Evaluating the impact of Keep Your Move in the Tube (KYMITT) on patient AM-PAC scores and discharge disposition.

IF 2.2 4区医学 Q1 REHABILITATION

PM&R Pub Date : 2025-01-15 DOI:10.1002/pmrj.13315

Miriah Mattox, Julie Ennis, Matthew McClain, Jennifer Trinidad, Alexander Bajorek, Tamela Fonseca, Katie West, Tonya King, Rebecca Lazensky

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引用次数: 0

Abstract

Background: The Sarasota Memorial Health Care System (SMHCS) Acute Care Rehabilitation Team began implementing the Keep Your Move in the Tube (KYMITT) protocol in February 2023 to improve patient mobility and offer an alternative to traditional sternal precautions. The goal of KYMITT is for patients to remain within a safe zone (referred to as "the tube") rather than complying with time and weight restrictions, which are the cornerstone of traditional sternal precautions. In previous studies, KYMITT was associated with greater independence after surgery without placing patients at an increased risk of experiencing a surgical site infection.

Objective: To test the hypothesis that KYMITT is associated with greater patient mobility and independence, without increasing the risk of surgical complications.

Methods: Researchers at SMHCS analyzed records of 614 open-heart surgery patients (n = 293 in the traditional sternal precautions group and n = 321 in the KYMITT protocol group) to determine the differences in their Activity Measure for Post-Acute Care (AM-PAC) mobility scores.

Results: The average last-recorded AM-PAC score for the traditional sternal precautions group was significantly lower than for those receiving the KYMITT protocol (19.2 [95% CI: 18.86-19.62] vs. 20.0 [95% CI: 19.62-20.35], p = .006). For patients with at least two AM-PAC scores recorded, the difference was calculated for each patient's first to last AM-PAC score (AM-PAC delta). There was not a statistically significant difference between groups with an average improvement of 2.7 (95% CI: 2.30-3.09) for the traditional sternal precautions group compared to 3.1 (95% CI: 2.71-3.45) for the KYMITT protocol, p = .16 when comparing average AM-PAC delta.

Conclusion: Overall, during the 7 months that KYMITT was conducted hospital-wide, a significant increase in average last-recorded AM-PAC scores was observed month to month (slope = 0.45, 95% CI: 0.27-0.62, p < .001).

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评估“管中活动”（KYMITT）对患者AM-PAC评分和出院处置的影响。

背景：萨拉索塔纪念医疗保健系统（SMHCS）急性护理康复团队于2023年2月开始实施Keep Your Move in The Tube （KYMITT）方案，以改善患者的活动能力，并提供传统胸骨预防措施的替代方案。KYMITT的目标是让患者保持在安全区域（称为“管”），而不是遵守时间和体重限制，这是传统胸骨预防措施的基石。在以前的研究中，KYMITT与术后更大的独立性相关，而不会增加患者经历手术部位感染的风险。目的：验证KYMITT与患者更大的活动能力和独立性相关的假设，而不会增加手术并发症的风险。方法：SMHCS的研究人员分析了614例心内直视手术患者的记录（n = 293例传统胸骨预防组和n = 321例KYMITT方案组），以确定他们急性期后护理活动测量（AM-PAC）活动评分的差异。结果：传统胸骨预防组的平均最后记录AM-PAC评分显著低于KYMITT方案组（19.2 [95% CI: 18.86-19.62] vs. 20.0 [95% CI: 19.62-20.35], p = 0.006）。对于至少记录两次AM-PAC评分的患者，计算每个患者第一次到最后一次AM-PAC评分（AM-PAC delta）的差异。两组间无统计学差异，传统胸骨预防组的平均改善为2.7 (95% CI: 2.30-3.09)，而KYMITT方案的平均改善为3.1 (95% CI: 2.71-3.45), p =。在比较平均AM-PAC delta时为16。结论：总体而言，在全院范围内进行KYMITT的7个月期间，观察到平均最后记录的AM-PAC评分逐月显著增加(斜率= 0.45,95% CI: 0.27-0.62, p

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来源期刊

PM&R REHABILITATION-SPORT SCIENCES

CiteScore

4.30

自引率

4.80%

发文量

187

审稿时长

4-8 weeks

期刊介绍： Topics covered include acute and chronic musculoskeletal disorders and pain, neurologic conditions involving the central and peripheral nervous systems, rehabilitation of impairments associated with disabilities in adults and children, and neurophysiology and electrodiagnosis. PM&R emphasizes principles of injury, function, and rehabilitation, and is designed to be relevant to practitioners and researchers in a variety of medical and surgical specialties and rehabilitation disciplines including allied health.