Increased physician and physical therapist communication is associated with earlier mobility and decreased length of stay in the cerebrovascular and trauma neuroscience population

Abstract Objective This study investigates if higher utilization of physical therapist assistants adversely affects patient outcomes in the acute rehabilitation setting for patients following a cerebrovascular accident (CVA). Methods Participants were admitted to 1 of 5 inpatient rehabilitation facilities following a CVA from 2008 to 2010. High physical therapist assistant use was defined as ≥20% of the physical therapist visits being provided by the physical therapist assistant for an episode of care. Multivariable regression techniques examined differences in functional outcome, discharge location, and length of stay between high and low physical therapist assistant use groups. Propensity scoring methods supplemented findings of the regression analyses. Results Of the 1561 participants, 496 (32%) had high physical therapist assistant involvement. Baseline participant characteristics such as age, sex, baseline motor function, and comorbidities did not differ between high and low physical therapist assistant use groups. After adjusting for patient characteristics, rehabilitation facility, and year, higher physical therapist assistant use did not adversely affect functional outcome or length of stay. Fewer conclusions can be drawn regarding discharge location, although there was no significant difference in discharge location between groups with high and low physical therapist assistant utilization. Propensity scoring methods supported the findings of the regression analyses. Conclusions Higher physical therapist assistant involvement in the rehabilitation of patients following CVA did not adversely affect functional outcome, increase length of stay, or reduce the likelihood of discharge to home from an inpatient rehabilitation facility. Impact The results demonstrate the value of the physical therapist assistant in the provision of physical therapy for patients with stroke in the inpatient rehabilitation setting. Higher involvement of the physical therapist assistant may provide cost savings while maintaining patient outcomes for this setting and population.

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Effects of Anemia on the Rehabilitation Outcomes in Elderly Patients in the Post-Acute Care Setting.

Blood ◽

10.1182/blood.v110.11.5158.5158 ◽

2007 ◽

Vol 110 (11) ◽

pp. 5158-5158 ◽

Cited By ~ 2

Author(s):

Maciej Witkos ◽

Michelle Uttaburanont ◽

Myra Vicenio ◽

Christopher Lang ◽

Rami Y. Haddad

Keyword(s):

Length Of Stay ◽

Medical Records ◽

Chart Review ◽

Physical Therapist ◽

Medical Center ◽

The United States ◽

Multivariate Model ◽

Rehabilitation Outcomes ◽

The North ◽

Median Change

Abstract Background - More than 3 million people in the United States over the age of 65 are anemic. The evidence indicates that older people with anemia suffer hospitalizations, physical decline and disability more than people without anemia. Additionally there are reports that anemia is an independent risk factor for this decline in physical performance in those over the age of 65. Objective - The goal of this study was to detail if anemia significantly affects patient’s rehabilitation outcomes by focusing on the ability to perform activities of daily living (ADL) as assessed by the physical therapist, the disposition upon discharge (meeting the therapy goals) and an analysis of length of stay (LOS) in relation to anemia. Methods - We conducted a chart review of 260 medical records of patients who underwent rehabilitation therapy at the North Chicago Veterans Affairs Medical Center, and detailed the progress of 69 of these patients who received ADL therapy. The study is ongoing with a projected chart review of 437 medical records, and with an estimated final sample size of 150. Univariate and multivariate analysis was conducted in relation to our outcome measures. Results - The anemic group had 43 patients and the non-anemic 26. Average values for anemic patients were: Hgb 11 Hct 32, MCV 88, MCH 29.2, RDW 15.6, Platelets 259, the non-anemic patients values were: Hgb 13.4, Hct 39, MCV 89, MCH 33.3, RDW 14.3, platelets 229. The patients with anemia had a median change in ADL scores of 9 versus non-anemic patients’ median change in scores of 12 (p=0.154). Length of stay was 51 days (median) for anemic patients and 36 days (median) for non-anemic patients (p=0.108) Of the non-anemic patients, 19 out of 26 (73%) met the goals of therapy and 21 out of 43 (49%) of the anemic patients met the goals of therapy (p=0.055). Surprisingly, only 3 out of the 43 (7%) anemic patients were treated for their anemia or had work up done to identify the cause of the anemia. The multivariate model for length of stay indicated that anemia was not significant (p=0.842), the morbidity of the patient was marginally not significant (p=0.089), however, the patients’ age was statistically significant at p=0.05. For the multivariate model of ADL improvement the results were: anemia p=0.186, sex p=0.298, Charlson index p=0.50. Conclusion - There is a definite lack in the identification and treatment of anemia in patients undergoing rehabilitation. Anemia exerts an influence on the course of patient therapy/recovery and should be addressed as an individual problem. Anemic patients undergoing rehabilitation are scoring lower, and are admitted longer to the hospital.

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Abstract WP155: Increased Physician and Physical Therapist Communication is Associated With Earlier Mobility and Decreased Length of Stay in the Cerebrovascular and Trauma Neuroscience Population

Stroke ◽

10.1161/str.47.suppl_1.wp155 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Danielle Burch ◽

Silke Bernert ◽

Justin F Fraser

Keyword(s):

Length Of Stay ◽

Physical Therapist ◽

Intervention Group ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Intervention Period ◽

Post Intervention ◽

Multidisciplinary Rounds ◽

Level I ◽

Post Intervention Group

Background and Purpose: There is growing interest in methods for early rehabilitation in patients with acute neurologic conditions. The purpose of this study was to identify whether increased coordination between the physical therapist and an attending cerebrovascular neurosurgeon through daily multidisciplinary rounds would correlate with positive changes in overall care. Hypothesis: We evaluated the hypothesis that a physical therapist participating in cerebrovascular neuroscience rounds would decrease the time to initial physical therapy (PT) consult, decrease hospital length of stay (LOS), decrease Intensive Care Unit (ICU) LOS, and decrease ventilator days. Methods: A retrospective review was performed of 235 patients who were admitted to the neuroscience service under a single cerebrovascular neurosurgeon over a 16-month period (April 2014 through July 2015) in a level-I trauma hospital. The study consisted of an eight-month pre-intervention period (n=117) where the physical therapist did not attend physician rounds and an eight-month post-intervention period (n=118). Results: In the post-intervention group the PT assessment occurred on average 1.57 days sooner than before the physical therapist participated in neuroscience physician rounds (p<0.001). Hospital LOS decreased by an average of 3.46 days (p=0.04) and ICU LOS decreased on average by 1.83 days (p=0.05) in the post-intervention group. Ventilator days decreased on average by 0.55 days, which was not statistically significant (p=0.26). Conclusions: In conclusion, daily coordination with multidisciplinary rounds between the physician and the physical therapist was associated with decreased time to initial PT assessment, decreased hospital LOS, and decreased ICU LOS in the neuroscience population.

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A Qualitative Investigation of Physical Therapists' Experiences and Feelings of Managing Patients With Nonspecific Low Back Pain

Physical Therapy ◽

10.2522/ptj.20100416 ◽

2012 ◽

Vol 92 (2) ◽

pp. 266-278 ◽

Cited By ~ 43

Author(s):

Janet E. Jeffrey ◽

Nadine E. Foster

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Physical Therapists ◽

Physical Therapist ◽

Working Relationships ◽

Low Back ◽

Pain Beliefs ◽

Semistructured Interviews ◽

Therapist Communication ◽

Beliefs And Attitudes

Background Physical therapists' management of patients with nonspecific low back pain (NSLBP) has been found to be associated with their beliefs and attitudes toward NSLBP, as well as with guideline recommendations. Greater knowledge of physical therapists' experiences and feelings of treating patients with NSLBP may help to explain these associations and increase our understanding of some of the challenges physical therapists face when treating patients with NSLBP in clinical practice. Objectives The objective of this study was to understand more about how the personal experiences and feelings of physical therapists might influence their decision making when treating patients with NSLBP. Design This was a qualitative study using a phenomenological hermeneutical approach and practitioner-as-researcher model. Methods Eleven semistructured interviews with physical therapists were conducted and analyzed using the hermeneutical circle to identify key themes relating to their experiences and feelings in treating patients with NSLBP. Results Three linked themes emerged: (1) physical therapists believe that NSLBP has an underlying mechanical and recurring nature, (2) physical therapists' attitude toward managing NSLBP is to empower patients to exercise and self-manage their pain and functional problems, and (3) physical therapists experience feelings of tension between the advice and treatment they feel is best for their patient and the patient's own beliefs and attitudes. Conclusions The experiences and feelings of physical therapists treating patients with NSLBP include conflict among their pain beliefs, attitudes, and working partnerships with patients. Treatment decisions may be influenced when physical therapists modify their beliefs and attitudes to reduce this sense of conflict. Improving physical therapist communication skills may help decrease feelings of conflict, enhance working relationships, and encourage a more consistent approach toward patients with NSLBP.

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