Journal of Acute Care Physical Therapy最新文献

{"title":"Therapists Predict Discharge Destination More Accurately Than the AM-PAC “6 Clicks” at Evaluation and Discharge for Patients With Isolated Coronary Artery Bypass Graft","authors":"Rebecca Bradley, K. Tecson, Jerry Schuchert, Michele Topping","doi":"10.1097/JAT.0000000000000202","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000202","url":null,"abstract":"Background: Clinicians and hospital care coordinators seek effective tools to assist with reducing length of stay, delivering appropriate postacute care services, and reducing readmissions for patients following coronary artery bypass grafting (CABG) surgery. Objective: To evaluate whether the discharge recommendation by the Activity Measure for Post-Acute Care (AM-PAC) “6 Clicks” Inpatient Basic Mobility and Daily Activity Short Forms agreed with therapists' recommendation and actual discharge disposition for patients who underwent isolated CABG. Methods: Physical therapists (PTs) and occupational therapists (OTs) recorded their respective AM-PAC “6 Clicks” score on a cohort of consecutive patients admitted for isolated CABG between March and April 2020. The level of agreement was compared between AM-PAC-projected discharge disposition, therapists' recommendation, and actual discharge disposition. Results: There were 58 patients who received discharge recommendations from PTs and OTs following isolated CABG. Upon PT initial evaluation, the AM-PAC “6 Clicks” Basic Mobility tool recommended postacute placement in all 58 (100%) cases, whereas PTs recommended postacute placement for only 1 (2%). Similarly, the AM-PAC “6 Clicks” Daily Activity tool recommended postacute placement in all 58 (100%) cases, whereas OTs recommended discharge to home for 44 (76%) cases and recommended further assessment of discharge needs on the remaining 14 (24%). At the final session, the AM-PAC “6 Clicks” Basic Mobility tool recommended postacute placement in 56 (98%) cases and PTs recommended discharge to home in all 58 (100%) cases. The AM-PAC “6 Clicks” Daily Activity tool recommended postacute placement for 25 (43%) cases, whereas OTs recommended discharge to home for 55 (95%) cases. Nearly all (56; 97%) patients were discharged to home, with the remaining 2 (3%) discharged to postacute placement. The 30- day readmission rate was 2%. Conclusion: We found the PT/OT recommendations were strongly associated with discharge disposition, but that the AM-PAC “6 Clicks” scores had poor agreement with therapists' recommendations and with actual discharge dispositions for patients with isolated CABG. The utility of this tool should be explored in other cardiac patient populations, such as valve replacements with and without sternotomy, and heart failure, to corroborate the results.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45497953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Mobilization Criteria Checklist 12 to 24 Hours After Intravenous Thrombolysis in Acute Ischemic Stroke","authors":"Charity E. Maqueda, C. Perme","doi":"10.1097/JAT.0000000000000194","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000194","url":null,"abstract":"Purpose: This study describes the development and utilization of a novel mobilization criteria checklist that can guide clinical decision making to safely initiate very early mobilization for patients with acute ischemic stroke within 12 to 24 hours after intravenous (IV) thrombolysis. Methods: The evidence was examined, and risk factors for hemorrhagic transformation and considerations for initiating or terminating mobility within the first 12 to 24 hours were identified. The information was formatted into a mobilization criteria checklist for use in a case study 12 to 24 hours after tissue plasminogen activator (tPA), an IV thrombolytic, was given for acute ischemic stroke at a certified comprehensive stroke center. Outcomes: The tool was an additive to clinical practice and provided a clinical guide to optimize patient safety for an established institutional practice. Discussion: A mobilization criteria checklist is a helpful tool to screen for serious risk factors of hemorrhagic transformation in the first 24 hours after IV thrombolysis for acute ischemic stroke. With further development, the foundational concepts may guide future research to establish clinical practice guidelines and a standard of care to optimize the selection of patients most appropriate for mobility within 12 to 24 hours.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47476358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Jumping Into Retirement","authors":"Traci L. Norris, S. Gorman, James M. Smith","doi":"10.1097/jat.0000000000000201","DOIUrl":"https://doi.org/10.1097/jat.0000000000000201","url":null,"abstract":"","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45950392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Mobilization for a Patient With a Right Ventricular Assist Device With an Oxygenator","authors":"Sheena O. MacFarlane, V. Lee, A. Simonds, Samantha Alvarez, Samantha Carty, Kevin H. Ewers, Victoria R. Kelly, P. Linden, Amanda L. Moskal","doi":"10.1097/jat.0000000000000198","DOIUrl":"https://doi.org/10.1097/jat.0000000000000198","url":null,"abstract":"","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47388666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of 2 Methods of Debriefing for Learning of Interprofessional Handoff Skills","authors":"J. Ronnebaum, Chunfa Jie, Kristina Salazar","doi":"10.1097/JAT.0000000000000200","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000200","url":null,"abstract":"Purpose: Interprofessional (IP) handoff communication is imperative for patient safety in high-risk environments. Debriefing is an essential component of the learning process of this skill. Currently, one method of debriefing has not proven more effective than another. Therefore, the purpose of this study was to compare 2 forms of debriefing (face-to-face [F2F] debriefing vs computerized personal reflection) on learning and retention of IP handoff communication. Methods: Fifty-two (n = 52) third-year doctor of physical therapy students completed IP simulated experiences, followed by debriefing. Subjects were divided into 2 groups: (a) F2F debriefing (n = 26) and (b) computerized personal reflection (n = 26). Observed IP handoff communication behaviors were measured with an assessment tool. Results: Overall IP handoff skills improved from pre- to posttest scores (P < .05). The F2F debriefing demonstrated greater improvement in the delivery of communication and content skills (P < .05) than computerized personal reflection debriefing. Conclusion: The F2F debriefing should be included in the training of current and future physical therapists.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41926820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of an Interprofessional Handoff Assessment for Doctor of Physical Therapy Students","authors":"J. Ronnebaum, Chunfa Jie, Kristina Salazar","doi":"10.1097/JAT.0000000000000196","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000196","url":null,"abstract":"Background and Purpose: Handoff communication, especially interprofessional (IPE) handoff communication, has been shown to make up a large portion of communication errors in health care. There is variability in the way professionals are trained and deliver the pertinent patient information in handoffs, which, causes confusion, makes recall difficult, and increases the incidence of medical errors. Thus, this study aimed at assessing IPE handoffs for individuals who are trained in SBAR (Situation, Background, Assessment, and Recommendation) method of IPE communication developed by TEAM STEPPS®. Method: To assess IPE handoffs for those who are trained with the SBAR method, an existing tool was modified to make it more explicit to IPE handoff communication using descriptors from SBAR. Reliability and internal consistency were evaluated using videos of IPE handoffs of doctor of physical therapy (DPT) students. Results: Spearman rank coefficients for the revised assessment domains ranged from 0.56 to 0.86, indicating a strong correlation. The communication and content domains had the highest level of correlation. The interrater reliability of the 5 raters was 0.85, indicating high reliability. Discussion and Conclusion: This assessment proved to be simple and reliable to measure IPE handoff communication skills during emergent situations between DPT students and standardized nurses. Thus, this assessment can be used to assess interprofessional handoffs, develop competencies improved teamwork, and reduce medical errors.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44768050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concurrent Validity Between the AM-PAC “6-Clicks” Basic Mobility Short Form and the WeeFIM in the Pediatric Acute Care Population","authors":"E. Gates, Sarah Eilerman, Rachel Bican","doi":"10.1097/JAT.0000000000000197","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000197","url":null,"abstract":"Purpose: To evaluate concurrent validity between the Activity Measure for Post-Acute Care (AM-PAC) “6-clicks” basic mobility short form (BMSF) and the Functional Independence Measure for Children (WeeFIM) and the interrater reliability for the AM-PAC BMSF for pediatric patients in the acute care setting. Methods: In this prospective, cross-sectional study, study participants completed the AM-PAC BMSF and the mobility domains of the WeeFIM. One therapist recorded scores for each of the outcome measures, while a second blinded therapist recorded scores for the AM-PAC BMSF. Spearman correlation coefficients (rs) were used to describe the relationships between measures, and the intraclass correlation coefficient (ICC) was used to assess interrater reliability. Results: n = 30 children (4-17 years of age) participated in this study. A significant, strong, and positive correlation was found between the AM-PAC BMSF and WeeFIM total scores (rs = 0.95, P < .001) as well as between the transfer scores (rs = 0.93, P < .001). Excellent agreement was found between raters for the AM-PAC BMSF (ICC = 0.97). Conclusions: The AM-PAC BMSF demonstrates strong concurrent validity compared with the WeeFIM and has an excellent interrater agreement, suggesting that it may be a valid and reliable measure to objectively quantify functional mobility for pediatric patients in the acute care setting.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43058163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of the 6-Minute Walk Test as a Predictive Measure on Hospital Readmission and Mortality in Individuals With Heart Failure","authors":"Cynthia Carballada, Mackenzie Mihalik, Alyssa Newman-Caro, Alysha A. Walter","doi":"10.1097/JAT.0000000000000195","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000195","url":null,"abstract":"Purpose: To review the effect distance walked during the 6-minute walk test (6MWT) has on determining the risk of hospital readmission and mortality for individuals with heart failure. Methods: A comprehensive literature search of PubMed, CINAHL, MEDLINE, ProQuest, and Web of Science was performed from February 2021 through September 2021. Article screening and data extraction were completed by 2 authors (C.C. and M.M.). The Quality in Prognostic Studies (QUIPS) assessment tool was used by 3 authors (A.B., C.C., and M.M.) to determine the level of bias for each study. Results: Ten studies were included in this systematic review after inclusion and exclusion criteria were applied. Title (κ= 0.75, confidence interval [CI] 0.68-0.82), abstract (κ= 1, CI 1-1), and full-text (κ= 1, CI 1-1) screens were completed by 2 authors (C.C. and M.M.). Studies in this review included subjects with both acute and chronic heart failure diagnoses. Statistically significant results were reported in 7 of 10 research studies in reference to the distance walked during the 6MWT, hospital readmission, and mortality rates. In the included studies, 6MWT cut-off distances ranged from 200 to 468 m, predicting future hospitalization for subjects with heart failure. Conclusion: The 6MWT may be an effective and easily accessible tool in the acute care setting for physical therapists to estimate the risk of rehospitalization and mortality in the heart failure population and may help with determining discharge recommendations.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48808283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uninterrupted Actigraphy Recording to Quantify Physical Activity and Sedentary Behaviors in Mechanically Ventilated Adults","authors":"Felipe González-Seguel, Agustín Camus-Molina, Macarena Leiva-Corvalán, K. Mayer, J. Leppe","doi":"10.1097/JAT.0000000000000193","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000193","url":null,"abstract":"Purpose: We evaluated the feasibility of quantification of physical activity (PA) and sedentary behaviors (SB) using actigraphy during an entire intensive care unit (ICU) length of stay. Methods: A prospective study was performed in a 12-bed ICU. Triaxial accelerometers were fitted on the right ankle of mechanically ventilated adults. Twenty accelerometers were available to guarantee uninterrupted actigraphy recording 24 hours/day. Data were analyzed: (1) between awakening and ICU discharge to quantify daytime PA/SB and (2) between admission and ICU discharge to quantify day/nighttime inactivity. Secondarily, we assessed the relationship between inactivity/SB and clinical variables. Results: Thirty patients were enrolled, obtaining 5477 recording hours. No patient reported discomfort or injury. The median (min-max) delay time between admission and accelerometer installation was 2.1 (0.0-11.9) hours. Actigraphy recording duration was 5.4 (2.2-34.4) days. The time spent in SB and PA (percentage of minutes per hour) was 94.7% and 5.3%, respectively. PA was stratified by light, moderate, and vigorous levels equating to 91.8%, 7.7%, and 0.5%, respectively. Inactivity time (r = 0.991, P ≤ .001) and SB (r = 0.859, P ≤ .001) were strongly correlated with ICU length of stay. Conclusions: Quantifying PA levels with continuous monitoring through actigraphy is feasible, demonstrating prolonged periods of inactivity/SB. This study highlights that uninterrupted actigraphy could contribute to pursuing the optimal dose and the intervention fidelity of the ICU mobilization in the subsequent clinical trials.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61771678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Partial Substitution of Simulation-Based Learning Allows Equal Student Self-confidence in the Acute Care Setting","authors":"Daniel C. Dale, E. Perlow, Ann M. Lucado","doi":"10.1097/JAT.0000000000000199","DOIUrl":"https://doi.org/10.1097/JAT.0000000000000199","url":null,"abstract":"Purpose: This study examines whether 20% substitution of a simulation-based learning experience (SBLE) during a physical therapist (PT) education integrated clinical experience (ICE) produces differences in student confidence in the acute care setting. Methods: Twenty-one students were randomized into 2 groups. The control group received the traditional 5 days of ICE. The experimental group received 4 days of ICE and 1 day of SBLE focused on the acute care setting. Students were administered the Acute Care Confidence Survey (ACCS) at the beginning, midterm, and conclusion of the semester. Statistical methods were used to examine within- and between-group differences in the ACCS. Results: Eleven of 15 items on the ACCS did not demonstrate any significant difference in change of scores between groups at midterm. Four items related to psychomotor-based skills showed a significant difference, with the group receiving simulation showing greater improvements in confidence scores at midterm. Acute care confidence improved significantly in both groups over time; however, no significant difference between groups was observed in self-reported confidence levels by the end of the semester. Conclusion: Health care simulation has the potential to increase the self-confidence of students in the acute care setting and should be further examined to see whether SBLE could potentially supplement or substitute ICE days in PT education.","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2022-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45660807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}