Journal of Acute Care Physical Therapy最新文献

{"title":"The Impact of Mobility Technicians on Mobility Rates for Hospitalized Adults in a Large Academic Medical Center","authors":"Chris L. Wells, Katherine Frampton, Linda B. Horn, Afnan M Gimie, Jason R. Falvey","doi":"10.1097/jat.0000000000000235","DOIUrl":"https://doi.org/10.1097/jat.0000000000000235","url":null,"abstract":"\u0000 \u0000 Promotion of early mobility is part of an ongoing effort to mitigate the iatrogenic effects of hospitalization. To assist with mobilization efforts, nursing departments hire mobility technicians (MTs). However, little is known about whether hospital units that hire MTs have increased rates of patient mobilization.\u0000 \u0000 \u0000 \u0000 The aim of this retrospective study was to determine whether units in an academic medical setting that hired an MT had greater improvements in mobility compared with similar units that did not hire an MT.\u0000 \u0000 \u0000 \u0000 Two levels of care-matched pairs of hospital units were used for this analysis. Within each pairing, one unit hired an MT. We captured activity days, defined as any documented out-of-bed activity in a 24-hour period, from standardized documentation. A monthly activity rate was calculated for each unit as the average daily percentage of patients who had out-of-bed orders. A difference-in-difference generalized linear model with a time-by-MT interaction, weighted for patient volume, was used to compare the relative improvement in mobility 6 months prior (baseline) to the hiring of an MT to periods 3 and 6 months post-hire.\u0000 \u0000 \u0000 \u0000 There was a 2.3% absolute increase in activity rate from preperiod to the 3-month postperiod for units that hired an MT, as compared with a 5.1% decline in similar units that did not have an MT. This 8.4% difference in activity rates was statistically significant (P = .03). Over 6 months, the effects of the program waned. Control units continued to decline with a 7.1% drop from baseline) compared with a marginal 0.1% increase in activity rates for units with an MT from baseline. This relative 7.6% increase in mobility was not significant (P = .13).\u0000 \u0000 \u0000 \u0000 There was a significant improvement in activity rates associated with MT hire that declined over time. These results may be contributed to a nonstructured MT utilization, variability with nursing education on the role of the MT, and staffing challenges that diverted the use of the MT to nonmobility activities.\u0000","PeriodicalId":505048,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":"62 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139841284","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":"Lower Functional Status and Sternal Precaution Noncompliance May Not Be Related to Dehiscence Post-Median Sternotomy","authors":"Michael J. Shoemaker, Ashley Van Dam, Katelyn Erickson, Jared Gregory, Gabrielle Ureste, Katelyn Preston, Amy Griswold","doi":"10.1097/jat.0000000000000234","DOIUrl":"https://doi.org/10.1097/jat.0000000000000234","url":null,"abstract":"\u0000 \u0000 The purpose of this study was to examine the relationship between functional status, compliance with sternal precautions, and aseptic osseous postoperative incision complications.\u0000 \u0000 \u0000 \u0000 Although there is limited research on upper extremity use and noncompliance with sternal precautions and sternal motion, there is a paucity of literature on functional status and noncompliance with sternal precautions and their effect on actual sternal complications, specifically aseptic osseous dehiscence.\u0000 \u0000 \u0000 \u0000 A retrospective medical record review was performed on 113 patients with an incisional complication following median sternotomy. Functional status was assessed using the AM-PAC “6-Clicks” Basic Mobility Short Form and initial gait distance. Compliance to sternal precautions was assessed using clinical documentation to determine the percentage of therapy sessions requiring cues. Propensity score matching was performed to select matched comparator records for those with aseptic osseous dehiscence. A descriptive, in-depth chart review was then performed to determine other possible clinical factors contributing to complication.\u0000 \u0000 \u0000 \u0000 Eight of 113 patients had aseptic osseous dehiscence. Initial AM-PAC “6-Clicks” score (U = 4.375, P = .036), initial gait distance (U = 7.252, P = .007), and number of ventilator days (U = 2.790, P = .005) were significantly different in the aseptic osseous group compared to other complication types. However, the number of ventilator days was the only variable that remained significant (U = 52.5, P = .028) between those with aseptic osseous dehiscence and the 8 matched comparators. The in-depth chart review revealed that the aseptic osseous group had respiratory complications in 5 of 8 records as compared with 2 of 8 records in the comparator group.\u0000 \u0000 \u0000 \u0000 The findings of this study suggest that confounding clinical factors besides functional status and compliance to sternal precautions could have contributed to aseptic osseous dehiscence following median sternotomy. Respiratory complications postoperatively may be a key confounding factor in aseptic osseous dehiscence. Therefore, the effect of functional status and noncompliance to traditional sternal precautions remains unclear.\u0000","PeriodicalId":505048,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":"377 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139841590","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":"Lower Functional Status and Sternal Precaution Noncompliance May Not Be Related to Dehiscence Post-Median Sternotomy","authors":"Michael J. Shoemaker, Ashley Van Dam, Katelyn Erickson, Jared Gregory, Gabrielle Ureste, Katelyn Preston, Amy Griswold","doi":"10.1097/jat.0000000000000234","DOIUrl":"https://doi.org/10.1097/jat.0000000000000234","url":null,"abstract":"\u0000 \u0000 The purpose of this study was to examine the relationship between functional status, compliance with sternal precautions, and aseptic osseous postoperative incision complications.\u0000 \u0000 \u0000 \u0000 Although there is limited research on upper extremity use and noncompliance with sternal precautions and sternal motion, there is a paucity of literature on functional status and noncompliance with sternal precautions and their effect on actual sternal complications, specifically aseptic osseous dehiscence.\u0000 \u0000 \u0000 \u0000 A retrospective medical record review was performed on 113 patients with an incisional complication following median sternotomy. Functional status was assessed using the AM-PAC “6-Clicks” Basic Mobility Short Form and initial gait distance. Compliance to sternal precautions was assessed using clinical documentation to determine the percentage of therapy sessions requiring cues. Propensity score matching was performed to select matched comparator records for those with aseptic osseous dehiscence. A descriptive, in-depth chart review was then performed to determine other possible clinical factors contributing to complication.\u0000 \u0000 \u0000 \u0000 Eight of 113 patients had aseptic osseous dehiscence. Initial AM-PAC “6-Clicks” score (U = 4.375, P = .036), initial gait distance (U = 7.252, P = .007), and number of ventilator days (U = 2.790, P = .005) were significantly different in the aseptic osseous group compared to other complication types. However, the number of ventilator days was the only variable that remained significant (U = 52.5, P = .028) between those with aseptic osseous dehiscence and the 8 matched comparators. The in-depth chart review revealed that the aseptic osseous group had respiratory complications in 5 of 8 records as compared with 2 of 8 records in the comparator group.\u0000 \u0000 \u0000 \u0000 The findings of this study suggest that confounding clinical factors besides functional status and compliance to sternal precautions could have contributed to aseptic osseous dehiscence following median sternotomy. Respiratory complications postoperatively may be a key confounding factor in aseptic osseous dehiscence. Therefore, the effect of functional status and noncompliance to traditional sternal precautions remains unclear.\u0000","PeriodicalId":505048,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":"45 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139781744","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":"Using Outcome Measures to Transition Ambulation From Physical Therapy to Nursing for Patients With Mechanical Circulatory Support","authors":"Rajashree S. Mondkar, Andrea Attorri, Carolyn Bridges, Agata Stawarz-Gugala, Catherine Stolboushkin, Terrence Schwing, Judith Ragsdale, Bobby Belarmino","doi":"10.1097/jat.0000000000000236","DOIUrl":"https://doi.org/10.1097/jat.0000000000000236","url":null,"abstract":"\u0000 \u0000 The primary aim of this pilot study was to propose cutoff scores for the functional outcome measures at which patients with mechanical circulatory support (MCS) device can transition ambulation from a skilled physical therapy service to a nursing-led ambulation program.\u0000 \u0000 \u0000 \u0000 This was an exploratory pilot study (N = 46) of patients in an intensive care unit (ICU) with MCS devices. Three functional outcome measures were used: Activity Measure for Post-Acute Care (AM-PAC), Perme ICU Mobility Score (Perme Score), and 5-m gait speed test (gait speed). Cutoff scores were identified using area under the curve (AUC) of receiver operating characteristic.\u0000 \u0000 \u0000 \u0000 Twenty-two patients (intra-aortic balloon pump n = 16; Impella n = 6) were transitioned to a nursing-led ambulation program. The proposed cutoff scores to transition to a nursing-led ambulation program were 19.5 raw score (whole number >19) (>45.44 t score) for AM-PAC, 29.5 (whole number >29) for Perme Score, and 0.57 m/s or more for gait speed.\u0000 \u0000 \u0000 \u0000 The proposed cutoff scores for the 3 commonly used outcome measures for patients in the ICU are possibly useful when transitioning the ambulation program safely from skilled physical therapy to nursing service.\u0000","PeriodicalId":505048,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":"1 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139781856","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":"Using Outcome Measures to Transition Ambulation From Physical Therapy to Nursing for Patients With Mechanical Circulatory Support","authors":"Rajashree S. Mondkar, Andrea Attorri, Carolyn Bridges, Agata Stawarz-Gugala, Catherine Stolboushkin, Terrence Schwing, Judith Ragsdale, Bobby Belarmino","doi":"10.1097/jat.0000000000000236","DOIUrl":"https://doi.org/10.1097/jat.0000000000000236","url":null,"abstract":"\u0000 \u0000 The primary aim of this pilot study was to propose cutoff scores for the functional outcome measures at which patients with mechanical circulatory support (MCS) device can transition ambulation from a skilled physical therapy service to a nursing-led ambulation program.\u0000 \u0000 \u0000 \u0000 This was an exploratory pilot study (N = 46) of patients in an intensive care unit (ICU) with MCS devices. Three functional outcome measures were used: Activity Measure for Post-Acute Care (AM-PAC), Perme ICU Mobility Score (Perme Score), and 5-m gait speed test (gait speed). Cutoff scores were identified using area under the curve (AUC) of receiver operating characteristic.\u0000 \u0000 \u0000 \u0000 Twenty-two patients (intra-aortic balloon pump n = 16; Impella n = 6) were transitioned to a nursing-led ambulation program. The proposed cutoff scores to transition to a nursing-led ambulation program were 19.5 raw score (whole number >19) (>45.44 t score) for AM-PAC, 29.5 (whole number >29) for Perme Score, and 0.57 m/s or more for gait speed.\u0000 \u0000 \u0000 \u0000 The proposed cutoff scores for the 3 commonly used outcome measures for patients in the ICU are possibly useful when transitioning the ambulation program safely from skilled physical therapy to nursing service.\u0000","PeriodicalId":505048,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":"60 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139841671","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 Impact of Mobility Technicians on Mobility Rates for Hospitalized Adults in a Large Academic Medical Center","authors":"Chris L. Wells, Katherine Frampton, Linda B. Horn, Afnan M Gimie, Jason R. Falvey","doi":"10.1097/jat.0000000000000235","DOIUrl":"https://doi.org/10.1097/jat.0000000000000235","url":null,"abstract":"\u0000 \u0000 Promotion of early mobility is part of an ongoing effort to mitigate the iatrogenic effects of hospitalization. To assist with mobilization efforts, nursing departments hire mobility technicians (MTs). However, little is known about whether hospital units that hire MTs have increased rates of patient mobilization.\u0000 \u0000 \u0000 \u0000 The aim of this retrospective study was to determine whether units in an academic medical setting that hired an MT had greater improvements in mobility compared with similar units that did not hire an MT.\u0000 \u0000 \u0000 \u0000 Two levels of care-matched pairs of hospital units were used for this analysis. Within each pairing, one unit hired an MT. We captured activity days, defined as any documented out-of-bed activity in a 24-hour period, from standardized documentation. A monthly activity rate was calculated for each unit as the average daily percentage of patients who had out-of-bed orders. A difference-in-difference generalized linear model with a time-by-MT interaction, weighted for patient volume, was used to compare the relative improvement in mobility 6 months prior (baseline) to the hiring of an MT to periods 3 and 6 months post-hire.\u0000 \u0000 \u0000 \u0000 There was a 2.3% absolute increase in activity rate from preperiod to the 3-month postperiod for units that hired an MT, as compared with a 5.1% decline in similar units that did not have an MT. This 8.4% difference in activity rates was statistically significant (P = .03). Over 6 months, the effects of the program waned. Control units continued to decline with a 7.1% drop from baseline) compared with a marginal 0.1% increase in activity rates for units with an MT from baseline. This relative 7.6% increase in mobility was not significant (P = .13).\u0000 \u0000 \u0000 \u0000 There was a significant improvement in activity rates associated with MT hire that declined over time. These results may be contributed to a nonstructured MT utilization, variability with nursing education on the role of the MT, and staffing challenges that diverted the use of the MT to nonmobility activities.\u0000","PeriodicalId":505048,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":"91 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139781226","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}