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Assessing Needs for Medical Rehabilitation: Its Use to Identify in Early Stage after Disease Onset
Research Posters educational materials to review at home. Participants were instructed to watch the video and review the instructional materials on a biweekly basis. Main Outcome Measure(s): Transfer Assessment Instrument (TAI). Results: After receiving the education, TAI score significantly increased (p Z 0.007) from an average score of 6.47 2.27 to 8.31 2.36. Conclusions: Preliminary results indicate that a structured educational program can significantly improve the transfer skills of individuals impacted by MS. Such improvements may lead to improved safety during transfers, a decrease in fall frequency and enhanced ability to perform desired instrumental activities of daily living. Further testing is needed to examine the long-term impact of improved transfer skills in individuals with MS. Key Words: Wheelchair, Education, Activities of daily living Disclosure(s): None Disclosed. Research Poster 3508 Hemiparetic Positioning of Hemiplegic Patients Rhonda Winegar (Texas State University) Objective(s): To evaluate whether FIM scores improved after staff were provided education on proper hemiparetic positioning of hemiplegic patients. Design: A quality improvement program was implemented to educate nursing and therapy staff on hemiparetic positioning of hemiplegic patients. Improvements in FIM scores during hospitalization were compared in patients who were treated prior to the quality improvement program and after utilizing a retrospective chart review. Setting: This project was conducted at a 60 bed free standing inpatient rehabilitation facility located in the Southwest. Participants: The study sample was composed of adult hemiplegic patients of all ages and diagnoses who had been admitted to the studied facility during the time of the study. Interventions: Six one hour inservices on hemiparetic positioning were offered at different times of the day and days of the week throughout a month. Main Outcome Measure(s): Functional Independence Measurement (FIM) scores in the areas of transfers from bed/chair/wheelchair, dressing upper and lower body and toileting were evaluated. Results: The sample consisted of 92 (preZ 28, postZ 64) hospitalized hemiplegic patients (56% male, mean age 68.3). All patients had significant improvements in FIM scores from admission to discharge. There were no significant differences observed between the groups on FIM change scores using Mann Whitney U: transfers from bed/chair/w/c (zZ -.822, pZ .411), upper body dressing (zZ -.104, pZ .917), lower body dressing (zZ -1.120, pZ .263), and toileting (zZ -1.259, pZ .208). Conclusions: While significant differences were not seen in FIM scores, this project encouraged intra-professional collaboration among the nursing and therapy staff that improved attention to patient positioning. It was also observed that nursing staff worked more cohesively with therapy staff in regards to therapy and reaching FIM score goals after the implementation of the quality improvement project. Key Words: Hemiplegia, Rehabilitation, Functional independence measurement scores Disclosure(s): None Disclosed. Research Poster 3516 Assessing Needs for Medical Rehabilitation: Its Use to Identify in Early Stage after Disease Onset Kazuhiro Harada (Kibi International University), Hiroyuki Hashidate Objective(s): The number of individuals with need for medical rehabilitation (NMR) services is increasing with population aging in Japan. We start assessing the extent of the NMR in clinical setting. This study aims to describe the need constructs quantitatively and the association with disability in an early stage after disease onset.
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e45 Design: Cross-sectional study. Setting: General hospital. Participants: Sixty-five consecutive patients receiving rehabilitation services. Interventions: N/A. Main Outcome Measure(s): NMR items referred to prior studies in Germany (Raspe H et al, 2005; Meng K et al, 2005), modified Rankin scale (mRS), functional ambulation classification (FAC), Barthel ADL index (BI), global rating of NMR by physical/occupational therapists as an external criterion. Results: NMR items were selected through its face validity based on occurrences of disease and symptom but working ability. Exploratory factor analysis (promax rotation) proposed 7-items measurement model with 3 subdomains; “forward-looking expectation in goal achievement”, “dysfunctions” and “supportive situation with rehabilitation service”. The total score showed significant correlation with the global rating (rhoZ.39) and no significant correlation with disability indices (mRS; -.01, FAC; -.09, BI; .00). The osteoarthritis/motor dysfunction group showed higher NMR scores than the cerebrovascular accident group (P < .05). Conclusions: The degree of NMR cannot be related to the level of disability as might be expect, because many factors involve a need occurrence during early stage after onset. A complementary use of NMR measure may validate an adequacy for rehabilitation resource provision. Key Words: Needs assessment, Measurement, Health services Disclosure(s): None Disclosed. Research Poster 3532 All You Need is LOS: Effects of Acute and Post-Acute Lengths of Stay on Patient Outcomes Jessica Jarvis (University of Texas Medical Branch, Galveston), Ioannis Malagaris, James Graham, Yu-Li Lin Objective(s): To determine the independent effects of hospital and inpatient rehabilitation facility lengths of stay on discharge functional status and discharge destination following inpatient rehabilitation. Design: Retrospective cohort study using the 100% Medicare files. Setting: Acute care hospitals and inpatient rehabilitation facilities across the U.S. Participants: 143,296 Medicare fee-for-services beneficiaries who experienced a stroke, hip fracture, or joint replacement and were discharged from inpatient rehabilitation in 2012. Interventions: N/A. Main Outcome Measure(s): Discharge functional status (FIM instrument) and discharge destination (community vs. institutional setting). Results: Mean (standard deviation) age of the sample was 76.5 (10.0) years. A majority of patients were female (63.5%), white (80.7%), lived with family or friends prior to their injury (64.5%), and had no tier-level comorbidities (70.7%). Mean hospital and inpatient rehabilitation lengths of stay were 5.1 (3.9) and 13.3 (6.1) days, respectively. Mean discharge FIM total rating was 88.1 (21.4) and 75.1% of patients were discharged to the community. In multivariable analyses, hospital length of stay was negatively associated with discharge functional status (bZ-.34 [95% CIZ.36, -.32]) and likelihood of community discharge (ORZ.970 [95% CIZ.966, .973]). Conversely, inpatient rehabilitation length of stay was positively associated with discharge functional status (bZ.47 [95% CIZ.46, .49]) and likelihood of community discharge (ORZ1.042 [95% CIZ1.039, 1.045]). Conclusions: Healthcare reform initiatives such as bundled payments and accountable care organizations will likely alter how patients are managed along the continuum of care. Our findings suggest that the combination of a shorter hospital and longer inpatient rehabilitation length of stay may lead to better functional outcomes. Key Words: Stroke, Medicare, Outcomes Disclosure(s): None Disclosed.
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e45 Design: Cross-sectional study. Setting: General hospital. Participants: Sixty-five consecutive patients receiving rehabilitation services. Interventions: N/A. Main Outcome Measure(s): NMR items referred to prior studies in Germany (Raspe H et al, 2005; Meng K et al, 2005), modified Rankin scale (mRS), functional ambulation classification (FAC), Barthel ADL index (BI), global rating of NMR by physical/occupational therapists as an external criterion. Results: NMR items were selected through its face validity based on occurrences of disease and symptom but working ability. Exploratory factor analysis (promax rotation) proposed 7-items measurement model with 3 subdomains; “forward-looking expectation in goal achievement”, “dysfunctions” and “supportive situation with rehabilitation service”. The total score showed significant correlation with the global rating (rhoZ.39) and no significant correlation with disability indices (mRS; -.01, FAC; -.09, BI; .00). The osteoarthritis/motor dysfunction group showed higher NMR scores than the cerebrovascular accident group (P < .05). Conclusions: The degree of NMR cannot be related to the level of disability as might be expect, because many factors involve a need occurrence during early stage after onset. A complementary use of NMR measure may validate an adequacy for rehabilitation resource provision. Key Words: Needs assessment, Measurement, Health services Disclosure(s): None Disclosed. Research Poster 3532 All You Need is LOS: Effects of Acute and Post-Acute Lengths of Stay on Patient Outcomes Jessica Jarvis (University of Texas Medical Branch, Galveston), Ioannis Malagaris, James Graham, Yu-Li Lin Objective(s): To determine the independent effects of hospital and inpatient rehabilitation facility lengths of stay on discharge functional status and discharge destination following inpatient rehabilitation. Design: Retrospective cohort study using the 100% Medicare files. Setting: Acute care hospitals and inpatient rehabilitation facilities across the U.S. Participants: 143,296 Medicare fee-for-services beneficiaries who experienced a stroke, hip fracture, or joint replacement and were discharged from inpatient rehabilitation in 2012. Interventions: N/A. Main Outcome Measure(s): Discharge functional status (FIM instrument) and discharge destination (community vs. institutional setting). Results: Mean (standard deviation) age of the sample was 76.5 (10.0) years. A majority of patients were female (63.5%), white (80.7%), lived with family or friends prior to their injury (64.5%), and had no tier-level comorbidities (70.7%). Mean hospital and inpatient rehabilitation lengths of stay were 5.1 (3.9) and 13.3 (6.1) days, respectively. Mean discharge FIM total rating was 88.1 (21.4) and 75.1% of patients were discharged to the community. In multivariable analyses, hospital length of stay was negatively associated with discharge functional status (bZ-.34 [95% CIZ.36, -.32]) and likelihood of community discharge (ORZ.970 [95% CIZ.966, .973]). Conversely, inpatient rehabilitation length of stay was positively associated with discharge functional status (bZ.47 [95% CIZ.46, .49]) and likelihood of community discharge (ORZ1.042 [95% CIZ1.039, 1.045]). Conclusions: Healthcare reform initiatives such as bundled payments and accountable care organizations will likely alter how patients are managed along the continuum of care. Our findings suggest that the combination of a shorter hospital and longer inpatient rehabilitation length of stay may lead to better functional outcomes. Key Words: Stroke, Medicare, Outcomes Disclosure(s): None Disclosed.