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Comparison of Outcomes Between Inpatient Rehabilitation Unit and Specialized Skilled Nursing Facility
Research Posters Participants: Patients with CLBP who demonstrated ‘directional preference’ for ‘McKenzie Extension Protocol (MEP)’. Interventions: Participants in the CBMT and TBMT groups received MEP involving a specific sequence of lumbosacral repeated movements in extension aimed to centralize, decrease or abolish symptoms. TBMT is the mobile phone-based application of the CBMT. Treatment was applied thrice weekly for eight weeks. Outcomes were assessed at 4th and 8th week of the study. Main Outcome Measure(s): Pain Intensity (PI), Back Extensors Muscles’ Endurance (BEME), Activity Limitation (AL), Participation Restriction (PR), General Health Status (GHS) and cost utility. Cost utility was calculated using quality-adjusted life-years derived from changes in the SF-12 items score. Results: Within-group comparison across baseline, 4th and 8th week indicate that both CBMT and TBMT had significant effects on PI (pZ0.001), BEME (pZ0.001), AL (pZ0.001), PR (pZ0.001) and GHS (pZ0.001) respectively. However, there were no significant differences (p>0.05) in the treatment effects between TBMT and CBMT, except for ‘energy fatigue’ (an item on GHS) where the TBMT produced significantly higher mean rank (pZ0.010). Estimated treatment cost per patient was $72.9 and $125.4 for TBMT and CBMT respectively (cost estimate ratio was 0.58:1). Cost utility values for TBMT per Quality Adjusted Life Years (QALYs) was $247.7 for ongoing cost only with a range of $222.9 and $272.5 for 10% increase and decrease in the QALYs. Conclusion/Discussion: The mobile-app platform of the MEP has comparable clinical outcomes with the traditional CBMT, as well as, lower cost estimate. Key Words: Low-Back Pain, Telerehabilitation, McKenzie Therapy, Mobile-App, Nigeria Disclosures: Nothing to disclose.
Research Poster 319799 Comparing Two Combined Treatment Method For Clbp: Pt With Lllt and Pt With Dry Needling Mitra Shojaei (Aryana Physical Therapy Clinic) Research Objectives: To compare the effectiveness of LLLT and Dry Needling treatment on pain, lumbar ROM and functional disability in chronic low back pain participants. Design: There are various treatment approaches available to CLBP. Recently, Dry Needling and LLLT has the more significant emphasis even though other various treatments are available. Setting: A total 150 chronic low back pain individuals were randomly assigned from referral patients to physiotherapy clinic that had been chronic LBP at last for 6 months and their age was between 26-65 years old. Participants: A total 150 chronic low back pain individuals were randomly assigned into three groups:1. conventional physiotherapy (Control Group), 2. conventional physiotherapy with laser therapy (Experimental Group-1), and 3. conventional physiotherapy with Dry Needling (Experimental group 2), nZ50 in each group. Interventions: All patients were treated for 3 weeks 45 mins for each therapy session. In group 1 we just had the conventional physiotherapy TNS, IF, HP, EXC. In group 2 we had the conventional physiotherapy and 7 mins of LLLT. In group 3 we had the conventional physiotherapy and 7 mins of DN. Main Outcome Measure(s): Improvement was assessed in lumbar range of motion (M.ST) and pain VAS used at prior interventions and after 3 weeks. Results: In this study results showed that laser group and dry Needling (DN) treatment group were effective in all the measures when compared to
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e47 control group. LLLT was more effective in improving lumbar ROM and reduction of pain when compared to DN. Conclusion/Discussion: The result of the study indicates that LLLT treatment was found to be superior to DN in improving lumbar ROM and reduction of pain among chronic low back pain participants. Key Words: CLBP, LLLT, DN Disclosures: Nothing to disclose.
Research Poster 305074 Comparison of Outcomes Between Inpatient Rehabilitation Unit and Specialized Skilled Nursing Facility Linda Krach (Courage Kenny Rehabilitation Institute), Brian LeLoup Research Objectives: To investigate the outcomes of individuals receiving inpatient rehabilitation services at a hospital based rehabilitation unit (IRU) and a specialized skilled nursing facility (SNF). Design: Retrospective analysis of case series including all individuals treated in IRU and specialized SNF in 2016. Setting: Inpatient rehabilitation locations of a large not-for-profit health system. Participants: All individuals admitted to the two IRUs and the one SNF during 2016. 915 were admitted to the IRUs and 177 to the SNF. Average age at admission to hospital based rehab unit and SNF were 62.8 and 55.1 respectively. Interventions: Intensive inpatient rehabilitation in a hospital based or SNF based program. The intensity of medical (physiatric) and nursing service was different between the settings. The average number of 15 minute units of therapy per day in the IPRU was 11 and in the SNF was 7.8. Main Outcome Measure(s): Include length of stay, discharge destination, functional change noted during stay, and demographic information such as age and diagnosis. Results: 41% of admissions to the SNF came from the hospital based acute inpatient rehabilitation units. An additional 8% came from acute care hospitals in the system. SNF overall community discharge rate is 86% and IRU rate is 69%. 92% of those admitted from the IRUs are discharged to the community. Of the populations served in IRU, those with spinal cord injury are most likely to be discharged to the SNF (19%). Average length of stay in IRU was 18 days and 92 days in SNF for those with all levels of SCI. Conclusion/Discussion: A combined IRU and specialized SNF model of care can facilitate discharge to the community for those with complex rehabilitation needs. Key Words: Rehabilitation, Spinal Cord Injury, Function Disclosures: None.
Research Poster 324308 Completing Documented Care Plans After New Acute Stroke: Multilevel Analyses From a National Stroke Audit Steven McPhail (Queensland University of Technology and Metro South Health), Jenny Fleming, Emma Finch Research Objectives: To investigate patient and clinical factors associated with the preparation (or lack thereof) of a written care plan for the posthospital-discharge period following new episodes of stroke.
Research Poster 319799 Comparing Two Combined Treatment Method For Clbp: Pt With Lllt and Pt With Dry Needling Mitra Shojaei (Aryana Physical Therapy Clinic) Research Objectives: To compare the effectiveness of LLLT and Dry Needling treatment on pain, lumbar ROM and functional disability in chronic low back pain participants. Design: There are various treatment approaches available to CLBP. Recently, Dry Needling and LLLT has the more significant emphasis even though other various treatments are available. Setting: A total 150 chronic low back pain individuals were randomly assigned from referral patients to physiotherapy clinic that had been chronic LBP at last for 6 months and their age was between 26-65 years old. Participants: A total 150 chronic low back pain individuals were randomly assigned into three groups:1. conventional physiotherapy (Control Group), 2. conventional physiotherapy with laser therapy (Experimental Group-1), and 3. conventional physiotherapy with Dry Needling (Experimental group 2), nZ50 in each group. Interventions: All patients were treated for 3 weeks 45 mins for each therapy session. In group 1 we just had the conventional physiotherapy TNS, IF, HP, EXC. In group 2 we had the conventional physiotherapy and 7 mins of LLLT. In group 3 we had the conventional physiotherapy and 7 mins of DN. Main Outcome Measure(s): Improvement was assessed in lumbar range of motion (M.ST) and pain VAS used at prior interventions and after 3 weeks. Results: In this study results showed that laser group and dry Needling (DN) treatment group were effective in all the measures when compared to
www.archives-pmr.org
e47 control group. LLLT was more effective in improving lumbar ROM and reduction of pain when compared to DN. Conclusion/Discussion: The result of the study indicates that LLLT treatment was found to be superior to DN in improving lumbar ROM and reduction of pain among chronic low back pain participants. Key Words: CLBP, LLLT, DN Disclosures: Nothing to disclose.
Research Poster 305074 Comparison of Outcomes Between Inpatient Rehabilitation Unit and Specialized Skilled Nursing Facility Linda Krach (Courage Kenny Rehabilitation Institute), Brian LeLoup Research Objectives: To investigate the outcomes of individuals receiving inpatient rehabilitation services at a hospital based rehabilitation unit (IRU) and a specialized skilled nursing facility (SNF). Design: Retrospective analysis of case series including all individuals treated in IRU and specialized SNF in 2016. Setting: Inpatient rehabilitation locations of a large not-for-profit health system. Participants: All individuals admitted to the two IRUs and the one SNF during 2016. 915 were admitted to the IRUs and 177 to the SNF. Average age at admission to hospital based rehab unit and SNF were 62.8 and 55.1 respectively. Interventions: Intensive inpatient rehabilitation in a hospital based or SNF based program. The intensity of medical (physiatric) and nursing service was different between the settings. The average number of 15 minute units of therapy per day in the IPRU was 11 and in the SNF was 7.8. Main Outcome Measure(s): Include length of stay, discharge destination, functional change noted during stay, and demographic information such as age and diagnosis. Results: 41% of admissions to the SNF came from the hospital based acute inpatient rehabilitation units. An additional 8% came from acute care hospitals in the system. SNF overall community discharge rate is 86% and IRU rate is 69%. 92% of those admitted from the IRUs are discharged to the community. Of the populations served in IRU, those with spinal cord injury are most likely to be discharged to the SNF (19%). Average length of stay in IRU was 18 days and 92 days in SNF for those with all levels of SCI. Conclusion/Discussion: A combined IRU and specialized SNF model of care can facilitate discharge to the community for those with complex rehabilitation needs. Key Words: Rehabilitation, Spinal Cord Injury, Function Disclosures: None.
Research Poster 324308 Completing Documented Care Plans After New Acute Stroke: Multilevel Analyses From a National Stroke Audit Steven McPhail (Queensland University of Technology and Metro South Health), Jenny Fleming, Emma Finch Research Objectives: To investigate patient and clinical factors associated with the preparation (or lack thereof) of a written care plan for the posthospital-discharge period following new episodes of stroke.