Journal of Acute Care Physical Therapy最新文献

{"title":"Implementation of Early Rehabilitation in Severe COVID-19 Respiratory Failure: A Scoping Review.","authors":"Daniel Miner, Kellen Smith, Mahtab Foroozesh, Justin H Price","doi":"10.1097/JAT.0000000000000204","DOIUrl":"10.1097/JAT.0000000000000204","url":null,"abstract":"<p><p>The purpose of this scoping review is to describe current clinical practice guidelines (CPGs) for early rehabilitation for individuals hospitalized in an intensive care unit with COVID-19 and examine practice patterns for implementation of mobility-related interventions.</p><p><strong>Methods: </strong>PubMed, EMBASE, and CINAHL databases were searched from January 1, 2020, through April 1, 2022. Selected studies included individuals hospitalized with severe COVID-19 and provided objective criteria for clinical decision making for mobility interventions. A total of 1464 publications were assessed for eligibility and data extraction. The PRISMA-ScR Checklist and established guidelines for reporting for scoping reviews were followed.</p><p><strong>Results: </strong>Twelve articles met inclusion criteria: 5 CPGs and 7 implementation articles. Objective clinical criteria and guidelines for implementation of early rehabilitation demonstrated variable agreement across systems. No significant adverse events were reported.</p><p><strong>Conclusions: </strong>Sixty percent (3/5) of CPGs restrict mobility for individuals requiring ventilatory support of more than 60% Fio₂ (fraction of inspired oxygen) and/or positive end-expiratory pressure (PEEP) greater than 10-cm H₂O (positive end-expiratory pressure). Preliminary evidence from implementation studies may suggest that some individuals with COVID-19 requiring enhanced ventilatory support outside of established parameters may be able to safely participate in mobility-related interventions, though further research is needed to determine safety and feasibility to guide clinical decision making.</p>","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":"14 2","pages":"63-77"},"PeriodicalIF":0.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10032217/pdf/jat-14-63.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9545001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public Perceptions of Mobility and Exercise in the Hospital and Intensive Care Unit","authors":"Amy Toonstra, Sydney Chelstrom, Emily Ciesynski, Brandon Hixson, Mackenzie Jensen","doi":"10.1097/JAT.0000000000000216","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000216","url":null,"abstract":"Introduction: The purpose of this study was to evaluate the public's perception of exercise and early mobility for individuals in hospital and intensive care unit (ICU) through use of a validated survey. Review of Literature: Limited research has been performed to assess the general public's views on the importance, safety, and role of exercise and mobility for patients in hospital and ICU. Identification of public perceptions will be important in addressing patient education and engagement needs in the acute care setting. Subjects: A total of 186 respondents with median (interquartile range) age 43 (23-61). Inclusion criteria were 18 years or older and able to read English. Methods: A prospective, descriptive design was used. A survey was adapted from a validated survey for ICU providers regarding perceived barriers to mobility and was adapted for administration to the public. Content validity was established by 6 content experts. The survey had 11 items and used a 5-point Likert scale to evaluate the public's beliefs surrounding benefits of exercise and mobility in hospital and ICU. Demographic information was collected. Cronbach's α measured internal consistency and Spearman's ρ calculated correlation of responses and demographics. Results: Internal consistency was acceptable at 0.75. Survey responses were neutral toward benefits of mobilization and exercise for patients in the ICU and positive toward hospitalized patients. There were no correlations between demographics and responses. Discussion and Conclusion: The small cohort of the public responded with a positive attitude toward mobilization and exercise for patients in the hospital, and a neutral attitude toward mobilization in the ICU. Increased education to patients regarding the benefits of exercise and mobility in the ICU may be important for improving patient knowledge and engagement in physical therapy.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":"14 1","pages":"128 - 133"},"PeriodicalIF":0.5,"publicationDate":"2023-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41666449","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":"Showing Our Value: Actionable Implementation Strategies","authors":"John Corsino, Kenneth Venere","doi":"10.1097/jat.0000000000000215","DOIUrl":"https://doi.org/10.1097/jat.0000000000000215","url":null,"abstract":"","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":"1 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44152262","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":"Clinical Implications of a Moderate Positive Correlation Between the Braden Score and the AM-PAC Basic Mobility Score in the Acute Care Setting","authors":"Abigail Magner, James E. Whetzel, Michelle Hill, Kay E. Goodall, M. Faherty","doi":"10.1097/JAT.0000000000000210","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000210","url":null,"abstract":"Introduction: The Braden scale (Braden) is a scoring system used by bedside nursing staff to document a patient's risk of developing a pressure injury. This scale is completed immediately upon hospital admission and every 12 hours throughout the hospital course. The Activity Measure for Post-Acute Care inpatient basic mobility short form “6 clicks” (AM-PAC) is a scale used by physical therapists (PT) that provides a numerical value to help determine a patient's activity limitations and translates into a potential discharge destination from the acute care setting. The AM-PAC is scored on initial physical therapy evaluation and every physical therapy session during hospital course. The relationship between the 2 has yet to be hypothesized. Methods: A total of 212 patient medical charts met the inclusion criteria for this retrospective chart review study. Criteria incorporated patients with acute care admission to a large tertiary care teaching hospital between March 1, 2019, and March 31, 2021. All patients received at least 1 physical therapy visit during the course of their admission. The Braden admission score for this study is defined as the score documented on the same day and time as the first physical therapy evaluation during admission. Admission AM-PAC score was defined as the score recorded during physical therapy evaluation not admission to hospital. Discharge AM-PAC was defined as the final physical therapy note documented during the hospital admission (may not line up with acute hospital discharge date). Admission and discharge scores for both scoring systems were calculated for comparison. Results: The Spearman correlation for the Braden and AM-PAC was positive with an R value of 0.613 (P = .000) for admission and an R value of 0.555 (P = .000) for discharge, making it a statistically significant relationship with a moderate correlation. When the Braden score increased in value, the AM-PAC score increased in value at admission and discharge of physical therapy. In addition, as the values increased, the standard deviation decreased. Trends in discharge destination were recorded; in each of these relationships the discharge and admission Braden and AM-PAC continued to change together and a correlation for the numeric value was gathered. Discussion: Overall, when calculated for comparison between patient admission and discharge, the numerical results of the Braden and AM-PAC scores had a positive moderate relationship. The result of the present study suggests that the Braden score obtained on hospital admission may assist in determining discharge needs early in hospital admission. Additionally, this relationship may allow for reallocation of hospital resources to areas of greater mobility needs, and allow for monitoring of a decline in patient function. Conclusion: The relationship between the Braden and AM-PAC scores may assist in closing the knowledge gap between bedside nursing and PT in terms of patient mobility. The use of this data","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":"14 1","pages":"105 - 111"},"PeriodicalIF":0.5,"publicationDate":"2023-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48424141","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":"Quantifying the Risk for Hospital Readmission When Physical Therapist Discharge Recommendations Are Not Followed","authors":"Jonathan R. Wright, Trisha Koch-Hanes, Ciera Cortney, Kathryn Lutjens, K. Raines, Daniel Young","doi":"10.1097/JAT.0000000000000212","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000212","url":null,"abstract":"Purpose: Studies suggest that implementing physical therapist discharge recommendations decreases 30-day hospital readmissions but may have miscounted readmissions. The purpose of this study was to obtain accurate readmission data and calculate the risk for readmission when therapists' recommendations are not followed. Methods: We conducted this prospective cohort study at a hospital in the Northwestern United States. Two hundred sixty-nine hospitalized participants with physical therapy orders consented to medical record data extraction and participated in a follow-up phone call. We compared physical therapist discharge recommendations to the actual discharge setting and services established for participants as documented in their medical record. Thirty days after discharge, we called participants to ask whether they had been readmitted to any hospital. We then analyzed associations between readmissions and the mismatch of therapist recommendations and participants' actual discharge locations and services received. Results: Twenty-one percent of discharges did not match the location and/or services recommended by the physical therapist. Sixty-six of the 269 participants were readmitted within 30 days. The odds for readmission were 2.3 times greater among participants who did not discharge to the location with the services recommended by their physical therapist. Conclusions: When physical therapist discharge location and services recommendations are not implemented, patients have increased risk of hospital readmission. This finding should inform stakeholders involved in discharge planning on the effect of following recommendations.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":"14 1","pages":"112 - 117"},"PeriodicalIF":0.5,"publicationDate":"2023-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41842810","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":"Future of the Academy 2023-2025","authors":"Traci L. Norris","doi":"10.1097/jat.0000000000000211","DOIUrl":"https://doi.org/10.1097/jat.0000000000000211","url":null,"abstract":"","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45776851","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":"Describing the Value of Physical Therapy in a Complex System Using the Socio-Ecological Model","authors":"James P. Crick, Gabriel Alain, Carmen E. Quatman, Lisa A. Juckett, C. Quatman‐Yates","doi":"10.1097/JAT.0000000000000209","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000209","url":null,"abstract":"A system is a collection of entities (ie, widgets, molecules, people, businesses) that interact in such a way that their resulting collective behavior is not immediately apparent by viewing the collected items separately. Hospital-based health care meets the definition of a system, but further specification is helpful to describe the value of components in the system. Complexity science offers a chance to reconceptualize our understanding of health care to an environment of connected parts operating together and adapting on the basis of inputs and outputs. The purpose of this conceptual article is to apply complexity science principles to acute care physical therapy in order to provide perspective on the value of the physical therapist in the hospital environment and on the contextual factors that influence the profession's value. We present a model, the Socio-Ecological Model for Acute Care, and apply this model to physical therapy in order to describe the interrelated factors influencing the profession's value to individual patients, to the hospital units on which they practice, to the hospital system as a whole, and how they contribute to policy discussions. Yet, this value is difficult to distinguish due to the multifarious inputs into the system. Providing a clear description of the value of physical therapy in hospital settings is essential in our current health care environment that is increasingly cost-conscious. We provide perspective for clinicians and health care leaders while suggesting needs for future research.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":"14 1","pages":"1 - 9"},"PeriodicalIF":0.5,"publicationDate":"2022-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46276009","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":"Student Confidence and Interest in Acute Care Physical Therapy Through Peer Simulation","authors":"L. Neely, Morris C. Beato, Samantha Viana, Sol Ayala, Nensi Brari, P. Pabian","doi":"10.1097/JAT.0000000000000205","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000205","url":null,"abstract":"Introduction: The COVID-19 pandemic caused various challenges to the academic setting, especially for health care programs that require face-to-face (F2F) interactions to learn psychomotor skills. Simulation is often used to integrate didactic knowledge and enhance psychomotor skills to prepare students for clinical education experiences. The purpose of this study was to compare student confidence and interest in setting type prior to a first clinical education experiences between students who completed an F2F peer simulation course and students who completed the course virtually. Methods: Subjects included second-year doctor of physical therapy students who participated in the F2F course in 2019 (n = 37) and those who completed the virtual course in 2020 (n = 36). A 5-item pre- and postcourse self-assessment was administered to evaluate student confidence and interest in the acute care setting. A factorial analysis of variance was used to examine confidence scores of both cohorts at pre- and postcourse assessment. Results: Confidence rating of students from both cohorts significantly improved from precourse to postcourse in all areas, indicating that all students showed improved perceived confidence in their clinical skills upon completion of the course. However, the ratings of “ability to respond to changes in patient status in the acute care setting” were significantly greater in the F2F cohort than in the virtual cohort at the end of the course. There was also a positive interaction effect of cohort year (delivery mode) indicating that the F2F cohort had a stronger response in level of perceived confidence compared with the virtual cohort. In addition, student interest in the acute care setting was significantly greater at postcourse assessment for students from both cohorts. Conclusion: Postcourse rating of student-perceived confidence in clinical skills performance and interest in the acute care setting improved regardless of the mode of delivery of the course. However, when examining student-perceived confidence levels to respond to change in patient status, students who participated in the F2F course felt more confident in their ability to do so. Although perceived confidence levels improved for all students, virtual learning of clinical skills may not be as effective in training students to safely treat complex patients in the acute care setting.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":"14 1","pages":"78 - 86"},"PeriodicalIF":0.5,"publicationDate":"2022-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49286309","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":"Showing Our Value","authors":"Traci L. Norris","doi":"10.1097/jat.0000000000000206","DOIUrl":"https://doi.org/10.1097/jat.0000000000000206","url":null,"abstract":"","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43161841","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":"Acute Care Physical Therapy and Sickle Cell Disease","authors":"Ben Reader, Melana Tysowsky, Andrew B Collins, A. Power-Hays","doi":"10.1097/JAT.0000000000000207","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000207","url":null,"abstract":"Background and Purpose: Vaso-occlusive crises (VOC) are the most common cause for hospitalization in children and adolescents with sickle cell disease (SCD) in the United States. Physical therapy interventions provide nonpharmacological pain management and help hospitalized patients maintain mobility and function, but little is known about their application to the unique pathophysiology of those with SCD. The purpose of this review is to summarize evidence relevant to the physical therapy management of children and adolescents hospitalized with VOC. Methods: A literature search of PubMed, Cochrane, CINAHL, and EMBASE databases was performed using key words relevant to physical therapy interventions for children and adolescents with SCD and acute pain. Results: Sixteen articles were included in this review. Interventions identified included heat, mobilization, transcutaneous electrical nerve stimulation, massage, yoga, mindfulness, breathing exercises, virtual reality, incentive spirometry, and patient/family education. Conclusions: Physical therapists may be able to aid in the acute pain management of patients with SCD. Current literature relies on small observational studies making generalization difficult. Future studies are critical to improve evidence-based physical therapy practice in this population.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":" 36","pages":"87 - 92"},"PeriodicalIF":0.5,"publicationDate":"2022-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41252001","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}