Journal of Acute Care Physical Therapy最新文献

{"title":"Safety of a Nurse-Driven Mobility Protocol in a Surgical Trauma Intensive Care Unit","authors":"K. Black, Stephanie Smith, M. Frotan, Kaeli Vandertulip, Amy Miller","doi":"10.1097/JAT.0000000000000146","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000146","url":null,"abstract":"Copyright © 2020 Academy of Acute Care Physical Therapy, APTA ABSTRACT Background: Traumatically injured patients are often admitted with complex multisystem injuries requiring a lengthy stay in the intensive care unit (ICU). Mobilizing patients in the ICU has been shown to reduce the adverse effects of immobility and can reduce the patient’s length of stay in the hospital. However, little information is available about the safety of mobilizing traumatically injured patients. Local Problem: This quality improvement project was designed to determine whether a nurse-driven mobility protocol could lead to more frequent mobilization of traumatically injured patients. We also sought to determine patient outcomes, measured by the length of stay, adverse effects, and days on mechanical ventilation. Methods: A multidisciplinary group developed a nurse-driven early mobility protocol. Nurses were trained on mobilization practices for injured patients; they then mobilized eligible patients on their unit for the subsequent 6 months. Results: Nurses mobilized close to 80% of eligible patients in the surgical trauma ICU (STICU) during the implementation period, which was an 87.14% increase in patient mobilization from the preimplementation period. No mobility-associated adverse effects were observed for the patients who were mobilized in the STICU. No significant change in length of stay or ventilator-days occurred. Conclusion: Interdisciplinary planning led by physical therapists can ensure that a nurse-driven mobility protocol is a safe and effective method to mobilize patients earlier and more frequently. Future studies should consider a broader range of traumatically injured patients and the long-term effects of mobilization in the STICU.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61771656","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":"Early Rehabilitation Following Saddle Pulmonary Embolism: Perspective From Physical Therapist as Patient","authors":"K. E. Brueilly, Colleen G. Hergott, A. Fox, Jeffrey S. Dowling","doi":"10.1097/JAT.0000000000000149","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000149","url":null,"abstract":"","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48246380","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":"Physical Therapy Screening of Occult Cancer Presenting as Hip Pain in Acute Care Setting","authors":"S. Thompson, David A. Krause, Beth A. Cloud-Biebl","doi":"10.1097/JAT.0000000000000148","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000148","url":null,"abstract":"Copyright © 2020 Academy of Acute Care Physical Therapy, APTA ABSTRACT Background and Purpose: Physical therapists (PTs) in the acute care setting evaluate patients to determine discharge plans and perform mobility-based safety evaluations. When presented with a common problem different from the referral diagnosis, in this case, hip pain, the PT must use knowledge of palpation, range of motion, special tests, and outcome tools to evaluate the patient and identify possible sources of their pain. This case report aims to describe a patient’s atypical presentation of hip pain that was ultimately diagnosed as metastatic bone disease. This report includes the description of differential diagnoses based on the patient examination, details of the subsequent events leading to her final diagnosis, and discussion of the importance of screening patients beyond their diagnosis in the acute care setting. Case Description: A 69-year-old woman was referred to physical therapy in the hospital following aortic surgery. During the initial evaluation, she described 10/10 hip pain that had gone undocumented thus far. Examination revealed pain with passive and active motion in all directions, increased pain with weight-bearing, and impaired mobility. Current evidence for the evaluation of hip pain was used to examine differential diagnoses aligned with the patient’s symptoms. Based on the PT’s evaluation, subsequent referrals and imaging were warranted and led to a diagnosis of metastatic adenocarcinoma. Conclusion: Hip pain caused by sinister pathologies is unusual. In this case, a PT identified “red flag” symptoms during the initial evaluation and collaborated with other providers for further investigation. The skilled evaluation and timely referral led to the discovery of previously undiagnosed metastatic adenocarcinoma.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47082500","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 and Occupational Therapy Early Intervention Pathway After Transcatheter Aortic Valve Replacement: A Retrospective Study","authors":"Adele Myszenski, B. Michon, Danielle Lupcke, Cynthia Melican, Narmean Pedawi, N. Ahmed, J. Wyman","doi":"10.1097/JAT.0000000000000147","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000147","url":null,"abstract":"Copyright © 2020 Academy of Acute Care Physical Therapy, APTA ABSTRACT Purpose: Transcatheter aortic valve replacement (tAVR) has emerged as a less-invasive alternative to traditional surgical aortic valve replacement. The purpose of this study was to examine the effect of a novel clinical pathway with an emphasis on early physical therapy and occupational therapy on patients undergoing tAVR in the acute care setting. Methods: A retrospective study was conducted involving 189 patients who underwent tAVR. The control group (n = 74) included patients who underwent tAVR prior to the implementation of the pathway. The intervention group (n = 115) included patients who underwent tAVR following the implementation of the pathway. Inpatient length of stay and discharge disposition were measured. Results: No differences in demographics or clinical variables were found; for example, mean age was 79.5 ± 11.2 years, with 57% male in the control group versus 81.6 ± 8.4 years and 59% male in the intervention group. Length of stay was significantly lower in the intervention group (control 6.9 ± 5.4 days, intervention 4.8 ± 5.4 days, P = .009) and significantly shorter length of stay postprocedure (control 4.8 ± 2.9 days, intervention 3.5 ± 4.0, P = .015). The incidence of the patient’s discharge disposition to home increased from 77% of patients in the control group to 86% of patients in the intervention group but was not statistically significant (P = .118). Conclusions: A clinical pathway specific to patients post-tAVR provided early mobility, targeted education, individualized functional goals, and discharge disposition recommendations. Patients in the intervention group experienced reduced hospital length of stay.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2020-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46488630","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 Protocol of Ankle ROM Goniometry Measurement in the Neuroscience ICU","authors":"J. Tolland, Kathleen Taglieri-Noble, Kevin McEnroy, Lauren A. Miccile","doi":"10.1097/JAT.0000000000000142","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000142","url":null,"abstract":"Background/Purpose: Prolonged intensive care unit (ICU) admission and symptoms of neurologic injury may increase the risk for joint contracture, negatively affecting function. Clear recommendations for assessing, monitoring, and providing interventions for contractures are limited. The purpose of our study was to determine the effect of implementing an ankle dorsiflexion (DF) measurement protocol in a patient population at risk for ankle contractures. We examined the effect of the measurement protocol on the frequency of measurement, ankle DF range of motion (ROM) from physical therapy (PT) evaluation to hospital discharge, and interventions provided. Methods: A measurement protocol of ankle DF ROM was implemented for patients admitted to the neuroscience ICU. A retrospective analysis was conducted of all patients who met eligibility criteria with a total hospital length of stay of more than 15 days and revealed 2 groups. A measurement group (MG) was evaluated by a physical therapist within 72 hours and included in the measurement protocol. A comparison group (CG) was not successfully evaluated per the measurement protocol and not included in the measurement protocol. Results: A total of 58 patients were analyzed. The MG (n = 27) received more measurements per week (P < .001) and more total sessions with measurements (P < .001); the CG (n = 31) received more estimated measurements (P = .005). More MG patients were assessed for the need for ROM intervention (P = .02). The CG received more interventions (mean [SD] = 0.94 [2.02]) than the MG (mean [SD] = 0.67 (1.00)], though not statistically significant. A subset of each group had analyzable ROM measurements. The MG subgroup (MGs) ROM change was positive (mean [SD] = 2.88°[8.55°]). The CG subgroup (CGs) was negative (mean [SD] = 4.50° [16.58°]); no significant difference was found. Discussion/Conclusion: The protocol increased the number of measurements performed. Ankle DF ROM was more frequently estimated in the CG. More MG patients were assessed for the need for ROM interventions; however, the number of interventions provided did not differ between groups. Ankle DF ROM goniometric measurements taken at a consistent frequency may affect the number of interventions provided. We were unable to determine the effect of the protocol on ROM measurements due to inconsistent measurement frequency and small sample size. Further studies are needed to assess barriers to consistent ROM measurement, assess the effects of increased measurement on ROM and functional outcomes, and the effect on the provision of intervention and allotment of resources.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2020-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44973878","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":"Effect of Physical Therapy Dosage on Functional Recovery Following TBI","authors":"J. Tolland, Lauren A. Miccile, Katherine M. Burke","doi":"10.1097/JAT.0000000000000127","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000127","url":null,"abstract":"Background/Purpose: Evidence supporting neurorehabilitation dosage after traumatic brain injury is limited. High-dose, high-intensity intervention, involving maximal frequency, time, and patient participation, facilitates neuroplasticity and optimizes outcomes. This patient made significant functional progress with the dosage of therapy provided, warranting investigation into the optimal dosage of therapy in this patient population.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/JAT.0000000000000127","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43068653","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":"In Need of Inspiration, Look Around You","authors":"S. Gorman","doi":"10.1097/jat.0000000000000145","DOIUrl":"https://doi.org/10.1097/jat.0000000000000145","url":null,"abstract":"","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46473061","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":"Novel Treatment of Subjective BPPV in the Medically Complex Geriatric Patient","authors":"D. Stam, J. Pernu","doi":"10.1097/JAT.0000000000000131","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000131","url":null,"abstract":"Background and Purpose: Peripheral vestibular disorders such as benign paroxysmal positional vertigo (BPPV) are a common, yet costly health care burden. In the older adult population, BPPV may go undiagnosed and contribute to a poorer quality of life and increased risk for falls and secondary injury. The presence of both acute and chronic medical complexities increases the challenge clinicians face in examination and evaluation. The purpose of this article is to present a case report of the treatment of subjective BPPV in an older adult with acute contraindications to traditional intervention techniques.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/JAT.0000000000000131","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45336388","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":"Applying Telehealth Technologies and Strategies to Provide Acute Care Consultation and Treatment of Patients With Confirmed or Possible COVID-19.","authors":"Emelia Exum, Brian L Hull, Alan Chong W Lee, Annie Gumieny, Christopher Villarreal, Diane Longnecker","doi":"10.1097/JAT.0000000000000143","DOIUrl":"10.1097/JAT.0000000000000143","url":null,"abstract":"<p><strong>Background and purpose: </strong>The COVID-19 pandemic continues to grow, with 19% of total confirmed patients classified as severe or critical experiencing complications such as dyspnea, hypoxia, acute respiratory distress syndrome, or multiorgan failure. These complications require rehabilitative care. Considering the contagious nature of COVID-19 and the necessity to decrease the volume of health care professionals entering confirmed COVID-19 patient rooms and becoming a potential disease vector, can audiovisual technologies employed by telehealth and telerehabilitation help?</p><p><strong>Case description: </strong>This case discusses the Baylor Scott and White Institute for Rehab (BSWIR) Physical Medicine and Rehabilitation (PMR) department COVID-19 acute care therapy team's creation of a telehealth strategy to provide early rehabilitative intervention without increasing the odds of disease transmission.</p><p><strong>Outcomes: </strong>The COVID-19 therapy team created a simple process for identifying and triaging care for patients with possible or confirmed COVID-19. These patients were evaluated and treated by the dedicated team using telehealth strategies. A structured risk-benefit analysis was used to determine when in-room care was indicated.</p><p><strong>Discussion: </strong>Acute care physical therapy, occupational therapy, and speech-language pathology telehealth strategies can add value by mitigating COVID-19-related harm and influencing recovery, while not unnecessarily becoming additional disease vectors consuming personal protective equipment. COVID-19 is not only an aggressive respiratory illness similar to acute respiratory distress syndrome but also highly contagious and a risk for health care providers. Telehealth strategies allow therapists to intervene early, opening the possibility to maximize recovery and prevent harm or decompensation. Telehealth strategies can be more prevention-focused while the patient is experiencing relatively good health with goals to maximize strength and endurance before the disease process evolves to critical illness. As COVID-19 progresses, therapy can help mitigate potential complications associated with prolonged intensive care unit stay and ventilator management.</p>","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2020-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/JAT.0000000000000143","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39056145","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":"Three-Fourths of ICU Physical Therapists Report Use of Assistive Equipment and Technology in Practice: Results of an International Survey","authors":"K. Mayer, Ramona A. Carper, S. Henson, Emily A. Clonce, Warren Jay Christian, Sherif M. Seif, A. Pastva, D. Needham, P. Morris","doi":"10.1097/JAT.0000000000000144","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000144","url":null,"abstract":"Introduction: Patients surviving critical illness develop persistent functional mobility impairments that significantly impact their quality of life. Early rehabilitation interventions in the intensive care unit (ICU) may mitigate the sequelae of critical illness. However, implementation of such interventions is very low in clinical practice. Assistive rehabilitation equipment and technology, such as tilt beds and cycle ergometers, provide physical therapists (PTs) with strategies to complement functional mobility interventions. Purpose: To determine PTs' self-reported use of assistive rehabilitation equipment and technology in their clinical practices in the ICU and to describe the rationale for their use. Methods: An online survey (Qualtrics), with closed- and open-ended questions, was distributed to PTs working in the ICU, via e-mail through the Academy of Acute Care Physical Therapy “PTinICU” e-mail listserv and the online ICU Recovery Network and Twitter. Descriptive statistics were used to assess frequency and rationale for the use of specific equipment and technology. Results: PTs (n = 206, mean age 39.6 ± 9.7 years, 82% female) completed the survey (81% in the United States and 19% from 12 countries outside of the United States). Respondents (153/206, 74%) reported using at least one type of equipment or technology. The most commonly used were hospital tilt beds and tilt tables (n = 106, 51%), mobilization chairs (n = 80, 39%), standing frames (n= 66, 32%), cycle ergometers (n = 63, 31%), and exercise platforms (n = 36, 17%). The most common rationale for use was as a bridge to functional mobility (response ranging from 17% to 44% depending on the technology). The most common reason for not using equipment or technology was limited or no access (71%, 37/53). PTs from outside the United States (vs US-based PTs) reported greater use of equipment or technology (n = 206, 92% vs 70%, P = .001). Conclusions: Approximately 75% of PTs completing this survey report use of assistive rehabilitation equipment and technology in their ICU clinical practice, emphasizing the need for further research to understand the clinical approaches for use and the efficacy of such technology.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44191387","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}