Social Support and Living Situation of Older Adults With Hip-Fracture: A Retrospective Cohort Study

Sustaining a hip-fracture is a life-changing event negatively affecting older adults. Although, social support is a known determinant of health outcomes, the relationship between social support and living situation of older adults with hip fracture remains under researched. For this study social support is conceptualized using the Finfgeld-Connett framework, where social support is seen as being composed of emotional and instrumental support. The objectives were to examine the relationship between two domains of social support and living situation: 1) after discharge; 2) 3-months after discharge; and 3) 6-months after discharge from an inpatient rehabilitation facility in a sample of older adults with hip fracture. Emotional support was measured as frequency of interaction with someone one week prior to hip fracture, whereas instrumental support was measured as help received in instrumental activities of daily living. Logistic regression was performed to examine the association between social support and living situation. Majority of study participants (N=139) were older (mean age 81.31), female (77.70%), had no cognitive impairment (68.35%), were not married (58.99%), and lived with someone (51.80%) in their own house (71.95%). Older adults with more emotional support were more likely to be discharged home, however little can be said about the effect of the association (OR 6.80, 95% CI 1.08, 22.31, P<.001). Persons receiving more instrumental support had less odds of living at home 3-months (OR 0.41, 95% CI 0.21, 0.78; P=.007) and 6-months after discharge (OR 0.59, 95% CI 0.38, 0.91, P=0.017). Social support is important for older adults during recovery.

The Effectiveness of Physical, Occupational, and Speech Therapy in the Treatment of Patients With COVID-19 in the Inpatient Rehabilitation Setting

Purpose The novel coronavirus disease (COVID-19) has resulted in prolonged hospitalizations due to complications of moderate-to-severe COVID-19, leaving many with significant debilitation and functional impairment. The purpose of this research study is to demonstrate the effectiveness of physical, occupational, and speech therapy in the treatment of individuals recovering from COVID-19 in the inpatient rehabilitation setting. Method An observational pretest–posttest study of patients diagnosed with COVID-19 admitted to Adventist HealthCare Rehabilitation was conducted. Results from the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF PAI), the Six-Minute Walk Test (6MWT), the Modified Barthel Index–Shah Version (mBI), the Orientation Log, and the Cognitive Log were collected and analyzed utilizing a paired t test. Results Statistically significant improvements ( p < .05) in IRF PAI ( p = 2.02 × 10 −14 ), 6MWT ( p = 2.29 × 10 −9 ), mBI ( p = 5.95 × 10 −9 ), Orientation Log ( p = 1.81 × 10 −2 ), and Cognitive Log ( p = 9.21 × 10 −4 ) scores demonstrate that physical, occupational, and speech therapy improved the mobility, self-care, and cognitive performance of individuals recovering from COVID-19 at the inpatient rehabilitation level of care. Conclusions These findings can be used to impact the appropriate progression of patients through the health care continuum. As treatment of COVID-19 continues to evolve, ongoing research in this area of practice is warranted to continue to demonstrate the role of rehabilitation in the recovery process.

Intensive rehabilitation programme for patients with subacute stroke in an inpatient rehabilitation facility: describing a protocol of a prospective cohort study

IntroductionRehabilitation is recognised as a cornerstone of multidisciplinary stroke care. Intensity of therapy is related to functional recovery although there is high variability on the amount of time and techniques applied in therapy sessions. There is a need to better describe stroke rehabilitation protocols to develop a better understanding of current practice increasing the internal validity and generalisation of clinical trial results. The aim of this study is to describe an intensive rehabilitation programme for patients with stroke in an inpatient rehabilitation facility, measuring the amount and type of therapies (physical, occupational and speech therapy) provided and reporting functional outcomes.Methods and analysisThis will be a prospective observational cohort study of patients with subacute stroke admitted to our inpatient rehabilitation facility during 2 years. A therapy recording tool was developed in order to describe the rehabilitation interventions performed in our unit. This tool was designed using the Delphi method, literature search and collaboration with senior clinicians. Therapists will record the time spent on different activities available in our unit during specific therapy sessions. Afterwards, the total time spent in each activity, and the total rehabilitation time for all activities, will be averaged for all patients. Outcome variables were divided into three different domains: body structure and function outcomes, activity outcomes and participation outcomes and will be assessed at baseline (admission at the rehabilitation unit), at discharge from the rehabilitation unit and at 3 and 6 months after stroke.Ethics and disseminationThis study was approved by the Medical Research Committee at Hospital del Mar Research Institute (Project ID: 34/C/2017). The results of this study will be presented at national and international congress and submitted for publication in peer-reviewed journals.Trial registration numberNCT04191109.

Improving Caregiver Health through Systematic Assessment and a Tailored Plan of Care

Caregivers often experience strain and negative effects on their well-being. We tested the effects of a caregiver assessment and tailored care plan for caregivers of patients transitioning home from an inpatient rehabilitation facility (IRF), a study involving two groups: usual care ( n = 225) (preimplementation) and intervention (postimplementation) ( n = 215). Caregivers in the intervention group were assessed using the 25-item self-reported Preparedness Assessment for the Transition Home during the IRF stay. A tailored care plan was implemented in response to the assessment. Caregivers in both groups completed the Modified Caregiver Strain Index and Global Health Scale at 30- and 90-day postdischarge. After adjusting for baseline and demographics, caregivers in the intervention group reported lower strain ( p < .01) and better overall health ( p < .05) at 30-day post-IRF discharge, relative to usual care. Implementing a systematic caregiver assessment and tailored care plan in the IRF may mitigate the adverse effects of caregiving.

Safety, Feasibility, and Outcomes of Frequent, Long-Duration Rehabilitation in an Inpatient Rehabilitation Facility after Prolonged Hospitalization for Severe COVID-19: An Observational Study

Objectives The objective of this study was to evaluate safety, feasibility, and outcomes of 30 patients within an inpatient rehabilitation facility following hospitalization for severe COVID-19 infection. Methods This was an Observational Study of 30 patients (ages 26–80) within a large, metropolitan academic hospital following hospitalization for complications from severe COVID-19. Ninety percent of the participants required critical care and 83% required mechanical ventilation during their hospitalization. Within an inpatient rehabilitation facility and model of care, frequent, long duration rehabilitation was provided by occupational therapists, physical therapists, and speech language pathologists. Results The average inpatient rehabilitation facility length of stay was 11 days (ranging from 4–22 days). Patients averaged 165 minutes per day (ranging from 140–205 minutes) total of physical therapy, occupational therapy, and speech therapy. Twenty eight of the 30 patients (93%) discharged to the community. One patient required readmission from the inpatient rehabilitation facility to the acute hospital. All 30 patients improved their functional status with inpatient rehabilitation. Conclusion In this cohort of 30 patients, inpatient rehabilitation after severe COVID-19 was safe and feasible. Patients were able to participate in frequent, long duration rehabilitation with nearly all patients discharging to the community. Clinically, inpatient rehabilitation should be considered for patients with functional limitations following severe COVID-19. Given 90% of our cohort required critical care, future studies should investigate the efficacy and effectiveness of inpatient rehabilitation following hospitalization for critical illness. Frequent, long duration rehabilitation shows promising potential to address functional impairments following hospitalization for severe COVID-19. Impact Statement Inpatient rehabilitation facilities should be considered as a discharge location for hospitalized survivors of COVID-19, especially severe COVID-19, with functional limitations precluding community discharge. Clinicians and administrators should consider inpatient rehabilitation and inpatient rehabilitation facilities to address the rehabilitation needs of COVID-19 and critical illness survivors.

Examining the Effectiveness of OT in the Treatment of Patients Recovering From COVID-19 in the Rehabilitation Setting

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. A pilot study was completed to examine the effectiveness of OT in helping individuals regain independence in activities of daily living after COVID-19. In a retrospective chart review, statistically significant results (p &lt; .05) on the Inpatient Rehabilitation Facility Patient Assessment Instrument and the Modified Barthel Index demonstrated that OT is effective in the rehabilitation setting to increase individuals' independence following a COVID-19 diagnosis. Primary Author and Speaker: Nelle Hannah Ouellette Additional Authors and Speakers: Leah Bellinger, Julie Leonard Contributing Authors: Leah Bellinger, Julie Leonard