Convergent Validity for the Functional Upper Extremity Levels (FUEL) in Stroke Rehabilitation.

IMPORTANCE: Research is needed to validate an easy-to-use, functional, evidence-based neurological upper extremity (UE) assessment that requires minimal training. OBJECTIVE: To establish convergent validity for the Functional Upper Extremity Levels (FUEL), a function-based upper limb measure, with the Upper Extremity Fugl-Meyer Assessment (UE-FMA), the gold standard assessment of upper limb recovery poststroke. DESIGN: Retrospective chart review of 292 clients with admission and discharge data for the UE-FMA and the FUEL. Correlation statistics were analyzed to determine a relationship between these assessments. SETTING: Inpatient stroke rehabilitation unit. PARTICIPANTS: Clients with a stroke diagnosis admitted to the stroke inpatient rehabilitation unit at a rehabilitation hospital between January 2017 and June 2019. OUTCOMES AND MEASURES: FUEL (a classification system) and UE-FMA (an impairment-based motor recovery assessment of the upper limb recovery poststroke). RESULTS: Pearson correlation coefficient yielded a significant positive correlation between the UE-FMA and the FUEL for both initial (r = .929) and discharge (r = .943) scores. CONCLUSIONS AND RELEVANCE: Convergent validity of the FUEL is established using the UE-FMA as a comparison. The FUEL can be applied in neurological rehabilitation to provide a clinical picture of a client's UE function. This research supports the value of the FUEL's application in clinical poststroke care. What This Article Adds: The FUEL is a valid tool to assess the UE in an acute neurological population.

A Retrospective Quality Improvement Study to Describe Operational Management Strategies in an Inpatient Rehabilitation Facility During the COVID-19 Pandemic.

The delivery of care in the inpatient rehabilitation setting was disrupted during the coronavirus disease 2019 (COVID-19) pandemic. As a 150-bed freestanding inpatient rehabilitation facility in the epicenter of the pandemic, Burke Rehabilitation Hospital was required to increase overall bed capacity for regional overflow needs and still maintain our mission to provide inpatient rehabilitation for patients with and without COVID-19. During the period between March and September 2020, Burke Rehabilitation Hospital treated over 300 rehabilitation patients who were COVID-19 positive and at one point had a census that was >50% COVID-19 positive. A model grounded in 5 priorities-communication, personal protective equipment, clinical service delivery, discharge planning, and patient/staff support-was implemented to reprioritize daily operations and ensure patient and staff safety while providing valuable rehabilitation services. The delivery of physical, occupational, speech, and recreational therapy services transformed, and a number of innovative clinical practices were developed. During the study period, 100% of our patients continued to be scheduled to receive therapy services. Patient length of stay values did increase during the pandemic (from 16.38d to 19.93d), and slightly more patients were discharged to home (68.7% compared with 68.3%). Despite modifications to rehabilitation care delivery, patients continued to make functional gains in the areas of self-care, mobility, and walking. Flexible leadership was pivotal in the development and implementation of new processes and procedures to meet the evolving needs of patients, staff, and the organization as a whole.

Development and Preliminary Reliability of the Functional Upper Extremity Levels (FUEL).

OBJECTIVE: The Functional Upper Extremity Levels (FUEL) is a new classification tool to assess a person's upper-extremity functional and physical performance after sustaining a stroke. The aim of this preliminary study was to develop the tool and determine its content validity and interrater reliability. METHOD: Forty-four licensed occupational therapists ranging in years of experience from 6 mo to 16 yr participated in this study. A two-phase study was conducted: (1) constructing the FUEL and determining its content validity and (2) ascertaining its interrater reliability. RESULTS: We found that the FUEL had initial content validity and substantial interrater reliability (Fleiss κ = .754). CONCLUSION: The FUEL can be a useful clinical and research tool in occupational therapy for the assessment and classification of upper-extremity function for people after stroke. Further studies with larger samples and comparison studies with other similar tools are required to support the tool's reliability and validity.