Implementing a 6-day physiotherapy service in rehabilitation: exploring staff perceptions

2019 ◽  
Vol 43 (1) ◽  
pp. 29
Author(s):  
Erin L. Caruana ◽  
Suzanne S. Kuys ◽  
Jane Clarke ◽  
Sandra G. Brauer
Keyword(s):  
Goal Attainment ◽  
Functional Independence ◽  
Rehabilitation Service ◽  
Staff Perceptions ◽  
Open Communication ◽  
Rehabilitation Unit ◽  
Physiotherapy Service ◽  
Before And After ◽  
Multidisciplinary Staff ◽  
Staff Engagement

Objective Australian weekend rehabilitation therapy provision is increasing. Staff engagement optimises service delivery. The present mixed-methods process evaluation explored staff perceptions regarding implementation of a 6-day physiotherapy service in a private rehabilitation unit. Methods All multidisciplinary staff working in the rehabilitation unit were surveyed regarding barriers, facilitators and perceptions of the effect of a 6-day physiotherapy service on length of stay (LOS) and patient goal attainment at three time points: before and after implementation, as well as after modification of a 6-day physiotherapy service. Descriptive statistics and thematic analysis was used to analyse the data. Results Fifty-one staff (50%) responded. Before implementation, all staff identified barriers, the most common being staffing (62%) and patient selection (29%). After implementation, only 30% of staff identified barriers, which differed to those identified before implementation, and included staff rostering and experience (20%), timing of therapy (10%) and increasing the allocation of patients (5%). Over time, staff perceptions changed from being unsure to being positive about the effect of the 6-day service on LOS and patient goal attainment. Conclusion Staff perceived a large number of barriers before implementation of a 6-day rehabilitation service, but these did not eventuate following implementation. Staff perceived improved LOS and patient goal attainment after implementation of a 6-day rehabilitation service incorporating staff feedback. What is known about this topic? Rehabilitation weekend services improve patient quality of life and functional independence while reducing LOS. What does this study add? Staff feedback during implementation and modification of new services is important to address potential barriers and ensure staff satisfaction and support. What are the implications for practitioners? Staff engagement and open communication are important to successfully implement a new service in rehabilitation.

Adipokines as Potential Biomarkers in the Neurorehabilitation of Obese Stroke Patients

2020 ◽  
Vol 17 (4) ◽  
pp. 437-445
Author(s):  
Irene Ciancarelli ◽  
Giovanni Morone ◽  
Marco Iosa ◽  
Stefano Paolucci ◽  
Loris Pignolo ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Functional Recovery ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Enzyme Linked Immunosorbent Assay ◽  
Stroke Patients ◽  
Rehabilitation Outcomes ◽  
Before And After ◽  
Forward Stepwise ◽  
Clinical Measures

Background: Limited studies concern the influence of obesity-induced dysregulation of adipokines in functional recovery after stroke neurorehabilitation. Objective: To investigate the relationship between serum leptin, resistin, and adiponectin and functional recovery before and after neurorehabilitation of obese stroke patients. The adipokine potential significance as prognostic markers of rehabilitation outcomes was also verified. Methods: Twenty obese post-acute stroke patients before and after neurorehabilitation and thirteen obese volunteers without-stroke, as controls, were examined. Adipokines were determined by commercially available enzyme-linked immunosorbent assay (ELISA) kits. Functional deficits were assessed before and after neurorehabilitation with the Barthel Index (BI), modified Rankin Scale (mRS), and Functional Independence Measure (FIM). Results: Compared to controls, higher leptin and resistin values and lower adiponectin values were observed in stroke patients before neurorehabilitation and no correlations were found between adipokines and clinical outcome measures. Neurorehabilitation was associated with improved scores of BI, mRS, and FIM. After neurorehabilitation, decreased values of Body Mass Index (BMI) and resistin together increased adiponectin were detected in stroke patients, while leptin decreased but not statistically. Comparing adipokine values assessed before neurorehabilitation with the outcome measures after neurorehabilitation, correlations were observed for leptin with BI-score, mRS-score, and FIM-score. No other adipokine levels nor BMI assessed before neurorehabilitation correlated with the clinical measures after neurorehabilitation. The forward stepwise regression analysis identified leptin as prognostic factor for BI, mRS, and FIM. Conclusions: Our data show the effectiveness of neurorehabilitation in modulating adipokines levels and suggest that leptin could assume the significance of biomarker of functional recovery.

scholarly journals Factors Related to Greater Functional Recovery after Suffering a Stroke

2021 ◽  
Vol 11 (6) ◽  
pp. 802
Author(s):  
María Vázquez-Guimaraens ◽  
José L. Caamaño-Ponte ◽  
Teresa Seoane-Pillado ◽  
Javier Cudeiro
Keyword(s):  
Functional Status ◽  
Hospital Discharge ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Primary Diagnosis ◽  
Rehabilitation Service ◽  
Bivariate Analysis ◽  
Linear Regression Models ◽  
Functional Assessments

Background: In a stroke, the importance of initial functional status is fundamental for prognosis. The aim of the current study was to investigate functional status, assessed by the Functional Independence Measure (FIM) scale, and possible predictors of functional outcome at discharge from inpatient rehabilitation. Methods: This is a retrospective study that was carried out at the Physical Medicine and Rehabilitation Service in A Coruña (Spain). A total of 365 consecutive patients with primary diagnosis of stroke were enrolled. The functional assessments of all patients were performed through the FIM. A descriptive and a bivariate analysis of the variables included in the study was made and a succession of linear regression models was used to determine which variables were associated with the total FIM at discharge. Results: Prior to having the stroke, 76.7% were totally independent in activities of daily living. The FIM scale score was 52.5 ± 25.5 points at admission and 83.4 ± 26.3 at hospital discharge. The multivariate analysis showed that FIM scores on admission were the most important predictors of FIM outcomes. Conclusions: Our study indicates that the degree of independence prior to admission after suffering a stroke is the factor that will determine the functionality of patients at hospital discharge.

Impact of Nosocomial Infection on Length of Stay and Functional Improvement Among Patients Admitted to an Acute Rehabilitation Unit

2001 ◽  
Vol 22 (02) ◽  
pp. 83-87 ◽  
Author(s):  
Joseph M. Mylotte ◽  
Robin Graham ◽  
Lucinda Kahler ◽  
B. Lauren Young ◽  
Susan Goodnough
Keyword(s):  
Length Of Stay ◽  
Nosocomial Infection ◽  
Functional Status ◽  
Functional Independence ◽  
Functional Improvement ◽  
Multivariate Linear Regression Analysis ◽  
Rehabilitation Unit ◽  
Cord Injury ◽  
Acute Rehabilitation ◽  
First Time

AbstractObjective:To identify factors predictive of length of stay (LOS) and the level of functional improvement achieved among patients admitted to an acute rehabilitation unit for the first time, with special reference to the role of nosocomial infection.Setting:A 40-bed acute rehabilitation unit within a 300-bed, tertiary-care, public, university-affiliated hospital.Study Population:All patients admitted to the unit between January 1997 and July 1998.Design:Prospective cohort study in which demographic and clinical data, including occurrence of nosocomial infection, were collected during the entire unit admission of each patient. Multivariate linear regression analysis was used to identify factors predictive of unit LOS or improvement in functional status as measured by the change in the Functional Independence Measure (FIM) score between admission and discharge (ΔFIM).Results:There were 423 admissions to the rehabilitation unit during the study period, of which 91 (21.5%) had spinal cord injury (SCI) as a principal diagnosis. One hundred seven nosocomial infections occurred during 84 (19.9%) of the 423 admissions. The most common infections were urinary tract (31.8% of all infections), surgical-site (18.5%), andClostridium difficilediarrhea (15%). Only one patient died of infection. After controlling for severity of illness on admission, functional status on admission, age, and other clinical factors, the significant positive predictors of unit LOS were as follows: SCI (P<.001), pressure ulcer (.002), and nosocomial infection (<.001). Significant negative predictors of ΔFIM were age (P<.001), FIM score on admission (<.001), prior hospital LOS (.002), and nosocomial infection (.007).Conclusions:Several variables were identified as contributing to a longer LOS or to a smaller improvement in functional status among patients admitted for the first time to an acute rehabilitation unit Of these variables, only nosocomial infection has the potential for modification. Studies of new approaches to prevent infections among patients undergoing acute rehabilitation should be pursued.

Abstract TP137: Robotic Upper Limb Therapy by a Trained Volunteer on an Inpatient Stroke Rehabilitation Unit

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Lisa Spinelli ◽  
Christine Trudell ◽  
Lisa Edelstein ◽  
Mike Reding
Keyword(s):  
Upper Limb ◽  
Stroke Rehabilitation ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Rehabilitation Unit ◽  
Software Applications ◽  
Upper Limb Function ◽  
Straight Line ◽  
One Step ◽  
Safety Considerations

Introduction: Having a therapist observe patients engaged in Robotic Upper Limb Therapy (RULT) is considered inefficient use of a therapist’s time and skill. We therefore assessed the feasibility of (RULT) administered by a trained volunteer. Methods: The Volunteer had two 30-minute training sessions by an Occupational Therapist (OT) rehearsing the MIT-Manus Planar Upper Limb Robotic software applications, proper positioning of the patient, and device shut-off and safety considerations. Initial patient sessions were supervised by the patient’s OT until the Volunteer demonstrated satisfactory performance. Inpatients on a Stroke Rehabilitation Unit were referred by their OT for RULT if they could initiate horizontal gravity-eliminated movement of the forearm and could follow one step commands. They were enrolled in 25 minute (RULT) sessions based upon the Volunteer’s availability from one to three half-days per week. Functional Independence Measures and Fugl-Meyer Scores were recorded at the time of Stroke Unit Admission by the OT unaware of (RULT) score results. Statistical analyses were performed using SPSS version 11.5 and significance was attributed if p<0.05 using 2-tailed analyses. Results: A total of 28 patients were enrolled in (RULT) but 2 were unable to participate due to pain in the affected upper limb. Participants had a mean of 3 ± 1.5 SD treatments each. Both the patients and volunteer considered their involvement in the program as worthwhile and meaningful. Admission MIT-Manus Adaptive-3 treatment software data showed that the Normalized Jerk+Line+Target (Norm JLT) Score [defined as (Jerk Score/237)+(Deviation from a Straight Line/13)+(Target Distance Error/14)] demonstrated a significant Spearman-rho Correlation with admission Functional Independence Measure (FIM) upper dressing r = -0.56 p=.003; and FIM grooming subscores r = -0.415, p=.035. The Norm JLT score also predicted change in Fugl-Meyer Upper Limb scores from admission to discharge r = - .788, p = 0.000. Conclusions: Robotic Upper Limb Therapy by a trained Volunteer on an inpatient Stroke Rehabilitation Unit is easily administered, is viewed by the patients and volunteer as rewarding, and provides objective measures useful for assessing upper limb function and outcome.

Exploring the Role of Occupational Therapy With Mothers Who Breastfeed

2021 ◽  
Vol 75 (5) ◽  
Author(s):  
Lauren Sponseller ◽  
Fern Silverman ◽  
Pamela Roberts
Keyword(s):  
Occupational Therapy ◽  
Goal Attainment ◽  
Intervention Group ◽  
New Mothers ◽  
Lactation Consultant ◽  
Personal Wellness ◽  
Occupational Profile ◽  
Before And After ◽  
Goal Attainment Scale ◽  
Occupational Therapy Practitioners

Importance: Occupational therapy practitioners can play a pivotal role in supporting breastfeeding mothers as they transition to and form new routines for this occupation. Objective: To explore whether occupational therapy programming can assist breastfeeding mothers in reaching their personal occupation-based wellness goals. Design: Mixed-methods design that involved development of an occupational profile and a goal attainment scale (GAS). After the intervention, participants rescored their GAS goals and completed a semistructured exit interview. Setting: Nonprofit lactation center located in the suburbs of a large mid-Atlantic U.S. city. Participants: Women recruited through convenience sampling who had been breastfeeding an infant for &lt;6 mo, who were not currently weaning, and who had met with a lactation consultant at least once since giving birth were eligible (N = 17). Intervention: Group occupational therapy that consisted of 10 weekly 1-hr sessions. Topics were based on occupational profiles, GAS scores, and lactation consultant input. Outcomes and Measures: Each participant created and scored three goals using the GAS before and after the intervention. Results: Data from 14 of the 17 participants were analyzed. The average postintervention GAS score was 56.50 (M = 50), indicating that most personal wellness goals were reached. Thematic analysis revealed that occupational therapy programming helped mothers persevere with breastfeeding, feel more confident as new parents, and value both themselves and their baby. Conclusions and Relevance: There is an increasing role for occupational therapy practitioners in helping new mothers reach their personal wellness goals in ways that support their ability to continue breastfeeding. What This Article Adds: Maternal wellness and breastfeeding represent an emerging area of practice in which occupational therapy practitioners can provide new mothers with physical, social, and psychological supports that help them maintain self-efficacy related to breastfeeding and other meaningful occupations. This study provides foundational evidence in support of this collaboration.

Clinical Application of a Self-Report, Functional Independence Outcomes Measure in the DVA's Blind Rehabilitation Service

2004 ◽  
Vol 98 (4) ◽  
pp. 197-211 ◽  
Author(s):  
William De l'Aune ◽  
Michael Williams ◽  
Gale R. Watson ◽  
Penny Schuckers ◽  
Gale Ventimiglia
Keyword(s):  
Clinical Application ◽  
Functional Independence ◽  
Self Report ◽  
Rehabilitation Service

scholarly journals Length of Stay in In-Patient Rehabilitation after Stroke in Qatar

2008 ◽  
Vol 8 ◽  
pp. 547-555
Author(s):  
Loganathan Venkatachalm ◽  
Ana Bobinac Georgievski ◽  
Wafaa Al Yazeedi ◽  
Rajvir Singh ◽  
Hilda Uribazo Garrido
Keyword(s):  
Length Of Stay ◽  
Hemorrhagic Stroke ◽  
Functional Independence Measure ◽  
Inpatient Rehabilitation ◽  
Significant Negative Correlation ◽  
Multivariate Regression Analysis ◽  
Functional Independence ◽  
Medical Rehabilitation ◽  
Rehabilitation Unit ◽  
Disability Scale

The objective of this study was to analyze the factors predicting length of stay in a stroke patient rehabilitation unit at Hamad Medical Corporation (HMC) in Qatar. The medical rehabilitation data of 100 stroke patients discharged from a 15-bed inpatient rehabilitation unit (IPRU) were collected retrospectively from medical records during the period from September 2004 to April 2007. A questionnaire was developed, and variables included in the study were age of the patient, length of stay in acute care (LOSa), length of stay in rehabilitation (LOSr), functional independence measure on admission and discharge (FIMa and FIMd), modified disability scale, and modified mobility scale. Patients were grouped by impairments defined by cause as ischemic or hemorrhagic stroke, and right or left body side deficit. A significant negative correlation was observed between LOSr and FIMa (r= −0.44,p= 0.00), and positive correlation between LOSr and LOSa (r= 0.37,p= 0.00). There was no correlation between LOSr and FIMd (r= −0.03,p= 0.76). We observed that low admission FIMa and FIMd were related to extended LOS in both acute and IPRU. Multivariate regression analysis was performed by taking age, LOSa, cause of hemorrhage or ischemia, and FIMa as independent variables, and LOSr as dependent variable. The model could explain only 26% variation for LOSr. This study supports the hypothesis of an association between LOSr, LOSa, and FIMa. Further research is needed to confirm the results of this and other similar studies.

Pharmacists’ Utilization of Non-HDL-C Levels in Managing Patients With Lipid Disorders

2020 ◽  
pp. 001857872091038
Author(s):  
Roda Plakogiannis ◽  
Joseph J. Saseen ◽  
Abraham Stefanidis
Keyword(s):  
Goal Attainment ◽  
Density Lipoprotein ◽  
Heart Association ◽  
Further Education ◽  
Lipoprotein Cholesterol ◽  
Blood Cholesterol ◽  
Atherosclerotic Cardiovascular Disease ◽  
Lipid Disorders ◽  
Before And After ◽  
Level Calculation

Background: Since 2013 there have been cholesterol guideline changes impacting pharmacists’ clinical practice in managing lipid disorders. For more than a decade, cholesterol management was based on the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol Adult Treatment Panel III guideline, highlighting non-high-density lipoprotein cholesterol (non-HDL-C) as a secondary target in persons with triglycerides ≥200 mg/dL, after low-density lipoprotein cholesterol goal attainment. The 2013 American College of Cardiology and American Heart Association (ACC/AHA) guideline differed from the traditional management of dyslipidemia, in part no longer emphasizing the utilization of non-HDL-C levels. Objective: To measure pharmacists’ attitudes and behavior regarding utilization of non-HDL-C level calculation before and after the inception of the 2013 ACC/AHA cholesterol guideline. Methods: Pharmacists in the American College of Clinical Pharmacy ambulatory care listserv participated in an electronic survey in November 2013, before the inception of the 2013 ACC/AHA guideline, and again in October 2018. Results: We collected 391 usable responses from participants; 212 responses in 2013 and 179 responses in 2018. The before and after comparison revealed that respondents in 2013 reported significantly higher frequency of calculating non-HDL-C levels (mean = 1.88, SD = 0.80) than respondents in 2018 (mean = 1.66, SD = 0.79) ( P ≤ .001). Also, the frequency that non-HDL-C level calculation alters decisions regarding course of treatment was lower in the 2018 (mean = 3.50, SD = 1.06) in comparison with 2013 (mean = 3.77, SD = 0.88) ( P ≤ .05). Furthermore, pharmacists were more favorable toward the inclusion of non-HDL-C level calculation in 2018 (mean = 3.77, SD = 1.05) than in 2013 (mean = 3.13, SD = 1.33) ( P ≤ .001). Conclusion and Relevance: Clinical pharmacists’ utilization of non-HDL-C levels in the clinical management of patients with hypercholesterolemia has decreased, highlighting the need for further education on the importance of evaluating non-HDL-C levels in the very high-risk atherosclerotic cardiovascular disease population.

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