Distribution of Staphylococcus aureus carriage among healthcare workers in a Japanese convalescent and rehabilitation hospital.

Earlobes, nasal cavities, and fingers of 145 healthcare workers in convalescent and rehabilitation hospital (60 nurses and 85 rehabilitation healthcare workers) were sampled. Of the 3 sites sampled, Staphylococcus aureus was detected in one or more sites in 25 nurses and 27 rehabilitation workers. S. aureus was detected in all 3 sites in 2 (8.0%) nurses and 2 (7.4%) rehabilitation workers, and the S. aureus isolates in each case showed related PFGE pattern. S. aureus was detected in both the fingers and nasal cavities of 5 (18.5%) of the rehabilitation healthcare workers; in all 5 cases, the PFGE patterns of the S. aureus isolates from each site belonged to same cluster based on PFGE. Of the 2 cases in which methicillinresistant S. aureus (MRSA) was recovered from earlobes, fingers, and nasal cavities, in both cases, MRSA isolates from the 3 sites were the same clone according to PFGE analysis and SCCmec type IV. As S. aureus was detected in pierced earlobes of nurses, hand hygiene must be practiced after touching pierced earlobes and before patient contact. The same S. aureus clone in the nasal cavity and earlobes indicates that the route of transmission is through the fingers.

Comparison of One-Year Postinjury Mobility Outcomes Between Locomotor Training and Usual Care After Motor Incomplete Spinal Cord Injury.

Objectives: To compare 1-year mobility outcomes of individuals with traumatic motor incomplete spinal cord injury (miSCI) who participated in standardized locomotor training (LT) within the first year of injury to those who did not. Methods: This retrospective case-control analysis conducted with six US rehabilitation hospitals used SCI Model Systems (SCIMS) data comparing 1-year postinjury outcomes between individuals with miSCI who participated in standardized LT to those who received usual care (UC). Participants were matched on age, gender, injury year, mode of mobility, and rehabilitation center. The primary outcome is the FIM Total Motor score. Other outcomes include the FIM Transfer Index, FIM Stairs, and self-reported independence with household mobility, community mobility, and stairs. Results: LT participants reported significantly better FIM Total Motor (difference = 2.812, 95% confidence interval [CI] = 5.896, 17.282) and FIM Transfer Index scores (difference = 0.958, 95% CI = 0.993, 4.866). No significant between-group differences were found for FIM Stairs (difference = 0.713, 95% CI = -0.104, 1.530) or self-reported household mobility (odds ratio [OR] = 5.065, CI = 1.435, 17.884), community mobility (OR = 2.933, 95% CI = 0.868, 9.910), and stairs (OR = 5.817, 95% CI = 1.424, 23.756) after controlling for multiple comparisons. Conclusion: LT participants reported significantly greater improvements in primary and secondary measures of mobility and independence (FIM Total Motor score; FIM Transfer Index) compared to UC participants. Self-reported mobility outcomes were not significant between groups.

Access to inpatient mood management services after stroke in Australian acute and rehabilitation hospitals.

OBJECTIVE: Post-stroke mental health impairments are common, but under-assessed and under-treated. We aim to describe trends in the provision of mood management to patients with stroke, and describe factors associated with adoption of national mood management recommendations for stroke within Australian hospitals. DESIGN: Secondary analysis of cross-sectional data from the biennial Stroke Foundation Audit Program. SETTING: Participating acute (2011-2021) and rehabilitation hospitals (2012-2020) in Australia. PARTICIPANTS: In the acute audit, 22,937 stroke cases were included from 133 hospitals. In the rehabilitation audit, 15,891 stroke cases were included from 127 hospitals. MAIN MEASURES: Hospital- and patient-level mood management processes. RESULTS: Among 133 acute hospitals (22,937 stroke episodes), improvements were made between 2011 and 2021 in utilization of mood screening (17% [2011], 33% [2021]; p < 0.001) and access to psychologists during hospital stay (18% [2011], 45% [2021]; p < 0.001). There was no change in access to a psychologist among those with a mood impairment (p = 0.34). Among 127 rehabilitation hospitals (15,891 stroke episodes) improvements were observed for mood screening (35% [2012], 61% [2020]; p < 0.001), and access to a psychologist during hospital stay (38% [2012], 68% [2020]; p < 0.001) and among those with a mood-impairment (30% [2012], 50% [2020]; p < 0.001). Factors associated with receiving mood management processes included: younger age, not requiring an interpreter and longer length of stay. CONCLUSIONS: Adherence to mood management recommendations has improved over 10 years within Australian hospitals. Those aged over 65, requiring an interpreter, or with shorter hospital stays are at risk of missing out on appropriate mood management.

Using Performance Status to Identify Risk of Acute Care Transfer in Inpatient Cancer Rehabilitation.

OBJECTIVE: To identify patient factors associated with acute care transfer (ACT) among cancer survivors admitted for inpatient medical rehabilitation. DESIGN: An exploratory, observational design was used to analyze retrospective data from electronic medical records. SETTING: Data were obtained from 3 separate inpatient rehabilitation hospitals within a private rehabilitation hospital system in the Northeast. PARTICIPANTS: Medical records were reviewed and analyzed for a total of 416 patients with a confirmed oncologic diagnosis treated in 1 of the inpatient rehabilitation hospitals between January and December 2020. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The primary outcome measure was the incidence of an ACT. Covariates included the adapted Karnofsky Performance Scale (KPS) for inpatient rehabilitation, demographic information, admission date, re-admission status, discharge destination, and cancer-related variables, such as primary cancer diagnosis and presence/location of metastases. RESULTS: One in 5 patients (21.2%) were transferred to acute care. Patients with hematologic cancer had a higher risk of ACT compared with those with central nervous system (CNS) cancer. Lower functional status, measured by the adapted KPS, was associated with a higher likelihood of ACT. Patients with an admission KPS score indicating the need for maximum assistance had the highest transfer rate (59.1%). CONCLUSIONS: These findings highlight the medical complexity of this population and increased risk of an interrupted rehabilitation stay. Considering patients' performance status, cancer type, and extent of disease may be important when assessing the appropriateness of IRF admission relative to patient quality of life. Earlier and improved understanding of the patient's prognosis will allow the cancer rehabilitation program to meet the patient's unique needs and facilitate an appropriate discharge to the community in an optimal window of time.

Assessment of functional fitness impacted by hospital rehabilitation in post-stroke patients who additionally contracted COVID-19.

Background: The aim of the study was to assess the effects of rehabilitation in post-stroke patients, or post-stroke patients with simultaneous COVID-19 infection, in relation to: improved locomotion efficiency, improved balance, reduced risk of falling as well as the patients' more effective performance in everyday activities. Methods: The study involved 60 patients in the early period (2-3 months) after a stroke. Group I consisted of 18 patients (30.0%) who, in addition to a stroke, also contracted COVID-19. Group II consisted of 42 patients (70%) post-stroke, with no SARS-CoV2 infection. The effects were assessed on the basis of: Tinetti test, Timed Up & Go test and Barthel scale. Results: Both groups achieved a statistically significant improvement in their Barthel score after therapy (p < 0.001). The Tinetti test, assessing gait and balance, showed that participants in Group I improved their score by an average of 4.22 points. ±4.35, and in Group II, on average, by 3.48 points ± 3.45 points. In the Timed Up & Go test over a distance of 3 m, significant improvement was achieved in both groups, as well but the effect was higher in Group I (p < 0.001). Conclusions: Hospital rehabilitation in the early period after stroke improved locomotion efficiency and balance, and reduced the risk of falls in post-stroke patients, both with and without COVID-19 infection.

Sacral Ulcer Development Risk Among Older Adult Patients in North Texas Rehabilitation Hospitals: Role of Comorbidities, Lifestyle, and Personal Factors.

PURPOSE: Sacral ulcers are a serious mortality risk for older adults; thus, we aimed to determine sacral ulcer risk factors among older adults who were recently admitted to rehabilitation hospitals. METHOD: We conducted a retrospective cohort study using the Texas Inpatient Discharge database (2021). The study included 1,290 rehabilitation hospital patients aged ≥60 years diagnosed with sacral ulcers. The control group comprised 37,626 rehabilitation hospital patients aged ≥60 years without sacral ulcers. Binary logistic regression was used to identify risks for sacral ulcer development adjusting for patient demographics, insurance type, and lifestyle. RESULTS: Comorbidities of dementia, Parkinson's disease, type 2 diabetes, and cardiac dysrhythmias were significantly associated with increased risk of sacral ulcers. Longer length of stay, Medicare, and Medicare HMO were also associated with sacral ulcers. Demographically, older age, male sex, identifying as African American, and having malnutrition all had a 50% increased prevalence of sacral ulcers. CONCLUSION: Findings indicate a need to proactively treat chronic comorbidities in vulnerable populations to reduce their possible risk for hospital-acquired infections and excess mortality from sacral ulcers. [Journal of Gerontological Nursing, 50(2), 32-41.].

The influence of communal spaces on patient activity in rehabilitation: a mixed methods study.

PURPOSE: This study aimed to determine whether patients are more active in communal spaces compared to their bedrooms and explore patient perspectives on communal spaces for activity, rest, and wellbeing. MATERIALS AND METHODS: A prospective study observed participants via behavioural mapping in a mixed inpatient rehabilitation unit for up to three days. Physical, social, and cognitive activity levels in communal spaces were compared with activity in bedrooms using independent t-tests. Three focus groups explored participants' perspectives on communal spaces for activity, rest and wellbeing using thematic analysis. RESULTS: Thirty-three participants (age 71.6 ± 13years, 39%male) were observed, and a subset (n = 12) (age 67.3 ± 16.9, 50%male) participated in focus groups. Participants spent a greater proportion of time being physically active (mean difference 22.7%, 95%CI 8.7-36.6, p = 0.002) and socially active (mean difference 23.6%, 95%CI 9.1-38.1, p = 0.002) in communal spaces than bedrooms. No difference in cognitive activity was found. Participants perceived communal spaces to positively influence mood and activity. Reduced independence was a barrier, while visitors, activities, and an inviting design attracted people to communal areas. CONCLUSION: Communal spaces may positively influence patient activity and mood during inpatient rehabilitation. Future studies should seek strategies to optimise engagement in communal environments.IMPLICATIONS FOR REHABILITATIONOptimising patient activity throughout the day in inpatient rehabilitation is important to support recovery.Communal spaces in inpatient rehabilitation hospitals can positively influence patient activity and mood.Strategies to promote use of communal spaces in the inpatient rehabilitation hospital are needed.

Effect of in-patient cardiac rehabilitation at rehabilitation hospital for cardiology patients: two-center trial.

The effectiveness of cardiac rehabilitation (CR) in patients with cardiovascular disease requiring continuous CR from an acute care hospital to a convalescent rehabilitation hospital is unknown. Therefore, we compared the effect of CR in a rehabilitation hospital for patients with cardiovascular disease with that of those who underwent cardiovascular surgery. Sixty-nine consecutive patients were admitted to two rehabilitation hospitals for CR. Patients were classified by primary disease into two groups: patients with cardiovascular disease (cardiology group, 26 patients) and patients who underwent cardiovascular surgery (surgery group, 43 patients). Clinical information, physical function, cognitive function, activities of daily living (ADL), quality of life (QOL), amount of CR, and length of hospital stay were compared between the two groups. Compared with clinical features, age was significantly higher in the cardiology group (P < 0.001), and the preadmission Barthel index was significantly lower in the cardiology group (P = 0.025). Physical function at the time of transfer was significantly lower in the cardiology group than in the surgery group for the short physical performance battery (P < 0.001), gait speed (P = 0.005), and 6-min walking distance (P = 0.042). No significant difference was found in the amount of CR performed or the length of hospital stay, and no interaction effects were observed in improvements in physical function, exercise tolerance, or QOL. In conclusion, in rehabilitation hospitals, patients with cardiovascular disease were older, had lower preadmission ADL, and had lower a physical function at transfer than those who underwent cardiovascular surgery, but CR improved physical function and QOL to the same extent. The results suggest that the recovery of patients with cardiovascular disease may be similar to those who undergo cardiovascular surgery.

A Case Study Implementing a Social Needs Screening Process and a Family Navigation Hub at Holland Bloorview Kids Rehabilitation Hospital.

Identifying and addressing clients' and families' most pressing social determinants of health needs are integral to quality healthcare. Healthcare leaders and front-line clinicians have long recognized the connection between unmet essential resource needs, such as food, housing and transportation and health outcomes. As a component of broader organizational efforts to improve equitable access to services, a social needs screening (SNS) initiative was introduced, along with a Family Navigation Hub providing navigation interventions. This paper describes the systematic approach taken to support the SNS initiative implementation and highlights evaluation results of the first year of activity.

Rehabilitation professionals' perspectives and experiences with the use of technologies for violence prevention: a qualitative study.

BACKGROUND: There is growing public policy and research interest in the development and use of various technologies for managing violence in healthcare settings to protect the health and well-being of patients and workers. However, little research exists on the impact of technologies on violence prevention, and in particular in the context of rehabilitation settings. Our study addresses this gap by exploring the perceptions and experiences of rehabilitation professionals regarding how technologies are used (or not) for violence prevention, and their perceptions regarding their efficacy and impact. METHODS: This was a descriptive qualitative study with 10 diverse professionals (e.g., physical therapy, occupational therapy, recreation therapy, nursing) who worked across inpatient and outpatient settings in one rehabilitation hospital. Data collection consisted of semi-structured interviews with all participants. A conventional approach to content analysis was used to identify key themes. RESULTS: We found that participants used three types of technologies for violence prevention: an electronic patient flagging system, fixed and portable emergency alarms, and cameras. All of these were perceived by participants as being largely ineffective for violence prevention due to poor design features, malfunction, limited resources, and incompatibility with the culture of care. Our analysis further suggests that professionals' perception that these technologies would not prevent violence may be linked to their focus on individual patients, with a corresponding lack of attention to structural factors, including the culture of care and the organizational and physical environment. CONCLUSIONS: Our findings suggest an urgent need for greater consideration of structural factors in efforts to develop effective interventions for violence prevention in rehabilitation settings, including the design and implementation of new technologies.

A U-shaped relationship between body mass index and functional recovery in older Japanese stroke survivors undergoing hospital rehabilitation.

OBJECTIVE: A relationship between body mass index and functional recovery in older survivors of stroke is unclear. Therefore, this study aimed to investigate the association of body mass index with post-stroke functional recovery in older Japanese stroke survivors undergoing hospital rehabilitation. METHODS: This was a multicenter retrospective observational study of 757 older survivors of stroke, from six convalescent rehabilitation hospitals in Japan. The participants were classified into seven categories according to body mass index at admission. The measurements included outcomes of the absolute gain in the motor subscale of the Functional Independence Measure. Poor functional recovery was defined as gain < 17 points. Multivariate logistic regression analysis was performed to examine the impact of these body mass index categories on poor functional recovery. RESULTS: The mean motor gains were highest in the 23.5-25.4 kg/m2 group (28.1 points), and lowest in the < 17.5 kg/m2 group (220.0 points). The results of the multivariate regression analyses (reference; 23.5-25.4 kg/m2 group) showed that the < 17.5 kg/m2 group (odds ratios 4.30; 95 % confidence intervals 2.09-8.87), the 17.5-19.4 kg/m2 group (1.99; 1.03-3.87), the 19.5-21.4 kg/m2 group (1.93; 1.05-3.54), and the ≥ 27.5 kg/m2 group (3.34; 1.33-8.42) were significantly associated with poor functional recovery, but not in the other groups. CONCLUSIONS: Older survivors of stroke with high-normal weight had the most favorable functional recovery among the seven groups. Meanwhile, both low and extremely high body mass indexes were associated with poor functional recovery.

Manual Wheelchair Configuration in Unilateral Upper- and Lower-Extremity Propulsion: A Randomized Crossover Study to Assess Effects of Rear Wheel Axle Position and Frame Type.

OBJECTIVE: To evaluate independence and exertion when using a lightweight wheelchair in comparison with ultra-lightweight wheelchairs (rigid and folding) for individuals with brain injury using a hemipropulsion technique. DESIGN: Randomized cross-over. SETTING: Rehabilitation hospital. PARTICIPANTS: Individuals diagnosed with brain injury resulting in hemiplegia using a hemipropulsion technique to mobilize in a manual wheelchair for at least 4 hours per day were recruited for this study. INTERVENTIONS: Eighteen participants were randomly assigned to complete skills and endurance testing in 3 different wheelchair configurations over a 3-week period: lightweight wheelchair; ultra-lightweight folding wheelchair; and ultra-lightweight rigid wheelchair. MAIN OUTCOME MEASURES: The primary outcome in this study was the percentage capacity score from the modified Wheelchair Skills Test 4.1. Secondary outcomes included the Wheelchair Propulsion Test, 100-m Push Test, heart rate, and rate of perceived exertion. RESULTS: Significant differences were found in the Wheelchair Skills Test (total score, low rolling resistance score, and the goal attainment score) favoring the ultra-lightweight wheelchairs over the lightweight wheelchair (P=.002, .001, and .016, respectively). Time to complete the 100-m push test was significantly faster for the ultra-lightweight rigid frame in comparison with the lightweight frame (P=.001; 30.89 seconds faster). Significance differences were not seen with the Wheelchair Propulsion Test measures across any of the wheelchair frames. Heart rate change and of perceived exertion were significantly lower for the ultra-lightweight rigid group in comparison with the lightweight group (P=.006 and .013, respectively). CONCLUSIONS: These data suggest that using an ultra-light weight wheelchair may lead to improved ability to complete wheelchair skills needed for successful mobility and a decrease in the actual and perceived physiological burden associated with propulsion in comparison to a lightweight wheelchair. A rigid frame may also enable faster mobility in comparison to a folding frame when hemi-propelling.

The impact of road safety strategy and policy on admissions to a national rehabilitation hospital; a 5-year retrospective review and reflection on trauma data.

BACKGROUND: Globally, road traffic collisions (RTCs) are a common cause of death and disability. Although many countries, including Ireland, have road safety and trauma strategies, the impact on rehabilitation services is unclear. This study explores how admissions with RTC related injuries to a rehabilitation facility has changed over 5 years and how they contrast to major trauma audit (MTA) serious injury data from the same timeframe. METHODS: A retrospective review of healthcare records with data abstraction in accordance with best practice was performed. Fisher's exact test and binary logistic regression were used to determine associations and statistical process control was used to analyse variation. All patients discharged with an International Classification of Diseases (ICD) 10 coded diagnosis of Transport accidents from 2014 to 2018 were included. In addition, serious injury data was abstracted from MTA reports. RESULTS: 338 cases were identified. Of these, 173 did not meet the inclusion criteria (readmissions) and were excluded. The total number analyzed was 165. Of these, 121 (73%) were male and 44 (27%) were female and 115 (72%) were under 40 years of age. The majority [128 (78%)] had traumatic brain injuries (TBI), 33 (20%) had traumatic spinal cord injuries and 4 (2.4%) had traumatic amputation The numbers varied over the time period of the study but showed normal variation and not special cause variation which suggests no significant impact of policy in the time frame. There was a large discrepancy between the number of severe TBIs reported in the MTA reports and the numbers admitted with RTC related TBI to the National Rehabilitation University Hospital (NRH). This suggests there may be many people not accessing the specialist rehabilitation services they require. CONCLUSION: Data linkage between administrative and health datasets does not currently exist but offers huge potential for understanding the trauma and rehabilitation ecosystem in detail. This is required to better understand the impact of strategy and policy.

An overview of the rehabilitation and psychiatric diagnoses of patients referred to a psychiatry consult liaison service at an inpatient rehabilitation hospital.

BACKGROUND: Patients presenting for inpatient rehabilitation following injury or illness are commonly affected by comorbid psychiatric illness. Currently, little is known about the utilization of a psychiatry consult service in an inpatient rehabilitation hospital. OBJECTIVE: To identify which rehabilitation patient populations most frequently received psychiatric consultation and recognize the most common psychiatric comorbidities after the implementation of a psychiatry consult liaison (PCL) service. DESIGN: A retrospective observational study in the form of a chart review examining the utilization patterns of a psychiatric consultation liaison service in the inpatient rehabilitation setting. Chart review was performed to extract patient demographics (age and sex), rehabilitation diagnosis, cause of rehabilitation diagnosis (intentional, accident, self-inflicted, or disease), reason for referral to psychiatry, and psychiatric diagnosis on initial consultation. Statistical software was used for statistical analysis to answer the pre-specified research questions. SETTING: A 178 bed, free-standing, academic rehabilitation hospital located in an urban Canadian center. PATIENTS: Any patient admitted to the inpatient rehabilitation hospital who received a psychiatric consultation between September 2016 and December 2019 was eligible for inclusion. RESULTS: A total of 1016 charts were reviewed in the initial chart review and  1008 were included. The most common rehabilitation diagnoses that were associated with a psychiatric consult were (% admissions receiving consultation): amputations (38%); burns (35%), neurologic disorder (28%), deconditioning (14%), and musculoskeletal injury (7%). Although 20% of patients did not meet criteria for a psychiatric diagnosis, most common psychiatric diagnoses included mood disorder, adjustment disorder, neurocognitive disorder, and delirium. CONCLUSION: There are significant perceived needs for psychiatric services in the inpatient rehabilitation setting. Although some patient groups such as patients with amputations, burns, and trauma may exhibit the highest utilization, the service supports mental health needs from many patient groups.

Usability, acceptability and clinical utility of a mobile app to screen for hearing loss in older adults in a geriatric rehabilitation hospital.

RATIONALE: Hearing loss is a common problem for older adults entering rehabilitation hospitals. AIMS AND OBJECTIVES: To pilot a hearing loss screening device to determine feasibility, usability, and impact on patient outcomes. METHODS: We screened all patients newly admitted to a geriatric day hospital for hearing loss using the SHOEBOX® QuickTest (SHOEBOX Ltd.) app as part of a quality improvement programme. We measured the time it took for each patient to complete screening and recorded any issues they had using the app. We recorded the number of patients who screened positive who did not have a previous diagnosis and changes in physician behaviours after they received their patients' results. RESULTS: Seventy-four patients with a mean age of 83.4 years used the hearing screener. All patients were able to complete the screening with a mean time to completion of 10 min and 48 s. Ninety-nine percent of patients screened positive for hearing loss. Of these positives 56% were in participants not already known to have hearing loss. Physicians often changed their behaviour after receiving results by using assistive devices during visits and referring to audiology for formal testing. CONCLUSIONS: Screening for hearing loss is feasible in a geriatric day hospital. The SHOEBOX QuickTest app is acceptable, usable, resulting in the identification of undiagnosed hearing loss and in changes to physician behaviour.

Nurses and physiotherapists' knowledge levels on autonomic dysreflexia in a rehabilitation hospital.

OBJECTIVE: Autonomic dysreflexia is a clinical syndrome that affects people with spinal cord lesions at or above the sixth thoracic vertebral level (T6). This study aims to determine the level of knowledge about autonomic dysreflexia among nurses and physiotherapists involved in spinal cord rehabilitation. DESIGN: Single-center survey study. SETTING: This was conducted at a rehabilitation hospital. OUTCOME MEASURE: : Autonomic dysreflexia knowledge test. PARTICIPANTS: Nurses (N = 36) and physiotherapists (N = 32) working at a local rehabilitation hospital participated in this study. RESULTS: In the autonomic dysreflexia knowledge test, the nurses obtained an average score of 6.63 ± 2.2 and the physiotherapists obtained an average score of 6.87 ± 1.89; there was no significant difference between the two groups (P > 0.05). Less than 25% of the participants had experience with autonomic dysreflexia and the test scores of the participants with this experience were significantly higher (P < 0.001). CONCLUSION: Similar to previous studies, the knowledge level of autonomic dysreflexia among nurses and physiotherapists working in rehabilitation hospitals was low. We think that there is a need for internationally standardized training programs to increase the knowledge level of autonomic dysreflexia for patients, caregivers, and health professionals.

Using activity-based therapy for individuals with spinal cord injury or disease: Interviews with physical and occupational therapists in rehabilitation hospitals.

OBJECTIVE: To understand if and how physical therapists (PTs) and occupational therapists (OTs) use activity-based therapy (ABT) and its associated technologies for the rehabilitation of individuals living with spinal cord injury or disease (SCI/D) in Canadian rehabilitation hospital settings. DESIGN: Qualitative study. SETTING: Through rehabilitation hospitals participating in the Rick Hansen Spinal Cord Injury Registry, we recruited licensed OTs and PTs to participate in focus groups. PARTICIPANTS: Twelve PTs and ten OTs from nine sites across eight provinces participated. OUTCOME MEASURES: To inform the development of a semi-structured interview guide, we used the Theoretical Domains Framework. To analyze the data, we used interpretive description. RESULTS: We identified three themes that influenced therapists' use of ABT and associated technologies for SCI/D rehabilitation. (1) Therapists' decision-making approach to ABT and technology. Therapist roles, site-specific dynamics and goal setting influenced decision-making. Assuming roles such as mentor, liaison and advocate led to more ABT use. Site-specific dynamics concerned levels of ABT knowledge, teamwork, and staffing. In hospital rehabilitation, there was competition between discharge and neurorecovery goals. (2) Therapist perceived individual factors. Patient factors either increased (i.e. patients' motivation, self-advocacy) or prevented (i.e. mourning period, tolerance) the likelihood that ABT was introduced by therapists. (3) ABT and equipment access. Technology was used for ABT in a variety of ways. Access was affected by visible (e.g. equipment cost) and invisible barriers (e.g. departmental relations). CONCLUSIONS: The use of ABT and its associated technologies in Canadian rehabilitation hospitals is variable. Ongoing education could be offered, and site-specific implementation strategies could be developed, to promote ABT use.

What Determinants Affect Inpatient Satisfaction in a Post-Acute Care Rehabilitation Hospital?

OBJECTIVE: To examine how specific hospital service domains (personal issues domain, discharge domain, rehabilitation doctor domain, nursing domain, physical therapist domain, occupational therapist domain, and food domain) influence final patient satisfaction scores, the overall quality of care, and willingness to recommend the hospital to others among patients in an inpatient rehabilitation hospital. DESIGN: Longitudinal study. SETTING: Patient-level data from electronic medical records were joined with Press Ganey (www.pressganey.com) satisfaction data for a single post-acute care inpatient rehabilitation facility in northeast Florida. PARTICIPANTS: Patients who participated in the inpatient rehabilitation survey (N=4,785). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Main outcome measures included final patient satisfaction scores, overall rating of care during the stay, and willingness to recommend the hospital to others. RESULTS: This study found the personal issues domain to be the most important factor in determining the final patient satisfaction score, overall rating of care, and likelihood to recommend the hospital to others, followed by the physical therapist, nurse, discharge, and food domains (P<.0001). Within the personal issues domain score, staff promptness and explanation upon arrival were areas identified as opportunities to make improvements that would result in the greatest positive effect. CONCLUSIONS: This work represents novel findings by investigating the major determinants of positive patient experience in a rehabilitation hospital setting. These findings provide actionable information to improve patient experience as well as where to focus improvement efforts using limited resources.

Percepção da qualidade de vida profissional de uma equipe de reabilitação / Perception of the quality of professional life of a rehabilitation team

Na saúde, o conceito de Qualidade de Vida Profissional (QVP) é utilizado para avaliar a influência que o trabalho exerce sobre o indivíduo, através da compaixão. Abrange duas dimensões, Satisfação por Compaixão e Fadiga por Compaixão. Reconhece-se que profissionais que atuam diretamente com a dor e o sofrimento alheio podem sofrer impacto na qualidade de vida. Objetivo: Investigar a percepção da QVP no trabalho de uma equipe multiprofissional de um hospital de reabilitação. Método: Pesquisa transversal, analítica e exploratória. Amostra aleatória por conveniência, composta por 40 profissionais da saúde que atuavam no setor de enfermaria de reabilitação do hospital, elegidos conforme os critérios pré-estabelecidos. Os instrumentos utilizados foram o Questionário Sociodemográfico e a Professional Quality of Life Scale (ProQOL)-Escala-BR. A coleta de dados ocorreu de forma remota, através do aplicativo WhatsApp® e foi viabilizada pelo Google Forms®. Os dados foram analisados por meio de estatística descritiva e inferencial. Resultados: Constatou-se níveis adequados de QVP na equipe de reabilitação, 47,5% apresentaram alto nível de satisfação por compaixão, enquanto não foram observados altos níveis de fadiga por compaixão. Quando analisadas as influências sociodemográficas, foram observadas significâncias estatísticas entre as variáveis satisfação por compaixão e sexo (p=0,021) e alteração do apetite com estresse traumático secundário (p=0,006). Conclusão: Verificou-se a prevalência de percepções equilibradas de QVP para a equipe de reabilitação analisada. Esse resultado demonstra a necessidade de investigações posteriores sobre as influências da organização e das condições ergonômicas, considerando o setor de atuação

In health, the concept of Professional Quality of Life (QVP) is used to assess the influence that work has on the individual, through compassion. It encompasses two dimensions, Satisfaction by Compassion and Fatigue by Compassion. It is recognized that professionals who work directly with the pain and suffering of others can suffer an impact on quality of life. Objective: To investigate the perception of QVP in the work of a multidisciplinary rehabilitation team at a rehabilitation hospital. Method. Cross-sectional, analytical and exploratory research. Random sample for convenience, composed of 40 health professionals who worked in the rehabilitation ward of the hospital, chosen according to pre-established criteria. The instruments used were the Sociodemographic Questionnaire and the ProQOL-BR Scale. Data collection took place remotely, through the WhatsApp® application and was made possible by Google Forms®. Data were analyzed using descriptive and inferential statistics. Results: Adequate levels of QVP were found in the rehabilitation team, 47.5% had a high level of compassion satisfaction, while high levels of compassion fatigue were not observed. When sociodemographic influences were analyzed, statistical significance was observed between the variables satisfaction with compassion and sex (p=0.021) and change in appetite with secondary traumatic stress (p=0.006). Conclusions: There was a prevalence of balanced QVP perceptions for the analyzed rehabilitation team. This result demonstrates the need for further investigations into the influences of organization and ergonomic conditions, considering the sector in which they operate

Effects of In-Hospital Rehabilitation on Preventing Hospital Readmissions in Patients With Cirrhosis: A Retrospective Cohort Study.

OBJECTIVES: To investigate the effect of rehabilitation on hospital readmissions in patients with cirrhosis. DESIGN: A retrospective cohort study. SETTING: Acute hospitals. PARTICIPANTS: Patients hospitalized due to cirrhosis (N=6485). INTERVENTIONS: We defined rehabilitation as any type and intensity of rehabilitation administered by physical, occupational, or speech therapists. MAIN OUTCOME MEASURES: Readmission within 30 days after discharge. RESULTS: Rehabilitation was provided to 1177 patients (19.0%). After propensity score matching, rehabilitation was associated with 30- and 90-day readmissions. CONCLUSIONS: The present study demonstrated that rehabilitation is associated with lower proportions of 30- and 90-day readmissions in patients with cirrhosis. Therefore, rehabilitation may be one way to reduce the risk of readmission in patients hospitalized for cirrhosis.