Applicability of the 48/6 Model of Care as a Health Screening Tool, and its Association with Mobility in Community-Dwelling Older Adults.

BACKGROUND: The 48/6 Model of Care is an integrative care initiative for improving the health outcomes of hospitalized older patients; however, its applicability in community-dwelling older adults as a health screening tool has not been investigated. The present study aimed to examine the applicability of this model, prevalence of dysfunction in 6 care areas, and its relationship with self-reported mobility in community-dwelling older adults. METHODS: This was a cross-sectional survey study of community-dwelling adults aged 65 or older. Participants were screened for problems using 9 items corresponding to the 6 care areas of the 48/6 Model of Care (cognitive functioning, functional mobility, pain management, nutrition and hydration, bladder and bowel management, and medication management). Mobility was assessed via the Life-Space Assessment (LSA). We examined the correlation between each screening item and the LSA. RESULTS: A total of 444 older adults (260 women, 58.6%) participated. The mean number of health problems was 2.3 ± 2.1, with the most common being pain, cognitive impairment, and urinary incontinence. These problems and LSA scores were significantly different by age groups. A multiple regression analysis showed that polypharmacy (ß = -10.567, P < 0.001), dysphagia (ß = -9.610, P = 0.021), and pain (ß = -7.369, P = 0.004) were significantly associated with life-space mobility after controlling for age. CONCLUSION: The 48/6 Model of Care is applicable to community-dwelling older adults, who show high prevalence of dysfunction in the 6 care areas. This study supports the role of the model in screening for the health status of older adults living in the community, and in estimating mobility.

Effects of emotionally charged auditory stimulation on gait performance in the elderly: a preliminary study.

OBJECTIVES: To evaluate the effect of a novel divided attention task-walking under auditory constraints-on gait performance in older adults and to determine whether this effect was moderated by cognitive status. DESIGN: Validation cohort. SETTING: General community. PARTICIPANTS: Ambulatory older adults without dementia (N=104). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: In this pilot study, we evaluated walking under auditory constraints in 104 older adults who completed 3 pairs of walking trials on a gait mat under 1 of 3 randomly assigned conditions: 1 pair without auditory stimulation and 2 pairs with emotionally charged auditory stimulation with happy or sad sounds. RESULTS: The mean age of subjects was 80.6±4.9 years, and 63% (n=66) were women. The mean velocity during normal walking was 97.9±20.6cm/s, and the mean cadence was 105.1±9.9 steps/min. The effect of walking under auditory constraints on gait characteristics was analyzed using a 2-factorial analysis of variance with a 1-between factor (cognitively intact and minimal cognitive impairment groups) and a 1-within factor (type of auditory stimuli). In both happy and sad auditory stimulation trials, cognitively intact older adults (n=96) showed an average increase of 2.68cm/s in gait velocity (F1.86,191.71=3.99; P=.02) and an average increase of 2.41 steps/min in cadence (F1.75,180.42=10.12; P<.001) as compared with trials without auditory stimulation. In contrast, older adults with minimal cognitive impairment (Blessed test score, 5-10; n=8) showed an average reduction of 5.45cm/s in gait velocity (F1.87,190.83=5.62; P=.005) and an average reduction of 3.88 steps/min in cadence (F1.79,183.10=8.21; P=.001) under both auditory stimulation conditions. Neither baseline fall history nor performance of activities of daily living accounted for these differences. CONCLUSIONS: Our results provide preliminary evidence of the differentiating effect of emotionally charged auditory stimuli on gait performance in older individuals with minimal cognitive impairment compared with those without minimal cognitive impairment. A divided attention task using emotionally charged auditory stimuli might be able to elicit compensatory improvement in gait performance in cognitively intact older individuals, but lead to decompensation in those with minimal cognitive impairment. Further investigation is needed to compare gait performance under this task to gait on other dual-task paradigms and to separately examine the effect of physiological aging versus cognitive impairment on gait during walking under auditory constraints.

Frailty recommendations and guidelines: an evaluation of the implementability and a critical appraisal of clinical applicability by the ISPRM Frailty Focus Group.

INTRODUCTION: Aging is associated with an increased burden of multi-morbidity and disease related functional loss and disability, widely impacting patients and health care systems. Frailty is a major actor in age-related disability and is an important target for rehabilitation interventions, considering that is a reversible condition. EVIDENCE ACQUISITION: A working group of members of the ISPRM, responding to WHO 2030 call for action to strengthen rehabilitation, was established to assess the quality and implementability of the existing guidelines for the rehabilitation of frailty. Guidelines were retrieved using a systematic search on Pubmed, Scopus and Web of Science and from the reference lists of screened articles. The included guidelines were evaluated using the AGREE II to assess their quality and using the AGREE-REX to assess their clinical credibility and implementability. Guidelines with a score >4 in the AGREE II item evaluating the overall quality of the guideline were considered for endorsement. Finally, nine external reviewers evaluated the applicability of each recommendation from the endorsed guidelines, providing comments about the barriers and facilitators for their implementation in their country. EVIDENCE SYNTHESIS: Ten guidelines were retrieved and evaluated by the working group, of which four guidelines, i.e. the WHO Guidelines on Integrated Care for Older People, the FOCUS guidelines, the Asia-Pacific Clinical Practice Guidelines for the Management of Frailty and the ICFSR International Clinical Practice Guidelines for Identification and Management of Frailty, were considered for endorsement. All these guidelines were rated as of adequate quality and implementability. CONCLUSIONS: The WHO Guidelines on Integrated Care for Older people (24) the ICFSR International Clinical Practice Guidelines for Identification and management of Frailty (15), the FOCUS guidelines (25) and the Asia Pacific Clinical Practice Guidelines (14) for the Management of Frailty have the best quality and applicability of the existing guidelines on the management of frailty, we suggest that should be employed to define the standards of care for patients with frailty. There are barriers for their implementation, as stated by our experts, to take into account, and some of them are country- or region-specific. Screening for frailty, exercise, nutrition, pharmacological management, social and psychological support, management of incontinence, and an overall comprehensive clinical management are the best tools to face upon frailty.

Trainee Insight into Pain Fellowship Programs: A Critical Evaluation of the Current Educational System by the APPD.

BACKGROUND: Since 1992, when the Accreditation Council of Graduate Medical Education (ACGME) acknowledged pain medicine as a subspecialty, the field has experienced significant growth in its number of programs, diversity of sponsoring specialties, treatment algorithms, and popularity among applicants. These shifts prompted changes to the educational model, overseen by program directors (PDs) and the ACGME. The pool of pain fellowship applicants also changed during that period. OBJECTIVES: This study aims to investigate trainees' reasons for applying to pain medicine fellowship programs as well as the applicants' specific expectations, interests, and motivations, thereby contributing to the remodeling and universal improvement of programs across the country. STUDY DESIGN: Online survey via SurveyMonkey. The online questionnaire targeted pain fellowship applicants in 2023 and current fellows in the US. METHODS: Our study was designed by board members of the Association of Pain Program Directors (APPD). The board disseminated a survey to those who applied to ACGME Pain Medicine fellowships in 2023 as well as to existing fellows. The survey was emailed to residency and fellowship PDs for dissemination to their trainees. The participants answered a 12-question survey on their reasons for pursuing pain medicine fellowships, expectations of and beyond those fellowships, and educational adjustments. RESULTS: There were 283 survey participants (80% applicants in residency training and 20% fellows). Participants ranked basic interventional procedures and a strong desire to learn advanced procedures as the most significant factors in pursuing a pain fellowship. Most trainees (70%) did not wish to pursue a 2-year fellowship, and 50% desired to go into private practice. LIMITATIONS: The relatively small number of respondents is a limitation that could introduce sampling error. Since most of the respondents were from the fields of physical medicine and rehabilitation (PM&R) and anesthesia, the use of convenience sampling reduced our ability to generalize the results to the wider community. Furthermore, approximately 80% of the trainees were residents, who might have had less experience in or knowledge of the survey's particulars than did the fellows. CONCLUSION: This survey demonstrated that procedural volume and diversity were important factors in trainees' decisions to apply to the field of pain medicine; however, extending the duration of a pain fellowship was not an option survey participants favored. Therefore, PDs and educational stakeholders in pain fellowship training need to develop creative strategies to maintain competitive applicants' interest while they adapt to our evolving field.

Motor dual-task effect on gait and task of upper limbs in older adults under specific task prioritization: pilot study.

BACKGROUND AND AIMS: Performing multiple tasks simultaneously may result in reduced performance of subtasks (dual-task cost) particularly among old individuals. Subtask performance during dual tasking is also known to be affected by task prioritization. However, it has not been well studied how the performance of subtasks is affected during motor dual task in old adults compared to young when instructed to prioritize one task over the other. This study aims to investigate the dual-task effect on subtasks during motor dual tasking under specific instruction of task prioritization in old compared to young adults. METHODS: Sixteen independent old and 18 young adults performed two single tasks (usual walking, holding a tray as steady as possible while standing) and two dual tasks (walking while holding a tray focusing attention on keeping tray as steady as possible-WTAT, and walking while holding tray focusing attention on walking-WTAW). Gait parameters [velocity and variability (coefficient of variation, CV) of stride length] and the pitch (forward-backward) and roll (side-to-side) angles of the tray were measured during the four conditions. RESULTS: During the WTAT compared to single tasks, both young and old groups showed reduced gait velocity (ß = -14.0 for old, -34.3 for young), increased gait variability (ß = 0.19 for old, 0.51 for young), and increased tray tilt (ß = 9.4 for old, 7.9 for young in pitch; ß = 8.8 for old, 5.9 for young in roll). Higher proportion of older individuals showed higher dual-task effect on tray stability, but lower dual-task effect on gait compared to young individuals. During WTAW, there was no difference in dual-task effect between age groups in tray stability or gait performance. CONCLUSIONS: Compared to young, older adults tend to compromise the task involving upper limbs during motor dual tasking even when instructed to prioritize this task over gait. These findings may have ramifications on developing training strategies to learn or relearn complex motor activities in seniors.

Association of delirium and spatial neglect in patients with right-hemisphere stroke.

BACKGROUND: Delirium, an acute and fluctuating decline in cognitive functioning, increases mortality and length of hospital stays (LOS) and adversely affects functional outcomes. Previous studies suggested that the incidence of delirium may be increased in right-hemisphere strokes. Similarly, spatial neglect, a disabling deficit in unilateral spatial processing, is more common and more severe following a right-sided stroke. Spatial neglect has been established as a risk factor for delirium. OBJECTIVE: It was hypothesized that functionally relevant spatial neglect and delirium are associated in patients with right-hemisphere stroke during acute inpatient rehabilitation. Data were examined from consecutive unilateral stroke patients evaluated with the 3-minute diagnostic interview for confusion assessment method (3D-CAM) and the Catherine Bergego Scale (CBS) via the Kessler Foundation Neglect Assessment Process (KF-NAP). DESIGN: A retrospective, cohort study. SETTING: Data collected in an acute inpatient rehabilitation facility. PARTICIPANTS: Six hundred twenty six patients with stroke were included. MAIN OUTCOME MEASURES: The measures were the relative risk of patients with right-hemisphere stroke having delirium when also positive for spatial neglect compared to patients with right-hemisphere stroke without spatial neglect, the incidence of 3D-CAM positive results by stroke hemisphere, and the effect of spatial neglect and delirium on functional outcomes for patients with right-brain stroke patients. RESULTS: There was a significantly higher risk of delirium in patients with right-hemisphere stroke with spatial neglect compared to patients with right-hemisphere stroke without spatial neglect. The rates of 3D-CAM positive results were not statistically different for left- compared to right-hemisphere strokes. Both delirium and spatial neglect had significant adverse effects on right-hemisphere stroke patients' functional independence. CONCLUSIONS: The results demonstrate an association between spatial neglect and delirium in patients with right hemisphere stroke in the acute inpatient rehabilitation setting. Because of the negative effect of these impairments on functional outcomes after stroke, prevention, early detection, and targeted treatments should be prioritized for these patients.

Clinical Characteristics and Outcomes of Inpatient Falls During Inpatient Rehabilitation: A Case-Control Study.

ABSTRACT: Inpatient falls have a significant impact on the outcomes of older patients during inpatient rehabilitation. A retrospective case-control study was conducted using data of 7066 adults aged 55 yrs or older to evaluate significant predictors of inpatient falls during inpatient rehabilitation and the association of inpatient falls with discharge destination and length of stay. A stepwise logistic regression was used to model odds of inpatient falls and home discharge with demographic and clinical characteristic variables and a multivariate linear regression to evaluate the association between inpatient falls and length of stay.Nine hundred thirty-one of 7066 patients (13.18%) had inpatient falls during inpatient rehabilitation. The group with inpatient falls had longer length of stay (14.22 ± 7.82 vs. 11.85 ± 5.33 days, P < 0.0001) and a decreased proportion of home discharges when compared with the group without inpatient falls. There were increased odds of inpatient falls among patients with diagnoses of head injury, other injuries, a history of falls, dementia, a divorced marital status, and a use of laxatives or anticonvulsants. Inpatient falls were associated with an increased length of stay (coefficient = 1.62, confidence interval = 1.19-2.06) and decreased odds of home discharge (odds ratio = 0.79, confidence interval = 0.65-0.96) after inpatient rehabilitation. This knowledge may be incorporated into strategies for reducing inpatient falls during inpatient rehabilitation.

Influence of preparedness on caregiver burden, depression, and quality of life in caregivers of people with disabilities.

Introduction: Caregiver preparedness is defined as the perceived preparation of caregivers to care for the physical and emotional needs of the patient. Purpose: This study investigated caregiver preparedness and its influences on caregiver burden, depression, and quality of life (QoL) in caregivers of individuals with disabilities. Methods: We conducted a multicenter cross-sectional survey study on caregivers caring for patients with disabilities. Sociodemographic characteristics were collected via questionnaires. The Preparedness for Caregiving Scale (PCS), Burden Interview (BI), Center for Epidemiologic Studies Depression Scale (CES-D), and EuroQol-Visual Analogue Scale (EQ-VAS) were administered. Results: A total of 151 caregivers were enrolled. The mean age of caregivers was 53.7 ± 12.4 years, and 80.8% were female. The majority of participants were the main caregivers of patients with stroke, spinal cord injury, or traumatic brain injury. The mean PCS score was 2.1 ± 0.9, demonstrating significant relationships with BI (r = -0.512, p < 0.001), CES-D (r = -0.622, p < 0.001), and EQ-VAS (r = 0.441, p < 0.001). The CES-D was significantly associated with the PCS after controlling other variables. However, PCS did not show any correlation with the duration of caregiving or amount of time spent per day on caregiving. Discussion: The clinical implications of this study are that higher caregiver preparedness is a predictor of less caregiver burden and depression, and better QoL. However, preparedness did not increase as the duration or time spent on caregiving was extended. Therefore, efforts to enhance the caregivers' preparedness are required to reduce caregiver burden and improve health outcomes for both caregivers and patients.

Depressive symptoms and gait dysfunction in the elderly.

OBJECTIVE: Assess the association between depressive symptoms (not meeting the criteria for major depression) and gait dysfunction in older adults. DESIGN: Cross-sectional study. SETTING: Einstein Aging Study, a community-based longitudinal aging study. PARTICIPANTS: Six hundred ten nondemented and nondepressed community-residing adults age 70 and older. MEASUREMENTS: Depressive symptoms measured using the 15-item Geriatric Depression Scale. To obtain a comprehensive assessment of gait, eight individual quantitative gait parameters were assessed: velocity (cm/s), stride length (cm), cadence (steps/min), swing phase (seconds), stance phase (seconds), double support phase (seconds), stride length variability (SD of stride length), and swing time variability (SD of swing time). Multiple linear regression analysis was applied to study the association of depressive symptoms with gait, adjusting for potential confounders including demographic variables, medical illnesses, and clinical gait abnormalities. RESULTS: Increased level of depressive symptoms was associated with worse velocity, stride, and swing time variability. The relationship of the remaining five gait variables with depressive symptoms was not significant in the fully adjusted models. CONCLUSIONS: Higher levels of depressive symptoms are associated with worse performance in specific quantitative gait variables in community-residing older adults.

Impact of Modified Cardiac Rehabilitation Within a Stroke Recovery Program on All-Cause Hospital Readmissions.

OBJECTIVE: A Stroke Recovery Program (SRP) including cardiac rehabilitation demonstrated lower all-cause mortality rates, improved cardiovascular function, and overall functional ability among stroke survivors. Neither an effect of SRP on acute care hospital readmission rates nor cost savings have been reported. DESIGN: This prospective matched cohort study included 193 acute stroke survivors admitted to an inpatient rehabilitation facility between 2015 and 2017. The 105 SRP participants and 88 nonparticipants were matched exactly for stroke type, sex, and race and approximately for age, baseline functional scores, and medical complexity scores. Primary outcome measured acute care hospital readmission rate up to 1 yr post-stroke. Secondary outcomes measured costs. RESULTS: A 22% absolute reduction (P = 0.006) in hospital readmissions was observed between the SRP participant (n = 47, or 45%) and nonparticipant (n = 59, or 67%) groups. This resulted in significant cost savings. The conventional care cost to the Center for Medicare and Medicaid Services for stroke patients for both readmissions and outpatient therapy is estimated at $9.67 billion annually. The yearly cost for these services with utilization of the SRP is $8.55 billion. CONCLUSION: Acute care hospital readmissions were reduced in stroke survivors who participated in SRP. Future study is warranted to examine whether widespread application of a similar program may improve quality of life and decrease cost.

Stair negotiation time in community-dwelling older adults: normative values and association with functional decline.

OBJECTIVES: To establish reference values for stair ascent and descent times in community-dwelling, ambulatory older adults, and to examine their predictive validity for functional decline. DESIGN: Longitudinal cohort study. Mean follow-up time was 1.8 years (maximum, 3.2y; total, 857.9 person-years). SETTING: Community sample. PARTICIPANTS: Adults 70 years and older (N=513; mean age, 80.8 ± 5.1y) without disability or dementia. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Time to ascend and descend 3 steps measured at baseline. A 14-point disability scale assessed functional status at baseline and at follow-up interviews every 2 to 3 months. Functional decline was defined as an increase in the disability score by 1 point during the follow-up period. RESULTS: The mean±SD stair ascent and descent times for 3 steps were 2.78 ± 1.49 and 2.83 ± 1.61 seconds, respectively. The proportion of self-reported and objective difficulty was higher with longer stair ascent and descent times (P<.001 for trend for both stair ascent and descent). Of the 472 participants with at least 1 follow-up interview, 315 developed functional decline, with a 12-month cumulative incidence of 56.6% (95% confidence interval [CI], 52.1%-61.3%). The stair negotiation time was a significant predictor of functional decline after adjusting for covariates including gait velocity (adjusted hazard ratio [aHR] per 1-s increase: aHR=1.12 [95% CI, 1.04-1.21] for stair ascent time; aHR=1.15 [95% CI, 1.07-1.24] for stair descent time). Stair descent time was a significant predictor of functional decline among relatively high functioning older adults reporting no difficulty in stair negotiation (P=.001). CONCLUSIONS: The stair ascent and descent times are simple, quick, and valid clinical measures for assessing the risk of functional decline in community-dwelling older adults including high-functioning individuals.

Telerehabilitation for Geriatrics.

Advancements in medical science and technology, along with global increases in life expectancy, are changing the way health care services are delivered to the aging society. Telerehabilitation refers to rehabilitation services involving evaluation and treatment. It is an attractive option for older adults who may have multiple comorbidities. Limited access to in-person services and the concern about potential exposure to severe acute respiratory syndrome coronavirus-2 during this pandemic accelerated the implementation of telerehabilitation. This article review the scope, need, and implementation of telehealth and telerehabilitation in the aging population from the perspective of clinicians, patients, and caregivers.

Abnormal synergistic gait mitigation in acute stroke using an innovative ankle-knee-hip interlimb humanoid robot: a preliminary randomized controlled trial.

Abnormal spasticity and associated synergistic patterns are the most common neuromuscular impairments affecting ankle-knee-hip interlimb coordinated gait kinematics and kinetics in patients with hemiparetic stroke. Although patients with hemiparetic stroke undergo various treatments to improve gait and movement, it remains unknown how spasticity and associated synergistic patterns change after robot-assisted and conventional treatment. We developed an innovative ankle-knee-hip interlimb coordinated humanoid robot (ICT) to mitigate abnormal spasticity and synergistic patterns. The objective of the preliminary clinical trial was to compare the effects of ICT combined with conventional physical therapy (ICT-C) and conventional physical therapy and gait training (CPT-G) on abnormal spasticity and synergistic gait patterns in 20 patients with acute hemiparesis. We performed secondary analyses aimed at elucidating the biomechanical effects of Walkbot ICT on kinematic (spatiotemporal parameters and angles) and kinetic (active force, resistive force, and stiffness) gait parameters before and after ICT in the ICT-C group. The intervention for this group comprised 60-min conventional physical therapy plus 30-min robot-assisted training, 7 days/week, for 2 weeks. Significant biomechanical effects in knee joint kinematics; hip, knee, and ankle active forces; hip, knee, and ankle resistive forces; and hip, knee, and ankle stiffness were associated with ICT-C. Our novel findings provide promising evidence for conventional therapy supplemented by robot-assisted therapy for abnormal spasticity, synergistic, and altered biomechanical gait impairments in patients in the acute post-stroke recovery phase.Trial Registration: Clinical Trials.gov identifier NCT03554642 (14/01/2020).

Technology Utilization in Fall Prevention.

ABSTRACT: Falls, defined as unplanned descents to the floor with or without injury to an individual, remain to be one of the most challenging health conditions. Fall rate is a key quality metric of acute care hospitals, rehabilitation settings, and long-term care facilities. Fall prevention policies with proper implementation have been the focus of surveys by regulatory bodies, including The Joint Commission and the Centers for Medicare and Medicaid Services, for all healthcare settings. Since October 2008, the Centers for Medicare and Medicaid Services has stopped reimbursing hospitals for the costs related to patient falls, shifting the accountability for fall prevention to the healthcare providers. Research shows that almost one-third of falls can be prevented and extensive fall prevention interventions exist. Recently, technology-based applications have been introduced in healthcare to obtain superior patient care outcomes and experience via efficiency, access, and reliability. Several areas in fall prevention deploy technology, including predictive and prescriptive analytics using big data, video monitoring and alarm technology, wearable sensors, exergame and virtual reality, robotics in home environment assessment, and personal coaching. This review discusses an overview of these technology-based applications in various settings, focusing on the outcomes of fall reductions, cost, and other benefits.

Reliability and validity of the Korean version of the Caregiver Burden Inventory.

The purpose of this study was to demonstrate the reliability and validity of the Korean version of the Caregiver Burden Inventory (CBI). The study was conducted as a multicenter cross-sectional survey for caregivers caring for patients with disabilities in outpatient or inpatient rehabilitation clinics. Sociodemographic characteristics and health-related quality of life were collected via questionnaires. The CBI and Burden Interview (BI) were administered, after which internal consistency and factor analysis of the CBI and correlation between the CBI and BI were explored. A total of 151 caregivers participated. The mean age of caregivers was 53.7 ± 12.4 years, and 80.8 % were women. The majority of caregivers were the main caregivers of stroke, spinal cord injury or traumatic brain injury. The factor analysis confirmed its five factorial structure. The time-dependence and physical burden scores of CBI were higher than those of other factors. All five-dimensional and total scores of CBI showed high internal consistency and were well correlated with BI. In conclusion, the CBI has proven its reliability, construct validity and concurrent validity for caregivers of disabled people and has shown its advantage as a multidimensional measure.

Association of Academic Physiatrists Women's Task Force Follow-up Report.

ABSTRACT: The Association of Academic Physiatrists convened a Women's Task Force in 2016, under the leadership of then Association of Academic Physiatrists President Gerard Francisco, MD, to evaluate data and metrics pertaining to the representation and inclusion of female physiatrists in the society. An initial published report focused on a retrospective analysis of data in categories such as leadership, conference presentations, and recognition awards. The findings, which highlighted areas in which the Association of Academic Physiatrists had been successful in supporting gender equity as well as areas in which female physiatrists were underrepresented, provided a base from which to strategically focus on closing gaps in representation. The task force developed an action plan that was approved by the Board of Trustees and included strategies aimed at closing gaps and collecting data to determine corresponding effectiveness. Because most of the categories fell under the supervision of various Association of Academic Physiatrists committees, an appointee from each committee ("diversity steward") liaised with the Women's Task Force. The diversity stewards reviewed the plan with their respective committees and collected data within their committee's purview. This task force follow-up report documents recent progress, consistent with the Association of Academic Physiatrists Board of Trustees commitment to transparency and gender equity.

Challenges and Lessons Learned for Acute Inpatient Rehabilitation of Persons With COVID-19: Clinical Presentation, Assessment, Needs, and Services Utilization.

OBJECTIVE: The aim of the study was to present: (1) physiatric care delivery amid the SARS-CoV-2 pandemic, (2) challenges, (3) data from the first cohort of post-COVID-19 inpatient rehabilitation facility patients, and (4) lessons learned by a research consortium of New York and New Jersey rehabilitation institutions. DESIGN: For this clinical descriptive retrospective study, data were extracted from post-COVID-19 patient records treated at a research consortium of New York and New Jersey rehabilitation inpatient rehabilitation facilities (May 1-June 30, 2020) to characterize admission criteria, physical space, precautions, bed numbers, staffing, employee wellness, leadership, and family communication. For comparison, data from the Uniform Data System and eRehabData databases were analyzed. The research consortium of New York and New Jersey rehabilitation members discussed experiences and lessons learned. RESULTS: The COVID-19 patients (N = 320) were treated during the study period. Most patients were male, average age of 61.9 yrs, and 40.9% were White. The average acute care length of stay before inpatient rehabilitation facility admission was 24.5 days; mean length of stay at inpatient rehabilitation facilities was 15.2 days. The rehabilitation research consortium of New York and New Jersey rehabilitation institutions reported a greater proportion of COVID-19 patients discharged to home compared with prepandemic data. Some institutions reported higher changes in functional scores during rehabilitation admission, compared with prepandemic data. CONCLUSIONS: The COVID-19 pandemic acutely affected patient care and overall institutional operations. The research consortium of New York and New Jersey rehabilitation institutions responded dynamically to bed expansions/contractions, staff deployment, and innovations that facilitated safe and effective patient care.

Inpatient Rehabilitation Delirium Screening: Impact on Acute Care Transfers and Functional Outcomes.

BACKGROUND: Delirium is well studied in the acute care setting, but there is limited understanding of its impact in the postacute care setting, particularly in the inpatient rehabilitation facility (IRF). OBJECTIVE: To investigate the prevalence and related outcomes of delirium in the IRF setting, particularly patients' transfers to acute care hospitals. DESIGN: Retrospective cohort study. SETTING: A freestanding IRF. PARTICIPANTS: Patients discharged from an IRF between January 2016 and December 2016 (12 months). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Transfer to acute care hospitals, motor and cognitive Functional Independence Measures (FIM), length of stay, discharge disposition. RESULTS: A total of 1567 patients (53.9% female, mean age 72.9 ± 13.9) were included in the analysis. Positive scores were found among 142 (9.1%) patients on a 3-Minute Diagnostic Interview for Confusion Assessment Method (3D-CAM), indicating delirium on admission. Fifty-nine (3.8%) were unscorable on 3D-CAM. Twice as many delirium patients were transferred to acute care hospitals compared to non-delirium patients (22.5% vs. 10.8%, P < .001). Multivariate logistic regression showed that, for patients with 3D-CAM positive scores, there was an increased risk of transfers to acute care hospitals at an odds ratio of 1.61 (1.03-2.53, P = .04) after adjusting for age, gender, neurological diagnosis, and motor FIM score. The delirium group also showed lower gains in motor function, increased lengths of stay, and reduced discharges to home when compared to the non-delirium group (P < .001). CONCLUSIONS: This study finds that delirium on admission to an IRF is associated with worsened outcomes related to function, length of stay, discharge status, and transfer to acute care hospitals. Positive delirium screening is an independent predictor for transfer to acute care hospitals from an IRF. Early identification of delirium is recommended in order to mitigate preventable transfers.

Risk factors of readmission to acute care hospital among individuals with heart failure and left ventricular assist device (LVAD) at inpatient rehabilitation setting (STROBE compliant article).

ABSTRACT: In post-acute care hospital setting, the heart failure (HF) individuals with left ventricular assist device (LVAD) have about 30% of transfer to acute care hospitals which requires readmission. There is relative increase in cost and mortality due to the readmission.The goal of this study is to identify possible risk factors at Inpatient Rehabilitation Unit (IRU) to decrease the rate of readmission to acute care hospitals.This study is retrospective study at the Inpatient Rehabilitation Unit (IRU)Twenty one individuals with HF and LVAD were admitted to IRU. We determined 2 subgroups. One is the readmission group (Readmission) and the other is the control group (Control). Readmission (n = 6) is the individuals who were transferred to acute care hospital, and Control (n = 15) is the individuals who were discharged.To compare Readmission group with Control group and evaluate demographic, laboratory, and functional outcome parameters. Main Outcome Measures are Body Mass Index (BMI), International Normalized Ratio (INR), and Functional independence measure (FIM).At admission, INR in Readmission group was 3.4 ±â€Š1.2 and in Control group was 2.2 ±â€Š0.5 with a statistically significant p value (P = .004) and FIM score in Readmission group was 81.2 ±â€Š15.9 and in Control group was 96.3 ±â€Š11.5 with a statistically significant p value (P = .023).The study showed the individuals with HF and LVAD at IRU had high INR and low FIM which may be the cause for readmission and need more attentive care. This data can help identify the factors causing readmission and help reduce the rate of readmission. Further evaluation is necessary to determine the cause for readmission.

The War on COVID-19 Pandemic: Role of Rehabilitation Professionals and Hospitals.

The global outbreak of coronavirus disease 2019 has created an unprecedented challenge to the society. Currently, the United States stands as the most affected country, and the entire healthcare system is affected, from emergency department, intensive care unit, postacute care, outpatient, to home care. Considering the debility, neurological, pulmonary, neuromuscular, and cognitive complications, rehabilitation professionals can play an important role in the recovery process for individuals with coronavirus disease 2019. Clinicians across the nation's rehabilitation system have already begun working to initiate intensive care unit-based rehabilitation care and develop programs, settings, and specialized care to meet the short- and long-term needs of these individuals. We describe the anticipated rehabilitation demands and the strategies to meet the needs of this population. The complications from coronavirus disease 2019 can be reduced by (1) delivering interdisciplinary rehabilitation that is initiated early and continued throughout the acute hospital stay, (2) providing patient/family education for self-care after discharge from inpatient rehabilitation at either acute or subacute settings, and (3) continuing rehabilitation care in the outpatient setting and at home through ongoing therapy either in-person or via telehealth.