Journal of Acute Care Physical Therapy最新文献_第2页

Patient-Reported Outcome Measure Use by Acute Care Pediatric Physical Therapists 急性护理儿科物理治疗师使用患者报告的结果测量方法

IF 0.5 Q4 REHABILITATION

Journal of Acute Care Physical Therapy

Pub Date : 2023-08-14 DOI: 10.1097/JAT.0000000000000222

Dana Tischler, Janine Wood, M. Shotwell, W. Pitney, Cade Mooney

Purpose: To describe the current use of and perceived benefits and barriers to using patient-reported outcome measures (PROMs) by pediatric physical therapists (PTs) in the acute care setting and to explore demographic factors that may explain the use of PROMs. Methods: An electronic survey was distributed to PTs who work in a pediatric acute care setting. Descriptive statistics were used to assess the frequency of PROM use, identify differences in PROM use based on demographic factors, and evaluate the likelihood of various benefits and barriers. Open-ended survey responses were analyzed inductively to identify common themes. Results: The survey was completed by a convenience sample of 92 pediatric acute care PTs (30% response rate). Half of the respondents (n = 46; 50%) reported “rarely” or “never” using PROMs, while only 4.3% (n = 4) reported “always” using PROMs. No significant differences were found in the frequency of PROM between years of experience, entry-level degree, clinical specialization, or other demographic factors. Participants were “somewhat” or “extremely likely” to use the rate of perceived exertion (71%), the Ages and Stages Questionnaire (24%), and the Pediatric Quality of Life Inventory (17%). The primary facilitator was improving communication with patients (68%), while the main barrier was lack of availability (57%). Thematic analysis of open-ended responses indicated that the benefits of using PROMs include improving communication, providing objective data, and measuring progress. Barriers identified include inadequate resources, lack of time, and irrelevance to clinical practice. Conclusion: Many pediatric acute care PTs underutilize PROMs, with reported barriers of limited access and lack of time hindering implementation within the pediatric acute care setting. Survey respondents reported the desire to measure health-related quality of life and participation, which may be feasible through future quality improvement or knowledge translation initiatives.

目的：描述儿科物理治疗师（PT）在急性护理环境中使用患者报告结果测量（PROMs）的现状、感知的益处和障碍，并探讨可能解释PROMs使用的人口统计学因素。方法：将一份电子调查分发给在儿科急性护理环境中工作的PT。描述性统计用于评估胎膜早破的使用频率，根据人口统计学因素确定胎膜早闭使用的差异，并评估各种益处和障碍的可能性。对不限成员名额调查的答复进行归纳分析，以确定共同主题。结果：调查是通过92个儿科急性护理PT的方便样本完成的（30%的应答率）。一半的受访者（n=46；50%）表示“很少”或“从未”使用PROM，而只有4.3%（n=4）表示“总是”使用PROM。在胎膜早破的发生率方面，经验年限、入门级学位、临床专业或其他人口统计学因素之间没有发现显著差异。参与者“有点”或“极有可能”使用感知用力率（71%）、年龄和阶段问卷（24%）和儿童生活质量问卷（17%）。主要促进因素是改善与患者的沟通（68%），而主要障碍是缺乏可用性（57%）。对开放式答复的专题分析表明，使用PROM的好处包括改善沟通、提供客观数据和衡量进展。确定的障碍包括资源不足、时间不足以及与临床实践无关。结论：许多儿科急性护理PT未充分利用PROM，据报道，在儿科急性护理环境中，使用受限和缺乏时间的障碍阻碍了PROM的实施。调查对象报告说，他们希望衡量与健康相关的生活质量和参与度，这可能通过未来的质量改进或知识翻译举措来实现。

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引用次数: 1

Transforming the Heart of Student Learning and Engagement 转变学生学习和参与的核心

IF 0.5 Q4 REHABILITATION

Journal of Acute Care Physical Therapy

Pub Date : 2023-08-14 DOI: 10.1097/JAT.0000000000000224

D. Stam, Greta M. Jenkins, Hannah Goettl, Jordan Martinson, Alex Fondrick, Russell Lindahl, Zach Withrow

Purpose: Entry-level physical therapists must effectively learn cardiovascular and physiological monitoring, including electrocardiography (ECG) interpretation, to fulfill the demands of acute care hospital settings. Preliminary evidence among medical students and young physicians suggests that proficiency in basic ECG interpretation may be insufficient to meet the needs of a society with increasing levels of cardiovascular disease. In addition, as a new generation of students (Generation Z) enters health care education programs, educators may need to adapt their instructional approaches and technology. The purpose of this study was to evaluate whether a novel virtual reality (VR) learning module resulted in more accurate ECG interpretation than a conventional written learning activity for predominantly Generation Z Doctor of Physical Therapy (DPT) students. The study also assessed whether a preference existed for either of the 2 activities. Methods: A blocked-randomized controlled crossover trial was integrated within a second-year cardiopulmonary course for DPT students. Students were blocked into 2 groups, VR-Conventional or Conventional-VR, based on the order in which they participated in the activities. Twenty-item multiple-choice knowledge assessments and a satisfaction survey were the outcomes. Results: Eighteen DPT students participated. Median pretest scores for the VR-Conventional group and the Conventional-VR group were 60% (interquartile range [IQR]: 50-75) and 65% (IQR: 55-75), respectively; the distributions were not different (Mann-Whitney U test =36.00, n1 = n2 = 9, P = .688, 2-tailed). Median posttest 1 scores for the VR-Conventional group and the Conventional-VR group were 70% (IQR: 62.50-85) and 75% (IQR: 67.50-85), respectively; the distributions were not different (Mann-Whitney U test = 39.00, n1 = n2 = 9, P = .893, 2-tailed). After crossing over, the VR-Conventional group scored 70% (IQR: 62.50-80) on posttest 2 while the Conventional-VR group scored 70% (IQR: 65-77.50); the distributions were not different (Mann-Whitney U test = 38.50, n1 = n2 = 9, P = .858, 2-tailed). Fifty percent of participants preferred the VR activity, 33% preferred the conventional written activity, and 17% had no preference. All participants reported wanting to see VR used more in education. Conclusions: VR was well received and may aid student engagement and motivation for learning complex topics such as ECG interpretation. In this study, VR was not superior to conventional learning activities for knowledge acquisition. Educators should additionally consider an evidence-based instructional design when choosing to integrate VR technologies in the classroom.

目的：初级物理治疗师必须有效学习心血管和生理监测，包括心电图（ECG）解释，以满足急性护理医院的需求。医学生和年轻医生的初步证据表明，基本心电图解释的熟练程度可能不足以满足心血管疾病日益严重的社会需求。此外，随着新一代学生（Z世代）进入医疗保健教育项目，教育工作者可能需要调整他们的教学方法和技术。本研究的目的是评估新型虚拟现实（VR）学习模块是否比以Z世代物理治疗博士（DPT）为主的传统书面学习活动更准确地解释心电图。该研究还评估了是否存在对这两种活动的偏好。方法：将一项分块随机对照交叉试验纳入DPT学生第二年的心肺课程中。根据学生参加活动的顺序，将他们分为两组，VR常规组或常规VR组。20项选择题知识评估和满意度调查是结果。结果：18名DPT学生参与。VR常规组和常规VR组的中位预测得分分别为60%（四分位间距[IQR]:50-75）和65%（IQR:55-75）；分布没有差异（Mann-Whitney U检验=36.00，n1=n2=9，P=.688，2-尾）。VR常规组和常规VR组的中位测试后1分分别为70%（IQR:62.50-85）和75%（IQR=67.50-85）；分布没有差异（Mann-Whitney U检验=39.00，n1=n2=9，P=.893，2-尾）。交叉后，VR常规组在后测2中的得分为70%（IQR:625.00-80），而常规VR组的得分为70%（IQR:65-77.50）；分布没有差异（Mann-Whitney U检验=38.50，n1=n2=9，P=.858，2-尾）。50%的参与者更喜欢VR活动，33%的人更喜欢传统的书面活动，17%的人不喜欢。所有参与者都表示希望看到虚拟现实更多地用于教育。结论：虚拟现实很受欢迎，可能有助于学生参与和激励学习复杂的主题，如心电图解释。在本研究中，虚拟现实在知识获取方面并不优于传统的学习活动。教育工作者在选择将虚拟现实技术融入课堂时，还应考虑循证教学设计。

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引用次数: 0

The Active Leg Raise Test 主动抬腿测试

IF 0.5 Q4 REHABILITATION

Journal of Acute Care Physical Therapy

Pub Date : 2023-08-14 DOI: 10.1097/JAT.0000000000000223

Jonathan R. Sutter, Ben Coyer, J. Mcgarvey, Meghan Georgieff, Joseph Pilon

Background and Purpose: There are important reasons to provide hospitalized patients with opportunities to move while hospitalized. Yet, it is apparent that, other than actually attempting the task of standing up, there is no predictive test available that would help a hospital professional decide whether the patient has adequate ability to safely attempt standing. The purpose of this research report is to describe a novel test that clinicians can use to help predict whether a patient is anticipated to be capable of standing up with little or no assistance. Approach: Hospitalized patients were requested to lift each lower extremity, one at a time, for 5 seconds, above a minimum height. To determine the predictive ability of the test to identify the ability to stand, results were compared against the “gold standard” of whether the patients were able to stand successfully as part of a physical therapy evaluation performed after the leg raise test. Outcomes: The sensitivity of the test was 0.91 (95% CI = 0.84-0.96) and the specificity was 0.71 (95% CI = 0.48-0.89). The positive predictive value was 0.94 (95% CI = 0.88-0.98) and the negative predictive value was 0.60 (95% CI = 0.39-0.79). Discussion and Conclusion: This test is simple, short, and well suited to the rapid pace of clinical decision-making that health care professionals face on a daily basis. This test is useful in helping acute care professionals answer a clinical question they encounter often, “Is it safe for this patient to try to stand up?”

背景和目的：为住院患者提供住院期间活动的机会是有重要原因的。然而，很明显，除了实际尝试站立之外，没有任何预测性测试可以帮助医院专业人员决定患者是否有足够的能力安全地尝试站立。本研究报告的目的是描述一种新型测试，临床医生可以使用该测试来帮助预测患者是否能够在很少或没有帮助的情况下站立。方法：住院患者被要求将每个下肢抬高，每次一个，持续5秒，超过最小高度。为了确定测试识别站立能力的预测能力，将结果与患者是否能够成功站立的“金标准”进行比较，作为抬腿测试后进行的物理治疗评估的一部分。结果：该试验的敏感性为0.91（95%CI=0.84-0.96），特异性为0.71（95%CI=4.48-0.89）。阳性预测值为0.94（95%CI=0.88-0.98），阴性预测值为0.60（95%CI=0.39-0.79），非常适合医疗保健专业人员每天面临的快速临床决策。这种测试有助于帮助急性护理专业人员回答他们经常遇到的临床问题，“这个病人试着站起来安全吗？”

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引用次数: 0

Student Experiences of a Home-Based Acute Care Curriculum 以家庭为基础的急症护理课程的学生体验

IF 0.5 Q4 REHABILITATION

Journal of Acute Care Physical Therapy

Pub Date : 2023-08-14 DOI: 10.1097/JAT.0000000000000225

Suzanne Trojanowski, Erica Sherman, Min Hui Huang

Background/Purpose: The COVID-19 pandemic disrupted physical therapy education beginning in March 2020. Acute care physical therapy is complex and has substantive psychomotor skills and safety demands. Students can experience significant challenges during acute care clinical education experiences (CEE); therefore, assessment of the effect of curricular adjustments on preparation for clinical experiences is paramount. Students can experience significant challenges during acute care CEE. Educational programs continue to assess the effect of pandemic dictated altered modes of delivery of laboratory-based courses on student outcomes. The purpose of this qualitative case report is to explore students' experiences of an online delivery mode of an acute care course and their perception of its ability to prepare the student for an acute care CEE. Case Description: Interviews were completed with physical therapist students after their terminal acute care CEE. Qualitative analysis was approached from an interpretive epistemological perspective and a phenomenological approach was used to explore students' experience in participating in an online delivery mode to gain the required skills to be effective during acute care physical therapist practice. Data analysis was completed using a thematic analysis approach. Outcomes: Seven students participated in qualitative interviews after their acute care educational experience. Qualitative results revealed 3 main themes: (1) Course Design, (2) Fidelity, and (3) Learner Characteristics as contributors to feelings of preparedness when transitioning from the classroom to an acute care CEE. Discussion and Conclusion: Despite COVID-19 disruptions to traditional in-person education delivery of an acute care laboratory-based course, a unique at-home delivery of acute care curriculum led to students reporting sufficient skill development to participate in an acute care CEE. Aspects of the unique course that students reported facilitated their learning were skill repetition and fidelity to clinical practice embedded in laboratory activities. Results can be used to intentionally design coursework to aide in building student confidence and preparation for acute care CEE.

背景/目的:从2020年3月开始，新冠肺炎大流行中断了物理治疗教育。急性护理物理治疗是复杂的，具有实质性的精神运动技能和安全要求。学生可以在急症护理临床教育经历(CEE)中经历重大挑战;因此，评估课程调整对临床经验准备的影响是至关重要的。学生在急症护理考试中会遇到重大挑战。教育项目继续评估大流行导致的实验室授课模式改变对学生成绩的影响。本定性案例报告的目的是探讨学生对急症护理课程在线交付模式的体验，以及他们对在线交付模式为学生准备急症护理课程的能力的看法。案例描述:访谈完成了物理治疗师学生在他们的晚期急症护理CEE。从解释认识论的角度进行定性分析，并使用现象学的方法来探索学生参与在线交付模式的经验，以获得在急性护理物理治疗师实践中有效所需的技能。数据分析采用专题分析方法完成。结果:7名学生在接受急症护理教育后参加了定性访谈。定性结果揭示了3个主要主题:(1)课程设计，(2)保真度，(3)学习者特征在从课堂过渡到急症护理CEE时对准备感的影响。讨论和结论:尽管COVID-19破坏了传统的急性护理实验室课程的面对面教育，但独特的急性护理课程在家交付使学生报告了足够的技能发展，可以参加急性护理CEE。学生们报告说，这门独特的课程促进了他们的学习，其中包括技能重复和对实验室活动中临床实践的忠诚。结果可以用来有意地设计课程，以帮助建立学生的信心和准备急症护理CEE。

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引用次数: 0

Perceptions of Patient-Reported Outcome Measures in Acute Care Pediatric Physical Therapy 急性护理儿童物理治疗中患者报告结果测量的感知

IF 0.5 Q4 REHABILITATION

Journal of Acute Care Physical Therapy

Pub Date : 2023-08-14 DOI: 10.1097/jat.0000000000000220

Dana Tischler, W. Pitney, Janine Wood, M. Shotwell, Cade Mooney

Purpose: To explore the perceptions and experiences of acute care pediatric physical therapists (PTs) regarding the use of patient-reported outcome measures (PROMs) and to understand the influence of PROMs on clinical decision-making and the plan of care. Methods: Thirteen acute care pediatric PTs participated in individual semistructured interviews using a qualitative phenomenological approach. Interview questions focused on how PROMs influence clinical practice and decision-making. Interviews also explored scenarios where using PROMs positively or negatively impacted patient and caregiver interactions. Researchers analyzed the interview transcripts using an inductive process to generate codes and resultant themes. Results: Participants described their experiences using PROMs in pediatric acute care, and 4 themes emerged: (1) PROMs can be difficult to implement in pediatric acute care, (2) PROMs can benefit pediatric acute care practice, (3) PROMs can improve service delivery and family-centered care, and (4) ideal PROM use in future practice. The Theoretical Domains Framework (TDF) was used to categorize positive and negative factors related to implementing evidence-based guidelines in the pediatric acute care setting. Conclusions: Acute care pediatric PTs report benefits and barriers to using PROMs with children and caregivers in the hospital setting. Findings support the need for future knowledge translation initiatives to facilitate the use of PROMs in pediatric acute care.

目的:探讨急症期儿科物理治疗师(PTs)对使用患者报告结局指标(PROMs)的认知和经验，并了解PROMs对临床决策和护理计划的影响。方法:采用定性现象学方法对13名急症儿科PTs进行了半结构化访谈。访谈问题集中在PROMs如何影响临床实践和决策。访谈还探讨了使用prom对患者和护理人员的互动产生积极或消极影响的情况。研究人员使用归纳过程来分析访谈记录，以生成代码和结果主题。结果:参与者描述了他们在儿科急症护理中使用PROM的经验，并提出了4个主题:(1)PROM在儿科急症护理中难以实施;(2)PROM可以使儿科急症护理实践受益;(3)PROM可以改善服务提供和以家庭为中心的护理;(4)在未来的实践中理想地使用PROM。理论领域框架(TDF)用于分类与在儿科急症护理环境中实施循证指南相关的积极因素和消极因素。结论:急性护理儿科PTs报告了在医院环境中与儿童和护理人员一起使用PROMs的好处和障碍。研究结果支持未来知识翻译倡议的必要性，以促进PROMs在儿科急症护理中的使用。

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引用次数: 0

Neonatal Physiotherapy Interventions in Reducing Acute Procedural Pain and Improving Neuromotor Development in a Preterm Neonate 新生儿物理治疗干预减少早产新生儿急性手术疼痛和改善神经运动发育

IF 0.5 Q4 REHABILITATION

Journal of Acute Care Physical Therapy

Pub Date : 2023-07-26 DOI: 10.1097/JAT.0000000000000221

N. Sharma, Asir John Samuel

Background: Repeated painful procedures are very common in neonatal intensive care unit (NICU). A combination of multisensory stimulation (MSS) and soft tissue therapy (STT) potentiates each other's analgesic effects and helps in reducing procedural pain. Case Description: Thirty-six weeks and 2 days old preterm neonate was undergoing venipuncture at right forearm for diagnostic purpose when admitted in NICU because of prematurity. MSS and STT were provided once in a day for 30 minutes, total for 5 days for pain relief and improvement in neuromotor outcomes. Outcomes: Pain intensity was assessed with Preterm Infant Pain Profile-Revised (PIPP-R) and Neonatal Pain, Agitation and Sedation Scale (N-PASS). The neuromotor outcomes were also assessed with Infant Neurological International Battery (INFANIB) and Premie-Neuro Scale. All the measurements were taken at baseline and after 5 days of intervention. The pain scores, PIPP-R and N-PASS, were measured at 30 seconds, 60 seconds, 90 seconds, and 120 seconds before the intervention. The PIPP-R: 7, 7, 10, and 6, and N-PASS scores before the intervention were: 2, 9, 4, and 5, respectively. After 5 days of intervention, the pain scores were PIPP-R: 3, 9, 3, and 3, and N-PASS: 3, 3, 4, and 4, respectively. The neuromotor tests, INFANIB and Premie-Neuro, were measured at baseline and postintervention. The scores were INFANIB: 58 and 60, respectively, and Premie-Neuro: 90 and 92, respectively. Discussion/Conclusion: Neonatal physiotherapist may give importance to procedural pain management in NICU settings to promote good clinical practice along with other physiotherapy interventions. Along with pain scores, neuromotor scores were improved after the 5th day of intervention in the preterm neonate. MSS and STT might help in reducing procedural pain and improving neuromotor outcomes after 5 days of intervention among preterm neonates.

背景：反复疼痛的手术在新生儿重症监护室（NICU）非常常见。多感觉刺激（MSS）和软组织治疗（STT）的结合增强了彼此的镇痛效果，有助于减轻手术疼痛。病例描述：36周零2天大的早产儿因早产在新生儿重症监护室接受右前臂静脉穿刺诊断。MSS和STT每天提供一次，持续30分钟，总共5天，用于缓解疼痛和改善神经运动结果。结果：采用经修订的早产儿疼痛谱（PIP-R）和新生儿疼痛、激动和镇静量表（N-PASS）评估疼痛强度。神经运动结果也通过婴儿神经国际组（INFANIB）和Premie神经量表进行评估。所有测量均在基线和干预5天后进行。在干预前30秒、60秒、90秒和120秒测量疼痛评分PIP-R和N-PASS。干预前的PIP-R:7、7、10和6以及N-PASS评分分别为：2、9、4和5。干预5天后，疼痛评分分别为PIP-R:3、9、3和3，以及N-PASS:3、3、4和4。神经运动测试，INFANIB和Premie Neuro，在基线和干预后进行测量。INFANIB:58分和60分，Premie Neuro:90分和92分。讨论/结论：新生儿物理治疗师可能会重视新生儿重症监护室环境中的程序性疼痛管理，以促进良好的临床实践以及其他物理治疗干预措施。除了疼痛评分外，早产儿的神经运动评分在干预第5天后也有所改善。MSS和STT可能有助于在早产儿干预5天后减轻手术疼痛并改善神经运动结果。

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引用次数: 0

Making a Difference—Supporting Members and Pursuing Excellence 有所作为——支持会员追求卓越

IF 0.5 Q4 REHABILITATION

Journal of Acute Care Physical Therapy

Pub Date : 2023-07-01 DOI: 10.1097/jat.0000000000000219

Traci L. Norris

引用次数: 0

Weathering the Storm: Professional Quality of Life in Acute Care Physical Therapy Before and During the COVID-19 Pandemic. 抗风暴:COVID-19大流行之前和期间急性护理物理治疗的专业生活质量。

IF 0.5 Q4 REHABILITATION

Journal of Acute Care Physical Therapy

Pub Date : 2023-07-01 DOI: 10.1097/JAT.0000000000000213

Evan Haezebrouck, Amy M Yorke

The COVID-19 pandemic overwhelmed hospital systems. Frontline workers, including physical therapists, experienced multiple challenges impacting job satisfaction. The Professional Quality of Life (ProQOL) measures constructs related to workplace quality of life.

Purpose: To describe levels of compassion satisfaction and compassion fatigue (consisting of burnout and secondary trauma) among a similar cohort of acute care physical therapy staff prior to and approximately 1 year into the pandemic.

Methods: Cross-sectional online survey methodology using the ProQOL was completed. A convenience sample of acute care physical therapy professionals employed at a large Midwestern academic medical center was surveyed at separate time points in 2018 (prepandemic) and 2021 (pandemic).

Results: A total of 54 (2018) and 53 (2021) acute care physical therapy professionals completed the survey. Overall, respondents reported moderate to high levels of compassion satisfaction with low to moderate levels of burnout and secondary trauma at both periods, consistent with other previously reported health care professionals. However, the respondents exhibited a shift toward worsening compassion fatigue, with increasing levels of burnout and secondary traumatic stress, and a decreased level of compassion satisfaction.

Conclusions: Describing the professional quality of life in a cohort of acute care physical therapy professionals before and during the pandemic provides a foundation of further understanding burnout and secondary traumatic stress. Future studies could be completed longitudinally to track changes in acute care physical therapy staff and explore effective support strategies.

COVID-19大流行使医院系统不堪重负。包括物理治疗师在内的一线工作者经历了影响工作满意度的多重挑战。职业生活质量(ProQOL)测量与工作场所生活质量相关的结构。目的:描述大流行前和大流行后大约1年的类似急性护理物理治疗人员的同情满意度和同情疲劳水平(包括倦怠和继发性创伤)。方法:采用ProQOL横断面在线调查方法。在2018年(大流行前)和2021年(大流行)的不同时间点对中西部一家大型学术医疗中心雇用的急性护理物理治疗专业人员进行了方便抽样调查。结果:共有54名(2018年)和53名(2021年)急症护理物理治疗专业人员完成了调查。总体而言，在这两个时期，受访者报告了中高水平的同情满意度，低至中等水平的倦怠和继发性创伤，与其他先前报告的卫生保健专业人员一致。然而，受访者表现出一种向恶化的同情疲劳转变，随着倦怠和继发性创伤压力水平的增加，同情满意度水平下降。结论:描述大流行之前和期间急性护理物理治疗专业人员队列的职业生活质量为进一步理解倦怠和继发性创伤应激奠定了基础。未来的研究可以纵向完成，追踪急症护理物理治疗人员的变化，探索有效的支持策略。

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引用次数: 1

Inspiratory Muscle Training While Hospitalized With Acute COVID-19 Respiratory Failure: A Randomized Controlled Trial. 急性新冠肺炎呼吸衰竭住院期间的吸气肌肉训练：一项随机对照试验。

IF 0.5 Q4 REHABILITATION

Journal of Acute Care Physical Therapy

Pub Date : 2023-07-01 Epub Date: 2023-05-01 DOI: 10.1097/JAT.0000000000000217

Haley Bento, Elizabeth Fisk, Emma Johnson, Bruce Goudelock, Maxwell Hunter, Deborah Hoekstra, Christopher Noren, Nathan Hatton, John Magel

Although inspiratory muscle training (IMT) has been used in outpatient settings for patients who recovered from COVID-19 respiratory failure, little data exist to support earlier implementation in acute care hospitals. This study aimed to assess the safety and feasibility of IMT during the acute disease phase of COVID-19.Design setting and patients: Sixty patients presenting with COVID-19 to a single academic medical center were randomized to control or intervention groups using systematic randomization.Measurements: Participants in the control group had their maximal inspiratory pressure (MIP) measured at enrollment and hospital discharge. They were also asked for their rating of perceived exertion on the Revised Borg Scale for Grading Severity of Dyspnea and were scored by researchers on the Activity Measure for Post-Acute Care (AM-PAC) 6-Clicks Mobility Scale and the Intensive Care Unit Mobility Scale (IMS). Control group patients otherwise received standard care. Participants in the intervention group, in addition to the measures described previously, received inspiratory threshold trainers with the goal of doing 2 sessions daily with a physical therapist for the duration of their inpatient hospitalization. In these sessions, the patient completed 3 sets of 10 breaths with the trainer. Initial resistance was set at 30% of their MIP, with resistance increasing 1 level for the subsequent session if the patients rated their during-activity rating of perceived exertion as less than 2. Changes in functional outcome measures, amount of supplemental oxygen, hospital length of stay (LOS), discharge location, adverse events, and mortality were assessed in group comparisons.Results: Of 60 enrolled patients, 41 (n = 19 in intervention and n = 22 in control) were included in the final data set, which required completion of the study, initial and discharge data points collected, and survival of hospitalization. Final groups were statistically similar. A total of 161 sessions of IMT were completed among the 19 patients in the intervention group. Mortality totaled 2 in the control group and 3 in the intervention group and adverse events during intervention occurred in only 3 (1.8%) sessions, all of which were minor oxygen desaturations. Sessions were unable to be completed for all potential reasons 11% of possible times. Dropout rate in the intervention group was 3 (10%). Both intervention and control groups demonstrated improved MIP, decreased supplemental oxygen requirements, improved function on the AM-PAC, and slightly decreased function on the IMS. Length of stay was shorter in the intervention group, and discharge disposition was similar between groups.Conclusions: With a low number of recorded adverse events, similar mortality between groups, and successful completion of 161 exercise sessions, IMT may be a feasible and safe intervention for some hosp

尽管吸气肌训练（IMT）已用于新冠肺炎呼吸衰竭康复患者的门诊，但几乎没有数据支持在急性护理医院早期实施。本研究旨在评估IMT在COVID-19急性疾病阶段的安全性和可行性。设计设置和患者：使用系统随机化，将60名在单个学术医疗中心出现COVID-19]的患者随机分为对照组或干预组。测量：对照组的参与者在入组和出院时测量了他们的最大吸气压力（MIP）。他们还被要求在修订的Borg呼吸困难严重程度分级量表中对感知用力进行评分，并由研究人员在急性后护理活动测量量表（AM-PAC）6次点击活动量表和重症监护室活动量表（IMS）中进行评分。对照组患者接受标准护理。除了之前描述的措施外，干预组的参与者还接受了吸气阈值培训，目标是在住院期间每天与理疗师进行两次培训。在这些课程中，患者与培训师一起完成了3组10次呼吸。初始阻力设定为MIP的30%，如果患者在活动期间对感知用力的评分小于2，则在随后的疗程中阻力增加1级。在组比较中评估了功能结果指标、补充氧气量、住院时间（LOS）、出院地点、不良事件和死亡率的变化。结果：在60名入选患者中，41名（干预组n=19，对照组n=22）被纳入最终数据集，这需要完成研究、收集初始和出院数据点以及住院生存率。最后一组在统计学上相似。在干预组的19名患者中，共完成了161次IMT治疗。对照组和干预组的死亡率分别为2和3，干预期间的不良事件仅发生在3次（1.8%）疗程中，均为轻微的氧饱和度降低。由于各种可能的原因，有11%的时间无法完成会话。干预组的辍学率为3（10%）。干预组和对照组均显示MIP改善，补充氧气需求减少，AM-PAC功能改善，IMS功能略有下降。干预组的住院时间更短，两组之间的出院倾向相似。结论：由于不良事件记录较少，各组死亡率相似，成功完成161次运动，IMT可能是一些新冠肺炎住院患者可行且安全的干预措施。

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引用次数: 0

The Impact of COVID-19 on Interprofessional Collaborative Practice Through the Lens of Acute Care Physical Therapists: A Case Series. 2019冠状病毒病对跨专业协作实践的影响通过急性护理物理治疗师的镜头:一个案例系列。

IF 0.5 Q4 REHABILITATION

Journal of Acute Care Physical Therapy

Pub Date : 2023-04-01 DOI: 10.1097/JAT.0000000000000208

Amy M Yorke, Leslie M Smith, Elizabeth Mostrom

This case report describes interprofessional collaborative practice experiences through the viewpoints of 3 acute care physical therapists who worked with patients with coronavirus disease-2019 (COVID-19) during the early months of the pandemic.

Methods: The cases presented in this case report were selected from a larger longitudinal qualitative multiple-case study investigating interprofessional collaborative practice experiences of physical therapists employed in inpatient settings prior to and during the pandemic. The cases provide detailed narrative descriptions of interprofessional collaborative practice before and during the pandemic from the perspective of 3 physical therapists working in acute care environments.

Results: The 3 physical therapists reported challenges to and opportunities for interprofessional collaborative practices that align with the 4 interprofessional educational competencies (values/ethics, roles/responsibilities, communication, and teams/teamwork).

Conclusions: The ability to provide patient-centered care through interprofessional collaborative practices was impacted by the COVID-19 pandemic. The rich narrative descriptions of our participants' experiences as members of interprofessional teams provide additional insight regarding the effect of the COVID-19 pandemic on interprofessional collaborative practice.

本病例报告通过3名急性护理物理治疗师的观点，描述了在大流行的最初几个月里与冠状病毒病-2019 (COVID-19)患者合作的跨专业合作实践经验。方法:本病例报告中的病例选自一项较大的纵向定性多病例研究，该研究调查了在大流行之前和期间在住院环境中雇用的物理治疗师的跨专业合作实践经验。这些病例从3名在急症护理环境中工作的物理治疗师的角度详细描述了大流行之前和期间的跨专业合作实践。结果:3位物理治疗师报告了与4种跨专业教育能力(价值观/伦理、角色/责任、沟通和团队/团队合作)相一致的跨专业合作实践的挑战和机遇。结论:通过跨专业协作实践提供以患者为中心的护理的能力受到COVID-19大流行的影响。参与者作为跨专业团队成员的丰富经历，为了解COVID-19大流行对跨专业协作实践的影响提供了额外的见解。

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