A quality improvement project targeting physical, cognitive and social activity levels in inpatient rehabilitation

2021 ◽  
Vol 28 (4) ◽  
pp. 1-15
Author(s):  
Rosemarie Marsiglio ◽  
Dina Watterson ◽  
Valentina Maric ◽  
Anne E Holland
Keyword(s):  
Patient Satisfaction ◽  
Therapy Group ◽  
Social Activity ◽  
Inpatient Rehabilitation ◽  
Rehabilitation Service ◽  
Independent Practice ◽  
Activity Levels ◽  
Table Tennis ◽  
Improvement Project ◽  
Rehabilitation Outcomes

Background/aims People undergoing inpatient rehabilitation largely spend their day by the bedside, inactive and alone. Increasing patients' physical, cognitive and social activity levels may improve rehabilitation outcomes for both the individual and the service. The aim of this study was to trial an activity programME that aimed to increase inpatient physical, cognitive and social activity levels, provided within existing resources whilE maintaining or increasing patient satisfaction. Methods A mixed-methods approach was used to develop and evaluate a multi-component activity programme for patients undergoing inpatient rehabilitation. Results Patient activity across the unit did not change but the amount of time spent alone during a weekday was significantly reduced. Patient satisfaction levels remained high. Each new therapy group was well received by patients and the volunteers who supported implementation. Novel programmes included table tennis coaching and independent gym access for selected inpatients, which were well used and not resource intensive. Therapist prescription of independent practice programmes remained low. Broader initiatives such as patient education folders require revision and further investment to succeed. Conclusions It is possible to change and evaluate multiple therapy services concurrently. The absence of change in overall activity levels demonstrates a need to establish the most successful components, harness support from the organisation to address some of the physical/environmental barriers and expand smaller programmes, and invest more time to consolidate the whole-of-service changes required to push the rehabilitation service in the direction of greater patient activity and ownership. Clinicians should pursue, implement, evaluate and revise novel programmes to engage their patient population.

scholarly journals Quality assurance in a rehabilitation service

2001 ◽  
Vol 57 (1) ◽  
pp. 7-11 ◽  
Author(s):  
H. Myezwa ◽  
V. R. P. M'kumbuzi ◽  
F. Mhuri
Keyword(s):  
Quality Assurance ◽  
Patient Satisfaction ◽  
Service Providers ◽  
Linear Increase ◽  
Rehabilitation Service ◽  
Clinical Documentation ◽  
Measuring Instrument ◽  
Rehabilitation Outcomes ◽  
Midlands Province ◽  
One Year

Aim: The aim of this study was to develop, implement and evaluate a Quality Assurance (QA) programme for use by nine rehabilitation departments in the Midlands province of Zimbabwe.Methodology: A participatory methodology was implemented to:1. Define and implement the parameters of quality for a rehabilitation service.2. Design standardised assessment forms for the different conditions managed.3. Develop, pilot and evaluate a QA measuring instrument to use in defining the QA profile of a rehabilitation service, and4. Determine patient satisfaction with the rehabilitation service. Administering a simple questionnaire, whose design was based on the Zimbabwe Patients Charter, accomplished this.Results: The process of developing, implementing and evaluation of the QA programme took six years. One year after implementation of the QA, all (J00%) patients coming into contact with the service had a rehabilitation record. The QA profile for the Midlands province rose from 55% in 1994 to a record high of 92.1% in 1998, and 89.4% in 1999. The patient satisfaction profile for each indicator also demonstrated a linear increase with areas such as satisfaction with service rising from 86% in 1997 to 100% in 2000, and satisfaction with benefit from the service rising from 76.6% in 1997 to 100% in 2000. Other qualitative benefits not depicted by the QA measuring instrument or the patient satisfaction instrument, but which were observed and expressed by rehabilitation staff as measures of success of the QA programme are discussed.Conclusion: This paper concludes that significant improvements in clinical documentation arising from the QA programme, translated to an overall increase in the service providers’ professional skills and knowledge base, and ultimately rehabilitation outcomes. The success of this process is attributed to its participatory and empowering nature.

scholarly journals P62 Getting to know you: a quality improvement project designed to enhance paediatric inpatient rehabilitation for those with non-inflammatory musculoskeletal pain

Rheumatology ◽  
2019 ◽  
Vol 58 (Supplement_4) ◽  
Author(s):  
Dearbhla McKenna ◽  
Madeline Rooney ◽  
Paul Jackson ◽  
Cathyrn Harkness
Keyword(s):  
Conflicts Of Interest ◽  
School Attendance ◽  
Inpatient Rehabilitation ◽  
Self Management ◽  
Rehabilitation Service ◽  
Management Approach ◽  
Improvement Project ◽  
Time To Build ◽  
Self Discovery ◽  
Typical Day

Abstract Background In November 2018 the paediatric rheumatology team in Belfast attended the Bridges self-management course. Bridges reflects on what works well as a team and how you can build upon current practice, with an emphasis upon a self-management approach. There are eleven Bridges principles aiming to help interdisciplinary team’s co-ordinate their service around the patient. Bridges believes that the language we use can improve our clinical practice, especially with regards to problem solving, encouraging self-discovery, encouraging patients to reflect and enabling them to take action. Our team felt that we should use this approach to enhance our inpatient rehabilitation service. We chose this group of patients as we felt that this can be a challenging group to treat and it can take a long time to build supportive and trusting relationships. Methods Prior to commencing this project each member of the multidisciplinary team assessed the patient individually on the first day of admission. In retrospect we discovered that this led to repetition for the patient and this assessment was very clinician led. It also focused on clinician led (SMART) goals and achieving these. We furthermore realised we did not separately ask patients and parents what they wanted to gain from our service. Our method of improvement was to devise three questionnaires. One for a parent, one for a child under fourteen and over fourteen. These are distributed prior to being assessed by the team, allowing us to gather information and negating the need for repetition. The questionnaire gathers information regarding family members, education, school attendance, additional educational assistance, past medical history. For the patient we ask, what are their main concerns, what has helped so far, what support the patient has, what activities they enjoy as a family and what they hope to gain from their inpatient stay. The patient must fill out a description of their typical day, including their mood. Questions specifically for the parents are asking why their child has been referred, what their main concerns are, to outline their typical day, what do they feel has helped and what do they aim to gain from our team. Results We have utilised the questionnaires for every inpatient since January 2019. All team members feel that this new approach allows us to gain valuable information from patients and their parents thus encouraging them to adopt a self-management approach and to prioritise the patient’s story. As a team we feel that we learn a lot about our patients using this method and that it is more time effective. It allows us to identify unrealistic hopes and discuss these. Conclusion We believe that using the Bridges approach and by mainly adapting our language skills and organisation we have improved this service. Conflicts of Interest The authors declare no conflicts of interest.

Observations of Activity Levels in a Purpose-Built, Inpatient, Rehabilitation Facility

2019 ◽  
Vol 12 (4) ◽  
pp. 26-38 ◽  
Author(s):  
Katharine Scrivener ◽  
Natasha Pocovi ◽  
Taryn Jones ◽  
Bridget Dean ◽  
Shaun Gallagher ◽  
...  
Keyword(s):  
Physical Activity ◽  
Body Position ◽  
Social Activity ◽  
Cognitive Activity ◽  
Inpatient Rehabilitation ◽  
Multidisciplinary Care ◽  
Activity Levels ◽  
Rehabilitation Facility ◽  
Mapping Techniques ◽  
The Impact

Background: Effective rehabilitation should include high levels of physical activity. The impact of the environmental design on activity levels has had minimal consideration. Purpose: This study investigates activity levels of inpatients undergoing rehabilitation in a new rehabilitation facility with innovative design and multidisciplinary care, comparing weekday and weekend activity levels, as well as changes over a 12-month period. Method: An observational study reporting participants’ location, people present, body position, and activity type on 2 weekdays and 1 weekend day using behavior mapping techniques. Fifteen participants were observed in a mixed rehabilitation unit with neurological, orthopedic, and other health conditions. Results: Results were calculated as the proportion of observations participants spent in each location, position, and performing activities (physical, cognitive, social), and time spent alone and inactive. On average, participants were engaged in activity for 86% (standard deviation [ SD] = 9) of the day, with physical activity accounting for 51% ( SD = 11), cognitive activity 28% ( SD = 10), and social activity 42% ( SD = 16). There was more physical activity (mean difference [ MD] 8% absolute, confidence interval [CI] = [4, 12], p < .01) and less social activity ( MD −6% absolute, CI [−11, −1], p = .02) on weekdays compared to weekends. Overall, participants were alone and inactive for 12% ( SD = 9) of the day. Participants observed in 2016 displayed similar results to those observed in 2015. Conclusion: High levels of activity were achieved in this facility that underwent environmental redesign, construction of new facilities, and implementation of evidence-based strategies.

scholarly journals Factors associated to functioning and health in relation to home rehabilitation in Sweden: a non-randomized pre-post intervention study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anette Johansson ◽  
Marie Ernsth Bravell ◽  
Eleonor I. Fransson ◽  
Sofi Fristedt
Keyword(s):  
Repeated Measures ◽  
Linear Models ◽  
Medical Condition ◽  
Rehabilitation Program ◽  
Community Dwelling ◽  
Rehabilitation Service ◽  
Post Intervention ◽  
Factors Associated ◽  
Rehabilitation Outcomes ◽  
Self Rated Health

Abstract Background Home rehabilitation is a growing rehabilitation service in many countries, but scientific knowledge of its components and outcomes is still limited. The aim of this study was to investigate; 1) which changes in functioning and self-rated health could be identified in relation to a home rehabilitation program in a population of community-dwelling citizens, and 2) how socio-demographic factors, health conditions and home rehabilitation interventions were associated to change in functioning and self-rated health after the home rehabilitation program. Method The sample consisted of participants in a municipal home rehabilitation project in Sweden and consisted of 165 community-dwelling citizens. General Linear Models (ANOVA repeated measures) was used for identifying changes in rehabilitation outcomes. Logistic regressions analysis was used to investigate associations between rehabilitation outcomes and potential factors associated to outcome. Result Overall improvements in functioning and self-rated health were found after the home rehabilitation program. Higher frequencies of training sessions with occupational therapists, length of home rehabilitation, and orthopaedic conditions of upper extremities and spine as the main health condition, were associated with rehabilitation outcomes. Conclusion The result indicates that the duration of home rehabilitation interventions and intensity of occupational therapy, as well as the main medical condition may have an impact on the outcomes of home rehabilitation and needs to be considered when planning such programs. However, more research is needed to guide practice and policymaking.

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.

scholarly journals Inpatient Rehabilitation: Prediction of Changes in Sensorimotor Performance in Multiple Sclerosis: A Pilot Study

2021 ◽  
Vol 10 (10) ◽  
pp. 2177
Author(s):  
Philipp Gulde ◽  
Joachim Hermsdörfer ◽  
Peter Rieckmann
Keyword(s):  
Multiple Sclerosis ◽  
Time Pressure ◽  
Inpatient Rehabilitation ◽  
Unhealthy Lifestyle ◽  
Rehabilitation Outcomes ◽  
Relapsing Remitting ◽  
Steps Per Day ◽  
Rest Time ◽  
Impacting Factors ◽  
Sensorimotor Performance

Inpatient rehabilitation has been shown to be an effective intervention for sensorimotor performance in multiple sclerosis (MS) patients. So far, predictions of the rehabilitation outcomes are limited. The objective was to predict inpatient rehabilitation outcomes by changes in the Watzmann Severity Scale (WSS), a statistical estimation of the EDSS by sensorimotor capacity. Sensorimotor performance and physical activity during rehabilitation (by actigraphy) were assessed in a sample of 28 MS patients at a facility for neurorehabilitation. Daily changes in the WSS were predicted by a model of multiple linear regression. The resulting model had an R2adjusted of 0.48 (p < 0.01) and revealed five impacting factors (a reduction in the WSS represents an improvement): the number of steps (β-weight = 0.52, p < 0.01), the duration of nocturnal rest time (β-weight = 0.46, p = 0.01), the EDSS at entry (β-weight = 0.38, p = 0.03), a relapsing-remitting MS (β-weight = 0.37, p = 0.03), and the performance in a visuomotor pursuit task with time pressure (β-weight = −0.35, p = 0.04). One standard deviation improvement was predicted when the patient at admission yielded 6600 fewer steps per day, 94 min less rest per night, −2.7 points in the EDSS at entry, a relapsing-remitting MS, and a pursuit task performance that decreased by 2.2 standard deviations. Overall, the patients improved by −0.22 ± 0.51 WSS points during 19.3 ± 4.5 d of inpatient rehabilitation. Different potential explanations of the findings are discussed, one of which proposes that the results reflect an unhealthy lifestyle which, in addition to MS, would explain the higher predicted improvements by rehabilitation tackling both MS and the patients’ lifestyle.

Improving WeeFIM score completion rates: An interdisciplinary inpatient rehabilitation unit quality improvement project

2021 ◽  
pp. 1-8
Author(s):  
Ashlee Jaffe ◽  
Maura Powell ◽  
Tami Konieczny ◽  
Carlene Osweiler ◽  
Genna Kreher
Keyword(s):  
Quality Improvement ◽  
Interdisciplinary Team ◽  
Inpatient Rehabilitation ◽  
Visualization Tool ◽  
Completion Rates ◽  
Intervention Period ◽  
Rehabilitation Unit ◽  
Improvement Project ◽  
Comprehensive Therapy ◽  
Therapy Services

PURPOSE: The WeeFIM is a tool commonly used in pediatric rehabilitation settings to measure objective patient progress while receiving comprehensive therapy services on inpatient rehabilitation units. This Quality Improvement (QI) project aimed for 95%of inpatients to have complete, on-time documented and displayed WeeFIM scores upon admission and discharge by 12/2017. METHODS: An interdisciplinary team examined historic WeeFIM completion rates. Using Plan-Do-Study-Act cycles, a unified flowsheet was developed in the electronic health record (EHR) to revamp workflow and identify opportunities for improvement, data accuracy, and finally sustainability. Progress was monitored in real time via an automated data visualization tool which monitored score timeliness and completeness. RESULTS: On-time admission completion rates increased from 0%to 95%during the intervention period. On-time discharge completion rates increased from 0%to 89%during the intervention period. This change has been sustained over 2 years with on-time admission and discharge scores averaging 79.4%and 77.9%respectively, and 96.4%of scores completed. CONCLUSION: Changes in the completion rate of WeeFIMs are sustainable, evidenced by ongoing maintenance of our initial gains over the course of multiple months. The incorporation of WeeFIM documentation into the workflow increased on-time and completion rates. The success of this project shows that integrating new tasks into provider workflows helps drive completion.

Poster 105 The Impact of Comorbidities and Complications on Burn Injury Inpatient Rehabilitation Outcomes

PM&R ◽  
2012 ◽  
Vol 4 ◽  
pp. S225-S226
Author(s):  
Paul Gerrard ◽  
Margaret A. DiVita ◽  
Richard Goldstein ◽  
Karen J. Kowalske ◽  
Paulette Niewczyk ◽  
...  
Keyword(s):  
Burn Injury ◽  
Inpatient Rehabilitation ◽  
Rehabilitation Outcomes ◽  
The Impact

The development of the rehabilitation community transition support team as a response to COVID-19

2021 ◽  
Vol 10 (4) ◽  
pp. 1-11
Author(s):  
Kelly Fenton ◽  
Katherine Kidd ◽  
Rachel Kingman ◽  
Sara Le-Butt ◽  
Michelle Gray
Keyword(s):  
Community Setting ◽  
Inpatient Rehabilitation ◽  
Rehabilitation Service ◽  
Structured Interviews ◽  
Face To Face ◽  
Community Transition ◽  
Support Team ◽  
Staff Experiences ◽  
Community Team ◽  
Transition Support

Background/aims The rehabilitation community transition support team was created as a response to the COVID-19 pandemic, resulting in faster discharges from the inpatient rehabilitation service. The aim of this evaluation was to explore the perspectives of staff and patients on their experience of the rehabilitation community transition support team. Methods Staff and patients in the new team were interviewed using semi-structured interviews. The data were analysed using thematic analysis. Results Staff interviews generated seven main themes: positive staff experiences; defining the ‘team’; mode of working; link role for the team; technology; relationships with patients; and support from colleagues. The patient analysis generated five themes: positive experiences of the rehabilitation community transition support team; relationship with rehabilitation community transition support team worker; mode of working; handling the hurdles of discharge; and defining the ‘team’. There were crossovers of staff and patient themes, particularly surrounding around face-to-face visits, defining the team and relationships. Patients indicated that contact with the community team helped them to overcome both practical and emotional hurdles of discharge. Conclusions The presence of a team supporting the transition from hospital to a community setting may be helpful for people who have been discharged.

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