Participant retention in follow-up studies of intensive care unit survivors - A scoping review.

OBJECTIVE: To synthesize participant retention data and related reporting in studies evaluating post-hospital outcomes of survivors of critical illness after an intensive care unit (ICU) stay. REVIEW METHOD USED: A synthesis of literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. DATA SOURCES: PubMed, EMBASE, PsycINFO, Cumulative Index of Nursing and Allied Health Literature, and the Cochrane Controlled Trials Registry. Hand searched reference lists and personal files of relevant narrative and systematic review articles. REVIEW METHODS: Articles were screened by pairs of independent reviewers. Similarly, data were abstracted by pairs of data collectors, with conflicts resolved by consensus or by a third reviewer. RESULTS: We included 243 publications, from 225 unique studies of 87,602 participants. Participant retention could not be calculated for any time-points in 13% of studies nor in 22% of all follow-up time-points. Retention ranged from 18-100%. When compared to follow-up before 1-month, retention at each later timepoint was not significantly different. Age and sex were not associated with retention and more recent studies had decreased retention (odds ratio: 0.94 [95% confidence interval: 0.92-0.96; p < 0.001]). Reporting of retention-related study methodology was inconsistent. CONCLUSION: Retention rate could not be calculated for 22% of study follow-up time-points, with retention at the remaining time-points generally being high (≥85%), but with high variability (18% - 100%). ICU survivorship research could be improved via: (i) more detailed guidance on reporting participant retention, and (ii) use of existing resources and best practices to facilitate better study design and to improve participant retention to preserve statistical power and reduce selection bias.

Dynamic Prediction of Post-Acute Care Needs for Hospitalized Medicine Patients.

OBJECTIVES: Use patient demographic and clinical characteristics at admission and time-varying in-hospital measures of patient mobility to predict patient post-acute care (PAC) discharge. DESIGN: Retrospective cohort analysis of electronic medical records. SETTING AND PARTICIPANTS: Patients admitted to the two participating Hospitals from November 2016 through December 2019 with ≥72 hours in a general medicine service. METHODS: Discharge location (PAC vs home) was the primary outcome, and 2 time-varying measures of patient mobility, Activity Measure for Post-Acute Care (AM-PAC) Mobility "6-clicks" and Johns Hopkins Highest Level of Mobility, were the primary predictors. Other predictors included demographic and clinical characteristics. For each day of hospitalization, we predicted discharge to PAC using the demographic and clinical characteristics and most recent mobility data within a random forest (RF) for survival, longitudinal, and multivariate (RF-SLAM) data. A regression tree for the daily predicted probabilities of discharge to PAC was constructed to represent a global summary of the RF. RESULTS: There were 23,090 total patients and compared to PAC, those discharged home were younger (64 vs 71), had shorter length of stay (5 vs 8 days), higher AM-PAC at admission (43 vs 32), and average AM-PAC throughout hospitalization (45 vs 35). AM-PAC was the most important predictor, followed by age, and whether the patient lives alone. The area under the hospital day-specific receiver operating characteristic curve ranged from 0.76 to 0.79 during the first 5 days. The global summary tree explained 75% of the variation in predicted probabilities for PAC from the RF. Sensitivity (75%), specificity (70%), and accuracy (72%) were maximized at a PAC probability threshold of 40%. CONCLUSIONS AND IMPLICATIONS: Daily assessment of patient mobility should be part of routine practice to help inform care planning by hospital teams. Our prediction model could be used as a valuable tool by multidisciplinary teams in the discharge planning process.

Repetitive head impacts among professional fighters: a pilot study evaluating Traumatic Encephalopathy Syndrome and postural balance.

OBJECTIVES: Clinical criteria for Traumatic Encephalopathy Syndrome (ccTES) were developed for research purposes to reflect the clinical symptoms of Chronic Traumatic Encephalopathy (CTE). The aims of this study were to 1) determine whether there was an association between the research diagnosis of TES and impaired postural balance among retired professional fighters, and 2) determine repetitive head impacts (RHI) exposure thresholds among both TES positive and TES negative groups in retired professional fighters when evaluating for balance impairment. METHODS: This was a pilot study evaluating postural balance among participants of the Professional Athletes Brain Health Study (PABHS). Among the cohort, 57 retired professional fighters met the criteria for inclusion in this study. A generalized linear model with generalized estimating equations was used to compare various balance measures longitudinally between fighters with and without TES. RESULTS: A significant association was observed between a TES diagnosis and worsening performance on double-leg balance assessments when stratifying by RHI exposure thresholds. Additionally, elevated exposure to RHI was significantly associated with increased odds of developing TES; The odds for TES diagnosis were 563% (95% CI = 113, 1963; p-value = 0.0011) greater among athletes with 32 or more professional fights compared to athletes with less than 32 fights when stratifying by balance measures. Likewise, the odds for TES diagnosis were 43% (95% CI = 10, 102; p-value = 0.0439) greater with worsening double leg stance balance in athletes exposed to 32 or more fights. CONCLUSION: This pilot study provides preliminary evidence of a relationship between declining postural balance and a TES diagnosis among retired professional fighters with elevated RHI exposure. Further research exploring more complex assessments such as the Functional Gait Assessment may be of benefit to improve clinical understanding of the relationship between TES, RHI, and balance.

Integrating lesbian, gay, bisexual, transgender, and queer (LGBTQ) competency into the dental school curriculum.

BACKGROUND: Decreasing healthcare disparities in marginalized communities requires healthcare providers who understand and appreciate social, economic, and cultural backgrounds. This includes care and education focused on individuals who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ). METHODS: This study examined dental students' and residents' self-reported clinical preparedness, prejudicial attitudes (implicit and explicit), and knowledge of health disparities that exist in the LGBTQ community using the Lesbian, Gay, Bisexual, Transgender Development of Clinical Skills Scale (LGBT-DOCSS) prior to and after the presentation of an LGBTQ competency course. RESULTS: A total of 178 dental students at a private US dental school ranging from D1 to first-year postdoctoral residency participated in the course and completed both pre-course survey and post-course survey. Sixty-seven percent of the students reported having formal training in LGBTQ competency prior to completing the pre-training survey. The results of the LGBT-DOCSS in this population following intervention training revealed an increased feeling of clinical preparedness in treating LGBTQ patients, decreased bias toward LGBTQ, and increased knowledge of health disparities in the LGBTQ community. A more significant percentage of male respondents self-reported prejudicial beliefs. Knowledge of LGBTQ health issues increased significantly among pre-clinical students. CONCLUSION: Introducing an early intervention LGBTQ competency course in the dental curriculum is an effective method of improving students' awareness and self-confidence in working with LGBTQ patients while decreasing biases that may have existed prior to a training course.

The effect of post-acute rehabilitation setting on 90-day mobility after stroke: A difference-in-difference analysis.

Background: After discharged from the hospital for acute stroke, individuals typically receive rehabilitation in one of three settings: inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), or home with community services (i.e., home health or outpatient clinics). The initial setting of post-acute care (i.e., discharge location) is related to mortality and hospital readmission; however, the impact of this setting on the change in functional mobility at 90-days after discharge is still poorly understood. The purpose of this work was to examine the impact of discharge location on the change in functional mobility between hospital discharge and 90-days post-discharge. Methods: In this retrospective cohort study, we used the electronic health record to identify individuals admitted to Johns Hopkins Medicine with an acute stroke and who had measurements of mobility [Activity Measure for Post Acute Care Basic Mobility (AM-PAC BM)] at discharge from the acute hospital and 90-days post-discharge. Individuals were grouped by discharge location (IRF=190 [40%], SNF=103 [22%], Home with community services=182 [(38%]). We compared the change in mobility from time of discharge to 90-days post-discharge in each group using a difference-in-differences analysis and controlling for demographics, clinical characteristics, and social determinants of health. Results: We included 475 individuals (age 64.4 [14.8] years; female: 248 [52.2%]). After adjusting for covariates, individuals who were discharged to an IRF had a significantly greater improvement in AM-PAC BM from time of discharge to 90-days post-discharge compared to individuals discharged to a SNF or home with community services (ß=-3.5 (1.4), p=0.01 and ß=-8.2 (1.3), p=<0.001, respectively). Conclusions: These findings suggest that the initial post-acute rehabilitation setting impacts the magnitude of functional recovery at 90-days after discharge from the acute hospital. These findings support the need for high-intensity rehabilitation and for policies that facilitate the delivery of high-intensity rehabilitation after stroke.

Assessing burnout among early career faculty in US dental schools.

BACKGROUND: Burnout is a condition characterized by emotional exhaustion, low personal accomplishment, and feelings of depersonalization that may evolve as a result of chronic occupational stress. Our goal for the study was to measure the degree of burnout among US dental school faculty with less than 10 years in academia. MATERIALS AND METHODS: A mixed method approach to data collection was utilized for the study and included: A. A 15-items demographics survey B. Maslach Burnout Inventory (MBI) combined with the Area-Work life Scale (AWS) C. A survey open-ended response to respondent's general feelings about work environment. RESULTS: MBI results from the data collected from 52 respondents indicate 7 or 13.46% of respondents are categorized with a 'burnout' profile. The most abundant categories recognized among this group are feelings of being "overextended" (34.62%) while 32.69% of the respondents self-report signs of being engaged. The results from this population indicate higher emotional exhaustion while levels of depersonalization are lower. The Area-Work life Scale (AWS) for this group indicates a higher sense of reward and control, while a lower frequency of workload balance and fairness are recognized. The data collected from the sample population suggest increased higher feelings of burnout at the 9-year mark, with increased administrative duties, and age range over 44 years. CONCLUSION: Identifying factors in workload, work environment, and influences in the home that lead to burnout early in a faculty member's tenure and introducing reduction mechanisms are key to enhancing faculty production, satisfaction, and retention.

Association between physical therapy frequency and postacute care for a national cohort of patients hospitalized with pneumonia.

BACKGROUND: Annually more than 300,000 patients hospitalized for pneumonia need postacute care. Patients and systems prefer home discharge, but physical limitations often necessitate postacute care. It is unknown whether frequency of physical therapy in the hospital affects postacute care discharges. OBJECTIVE: Examine the relationship between physical therapy visit frequency and disposition among a national sample of patients hospitalized with pneumonia. DESIGNS: Observational cohort study. SETTING: Acute care hospital. PARTICIPANTS: Adult patients with primary diagnosis of pneumonia in the Premier Data Set who received physical therapy in the hospital during a 5-day window, with therapy on at least days 1 and 5. INTERVENTION: Physical therapy visit frequency. MAIN OUTCOME AND MEASURES: Discharge disposition (home or postacute care). RESULTS: We included 18,886 patients from 595 hospitals. Just over half were discharged home (n = 9638; 51.0%) and 558 (2.95%) died. Patients getting more frequent therapy were older, non-Hispanic white, treated in small non-teaching rural hospitals in the West, Midwest, or South, and had fewer severe illness indicators. In adjusted models, patients who received physical therapy on 100% of days were 7% [(95% confidence interval, 4.3-9.7), p < .0001] more likely to go home than patients who received physical therapy on 40% of days. As a falsification test, we found that there was no relationship between physical therapy frequency and all-cause mortality. Physical therapy visit frequency was positively associated with discharge to home. Increasing visit frequency of physical therapy in hospitals might reduce the need for postacute care, but randomized controlled trials are needed to confirm the effect.

Physical therapy provision for patients with pneumonia in US hospitals.

BACKGROUND: Physical therapy (PT) appears beneficial for hospitalized patients. Little is known about PT practice patterns and costs across hospitals. OBJECTIVE: To examine whether receiving PT is associated with specific patient and hospital characteristics for patients with pneumonia. We also explored the variability in PT service provision and costs between hospitals. METHODS: We included administrative claims from 2010 to 2015 in the Premier Healthcare Database, inclusive of 644 US hospitals. We examined associations between receiving at least one PT visit and patient (age, race, insurance, intensive care utilization, comorbidity status, and length of stay) and hospital (academic status, rurality, size, and location) characteristics. Exploratory measures included timing and proportion of days with PT visits, and per-visit and per-admission costs. RESULTS: Of 768,010 patients, 49% had PT. After adjustment, older age most significantly increased the probability of receiving PT (+38.0% if >80 vs. ≤50 years). Higher comorbidity burden, longer length of stay, and hospitalization in an urban setting were also associated with higher probability. Hospitalization in the South most significantly decreased the probability (-9.1% vs. Midwest). Patients without Medicare and Non-White patients also had lower probability. Median (interquartile range) days to first visit was 2 (1-4). Mean proportion of days with a visit was 35% ± 20%. Median per-visit cost was $88.90 [$56.70-$130.90] and per-admission was $224.00 [$137.80-$369.20]. CONCLUSION: Both clinical (intensive care utilization and comorbidity status) and non-clinical (age, race, rurality, location) factors were associated with receiving PT. Within and between hospitals, there was high variability in the number and frequency of visits, and costs.

Musculoskeletal Injury Concealment in the Reserve Officers' Training Corps: A Survey of Cadets' Reporting Behaviors.

BACKGROUND: Among service members, musculoskeletal injuries threaten military readiness and place a substantial burden on medical and financial resources. Emerging research suggests that service members regularly conceal injuries, especially in training environments. The Reserve Officers' Training Corps (ROTC) is a critical training environment for future U.S. military commissioned officers. Training activities expose cadets to a high risk of injury while in the ROTC. The purpose of this study was to explore injury-reporting behaviors in cadets and factors associated with injury concealment. MATERIALS AND METHODS: We invited Army, Air Force, and Naval cadets from six host universities participating in officer training to complete an online, self-reported survey regarding injury reporting and concealment. Cadets answered questions about pain or injuries experienced during officer training. Survey questions pertained to an injury's anatomic location, onset, severity, functional limitations, and whether or not the injury had been reported. Cadets also selected factors that influenced the decision to report or conceal injuries from predetermined lists in a "choose any" fashion. A series of χ2 tests of independence compared the relationship between injury reporting and other injury characteristics for each individual injury. RESULTS: One hundred fifty-nine cadets (121 Army, 26 Air Force, and 12 Naval) completed the survey. Eighty-five cadets disclosed a total of 219 injuries. Two-thirds of injuries (144/219) were concealed. Twenty-six percent of participants (22/85) reported all injuries, whereas the remainder (63/85, 74%) had at least one concealed injury. In relation to injury reporting/concealment, there was a weak association with injury onset (χ21 = 4.24, P = .04, V = 0.14), a moderate association with anatomic location (χ212 = 22.64, P = .03, V = 0.32), and relatively strong associations with injury severity (χ23 = 37.79, P < .001, V = 0.42) and functional limitations (χ23 = 42.91, P < .001, V = 0.44). CONCLUSIONS: Two-thirds of injuries went unreported in this sample of ROTC cadets. Functional limitations, symptom severity, and injury onset may be the largest factors that influence the decision to report or conceal musculoskeletal injuries. This study establishes the foundation for researching injury reporting in cadets and adds to the existing military evidence on the topic.

A unit-based, multi-center evaluation of adopting mobility measures and daily mobility goals in the hospital setting.

BACKGROUND: Promoting patient mobility helps improve patient outcomes, but mobility status is not widely tracked nor do patients have specific individualized mobility goals. PURPOSE: We evaluated nursing adoption of mobility measures and daily mobility goal achievement using the Johns Hopkins Mobility Goal Calculator (JH-MGC), a tool to guide an individualized patient mobility goal based on the level of mobility capacity. METHOD: Built on a translating research into practice framework, the Johns Hopkins Activity and Mobility Promotion (JH-AMP) program was the vehicle to promote use of the mobility measures and the JH-MGC. We evaluated a large-scale implementation effort of this program on 23 units across two medical centers. FINDINGS: Units significantly improved documentation compliance to mobility measures and achieving daily mobility goals. Units with the highest documentation compliance rates had higher rates of daily mobility goal achievement, especially for longer distance ambulation goals. DISCUSSION: The JH-AMP program improved adoption of mobility status tracking and higher nursing inpatient mobility levels.

Identifying Cognitive Impairment in the Acute Care Hospital Setting: Finding an Appropriate Screening Tool.

IMPORTANCE: Identifying cognitive impairment in adults in acute care is essential so that providers can address functional deficits and plan for safe discharge. Occupational therapy practitioners play an essential role in screening for, evaluating, and treating cognitive impairment. OBJECTIVE: To test and compare the psychometrics and feasibility of three cognitive screens and select the ideal screen for use in acute care. DESIGN: Prospective mixed methods. SETTING: Acute care hospital. PARTICIPANTS: Fifty adults. OUTCOMES AND MEASURES: We examined the interrater reliability, administration time, and usability of the Brief Cognitive Assessment Tool Short Form (BCAT-SF), the Activity Measure for Post-Acute Care "6-Clicks" Applied Cognitive Inpatient Short Form (AM-PAC ACISF), and the Montreal Cognitive Assessment (MoCA). We compared the construct validity, sensitivity, and specificity of the BCAT-SF and AM-PAC ACISF with those of the MoCA. RESULTS: Interrater reliability was good to excellent; ICCs were .98 for the MoCA, .97 for the BCAT-SF, and .86 for the AM-PAC ACISF. The BCAT-SF and the AM-PAC ACISF both had 100% sensitivity, and specificity was 74% for the BCAT-SF and 98% for the AM-PAC ACISF. The optimal cutoff score for cognitive impairment on the AM-PAC ACISF was <22. Administration time of the AM-PAC ACISF (1.0 min) was significantly less than that of the BCAT-SF (5.0 min) and the MoCA (13.3 min; p < .001). CONCLUSIONS AND RELEVANCE: Each screen demonstrated acceptable reliability and construct validity. The AM-PAC ACISF had the optimum mix of performance and feasibility for the fast-paced acute care setting. What This Article Adds: Early identification of cognitive impairment using the AM-PAC ACISF can allow for timely occupational therapy intervention in acute care settings.

Revealing the tension: The relationship between high fall risk categorization and low patient mobility.

BACKGROUND: Using an inpatient fall risk assessment tool helps categorize patients into risk groups which can then be targeted with fall prevention strategies. While potentially important in preventing patient injury, fall risk assessment may unintentionally lead to reduced mobility among hospitalized patients. Here we examined the relationship between fall risk assessment and ambulatory status among hospitalized patients. METHODS: We conducted a retrospective cohort study of consecutively admitted adult patients (n = 48,271) to a quaternary urban hospital that provides care for patients of broad socioeconomic and demographic backgrounds. Non-ambulatory status, the primary outcome, was defined as a median Johns Hopkins Highest Level of Mobility <6 (i.e., patient walks less than 10 steps) throughout hospitalization. The primary exposure variable was the Johns Hopkins Fall Risk Assessment Tool (JHFRAT) category (Low, Moderate, High). The capacity to ambulate was assessed using the Activity Measure for Post-Acute Care (AM-PAC). Multivariable regression analysis controlled for clinical demographics, JHFRAT items, AM-PAC, comorbidity count, and length of stay. RESULTS: 8% of patients at low risk for falls were non-ambulatory, compared to 25% and 54% of patients at moderate and high risk for falls, respectively. Patients categorized as high risk and moderate risk for falls were 4.6 (95% CI: 3.9-5.5) and 2.6 (95% CI: 2.4-2.9) times more likely to be non-ambulatory compared to patients categorized as low risk, respectively. For patients with high ambulatory potential (AM-PAC 18-24), those categorized as high risk for falls were 4.3 (95% CI: 3.5-5.3) times more likely to be non-ambulatory compared to patients categorized as low risk. CONCLUSIONS: Patients categorized into higher fall risk groups had decreased mobility throughout their hospitalization, even when they had the functional capacity to ambulate.

Fear of Falling Avoidance Behavior in Parkinson's Disease: Most Frequently Avoided Activities.

BACKGROUND: Fear of falling avoidance behavior (FFAB) is common in Parkinson's disease (PD). OBJECTIVES: The objectives of the study are to determine what activities are most avoided due to FFAB among people with PD and whether any associations exist with demographic factors or fall history. METHOD: Cross-sectional analysis of 174 individuals with PD using the Modified FFAB Questionnaire. RESULTS: Walking in dimly lit, unfamiliar places, and different surfaces, lifting and carrying objects, walking in crowded places, recreational/leisure activities, and going up/downstairs were most avoided. Fallers reported more FFAB (ps < .029). FFAB for certain activities was associated with increased or decreased odds of falling. CONCLUSION: Individuals with PD avoid walking in compromised situations and engaging in recreational/leisure activities due to FFAB. While excessive FFAB may increase the odds of falling, protective forms may be associated with decreased odds. Targeting FFAB among individuals with PD may increase safe participation in meaningful occupations in the home and community.

Psychological Factors Associated With Fear of Falling Avoidance Behavior in Parkinson's Disease: The Role of Depression, Anxiety, and Catastrophizing.

PURPOSE: The purpose of this study was to examine the relationship between psychological factors (depression, anxiety, and catastrophizing) and fear of falling avoidance behavior (FFAB) among individuals with Parkinson's disease (PD). METHODS: A secondary analysis of cross-sectional data from 59 individuals with PD using hierarchical multiple regression. RESULTS: Disease severity (Movement Disorder Society - Unified PD Rating Scale) and catastrophizing (Consequences of Falling Questionnaire (CoF)) explained approximately 48.2% of the variance in the FFAB Questionnaire scores (P < .001). Catastrophizing was the only significant psychological variable (P < .001). The damage to identity subscale of the CoF was significant in the final model (P < .001). CONCLUSIONS: Catastrophizing about the consequences of falls explained the largest portion of variability in FFAB after controlling for disease severity. Catastrophizing about the immediate consequences of falling may play a prominent role in FFAB and may be a potential treatment target for mitigating FFAB.

Improving patient selection for use of consumer grade physical activity monitors in the hospital.

BACKGROUND: Bedrest is toxic for inpatients and consumer grade physical activity monitors offer an economical solution to monitor patient ambulation. But these devices may not be accurate in debilitated hospitalized patients who frequently ambulate very slowly. OBJECTIVE: To determine whether measures of physical capacity can help identify inpatients for whom wearable physical activity monitors may accurately measure step count. METHODS: Prospective observational study of 54 adult inpatients with acute neurological diagnoses. Patients were assessed using 2 physical capacity assessments (Activity Measure for Post-Acute Care Inpatient Mobility Short Form [AM-PAC IMSF] and Katz Activities of Daily Living [ADL] scale). They also completed a 2-minute walk test (2MWT) wearing a consumer grade physical activity monitor. RESULTS: The wearable activity monitor recorded steps (initiated) in 33 (61%) of the inpatients, and for 94% of inpatients with gait speeds >0.43 m/s. Physical capacity assessments correlated well with gait speed, AM-PAC IMSF r = 0.7, and Katz ADL r = 0.6, p < 0.05. When the physical activity monitor initiated, the mean absolute percent error (SD) comparing device calculated steps to observed steps, was 10% (13). AM-PAC IMSF (T-score >45) and Katz ADL (>5) cutoff scores identified inpatients for whom physical activity monitors initiated with a sensitivity of 94 and 91%, respectively. CONCLUSIONS: Physical capacity assessments, such as AM-PAC, and Katz ADL, may be a useful and feasible screening strategy to help identify inpatients where wearable physical activity monitors can measure their mobility.

Inpatient physical activity across a large university city hospital: a behavioral mapping study.

BACKGROUND: Physical inactivity is common during hospitalization. Physical activity has been described in different inpatient populations but never across a hospital. PURPOSE: To describe inpatient movement behavior and associated factors throughout a single university hospital. METHODS: A prospective observational study was performed. Patients admitted to clinical wards were included. Behavioral mapping was undertaken for each participant between 9AM and 4PM. The location, physical activity, daily activity, and company of participants were described. Barriers to physical activity were examined using linear regression analyses. RESULTS: In total, 345 participants from 19 different wards were included. The mean (SD) age was 61 (16) years and 57% of participants were male. In total, 65% of participants were able to walk independently. On average participants spent 86% of observed time in their room and 10% of their time moving. A physiotherapist or occupational therapist was present during 1% of the time, nursing staff and family were present 11% and 13%, respectively. Multivariate regression analysis showed the presence of an intravenous line (p = .039), urinary catheter (p = .031), being female (p = .034), or being dependent on others for walking (p = .016) to be positively associated with the time spent in bed. Age > 65, undergoing surgery, receiving encouragement by a nurse or physician, reporting a physical complaint or pain were not associated with the time spent in bed (P > .05). CONCLUSION: As family members and nursing staff spend more time with patients than physiotherapists or occupational therapists, increasing their involvement might be an important next step in the promotion of physical activity.

Key Data Elements for Longitudinal Tracking of Physical Function: A Modified Delphi Consensus Study.

OBJECTIVE: Physical function is associated with important outcomes, yet there is often a lack of continuity in routine assessment. The purpose of this study was to determine data elements and instruments for longitudinal measurement of physical function in routine care among patients transitioning from acute care hospital setting to home with home health care. METHODS: A 4-round modified Delphi process was conducted with 13 participants with expertise in physical therapy, health care administration, health services research, physiatry/medicine, and health informatics. Three anonymous rounds identified important and feasible data elements. A fourth in-person round finalized the recommended list of individual data elements. Next, 2 focus groups independently provided additional perspectives from other stakeholders. RESULTS: Response rates were 100% for online rounds 1, 3, and 4 and 92% for round 2. In round 1, 9 domains were identified: physical function, participation, adverse events, behavioral/emotional health, social support, cognition, complexity of illness/disease burden, health care utilization, and demographics. Following the fourth round, 27 individual data elements were recommended. Of these, 20 (74%) are "administrative" and available from most hospital electronic medical records. Additional focus groups confirmed these selections and provided input on standardizing collection methods. A website has been developed to share these results and invite other health care systems to participate in future data sharing of these identified data elements. CONCLUSION: A modified Delphi consensus process was used to identify critical data elements to track changes in patient physical function in routine care as they transition from acute hospital to home with home health. IMPACT: Expert consensus on comprehensive and feasible measurement of physical function in routine care provides health care professionals and institutions with guidance in establishing discrete medical records data that can improve patient care, discharge decisions, and future research.

Psychometric Testing of the Activity Measure for Post-Acute Care (AM-PAC) in the Pediatric Acute Care Setting.

PURPOSE: To determine interrater reliability and construct validity of the Activity Measure for Post-Acute Care (AM-PAC) Inpatient "6-clicks" Short Forms for children in acute care. METHODS: Eight physical therapists (PTs) scored the AM-PAC Basic Mobility, 30-second walk test (30SWT), and Timed Up and Go (TUG) for 54 patients (4-17 years); 6 occupational therapists (OTs) scored the AM-PAC Daily Activity and handgrip dynamometry for 50 patients (5-17 years). Correlations between the AM-PAC Basic Mobility, 30SWT, and TUG and between the Daily Activity AM-PAC and handgrip dynamometry were calculated for evidence of construct validity. RESULTS: Interrater reliability for the AM-PAC was excellent for PTs and OTs. Validity was strong to moderate for Basic Mobility when compared with the 30SWT and TUG. Daily Activity had weak correlation with mean left handgrip strength and no correlation with mean right handgrip strength. CONCLUSIONS: AM-PAC Short Forms have acceptable psychometrics for use among children in acute care.

Participant retention in trauma intensive care unit (ICU) follow-up studies: a post-hoc analysis of a previous scoping review.

BACKGROUND: The study aimed to synthesize participant retention-related data for longitudinal follow-up studies of survivors from trauma intensive care units (ICUs). METHODS: Within a published scoping review evaluating ICU patient outcomes after hospital discharge, two screeners independently searched for trauma ICU survivorship studies. RESULTS: There were 11 trauma ICU follow-up studies, all of which were cohort studies. Twelve months (range: 1-60 months) was the most frequent follow-up time point for assessment (63% of studies). Retention rates ranged from 54% to 94% across time points and could not be calculated for two studies (18%). Pooled retention rates at 3, 6, and 12 months were 75%, 81%, and 81%, respectively. Mean patient age (OR 0.85 per 1-year increase, 95% CI 0.73 to 0.99, p=0.036), percent of men (OR 1.07, 95% CI 1.04 to 1.10, p=0.002), and publication year (OR 0.89 per 1-year increase, 95% CI 0.82 to 0.95, p=0.007) were associated with retention rates. Early (3-month) versus later (6-month, 12-month) follow-up time point was not associated with retention rates. DISCUSSION: Pooled retention rates were >75%, at 3-month, 6-month, and 12-month time points, with wide variability across studies and time points. There was little consistency with reporting participant retention methodology and related data. More detailed reporting guidelines, with better author adherence, will help improve reporting of participant retention data. Utilization of existing research resources may help improve participant retention. LEVEL OF EVIDENCE: Level III: meta-analyses (post-hoc analyses) of a prior scoping review.