Journal of Acute Care Physical Therapy最新文献

{"title":"The Role of Physical Therapy Following CAR T-Cell Therapy: A Case Report","authors":"Helaine Firestein","doi":"10.1097/jat.0000000000000183","DOIUrl":"https://doi.org/10.1097/jat.0000000000000183","url":null,"abstract":"Background: Diffuse large B-cell lymphoma (DLBCL) affects 7 out of 100 000 people in the United States every year. Chimeric antigen receptor (CAR) T-cell therapy is approved by the Food and Drug Administration to treat patients with relapsed/refractory DLBCL who have not responded to 2 prior lines of therapy. CAR T-cell therapy can lead to debilitating side effects necessitating rehabilitation intervention. Case Description: This case report details a 38-year-old woman with refractory DLBCL who received CAR T-cell therapy. The patient experienced grade 2 cytokine release syndrome and grade 4 immune effector cell-associated neurotoxicity syndrome, which resulted in, among other symptoms, lower extremity paraplegia. Upon medical stabilization, the patient was referred to physical therapy. Outcomes: The patient participated in acute care rehabilitation for 8 weeks and progressed significantly toward her prior level of function before being discharged to an inpatient rehabilitation facility. Upon discharge, the patient was able to ambulate with a rolling walker, a knee orthosis, and supervision for safety and had initiated stair training. Discussion/Conclusion: Physical therapists need to understand and recognize the range of side effects that can occur following CAR T-cell therapy. As more patients receive CAR T-cell therapy to treat malignancies, acute care oncology units will undoubtedly be challenged with patients exhibiting severe side effects. Physical therapists are well trained to address physical impairments resulting from CAR T-cell therapy's side effects and will play a vital role in these patients' interdisciplinary care.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45067430","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":"Troponin Elevation Following Percutaneous Coronary Intervention in Acute Coronary Syndrome","authors":"Daniel Miner, Kevin M Parcetich, Kellen Smith","doi":"10.1097/JAT.0000000000000181","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000181","url":null,"abstract":"Background: Recent advances in revascularization procedures have improved survival rates for individuals with acute coronary syndrome (ACS). However, evidence to guide clinical decision-making for early mobility following percutaneous coronary intervention (PCI) is extremely limited. Purpose: The purpose of this clinical perspective and literature review is to provide context for the clinical interpretation of cardiac troponin (cTn) levels in individuals with ACS following revascularization via PCI and present an evidence-supported clinical decision-making algorithm to guide clinicians in the appropriate timing of initiation of early mobility for individuals with ACS. Methods: A literature review on cTn values is presented to guide the clinical interpretation of laboratory values for clinical decision-making. A comparison of consensus-based guidelines for early mobility is presented as the basis for proposing a novel algorithm for clinical decision-making in individuals with ACS following PCI. Conclusion: The clinical value and utility of postprocedural cTn levels in individuals with ACS following PCI is to help understand prognosis and mortality but does not provide sufficient information about the safety of initiating early mobility following PCI. Decisions for initiation of early mobility in this population using the proposed evidence-supported algorithm may help avoid unnecessary prolongation of bed rest.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44047913","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":"APTA Cross Sections and Academies Recommendations for COVID-19 Core Outcome Measures","authors":"C. Wells, D. Kegelmeyer, K. Mayer, Sowmya Kumble, A. Reilley, A. Campbell, Rebecca J. Martin","doi":"10.1097/JAT.0000000000000172","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000172","url":null,"abstract":"Purpose: The novel coronavirus (COVID-19) emerged as a major health concern within the United States in early 2020. Because this is a novel virus, little guidance exists for best practice to evaluate this population within the field of physical therapy. Methods: An expert task force appointed by the leadership of 9 different academies or sections of the American Physical Therapy Association was formed to develop recommendations for a set of core outcome measures for individuals with or recovering from COVID-19. Results: This perspective provides guidance on a best practice recommendation to physical therapists and researchers regarding the use of core outcome measures for individuals with or recovering from COVID-19. The process for the selection of core measures for this population is presented and discussed. Conclusions: Core outcome measures improve the ability to track progress and change across the continuum of care at both the patient and population levels.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47375746","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":"Instrumented and Standard Measures of Physical Performance in Adults With Chronic Kidney Disease","authors":"Laura M. Johnstone, B. Roshanravan, Sean D. Rundell, B. Kestenbaum, Sarah Fay Baker, D. Berry, E. McGough","doi":"10.1097/JAT.0000000000000179","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000179","url":null,"abstract":"Background: Chronic kidney disease (CKD) is a common pathology encountered by acute care physical therapists. CKD is associated with reduced physical function and fall risk. The purpose of this study was to (1) examine the test-retest reliability of standard and instrumented physical performance measures and (2) describe the relationship between subjective fall risk and objective physical performance in people with CKD. Methods: Twenty-one adults with CKD completed a battery of standard and instrumented physical performance measures 1 week apart. Standard measures were the Short Physical Performance Battery (SPPB), gait speed, 5 times sit-to-stand (FSTS), 2-minute walk test (2MWT), and quadriceps (QS) and grip (GS) strength dynamometry. Instrumented measures included parameters of gait, sit-stand, and postural sway. Intraclass correlation coefficients (ICC) assessed test-retest reliability, and Pearson correlations (adjusted for age) assessed the relationships between the Fall Risk Questionnaire (FRQ) and standard physical performance. Results: Excellent to moderate test-retest reliability was demonstrated in the standard and instrumented physical performance measures. A subset of standard measures was significantly associated with the FRQ score. Conclusions: This study supports the clinical reliability of a battery of standard physical performance measures and a subset of instrumented parameters for use in adults with CKD. The FRQ may be useful for screening fall risk considering its relationship to objective physical performance.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48955555","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":"Utilization of Forearm Crutches to Avoid Lymphedema After Breast Cancer Lymph Node Surgery: A Case Report","authors":"Sue E. Curfman, G. P. Austin, Ben Radack","doi":"10.1097/JAT.0000000000000180","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000180","url":null,"abstract":"Background: Despite many patients with breast cancer being advised to limit upper extremity (UE) use, there is growing evidence that UE use is not associated with lymphedema. Subsequently, clinicians may be unsure of how to advise patients with a history of breast cancer who need assistive devices to ambulate. Study Design/Case Description: A 51-year-old woman who had recently undergone treatment for breast cancer sustained a knee injury requiring the use of crutches. Forearm crutches were used instead of axillary crutches to minimize the potential for irritation to the axillary lymphatic vessels and thus reduce the risk for lymphedema. L-Dex measures were used to monitor for lymphedema. Outcomes: L-Dex scores did not exceed the change of more than +7.1 to indicate the presence of lymphedema. Furthermore, there were no clinical signs or symptoms of lymphedema while using crutches and in the 7 months following. Discussion: Prolonged rigorous UE use by ambulating non-weight-bearing with forearm crutches within 1 to 2 months of treatment for breast cancer did not result in UE lymphedema. This case report reinforces the growing body of evidence that avoiding aggressive UE activity may not be necessary in those at low risk of lymphedema and informs assistive device prescription for patients with breast cancer.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44881616","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 Rehabilitation Following Upper and Lower Extremity Free Flap Surgery: A Review of Best Practices and Case Reports","authors":"D. Fufa, D. Osei, Samantha Antonietti, Kathryn Keaney","doi":"10.1097/JAT.0000000000000171","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000171","url":null,"abstract":"Purpose: The purpose of this article is to highlight the guiding principles and protocols for immediate and early postoperative management of upper and lower extremity flaps. We review critical principals of flap monitoring, dangling protocols, splinting, and positioning, as they relate to the physical and occupational therapists' acute care of patients following flap surgery. We refer to the protocol used at our facility but also discuss other protocols used in different hospitals. Case Demonstrations: Two cases have been discussed in this article, one involving the upper extremity and the other involving the lower extremity. The first case is a 43-year-old man who fell on the subway tracks, resulting in severe electrical burns requiring an anterolateral thigh flap for soft tissue coverage of exposed bone. The second case is a 55-year-old patient who was involved in a motor vehicle accident resulting in an open knee wound requiring a free latissimus dorsi muscle transfer for soft tissue coverage. Conclusion: There is no “gold standard” when treating a patient after flap surgery. As therapists, after a bed rest order is lifted, we initiate mobilizing a patient. Therefore, we may be present when a flap is at risk for compromise. As such, therapists should become familiar with the surgeon's protocol at their facility and understand how to appropriately progress patients. Additionally, a therapist should comprehend ways to assess a flap and familiarize themselves with principles of flap management.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42642595","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":"Acceptability of Physiotherapists in the Emergency Department for the Care of Adults With Musculoskeletal Disorders","authors":"Amélia Béland, E. Matifat, Émie Cournoyer, Kadija Perreault, F. Desmeules","doi":"10.1097/JAT.0000000000000178","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000178","url":null,"abstract":"Purpose: Over the past decades, pressure on emergency departments (EDs) has been increasing. New ED models of care including physiotherapists in more autonomous roles, often called advanced practice physiotherapy (APP) care, are emerging to improve access to care, especially for patients with musculoskeletal disorders (MSKDs). As such, the purpose of this study was to assess patient' acceptability of APP ED care for patients with MSKDs. Methods: Patients consulting for an MSKD were recruited in 1 Canadian ED and completed a 13-question survey assessing their acceptability of ED APP care. Descriptive analyses as well as χ2 and Fisher's exact tests, with associated 95% confidence interval, were performed. Results: Forty-one patients completed the survey. A majority of respondents (56%) trusted APPs to provide accurate diagnoses for MSKD in the ED, and 80.5% were confident they would provide safe care. Most participants felt confident that APPs would appropriately order medical imaging tests (73%) or prescribe medication (66%) when necessary. Sixty-six percent of participants agreed that seeing only a physiotherapist without the intervention of a physician would reduce their length of ED stay. Conclusions: Within this exploratory survey, participants were favorable to ED APP for the care of MSKD, suggesting that implementation of such models would be accepted by patients with MSKD presenting to an ED.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44940523","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":"Letter to the Editor April 29, 2021","authors":"E. Hillegass, K. Lukaszewicz, M. Puthoff","doi":"10.1097/JAT.0000000000000176","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000176","url":null,"abstract":"","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41702903","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":"How Do You Plan to End This Year?","authors":"Traci L. Norris","doi":"10.1097/JAT.0000000000000173","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000173","url":null,"abstract":"","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43564001","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":"Rehabilitation Outcomes for Patients With Severe Presentation of COVID-19: A Case Series.","authors":"Kathryn Solon, Allison Larson, Julie Ronnebaum, Catherine Stevermer","doi":"10.1097/JAT.0000000000000153","DOIUrl":"10.1097/JAT.0000000000000153","url":null,"abstract":"<p><p>To provide an outline of the timeline from acute care admission to inpatient rehabilitation facility discharge and describe the functional progress and tolerance of 2 individuals who were hospitalized but not intubated because of COVID-19.</p><p><strong>Method: </strong>Retrospective data were collected from the electronic medical record to describe the rehabilitation course of the first 2 consecutive patients admitted to the rehabilitation facility who were recovering from COVID-19. Both patients were octogenarian men who experienced functional decline while hospitalized for symptoms of COVID-19 and were recommended for further inpatient rehabilitation services. Progress during inpatient rehabilitation was tracked using the following outcome measures: Centers for Medicare & Medicaid Services Quality Indicators (QI), 6-Minute Walk Test, 10-Meter Walk Test, Timed Up and Go, and Berg Balance Scale.</p><p><strong>Results: </strong>Patient 1 had an 18-day acute care stay, a 13-day inpatient rehabilitation facility stay, and was discharged to home. Patient 2 had an interrupted 19-day acute care stay, a 15-day inpatient rehabilitation facility stay, and was discharged to a skilled nursing facility. Patient 1 improved 160.98 m in the 6-Minute Walk Test, 0.08 m/s in self-selected walking speed, and 85 points in the total Quality Indicators score. Patient 2 improved 115.22 m in the 6-Minute Walk Test, 0.14 m/s in self-selected walking speed, and 39 points in the total Quality Indicators score.</p><p><strong>Conclusion: </strong>The patients made clinically meaningful improvements in each outcome measure during their length of stay for inpatient rehabilitation. This reveals the positive rehabilitation potential of 2 older adult patients with COVID-19 and demonstrates the patients' ability to maintain inpatient rehabilitation facility level of activity. With individualized care and discharge planning, similar patients may make significant gains in function despite advanced age and comorbid conditions.</p>","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8224693/pdf/jat-12-115.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39056146","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}