instructed to perform structured home-based exercises without supervision by a physical therapist that consisted of muscle stretching, muscle training, and functional training for 6 months.Main Outcome Measures
The primary outcome was the score on the ALS Functional Rating Scale–Revised (ALSFRS-R), which is composed of 3 domains: bulbar function, limb function, and respiratory function. The score ranges from 0 to 48 points, with a higher score indicating better function.Results
In the Home-EX group, 15 patients completed the home-based exercises for 6 months, and 6 patients dropped out because of medical reasons or disease progression. No adverse events were reported. The Home-EX group was found to have a significantly higher respiratory function subscore and total score on the ALSFRS-R than the control group at follow-up (P<.001 and P<.05, respectively).Conclusions
Structured home-based exercises without supervision by a physical therapist could be used to alleviate functional deterioration in patients with early-stage ALS. 相似文献18.
19.
Debra Parker Oliver Karla Washington George Demiris Audrey Wallace Marc R. Propst Aisha M. Uraizee Kevin Craig Margaret F. Clayton Maija Reblin Lee Ellington 《Journal of pain and symptom management》2018,55(3):922-929
Context
Shared decisions between health care providers and patients and families are replacing the traditional physician-driven plans of care. Hospice philosophy recognizes the patient and family as a unit of care and embraces their role in decision making.Objective
The goal of this study was to evaluate the shared decisions between hospice nurses and patients and family members.Methods
A secondary analysis of audio recordings of 65 home hospice nurse visits from 65 home hospice nurse visits in 11 different U.S. hospice programs.Results
To varying degrees, hospice nurses used all the recommended elements of shared decision making during home visits with patients and families; however, not all elements were used in every visit. The most commonly used element was defining a problem, and the least used element was the assessment of patient and family understanding.Conclusions
Hospice staff can benefit from a more purposeful shared decision-making process and a greater focus on assessment of patient and family understanding and ability to implement plans of care. 相似文献20.
Genevieve Hendrey Ross A. Clark Anne E. Holland Benjamin F. Mentiplay Carly Davis Cristie Windfeld-Lund Melissa J. Raymond Gavin Williams 《Archives of physical medicine and rehabilitation》2018,99(12):2430-2446