Occupational therapy practice for post-acute COVID-19 inpatients requiring rehabilitation.

INTRODUCTION: COVID-19 caused significant occupational disruption to people's life roles, with some people requiring an inpatient rehabilitation admission. Occupational therapists assessed and treated these patients using previous knowledge of similar conditions due to limited specificity in available guidelines to inform practice. The aim of this study was to investigate current practice with post-acute COVID-19 (PAC) patients within an inpatient rehabilitation setting in Australia, to better understand the role and impact of occupational therapy. METHODS: A mixed-method study was conducted, including electronic medical record audits (October 2021 October 2022) and descriptive patient interviews at a large metropolitan subacute service. Descriptive statistics and qualitative analysis were used to summarise and interpret data. CONSUMER AND COMMUNITY INVOLVEMENT: No involvement. RESULTS: A total of 24 patient electronic medical records were audited, and 10 patient interviews were completed. Three overarching categories were identified within the 685 occasions of occupational therapy service audited-occupational engagement, education provision and discharge planning. Patients identified the value of occupational therapy by reflecting on their lived experiences of engaging with occupational therapists and associated changes in occupational performance between COVID-19 diagnoses and discharge home. CONCLUSION: Occupational therapists possess a unique skill set that directly addresses the occupational needs and priorities of PAC patients. This study adds to the growing body of evidence supporting the contribution of occupational therapy to the management of COVID-19; however, further research is needed to develop evidence-based practice resources and advocate for system changes that improve quality of life for COVID-19 patients. PLAIN LANGUAGE SUMMARY: During the COVID-19 pandemic, a lot of people got very sick. Some of these people needed more time and support to get better. Occupational therapists were important during this time because they helped these people to do their daily activities again. Because there were not many resources on how to do this, we looked into what occupational therapists were doing to help these people. We looked at patient hospital files and also talked to them to understand this better. We found that occupational therapists focused on three main areas: helping patients do activities that were important to them, teaching them about COVID-19 and helping them plan to leave the hospital. This study shows that occupational therapists are skilled at helping people with COVID-19. But more research is needed to make resources and also help with changing the healthcare system to further help people get better from COVID-19.

Costs and length of stay associated with early supported discharge for moderate and severe stroke survivors.

GOAL: This study aimed to compare the length of stay, saved days and service costs associated with an early supported discharge model of care for mild, moderate and severe stroke survivors, to standard treatment. MATERIALS AND METHODS: A two centre cohort study, employing a quasi-experimental design with a control group of convenience. Forty-four participants were recruited when they were deemed suitable for discharge home with intensive rehabilitation and services, with three dropouts from the treatment group (treatment n = 28, control n = 13). There were no significant differences between the groups for gender, age, Functional Independence Measure, Berg Balance Test and Modified Ranking Scale total scores at baseline. There were also no significant differences between the groups for subsequent readmissions or complications. Length of stay was measured by the days between admission and discharge from both inpatient and community services. Costs were measured by daily amounts calculated for this service. FINDINGS: The treatment group spent significantly fewer days on the acute and inpatient rehabilitation wards, with over half avoiding subacute admission altogether. However, the control group spent significantly fewer days receiving intensive rehabilitation. The treatment group cost less on average per patient, but was not significantly different in terms of overall costs per admission. CONCLUSION: Stroke survivors receiving an early supported discharge model of care spent fewer days in hospital, frequently avoided subacute admission and incurred less cost per patient than those receiving standard treatment. These findings indicate that early supported discharge reduces length of inpatient stay, for a similar cost to standard treatment.

Evaluating the implementation of an early supported discharge (ESD) program for stroke survivors: A mixed methods longitudinal case study.

BACKGROUND: Early supported discharge (ESD) models of care for stroke survivors coordinate inpatient and community services, with the aim of reducing length of stay. While there is an established evidence base around the clinical outcomes of ESD), less is known about the implementation of this approach into existing stroke care service. The aim of this case study was to describe staff perceptions of the implementation of an ESD model of care for stroke survivors at a large metropolitan public hospital in Australia. METHODS: This case study utilised a mixed methods design, which was designed in explicit alignment with the Consolidated Framework for Implementation Research (CFIR). Participants included staff that referred patients for ESD, and staff involved in the planning, implementation or delivery of ESD. Survey data was collected at three time points (ESD commencement, 3 months and 6 months), and focus groups were undertaken at the conclusion of the study. All quantitative data was analysed descriptive, while qualitative data was evaluated using thematic analysis. RESULTS: Results from both sources of data identified changes in staff perceptions of ESD implementation over time. While very few changes were statistically significant, they were diverse patterns of change across the CFIR constructs over time. The characteristics of individuals and ESD characteristics attracted consistently positive perceptions, while patient needs and resources was the most prevalent theme within the data. While perceptions of factors related to the inner setting were mixed, there was a steady improvement in perceptions about the process across the later stages of implementation. CONCLUSIONS: The sophistication of knowledge translation and implementation in modern complex healthcare environments is highlighted by the multiple interactions between the CFIR domains and constructs. While the implementation process described was generally positive and effective, using the CFIR as a framework confirmed that it also entailed some challenges and unanticipated outcomes.