Journal of Acute Care Physical Therapy最新文献

{"title":"Early Mobilization of Patients Receiving Vasoactive Drugs in Critical Care Units: A Systematic Review","authors":"Prasobh Jacob, P. Surendran, Muhamed Aleef E M, T. Papasavvas, Reshma Praveen, Narasimman Swaminathan, Fiona Milligan","doi":"10.1097/JAT.0000000000000140","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000140","url":null,"abstract":"Purpose: Mobilization is feasible, safe, and beneficial to patients admitted to critical care units. Vasoactive therapy appears to be one of the most common barriers to early mobilization. Many recent publications have studied the safety and feasibility of mobilizing patients with these vasoactive drugs. The aim of this review was to synthesize the prevailing evidence pertaining to mobilizing patients receiving vasoactive drugs. Methods: The protocol was developed and registered on PROSPERO (CRD42019127448). A comprehensive literature search was conducted using PubMed, Physiotherapy Evidence Database (PEDRO), Cochrane Central, and Embase (through Cochrane) for original research, including case studies and consensus guidelines. PRISMA guidelines were used to conduct and report this review. The included articles were appraised using the Newcastle-Ottawa Scale independently and a consensus reached by 3 reviewers. Results and Conclusion: Evidence determining specific doses of vasoactive drugs that would allow safe mobilization of patients in critical care is lacking. The criteria that have been used to determine the eligibility to mobilize patients on vasoactive drugs have not been consistent.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2020-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/JAT.0000000000000140","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44355653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Welcome, APTA Acute Care","authors":"S. Gorman","doi":"10.1097/jat.0000000000000139","DOIUrl":"https://doi.org/10.1097/jat.0000000000000139","url":null,"abstract":"","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/jat.0000000000000139","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48443082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Collaborative Care Across the Acute and Subacute Continuum Facilitated by Physical Therapy in the Emergency Department","authors":"J. Seip, Peter Drinkwine","doi":"10.1097/JAT.0000000000000121","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000121","url":null,"abstract":"Background: Research has supported the use of physical therapy services within emergency departments (EDs) in relation to fall reduction, reduced readmissions, and positive patient satisfaction. While the evidence supports the use of physical therapy services in the ED, other authors fail to provide examples of what collaboration looks like at the personal, professional, and patient levels. This case report is unique in that it describes the effects of collaborative care across the acute and subacute continuum starting at the initial ED presentation. Case Report: A medically complex patient with multiple medical comorbidities and mobility deficits presenting from the home environment was evaluated by a physical therapist in the ED. The evaluation consisted of musculoskeletal and mobility assessments, as well as assistance with discharge planning. This early collaboration resulted in a streamlined workup of the patient's orthopedic problems, a positive patient experience, and a positive outcome without readmission. This patient's entire workup, rehabilitation, and safe home discharge with improved home access and quality of life occurred in the span of 6 days. Conclusion: This case describes a medically complex patient with high risk for readmission. A model of collaborative care was used by consulting a physical therapist in the ED to help address these problems, which resulted in a positive outcome. The patient reported satisfaction with his care and did not return to the hospital for mobility-related impairments. The patient and his wife/caregiver also reported improvements in quality of life because of his rehabilitation and improved mobility. All of this occurred over a short span of 6 days. The authors hope that this case will lead to further discussion and research concerning the potential positive effects of early collaborative care between providers and staff physical therapists in the ED setting.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/JAT.0000000000000121","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48963399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Qualitative Exploration of Simulation as a Tool for Learning in Physical Therapist Education","authors":"P. Donlan, Kristin Curry Greenwood, Sheri R. Kiami","doi":"10.1097/JAT.0000000000000122","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000122","url":null,"abstract":"Background: Physical therapists must be able to practice in acute care environments, integrate complex information to ensure patient safety, and effectively adapt to the changing medical needs of patients. Simulation-based learning experiences (SBLEs) have been found to be useful teaching methods to prepare clinicians for high-risk acute care experiences. While research has examined the use of SBLE in physical therapist education, a clear focus has not been given to SBLE in the neurologic curriculum, where students must incorporate knowledge of critical care medical management with neurorehabilitation expertise. The purpose of this study was to understand how SBLE, within a neurorehabilitation curriculum, contributes to physical therapist students' learning. Methods: Using the reflective practitioner theory as a framework for inquiry, qualitative data were gathered from 2 focus groups and analyzed through conventional content analysis. Results: An analysis of transcripts yielded 3 major themes: (1) promotes advanced clinical performance through reflection; (2) promotes authenticity without high risk; and (3) highlights the value of teamwork. Participants conveyed that synthesis of neurologic management content material in conjunction with skill execution was uniquely able to promote higher order learning. Additionally, they underscored the importance of designing the activity to enhance learning rather than using it solely for assessment. Further, participants highlighted how collaboration during a simulation activity advances clinical performance and communication. Conclusion: Consideration should be given to designing specific neurorehabilitation scenarios that mimic real life, include interprofessional or group collaboration, and provide an opportunity for post-SBLE reflection.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/JAT.0000000000000122","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43269217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improvement of Physical and Occupational Therapy Referral Process to Reduce Unskilled Consults","authors":"Matthew R. Bednarczyk, K. Pritchard, Will Barquin, A. Beyer, Christine Stankiewicz","doi":"10.1097/JAT.0000000000000115","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000115","url":null,"abstract":"Purpose: Baseline data collected for 9 months showed that physical (PT) and occupational therapy (OT) services were consulted 14.5% of the time for unskilled therapy needs. The goal of this performance improvement project was to identify whether acute care physical and occupational therapists can reduce unskilled consults using a multidisciplinary education intervention. Methods: Therapists were trained on how to define and use each of 4 categories of unskilled consults. An interdisciplinary focus group was formed to gain feedback from providers with regard to the culture of mobility, the role of PT and OT, skilled versus unskilled consults, and strategies to reduce these unskilled consults. After discussion, the focus group determined that the primary strategy to reduce unskilled consults is to incorporate mobility and activities of daily living (ADL) discussion for each patient into interdisciplinary rounds (IDR). Results: Data show that PT and OT services collectively were consulted for unskilled therapy needs 3.05% of the time, compared with baseline data of 14.5%, which is a clinically meaningful decrease. Conclusion: Results provide preliminary evidence that an interdisciplinary approach using IDR can assist with reducing unskilled consults. Establishing a focus group can assist the initiatives through education on what defines an unskilled consult, collaboration, and improved communication regarding patient mobility and ADL performance while hospitalized.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/JAT.0000000000000115","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48567464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing a Rehabilitation Protocol for Spatial Neglect Assessment and Treatment in an Acute Care Hospital","authors":"K. Hreha, Peii Chen, J. Larosa, Christopher Santos, Cindy Gocon, A. Barrett","doi":"10.1097/JAT.0000000000000117","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000117","url":null,"abstract":"Purpose: Spatial neglect can occur after stroke, causing disabling spatial errors limiting functional abilities. In rehabilitation research, administration of spatial neglect assessment and treatment protocols can improve function. The objective of this study was to implement those protocols, the Kessler Foundation Neglect Assessment Process (KF-NAP) and the Kessler Foundation Prism Adaptation Treatment (KF-PAT), in an acute care hospital to determine their feasibility and sustainability. Methods: We formally instructed participating therapists, followed by a 5-month training phase and then 6-month implementation phase. Patient participants included right brain stroke survivors, at acute care. We measured patient-based (study participation rates, refusals) and institutional-based feasibility (fidelity and maintenance) for both protocols. Results: A total of 126 of 145 patients with stroke meeting the inclusion criteria were assessed for spatial neglect. Among the 126, 20.6% had spatial neglect. Ten of the 26 patients with spatial neglect were treated with the KF-PAT. There were no refusals; however, 3 people were not seen because of medical scheduling. Overall, the fidelity of both protocols was maintained because main concepts and components were not changed. However, adaptations to both protocols were required secondary to lack of time and medical complexity of the patients. Conclusions: Implementation of a standard rehabilitation assessment and treatment protocol for spatial neglect in acute care is feasible. The findings related to fidelity are promising; however, further research is recommended.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/JAT.0000000000000117","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48052824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"JACPT Reviewers for 2019","authors":"","doi":"10.1097/jat.0000000000000141","DOIUrl":"https://doi.org/10.1097/jat.0000000000000141","url":null,"abstract":"","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47171879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Design and Implementation of the Health Professions Simulation Assessment, a Tool to Assess Students' Perceptions of Simulation Experiences","authors":"Kristin Curry Greenwood, Jennifer L. Kirwin, Zhiguang Huo","doi":"10.1097/JAT.0000000000000123","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000123","url":null,"abstract":"Background: Simulation is an important educational method in the health professions. While several academic programs have shared simulation quality assessment tools that are intended to be used in a particular discipline, a valid and reliable assessment that can be used by a variety of entry-level health professions education programs is lacking. In order to improve and refine interprofessional simulation programs, a tool that is acceptable to the multiple professions that participate in interprofessional simulation education is needed. The purpose of this study was to design and analyze an evidence-based quality assessment tool that could capture students' perceptions of simulation experiences and could be used by multiple health professions. Subjects: The study included 329 students from different health professions majors who participated as part of their required coursework. Methods: An evidence-based Health Professions Simulation Assessment (HPSA) was created in 2016, pilot tested in 2017, and then disseminated to a larger cohort in 2018. The results of the second dissemination were analyzed using R software to understand the validity and utility of the tool. Results: The response rate for each question was more than 90% and the mean rate of agreement was 79.0% (±8.9%). We observed a high correlation among all pairs of questions (mean 0.51, SD 0.19). In addition, we performed hierarchical clustering and identified 4 clusters of questions that were highly correlated (preparation for experience, self-reflection/emotions, debriefing, and fidelity). Conclusion: An evidence-based tool was created that could be used in a variety of health professions programs to evaluate students' perceptions of the quality of a simulation. This easily administered tool demonstrated satisfactory agreement; the data gathered through its use may be used to improve the quality of simulations in entry-level health professions education programs. This tool was found to be acceptable to multiple professions and could be used in interprofessional student groups to obtain a shared assessment of a simulation. Further research is warranted to determine validity among interprofessional groups of students.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/JAT.0000000000000123","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47985462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Survey Study of Health Promotion, Wellness, and Prevention in Wound Management Environments","authors":"D. Wendland, David W. M. Taylor, Ann M. Lucado","doi":"10.1097/JAT.0000000000000124","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000124","url":null,"abstract":"Purpose: To survey physical therapists and physical therapist assistants practicing in wound management environments regarding their personal beliefs, clinical practices, and perceived barriers to incorporating health promotion, wellness, and prevention (HPWP) in practice. Methods: A 30-question validated survey was sent to wound care therapists. Results: The qualified response rate was 29%. Therapists reported a belief in their professional role in HPWP as follows: physical (97%), psychological (82%), emotional (79%), intellectual (73%), occupational (73%), social (71%), and spiritual (55%). Practice behaviors that were frequently included by these individuals included nutrition optimization (88%), diabetes/metabolic syndrome education (81%), physical activity/fitness prescription (81%), and tobacco cessation (78%). Conditions least addressed included violence (91%) and substance-free living (75%). Common barriers included lack of resources, time, patient interest, and economic limitations of patients. Respondent lifestyles were generally healthier than adults in the United States. Conclusions: There is an increasing need in physical therapist practice to actively promote health and wellness at the level of the individual. Modeling health behaviors is important to include as well and may be beneficial to support patient healthy lifestyle. While wound management therapists do well in promoting health in certain areas, work is still needed in others.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/JAT.0000000000000124","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47229827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Utilization of Vital Signs During Physical Therapy Evaluation and Intervention After Elective Total Joint Replacement: A Mixed-Methods Pilot Study","authors":"James P. Crick, Nancy Smith","doi":"10.1097/JAT.0000000000000137","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000137","url":null,"abstract":"Background: Previous literature in physical therapy has suggested that vital signs (VS) are not used as often as is recommended in clinical practice. However, this finding has not been established in the immediate postorthopedic surgery population, and physical therapy practitioners' views toward VS assessment in this population have not been previously examined. Therefore, the purpose of the current study was to (1) determine how often VS are measured via chart review, (2) describe attitudes, inclinations, and factors that may influence VS measurement by physical therapist practitioners, and (3) provide an explanation for the use or nonuse of VS in an immediate postorthopedic surgical population. Methods: This was a mixed-methods study with 2 phases. Phase 1 (quantitative) involved a retrospective chart review of 50 patients treated after total joint arthroplasty. Phase 2 (qualitative) involved interviewing 2 physical therapists and 1 physical therapist assistant who had treated patients in phase 1 to provide an explanation for phase 1 data. Quantitative analysis was performed on phase 1 data, and qualitative analyses were performed on phase 2 data. These data were subsequently corroborated. Results: Vital signs were documented on only 29 occasions over 134 therapy sessions. No correlation was found between comorbidities and VS assessment. Five major themes were induced from the qualitative data. Discussion: The results of this study suggest that physical therapy practitioners may practice in a manner that is inconsistent with their beliefs with respect to the assessment of VS for patients following total joint arthroplasty. Multiple explanatory mechanisms for VS utilization are suggested by physical therapy clinicians.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2020-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41890713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}