- Email: [email protected]
Poster 32: A Comparison of Early versus Late Unplanned Transfers from Acute Rehabilitation
Abstracts / PM R 9 (2017) S131-S290 Poster 32: A Comparison of Early versus Late Unplanned Transfers from Acute Rehabilitation Nicole A. Strong, DO (University of Rochester Medical Center, Rochester, New York, United States), Matthew C. Kruppenbacher, DO, Sara Salim, MD, Franchesca Konig Toro, MD Disclosures: Nicole A. Strong, DO: I Have No Relevant Financial Relationships To Disclose Objective: To identify the incidence of unplanned transfer and characteristics of those patients who required early versus late unplanned transfer from the acute rehabilitation unit to either a medical or surgical unit. Design: Retrospective Observational Study. Setting: Acute rehabilitation unit in a tertiary care hospital. Participants: Charts were reviewed for a total of 152 patients who experienced an unplanned transfer from an acute rehabilitation unit over a 5-year period. Interventions: Not applicable. Main Outcome Measures: Time of transfer; early transfer being within the first 3 days of admission, and late transfer being defined as anytime after the first 3 days. Results: Of 1,961 total patients admitted to acute rehabilitation during the 5-year study period, 152 required an unplanned transfer (7.8%). Transferred patients’ diagnoses included debility (21.2%), ischemic stroke (20.4%), SCI (16.4%), intracranial hemorrhage (11.2%), and other diagnostic groups (30.9%). Of the transferred patients, 60% were over age 65 and 61.2% had received a surgery prior to their rehabilitation admission. In regards to time of transfer, 20.4% were transferred early and 79.6% were transferred late. The 3 most common reasons for early transfer were infection (25.8%), ischemic stroke (19.4%), and intracranial hemorrhage (19.4%). In comparison, the 3 most common reasons for late transfer were ischemic cardiac event (24.0%), infection (19.0%), and intracranial hemorrhage (14.5%). The early transfer group trended to have older patients (mean age 69.8) compared to the late transfer group (mean age 63.5), p¼.058. Conclusions: Older patients, those with a diagnosis of debility or ischemic stroke, and patients with an active infection may have a higher risk of early, unexpected transfer from the acute rehabilitation setting. Careful assessment of these factors prior to rehabilitation admission may aid in reducing unplanned transfer rates. Further study of these populations and potential risk factors may provide more insight into how to optimize the timing of an acute rehabilitation admission. Level of Evidence: Level IV Poster 33: The Use of a Virtual Therapy Environment in an Intensive Care Setting is Safe and Acceptable: A Pilot Study Sara Parke, MD (Harborview Medical Center, University of Washington), Catherine L. Hough, MD, Aaron E. Bunnell, MD Disclosures: Sara Parke: I Have No Relevant Financial Relationships To Disclose Objective: Mobilization in critical illness has been documented to reduce neuromuscular complications, but access to rehabilitation services is often limited in the intensive care setting. Virtual environments designed to deliver therapy may increase access to rehabilitation services and improve patient motivation to participate. Jintronix KinectÒ software delivers specific therapeutic interventions using a virtual gaming platform. Here we determine its safety, feasibility and acceptability in the intensive care unit (ICU). Design: Cohort Study. Setting: Level 1 Trauma Center ICU. Participants: 19 adults admitted to the ICU between September and November 2016.
S151
Interventions: One session with a goal of 14 Jintronix modules targeting arm, leg, and/or trunk strength, range of motion and endurance. Main Outcome Measures: A trained observer recorded events related to (A) safety (falls, line dislodgement, medical events), and (B) feasibility (activity completion rate, assistance required, and technical errors). Patients completed a survey to determine (C) acceptability (enjoyment, comfort and perceived therapeutic benefit). Results: Mean intervention time was 29 minutes. (A) There were no falls, lines dislodged, or medical events. (B) Five subjects (27%) completed all 14 modules. The remaining subjects completed a mean of 7.8 modules per person. Fatigue was the most common reason for cessation (11). Subjects required physical assistance or verbal cues in 41% of modules (73). Technical errors affected 24% of modules (44), and led to activity cessation in 1 case. (C) Nearly all subjects reported the activity was enjoyable (18), comfortable (16), safe (19), easy to understand (18), would improve range of motion (17), would improve strength (18), and would motivate them to continue (18). Conclusions: Use of a virtual therapy environment in an intensive care setting is safe and acceptable. The feasibility of the intervention may be limited by technical errors. Level of Evidence: Level II
Poster 34: Massage Therapy in Cancer Patients with Venous Thromboembolism: A Case Series Amy H. Ng, MD MPH (University of Texas, MD Anderson Cancer Center), George J. Francis, MD, Pamela A. Sumler, LMT, BCTMB Disclosures: Amy Ng: I Have No Relevant Financial Relationships To Disclose Objective: We retrospectively reviewed cancer patients who received massage therapy following a diagnosis of venous thromboembolism (VTE). Patients who received massage therapy and completed a pre and post Edmonton Symptom Assessment Scale (ESAS) were included in data analysis. Our hypothesis was that massage therapy can be safely administered in cancer patients with VTE and improve overall symptoms. Design: Retrospective Chart Review. Setting: Cancer rehabilitation patients admitted to a tertiary cancer center. Participants: A case series of 24 patients were reviewed from 20142016. Interventions: Not applicable. Main Outcome Measures: Collected measurements included cancer diagnosis, VTE diagnosis date and treatment, massage therapy date(s), ESAS assessments and complications resulting in readmission to hospital within 7 days. Results: A total of 24 patients were included in this retrospective chart review. The top cancer diagnoses included liquid tumor and GI with 5 patients (20.8%) each. 15 patients (62.5%) completed both pre and post ESAS scores. 9 patients (37.5%) did not have completed ESAS scores. Post massage therapy, the greatest area of improvement was pain, with a mean decrease in ESAS score of -2.8 + 1.2. Other areas of improvement included Fatigue, Anxiety, Drowsiness and Feeling of well-being. 1 out of 24 patients (4%) had a complication within 7 days, with a new DVT, however patient had a known history of Factor V Leiden variant with multiple DVTs previously despite therapeutic treatment with anticoagulation. Conclusions: Generally, massage therapy is safe for patients who have cancer and recent history of VTE. Massage therapy has shown great benefits in symptom relief for cancer patients, especially in pain relief. Clinical correlation with known risks factors such as Factor V Leiden or coagulopathy disorders may need to be examined prior to massage. Level of Evidence: Level IV
S151
Interventions: One session with a goal of 14 Jintronix modules targeting arm, leg, and/or trunk strength, range of motion and endurance. Main Outcome Measures: A trained observer recorded events related to (A) safety (falls, line dislodgement, medical events), and (B) feasibility (activity completion rate, assistance required, and technical errors). Patients completed a survey to determine (C) acceptability (enjoyment, comfort and perceived therapeutic benefit). Results: Mean intervention time was 29 minutes. (A) There were no falls, lines dislodged, or medical events. (B) Five subjects (27%) completed all 14 modules. The remaining subjects completed a mean of 7.8 modules per person. Fatigue was the most common reason for cessation (11). Subjects required physical assistance or verbal cues in 41% of modules (73). Technical errors affected 24% of modules (44), and led to activity cessation in 1 case. (C) Nearly all subjects reported the activity was enjoyable (18), comfortable (16), safe (19), easy to understand (18), would improve range of motion (17), would improve strength (18), and would motivate them to continue (18). Conclusions: Use of a virtual therapy environment in an intensive care setting is safe and acceptable. The feasibility of the intervention may be limited by technical errors. Level of Evidence: Level II
Poster 34: Massage Therapy in Cancer Patients with Venous Thromboembolism: A Case Series Amy H. Ng, MD MPH (University of Texas, MD Anderson Cancer Center), George J. Francis, MD, Pamela A. Sumler, LMT, BCTMB Disclosures: Amy Ng: I Have No Relevant Financial Relationships To Disclose Objective: We retrospectively reviewed cancer patients who received massage therapy following a diagnosis of venous thromboembolism (VTE). Patients who received massage therapy and completed a pre and post Edmonton Symptom Assessment Scale (ESAS) were included in data analysis. Our hypothesis was that massage therapy can be safely administered in cancer patients with VTE and improve overall symptoms. Design: Retrospective Chart Review. Setting: Cancer rehabilitation patients admitted to a tertiary cancer center. Participants: A case series of 24 patients were reviewed from 20142016. Interventions: Not applicable. Main Outcome Measures: Collected measurements included cancer diagnosis, VTE diagnosis date and treatment, massage therapy date(s), ESAS assessments and complications resulting in readmission to hospital within 7 days. Results: A total of 24 patients were included in this retrospective chart review. The top cancer diagnoses included liquid tumor and GI with 5 patients (20.8%) each. 15 patients (62.5%) completed both pre and post ESAS scores. 9 patients (37.5%) did not have completed ESAS scores. Post massage therapy, the greatest area of improvement was pain, with a mean decrease in ESAS score of -2.8 + 1.2. Other areas of improvement included Fatigue, Anxiety, Drowsiness and Feeling of well-being. 1 out of 24 patients (4%) had a complication within 7 days, with a new DVT, however patient had a known history of Factor V Leiden variant with multiple DVTs previously despite therapeutic treatment with anticoagulation. Conclusions: Generally, massage therapy is safe for patients who have cancer and recent history of VTE. Massage therapy has shown great benefits in symptom relief for cancer patients, especially in pain relief. Clinical correlation with known risks factors such as Factor V Leiden or coagulopathy disorders may need to be examined prior to massage. Level of Evidence: Level IV