Journal of Acute Care Physical Therapy最新文献

英文中文

The Role of Physical Therapy Following CAR T-Cell Therapy: A Case Report CAR T细胞治疗后物理治疗的作用：一例报告

IF 0.5

Journal of Acute Care Physical Therapy

Pub Date : 2021-09-29 DOI: 10.1097/jat.0000000000000183

Helaine Firestein

Background: Diffuse large B-cell lymphoma (DLBCL) affects 7 out of 100 000 people in the United States every year. Chimeric antigen receptor (CAR) T-cell therapy is approved by the Food and Drug Administration to treat patients with relapsed/refractory DLBCL who have not responded to 2 prior lines of therapy. CAR T-cell therapy can lead to debilitating side effects necessitating rehabilitation intervention. Case Description: This case report details a 38-year-old woman with refractory DLBCL who received CAR T-cell therapy. The patient experienced grade 2 cytokine release syndrome and grade 4 immune effector cell-associated neurotoxicity syndrome, which resulted in, among other symptoms, lower extremity paraplegia. Upon medical stabilization, the patient was referred to physical therapy. Outcomes: The patient participated in acute care rehabilitation for 8 weeks and progressed significantly toward her prior level of function before being discharged to an inpatient rehabilitation facility. Upon discharge, the patient was able to ambulate with a rolling walker, a knee orthosis, and supervision for safety and had initiated stair training. Discussion/Conclusion: Physical therapists need to understand and recognize the range of side effects that can occur following CAR T-cell therapy. As more patients receive CAR T-cell therapy to treat malignancies, acute care oncology units will undoubtedly be challenged with patients exhibiting severe side effects. Physical therapists are well trained to address physical impairments resulting from CAR T-cell therapy's side effects and will play a vital role in these patients' interdisciplinary care.

背景:弥漫性大b细胞淋巴瘤(DLBCL)在美国每年影响10万人中的7人。嵌合抗原受体(CAR) t细胞疗法被美国食品和药物管理局批准用于治疗复发/难治性DLBCL患者，这些患者对先前的2条治疗线没有反应。CAR - t细胞疗法可能导致衰弱的副作用，需要康复干预。病例描述:本病例报告详细介绍了一位38岁的难治性DLBCL患者接受CAR - t细胞治疗。患者经历了2级细胞因子释放综合征和4级免疫效应细胞相关神经毒性综合征，除其他症状外，还导致下肢截瘫。在医疗稳定后，患者被转介到物理治疗。结果:患者参加了8周的急性护理康复治疗，在出院到住院康复机构之前，患者的功能明显恢复到原来的水平。出院后，患者能够使用滚动助行器、膝关节矫形器和安全监护行走，并开始了楼梯训练。讨论/结论:物理治疗师需要了解和认识CAR - t细胞治疗后可能发生的一系列副作用。随着越来越多的患者接受CAR - t细胞疗法治疗恶性肿瘤，急性肿瘤护理单位无疑将面临严重副作用的挑战。物理治疗师受过良好的训练，可以解决CAR - t细胞疗法副作用导致的身体损伤，并将在这些患者的跨学科护理中发挥重要作用。

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引用次数: 0

Troponin Elevation Following Percutaneous Coronary Intervention in Acute Coronary Syndrome 急性冠脉综合征经皮冠状动脉介入治疗后肌钙蛋白升高

IF 0.5

Journal of Acute Care Physical Therapy

Pub Date : 2021-09-23 DOI: 10.1097/JAT.0000000000000181

Daniel Miner, Kevin M Parcetich, Kellen Smith

Background: Recent advances in revascularization procedures have improved survival rates for individuals with acute coronary syndrome (ACS). However, evidence to guide clinical decision-making for early mobility following percutaneous coronary intervention (PCI) is extremely limited. Purpose: The purpose of this clinical perspective and literature review is to provide context for the clinical interpretation of cardiac troponin (cTn) levels in individuals with ACS following revascularization via PCI and present an evidence-supported clinical decision-making algorithm to guide clinicians in the appropriate timing of initiation of early mobility for individuals with ACS. Methods: A literature review on cTn values is presented to guide the clinical interpretation of laboratory values for clinical decision-making. A comparison of consensus-based guidelines for early mobility is presented as the basis for proposing a novel algorithm for clinical decision-making in individuals with ACS following PCI. Conclusion: The clinical value and utility of postprocedural cTn levels in individuals with ACS following PCI is to help understand prognosis and mortality but does not provide sufficient information about the safety of initiating early mobility following PCI. Decisions for initiation of early mobility in this population using the proposed evidence-supported algorithm may help avoid unnecessary prolongation of bed rest.

背景:血管重建术的最新进展提高了急性冠脉综合征(ACS)患者的生存率。然而，指导经皮冠状动脉介入治疗(PCI)后早期活动能力的临床决策的证据非常有限。目的:本临床观点和文献综述的目的是为经PCI血运重建术后ACS患者心肌肌钙蛋白(cTn)水平的临床解释提供背景，并提出一种循证支持的临床决策算法，以指导临床医生在ACS患者开始早期活动的适当时机。方法:对cTn值进行文献综述，以指导临床对实验室值的解释，指导临床决策。对基于共识的早期活动指南进行比较，提出了一种新的算法，用于ACS患者PCI后的临床决策。结论:在PCI术后ACS患者中，术后cTn水平的临床价值和应用有助于了解预后和死亡率，但不能提供PCI术后早期活动安全性的足够信息。在这一人群中，使用建议的证据支持算法进行早期活动的决定可能有助于避免不必要的卧床休息时间延长。

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引用次数: 1

APTA Cross Sections and Academies Recommendations for COVID-19 Core Outcome Measures APTA横截面和学院对COVID-19核心结果测量的建议

IF 0.5

Journal of Acute Care Physical Therapy

Pub Date : 2021-09-09 DOI: 10.1097/JAT.0000000000000172

C. Wells, D. Kegelmeyer, K. Mayer, Sowmya Kumble, A. Reilley, A. Campbell, Rebecca J. Martin

Purpose: The novel coronavirus (COVID-19) emerged as a major health concern within the United States in early 2020. Because this is a novel virus, little guidance exists for best practice to evaluate this population within the field of physical therapy. Methods: An expert task force appointed by the leadership of 9 different academies or sections of the American Physical Therapy Association was formed to develop recommendations for a set of core outcome measures for individuals with or recovering from COVID-19. Results: This perspective provides guidance on a best practice recommendation to physical therapists and researchers regarding the use of core outcome measures for individuals with or recovering from COVID-19. The process for the selection of core measures for this population is presented and discussed. Conclusions: Core outcome measures improve the ability to track progress and change across the continuum of care at both the patient and population levels.

目的：新型冠状病毒（新冠肺炎）于2020年初在美国成为一个主要的健康问题。由于这是一种新型病毒，因此在物理治疗领域内，很少有最佳实践指南来评估这一人群。方法：由美国物理治疗协会9个不同学院或部门的领导层任命的专家工作组成立，为新冠肺炎患者或康复者制定一套核心结果指标建议。结果：这一观点为物理治疗师和研究人员提供了关于新冠肺炎患者或康复者使用核心结果测量的最佳实践建议的指导。介绍并讨论了为这一群体选择核心指标的过程。结论：核心结果指标提高了在患者和人群层面跟踪连续护理进展和变化的能力。

引用次数: 2

Instrumented and Standard Measures of Physical Performance in Adults With Chronic Kidney Disease 成人慢性肾脏疾病患者身体机能的仪器和标准测量

IF 0.5

Journal of Acute Care Physical Therapy

Pub Date : 2021-08-18 DOI: 10.1097/JAT.0000000000000179

Laura M. Johnstone, B. Roshanravan, Sean D. Rundell, B. Kestenbaum, Sarah Fay Baker, D. Berry, E. McGough

Background: Chronic kidney disease (CKD) is a common pathology encountered by acute care physical therapists. CKD is associated with reduced physical function and fall risk. The purpose of this study was to (1) examine the test-retest reliability of standard and instrumented physical performance measures and (2) describe the relationship between subjective fall risk and objective physical performance in people with CKD. Methods: Twenty-one adults with CKD completed a battery of standard and instrumented physical performance measures 1 week apart. Standard measures were the Short Physical Performance Battery (SPPB), gait speed, 5 times sit-to-stand (FSTS), 2-minute walk test (2MWT), and quadriceps (QS) and grip (GS) strength dynamometry. Instrumented measures included parameters of gait, sit-stand, and postural sway. Intraclass correlation coefficients (ICC) assessed test-retest reliability, and Pearson correlations (adjusted for age) assessed the relationships between the Fall Risk Questionnaire (FRQ) and standard physical performance. Results: Excellent to moderate test-retest reliability was demonstrated in the standard and instrumented physical performance measures. A subset of standard measures was significantly associated with the FRQ score. Conclusions: This study supports the clinical reliability of a battery of standard physical performance measures and a subset of instrumented parameters for use in adults with CKD. The FRQ may be useful for screening fall risk considering its relationship to objective physical performance.

背景:慢性肾脏疾病(CKD)是急性护理物理治疗师遇到的常见病理。慢性肾病与身体功能下降和跌倒风险有关。本研究的目的是:(1)检验标准和仪器测量的重测信度，(2)描述CKD患者主观跌倒风险与客观身体表现之间的关系。方法:21名成年CKD患者间隔1周完成一系列标准和仪器物理性能测量。标准测量方法为短时间体能测试(SPPB)、步态速度、5次坐立(FSTS)、2分钟步行测试(2MWT)、股四头肌(QS)和握力(GS)力量测定仪。仪器测量包括步态、坐立和姿势摇摆参数。班级内相关系数(ICC)评估了重测信度，Pearson相关性(经年龄调整)评估了跌倒风险问卷(FRQ)与标准身体表现之间的关系。结果:在标准和仪器物理性能测量中证明了优异至中等的测试-重测可靠性。标准测量的一个子集与FRQ评分显著相关。结论:本研究支持一组标准身体表现测量和一组仪器参数用于成人慢性肾病患者的临床可靠性。考虑到FRQ与客观身体表现的关系，FRQ可能有助于筛选跌倒风险。

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引用次数: 1

Utilization of Forearm Crutches to Avoid Lymphedema After Breast Cancer Lymph Node Surgery: A Case Report 使用前臂拐杖避免乳腺癌淋巴结手术后淋巴水肿1例报告

IF 0.5

Journal of Acute Care Physical Therapy

Pub Date : 2021-08-13 DOI: 10.1097/JAT.0000000000000180

Sue E. Curfman, G. P. Austin, Ben Radack

Background: Despite many patients with breast cancer being advised to limit upper extremity (UE) use, there is growing evidence that UE use is not associated with lymphedema. Subsequently, clinicians may be unsure of how to advise patients with a history of breast cancer who need assistive devices to ambulate. Study Design/Case Description: A 51-year-old woman who had recently undergone treatment for breast cancer sustained a knee injury requiring the use of crutches. Forearm crutches were used instead of axillary crutches to minimize the potential for irritation to the axillary lymphatic vessels and thus reduce the risk for lymphedema. L-Dex measures were used to monitor for lymphedema. Outcomes: L-Dex scores did not exceed the change of more than +7.1 to indicate the presence of lymphedema. Furthermore, there were no clinical signs or symptoms of lymphedema while using crutches and in the 7 months following. Discussion: Prolonged rigorous UE use by ambulating non-weight-bearing with forearm crutches within 1 to 2 months of treatment for breast cancer did not result in UE lymphedema. This case report reinforces the growing body of evidence that avoiding aggressive UE activity may not be necessary in those at low risk of lymphedema and informs assistive device prescription for patients with breast cancer.

背景：尽管许多癌症患者被建议限制上肢（UE）的使用，但越来越多的证据表明，UE的使用与淋巴水肿无关。随后，临床医生可能不确定如何建议有癌症病史、需要辅助设备行走的患者。研究设计/病例描述：一名51岁的女性最近接受了癌症治疗，膝盖受伤，需要使用拐杖。使用前臂拐杖代替腋窝拐杖，以最大限度地减少对腋窝淋巴管的刺激，从而降低淋巴水肿的风险。L-Dex测量用于监测淋巴水肿。结果：L-Dex评分变化不超过+7.1，表明存在淋巴水肿。此外，在使用拐杖期间和之后的7个月内，没有淋巴水肿的临床体征或症状。讨论：在癌症治疗的1至2个月内，通过前臂拄着拐杖不负重地移动，长期严格使用UE不会导致UE淋巴水肿。该病例报告强化了越来越多的证据，即对于淋巴水肿风险较低的患者来说，避免攻击性UE活动可能不是必要的，并为癌症患者的辅助设备处方提供了依据。

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引用次数: 0

Acute Care Rehabilitation Following Upper and Lower Extremity Free Flap Surgery: A Review of Best Practices and Case Reports 上肢和下肢游离皮瓣手术后的急性护理康复：最佳实践和病例报告综述

IF 0.5

Journal of Acute Care Physical Therapy

Pub Date : 2021-07-21 DOI: 10.1097/JAT.0000000000000171

D. Fufa, D. Osei, Samantha Antonietti, Kathryn Keaney

Purpose: The purpose of this article is to highlight the guiding principles and protocols for immediate and early postoperative management of upper and lower extremity flaps. We review critical principals of flap monitoring, dangling protocols, splinting, and positioning, as they relate to the physical and occupational therapists' acute care of patients following flap surgery. We refer to the protocol used at our facility but also discuss other protocols used in different hospitals. Case Demonstrations: Two cases have been discussed in this article, one involving the upper extremity and the other involving the lower extremity. The first case is a 43-year-old man who fell on the subway tracks, resulting in severe electrical burns requiring an anterolateral thigh flap for soft tissue coverage of exposed bone. The second case is a 55-year-old patient who was involved in a motor vehicle accident resulting in an open knee wound requiring a free latissimus dorsi muscle transfer for soft tissue coverage. Conclusion: There is no “gold standard” when treating a patient after flap surgery. As therapists, after a bed rest order is lifted, we initiate mobilizing a patient. Therefore, we may be present when a flap is at risk for compromise. As such, therapists should become familiar with the surgeon's protocol at their facility and understand how to appropriately progress patients. Additionally, a therapist should comprehend ways to assess a flap and familiarize themselves with principles of flap management.

目的:本文的目的是强调指导原则和方案的即时和早期的术后处理的上肢和下肢皮瓣。我们回顾了皮瓣监测、悬垂方案、夹板和定位的关键原则，因为它们与皮瓣手术后患者的物理和职业治疗师的急性护理有关。我们参考了我们医院使用的协议，但也讨论了不同医院使用的其他协议。案例演示:本文讨论了两个案例，一个涉及上肢，另一个涉及下肢。第一个病例是一名43岁男子，他在地铁轨道上摔倒，导致严重电烧伤，需要用大腿前外侧皮瓣覆盖暴露的骨头。第二个病例是一名55岁的患者，因机动车事故导致开放性膝盖伤口，需要游离背阔肌转移以覆盖软组织。结论:皮瓣术后治疗不存在“金标准”。作为治疗师，在解除卧床休息命令后，我们开始动员病人。因此，当皮瓣有妥协的危险时，我们可能在场。因此，治疗师应该熟悉他们机构的外科医生的协议，并了解如何适当地治疗患者。此外，治疗师应该了解评估皮瓣的方法，熟悉皮瓣管理的原则。

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引用次数: 0

Acceptability of Physiotherapists in the Emergency Department for the Care of Adults With Musculoskeletal Disorders 急诊科物理治疗师对成人肌肉骨骼疾病护理的可接受性

IF 0.5

Journal of Acute Care Physical Therapy

Pub Date : 2021-07-16 DOI: 10.1097/JAT.0000000000000178

Amélia Béland, E. Matifat, Émie Cournoyer, Kadija Perreault, F. Desmeules

Purpose: Over the past decades, pressure on emergency departments (EDs) has been increasing. New ED models of care including physiotherapists in more autonomous roles, often called advanced practice physiotherapy (APP) care, are emerging to improve access to care, especially for patients with musculoskeletal disorders (MSKDs). As such, the purpose of this study was to assess patient' acceptability of APP ED care for patients with MSKDs. Methods: Patients consulting for an MSKD were recruited in 1 Canadian ED and completed a 13-question survey assessing their acceptability of ED APP care. Descriptive analyses as well as χ2 and Fisher's exact tests, with associated 95% confidence interval, were performed. Results: Forty-one patients completed the survey. A majority of respondents (56%) trusted APPs to provide accurate diagnoses for MSKD in the ED, and 80.5% were confident they would provide safe care. Most participants felt confident that APPs would appropriately order medical imaging tests (73%) or prescribe medication (66%) when necessary. Sixty-six percent of participants agreed that seeing only a physiotherapist without the intervention of a physician would reduce their length of ED stay. Conclusions: Within this exploratory survey, participants were favorable to ED APP for the care of MSKD, suggesting that implementation of such models would be accepted by patients with MSKD presenting to an ED.

目的：在过去的几十年里，急诊科的压力一直在增加。新的ED护理模式正在出现，包括物理治疗师扮演更自主的角色，通常被称为高级实践物理治疗（APP）护理，以改善获得护理的机会，特别是对于肌肉骨骼疾病（MSKDs）患者。因此，本研究的目的是评估患者对MSKDs患者APP ED护理的可接受性。方法：在1名加拿大ED中招募了MSKD咨询患者，并完成了一项13个问题的调查，评估他们对ED APP护理的可接受性。进行描述性分析以及χ2和Fisher精确检验，并进行相关的95%置信区间。结果：41名患者完成了调查。大多数受访者（56%）相信APP能为ED中的MSKD提供准确的诊断，80.5%的人相信他们能提供安全的护理。大多数参与者相信APP会在必要时适当地进行医学成像测试（73%）或开药（66%）。66%的参与者同意，在没有医生干预的情况下只看理疗师会缩短他们的ED住院时间。结论：在这项探索性调查中，参与者对ED APP治疗MSKD持赞成态度，这表明这种模型的实施将被接受ED的MSKD患者所接受。

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引用次数: 0

Letter to the Editor April 29, 2021 致编辑的信2021年4月29日

IF 0.5

Journal of Acute Care Physical Therapy

Pub Date : 2021-07-14 DOI: 10.1097/JAT.0000000000000176

E. Hillegass, K. Lukaszewicz, M. Puthoff

引用次数: 0

How Do You Plan to End This Year? 你打算如何结束这一年?

IF 0.5

Journal of Acute Care Physical Therapy

Pub Date : 2021-07-01 DOI: 10.1097/JAT.0000000000000173

Traci L. Norris

引用次数: 0

Rehabilitation Outcomes for Patients With Severe Presentation of COVID-19: A Case Series. 严重 COVID-19 患者的康复效果：病例系列。

IF 0.5 Q4 REHABILITATION

Journal of Acute Care Physical Therapy

Pub Date : 2021-07-01 Epub Date: 2020-12-14 DOI: 10.1097/JAT.0000000000000153

Kathryn Solon, Allison Larson, Julie Ronnebaum, Catherine Stevermer

To provide an outline of the timeline from acute care admission to inpatient rehabilitation facility discharge and describe the functional progress and tolerance of 2 individuals who were hospitalized but not intubated because of COVID-19.

Method: Retrospective data were collected from the electronic medical record to describe the rehabilitation course of the first 2 consecutive patients admitted to the rehabilitation facility who were recovering from COVID-19. Both patients were octogenarian men who experienced functional decline while hospitalized for symptoms of COVID-19 and were recommended for further inpatient rehabilitation services. Progress during inpatient rehabilitation was tracked using the following outcome measures: Centers for Medicare & Medicaid Services Quality Indicators (QI), 6-Minute Walk Test, 10-Meter Walk Test, Timed Up and Go, and Berg Balance Scale.

Results: Patient 1 had an 18-day acute care stay, a 13-day inpatient rehabilitation facility stay, and was discharged to home. Patient 2 had an interrupted 19-day acute care stay, a 15-day inpatient rehabilitation facility stay, and was discharged to a skilled nursing facility. Patient 1 improved 160.98 m in the 6-Minute Walk Test, 0.08 m/s in self-selected walking speed, and 85 points in the total Quality Indicators score. Patient 2 improved 115.22 m in the 6-Minute Walk Test, 0.14 m/s in self-selected walking speed, and 39 points in the total Quality Indicators score.

Conclusion: The patients made clinically meaningful improvements in each outcome measure during their length of stay for inpatient rehabilitation. This reveals the positive rehabilitation potential of 2 older adult patients with COVID-19 and demonstrates the patients' ability to maintain inpatient rehabilitation facility level of activity. With individualized care and discharge planning, similar patients may make significant gains in function despite advanced age and comorbid conditions.

目的：概述2名因COVID-19住院但未插管的患者从急诊入院到住院康复机构出院的过程，并描述其功能进展和耐受性：方法：我们从电子病历中收集了回顾性数据，以描述因 COVID-19 而连续入住康复机构的前两名患者的康复过程。这两名患者均为八旬男性，在因COVID-19症状住院期间出现功能衰退，被建议进一步接受住院康复服务。住院康复期间的进展情况通过以下结果指标进行跟踪：医疗保险和医疗补助服务中心质量指标（QI）、6 分钟步行测试、10 米步行测试、定时起立和走动以及伯格平衡量表：患者 1 在急症护理机构住院 18 天，在康复机构住院 13 天，出院回家。患者 2 中断了 19 天的急诊治疗，在康复机构住院 15 天，出院后入住专业护理机构。患者 1 的 6 分钟步行测试成绩提高了 160.98 米，自选步行速度提高了 0.08 米/秒，质量指标总分提高了 85 分。患者 2 的 6 分钟步行测试成绩提高了 115.22 米，自选步行速度提高了 0.14 米/秒，质量指标总分提高了 39 分：结论：在住院康复期间，患者的各项指标都有了有临床意义的改善。这揭示了两名患有 COVID-19 的老年患者具有积极的康复潜力，并证明患者有能力维持住院康复设施的活动水平。通过个性化护理和出院规划，类似患者尽管年事已高并患有合并症，但其功能仍有可能显著提高。

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