Content Validity Testing of a Novel Cognitive Screen, the Gaylord Occupational Therapy Cognitive (GOT-Cog), to Improve Inpatient Occupational Therapy Treatment Planning.

IMPORTANCE: No single cognitive screen adequately captures all cognitive domains that are important for inpatient occupational therapy treatment planning. OBJECTIVE: To quantify the content validity of a novel 22-item cognitive screen, the Gaylord Occupational Therapy Cognitive (GOT-Cog) screen, developed to better inform inpatient occupational therapy treatment planning. DESIGN: Delphi-style expert panel review. SETTING: Long-term acute care hospital. PARTICIPANTS: The first panel was attended by four occupational therapists, two speech-language pathologists, one physician assistant, and two neuropsychologists; the second, by four occupational therapists, one speech-language pathologist, and one physician assistant. INTERVENTION: Each Delphi panel discussed the relevance, essentiality, and clarity of each item. After each discussion, panelists completed a content validity survey to summarize their evaluation of each item. OUTCOMES AND MEASURES: On the basis of panelists' survey responses, item- and scale-level relevance, essentiality, and clarity were quantified by calculating the respective content validity index (CVI), content validity ratio (CVR), and content clarity index (CCI). Universal agreement (UA) and κ statistics were also calculated, as appropriate. RESULTS: Upon presenting the initial 23-item instrument covering 10 cognitive domains to the first Delphi panel, several questions were added, removed, or rewritten, resulting in a 22-item instrument representing nine domains. After the second panel, several questions were again rewritten, and the domains reorganized. All scale-level metrics improved, including CVI (from 0.87 to 1.0), UA (0.52 to 1.0), CVR (0.43 to 0.94), and CCI (2.26 to 2.92). CONCLUSIONS AND RELEVANCE: GOT-Cog displays overall excellent content validity and can proceed to construct validity testing. Plain-Language Summary: By reporting on the content validity of the Gaylord Occupational Therapy Cognitive screen, this brief report begins the necessary process of evaluating the measure's overall validity and reliability.

Physical and occupational therapists' perceptions of sustainability of a knowledge translation intervention to improve the use of outcome measures in inpatient rehabilitation: a qualitative study.

PURPOSE: To assess the perceptions, barriers, and facilitators of sustaining the use of outcome measures of physical and occupational therapists following a three-year knowledge translation intervention. METHODS: A phenomenological qualitative study was conducted at an inpatient rehabilitation hospital on 13 clinicians (6 physical therapists and 7 occupational therapists) participating in the knowledge translation intervention. Data collection used semi-structured interviewing during three focus groups to understand the lived experience of clinicians participating in the knowledge translation project. Data were analyzed using the Consolidated Framework for Implementation Research (CFIR) codebook. RESULTS: Two investigators coded twelve CFIR constructs into barriers and facilitators for outcome measure use. Four key themes emerged as determinants for outcome measures use: (1) Organizational support and clinician engagement; (2) the knowledge translation intervention; (3) the outcome measures themselves; and (4) the patients. Clinicians reported using outcome measures for patient education, treatment planning, and goal setting, while they found other outcome measures lacked functional significance. Facilitators included organizational support, access to knowledge, ongoing training, and clinician engagement. Ongoing barriers included the need for more training and the need to select different tests. CONCLUSIONS: This study found proper selection of outcomes measures is important and attributed the sustainability of the knowledge translation intervention to organizational support, clinician engagement and ongoing training. The clinicians wanted continued training to overcome new barriers. Barriers identified in this study were unique to the typical barriers identified for outcome measure use. Ongoing barrier assessments are needed for continued refinement of knowledge translation interventions to enhance sustainability.

Patient Outcomes and Lessons Learned From Treating Patients With Severe COVID-19 at a Long-term Acute Care Hospital: Single-Center Retrospective Study.

BACKGROUND: With the continuation of the COVID-19 pandemic, shifting active COVID-19 care from short-term acute care hospitals (STACHs) to long-term acute care hospitals (LTACHs) could decrease STACH census during critical stages of the pandemic and maximize limited resources. OBJECTIVE: This study aimed to describe the characteristics, clinical management, and patient outcomes during and after the acute COVID-19 phase in an LTACH in the Northeastern United States. METHODS: This was a single-center group comparative retrospective analysis of the electronic medical records of patients treated for COVID-19-related impairments from March 19, 2020, through August 14, 2020, and a reference population of medically complex patients discharged between December 1, 2019, and February 29, 2020. This study was conducted to evaluate patient outcomes in response to the holistic treatment approach of the facility. RESULTS: Of the 127 total COVID-19 admissions, 118 patients were discharged by the data cutoff. At admission, 29.9% (38/127) of patients tested positive for SARS-CoV-2 infection. The mean age of the COVID-19 cohort was lower than that of the reference cohort (63.3, 95% CI 61.1-65.4 vs 65.5, 95% CI 63.2-67.8 years; P=.04). There were similar proportions of males and females between cohorts (P=.38); however, the proportion of non-White/non-Caucasian patients was higher in the COVID-19 cohort than in the reference cohort (odds ratio 2.79, 95% CI 1.5-5.2; P=.001). The mean length of stay in the COVID-19 cohort was similar to that in the reference cohort (25.5, 95% CI 23.2-27.9 vs 29.9, 95% CI 24.7-35.2 days; P=.84). Interestingly, a positive correlation between patient age and length of stay was observed in the COVID-19 cohort (r2=0.05; P=.02), but not in the reference cohort. Ambulation assistance scores improved in both the reference and COVID-19 cohorts from admission to discharge (P<.001). However, the mean assistance score was greater in the COVID-19 cohort than in the reference cohort at discharge (4.9, 95% CI 4.6-5.3 vs 4.1, 95% CI 3.7-4.7; P=.001). Similarly, the mean change in gait distance was greater in the COVID-19 cohort than in the reference cohort (221.1, 95% CI 163.2-279.2 vs 146.4, 95% CI 85.6-207.3 feet; P<.001). Of the 16 patients mechanically ventilated at admission, 94% (15/16) were weaned before discharge (mean 11.3 days). Of the 75 patients admitted with a restricted diet, 75% (56/75) were discharged on a regular diet. CONCLUSIONS: The majority of patients treated at the LTACH for severe COVID-19 and related complications benefited from coordinated care and rehabilitation. In comparison to the reference cohort, patients treated for COVID-19 were discharged with greater improvements in ambulation distance and assistance needs during a similar length of stay. These findings indicate that other patients with COVID-19 would benefit from care in an LTACH.

A Novel Body Weight-Supported Postural Perturbation Module for Gait and Balance Rehabilitation After Stroke: Preliminary Evaluation Study.

BACKGROUND: Impaired balance regulation after stroke puts patients and therapists at risk of injury during rehabilitation. Body weight support systems (BWSSs) minimize this risk and allow patients to safely practice balance activities during therapy. Treadmill-based balance perturbation systems with BWSSs are known to improve balance in patients with age- or disease-related impairments. However, these stationary systems are unable to accommodate complex exercises that require more freedom of movement. OBJECTIVE: This study aims to evaluate the effect of a new balance perturbation module, which is directly integrated into a track-mounted BWSS, on balance impairments secondary to acute stroke. METHODS: This unblinded quasi-randomized controlled preliminary study was conducted in a rehabilitation-focused long-term acute care hospital. Participants were recruited from stroke rehabilitation inpatients with an admission Berg Balance Scale (BBS) score of 21 (out of 56) or greater. Over a 2-week period, consented participants completed 8 BWSS or BWSS with perturbation (BWSS-P) treatment sessions; study activities were incorporated into regular treatment to avoid disruption of their normal care. Although both groups conducted the same balance and gait activities during their treatment sessions, the BWSS-P sessions included lateral, anterior, and posterior balance perturbations. Pre- and postintervention BBS and Activities-Specific Balance Confidence (ABC) assessments were the primary outcome measures collected. Institutional BBS data from the year before installation of the track-mounted BWSS were retrospectively included as a post hoc historical standard of care comparison. RESULTS: The improved postintervention BBS and ABC assessment scores showed that all participants benefited from therapy (P<.001 for all pre- and postintervention comparisons). The average BBS percent change for the BWSS-P sample (n=14) was 66.95% (SD 43.78%) and that for the BWSS control sample (n=15) was 53.29% (SD 24.13%). These values were greater than those for the standard of care group (n=30; mean 28.31%, SD 17.25%; P=.02 and P=.005 respectively), with no difference among the BWSS groups (P=.67). ABC score changes were also similar among the preintervention and postintervention BWSS groups (P=.94 and P=.92, respectively). CONCLUSIONS: Both BWSS groups demonstrated similar BBS and ABC score improvements, indicating that balance perturbations were not detrimental to postacute stroke rehabilitation and were safe to use. These data provide strong rationale and baseline data for conducting a larger follow-up study to further assess if this new perturbation system provides additional benefit to the rehabilitation of gait and balance impairments following stroke. TRIAL REGISTRATION: ClinicalTrials.gov NCT04919161; https://clinicaltrials.gov/ct2/show/NCT04919161.