Inpatient Rehabilitation Facility Ownership Type Yields Mixed Performances on Quality Measures.

OBJECTIVE: To evaluate the effects of inpatient rehabilitation facility (IRF) ownership type on IRF-Quality Reporting Program (IRF-QRP) measures. DESIGN: Cross-sectional, observational design. SETTING: We used 2 Centers for Medicare and Medicare publicly-available, facility-level data sources: (1) IRF compare files and (2) IRF rate setting files - final rule. Data from 2021 were included. PARTICIPANTS: The study sample included 1092 IRFs (N=1092). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We estimated the effects of IRF ownership type, defined as for-profit and nonprofit, on 15 IRF-QRP measures using general linear models. Models were adjusted for the following facility-level characteristics: (1) Centers for Medicare and Medicaid census divisions; (2) number of discharges; (3) teaching status; (4) freestanding vs hospital unit; and (5) estimated average weight per discharge. RESULTS: Ownership type was significantly associated with 9 out of the fifteen IRF-QRP measures. Nonprofit IRFs performed better with having lower readmissions rates within stay and 30-day post discharge. For-profit IRFs performed better for all the functional measures and with higher rates of returning to home and the community. Lastly, for-profit IRFs spent more per Medicare beneficiary. CONCLUSIONS: Ideally, IRF performance would not vary based on ownership type. However, we found that ownership type is associated with IRF-QRP performance scores. We suggest that future studies investigate how ownership type affects patient-level outcomes and the longitudinal effect of ownership type on IRF-QRP measures.

Social Support and Social Stress Among Suicidal Inpatients at Military Treatment Facilities: A Multidimensional Investigation.

ABSTRACT: The associations between social support and stress with internalizing symptoms (depressive symptoms and hopelessness) and hazardous drinking were tested in an inpatient sample of suicidal military personnel. Baseline data from a randomized clinical trial were analyzed. Different sources of support and stressors in the social context of military personnel were differentially linked to internalizing symptoms and hazardous drinking. In the full sample ( n = 192), family and nonfamily support were both inversely associated with internalizing symptoms but not hazardous drinking. Family stress was positively associated with internalizing symptoms. In a subsample of service members who had a history of deployment ( n = 98), postdeployment social support was protective against internalizing symptoms, whereas deployment harassment was associated with increased odds of hazardous drinking. Results underscore the need for assessment of various dimensions of social support and stress to guide case formulation and optimize strategies to support patients' mental well-being and adaptive coping.

Current state of musculoskeletal fellowship program directors and future directions.

OBJECTIVE: To better understand the current state of musculoskeletal fellowship program directors and identify opportunities for formal training that could increase job satisfaction, provide a broader knowledge base for mentoring/advising trainees and increase diversity in musculoskeletal radiology. MATERIALS AND METHODS: Eighty-one fellowship program directors who signed the Fellowship Match Memorandum of Understanding with the Society of Skeletal Radiology were sent a survey with questions about demographics, career, background, and training both for musculoskeletal radiology and for the fellowship director role. RESULTS: A 57/81 (70%) of program directors responded, representing 27 different states with a range of 1-9 fellowship positions. Nearly half are in their forties (48%) with most identifying as White (67%) followed by Asian (30%). The majority are male (72%) with over half (60%) remaining at the institution where they completed prior training. Over half plan to change roles within 5 years and do not feel adequately compensated. Top qualities/skills identified as important for the role include effective communication, being approachable, and clinical excellence. Other than clinical excellence, most do not report formal training in skills identified as important for the role. CONCLUSIONS: Given the high amount of interaction with trainees, program directors play a key role in the future of our subspecialty. The low diversity among this group, the lack of formal training, and the fact that most do not feel adequately compensated could limit mentorship and recruitment. Program directors identified effective communication, organizational/planning skills, and conflict resolution as the top skills they would benefit from formal training.

Participants With Acquired Brain Injury Realized They "Could Still Do Things" After a Yoga Intervention: A Qualitative Descriptive Study.

IMPORTANCE: Occupational therapy practitioners use yoga in practice to achieve holistic care, and the American Occupational Therapy Association has provided guidance on the use of yoga in occupational therapy. For people with acquired brain injury (ABI), however, it is unknown whether yoga affects occupational performance. OBJECTIVE: To explore the perceived impact of an adapted yoga intervention on occupational performance using the Occupational Therapy Practice Framework: Domain and Process (4th ed.; OTPF-4) for participants with ABI. DESIGN: Qualitative descriptive study using virtual, semistructured interviews. An inductive, holistic, open-coding process, followed by a deductive process to map open codes to the OTPF-4. PARTICIPANTS: Nine individuals with ABI were recruited from a yoga intervention study. RESULTS: The theme generated from the data-"Yoga participants with ABI realized that they could still do quite a bit"-was supported by two major categories from the OTPF-4: Occupations and Performance Skills. Participants described improvements in their functional performance (i.e., motor skills, process skills) and how these factors were synergistically connected to their occupational performance (i.e., self-care, leisure). CONCLUSIONS AND RELEVANCE: This study provides novel insight into how functional performance improved so participants could "still do things," such as engaging in occupations. When participants described improved performance skills, they simultaneously described re-engagement with their meaningful occupations. Participants also perceived an improvement in their mind-body connection, which should be further explored in future studies. This study generated original findings about participants' perceptions of an adapted yoga intervention as they relate to the OTPF-4. Plain-Language Summary: This study reports individuals' perceptions of their re-engagement with occupations and changes in occupational performance skills after participating in an adaptive yoga intervention. We highlight the distinct contribution that adaptive yoga-an intervention modality that can be used by occupational therapy practitioners-may have, using the OTPF-4 to connect the participants' perceptions about their improvements in occupational performance.

Update on elbow arthroplasties with emphasis on imaging.

Elbow arthroplasty is increasing in popularity and can be used to treat many conditions, such as trauma, primary and secondary osteoarthritis, inflammatory arthritis, and osteonecrosis. Total elbow arthroplasty (TEA) is reserved for patients with severe symptoms refractory to more conservative management. In addition to TEA, hemi-arthroplasty, interposition arthroplasty, and resection arthroplasty also play roles in the management of elbow pain. There are specific indications for each type of arthroplasty. Postoperative complications may occur with elbow arthroplasties and may be surgery or hardware related. Imaging is important in both pre-operative planning as well as in post-surgical follow-up. This article reviews the different types of elbow arthroplasties, their indications, their normal postoperative imaging appearances, and imaging findings of potential complications.

Barriers and Facilitators to the Adoption of Evidence-Based Interventions for Adults Within Occupational and Physical Therapy Practice Settings: A Systematic Review.

OBJECTIVE: Synthesize data regarding barriers and facilitators of adoption (ie, adoption determinants) of evidence-based occupational (OT) and physical therapy (PT) interventions within real-world practice. Whether evidence varied across disciplines, settings, and use of theoretical frameworks was also examined. DATA SOURCES: Literature published from database inception to December 9, 2022, in OVID MEDLINE, EMBASE, OVID PsycINFO, Web of Science Core Collection, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, and Google Scholar. STUDY SELECTION: Original research including: (1) stakeholder insight into adoption determinants; (2) discrete evidence-based interventions delivered/supervised by an OT and/or PT; (3) intervention recipients aged 18 or older; and (4) data regarding adoption determinants. Two reviewers independently screened and evaluated studies for inclusion, with a third resolving discrepancies. Of the 3036 articles identified, 45 articles were included. DATA EXTRACTION: Data were extracted by a primary reviewer, independently evaluated by a second reviewer, and conflicts were resolved via group consensus. DATA SYNTHESIS: A descriptive synthesis approach was used to categorize adoption determinants according to constructs from the Consolidated Framework for Implementation Research. 87% of studies were published after 2014. Many studies: described PT interventions (82%); were within the outpatient setting (44%); had data gathered after implementing the intervention (71%); and did not report use of a theoretical framework to inform data collection (62%). Lack of available resources (64%) and knowledge/beliefs about the intervention (53%) were the most common barrier and facilitator, respectively. Variability in adoption determinants was observed according to discipline, setting, and use of a theoretical framework. CONCLUSIONS: Findings suggest a recent surge of scientific investment in understanding adoption determinants for evidence-based OT and PT interventions. Such knowledge can inform efforts aimed at improving OT and PT quality, thereby enhancing patient outcomes. However, our review highlighted gaps with significant implications for the delivery of evidence-based OT and PT within real-world practice settings.

Imaging of osteoarthritis from the ankle through the midfoot.

Ankle, hindfoot, and midfoot osteoarthritis (OA) is most commonly posttraumatic and tends to become symptomatic in younger patients. It often results from instability due to insufficiency of supportive soft tissue structures, such as ligaments and tendons. Diagnostic imaging can be helpful to detect and characterize the distribution of OA, and to assess the integrity of these supportive structures, which helps determine prognosis and guide treatment. However, the imaging findings associated with OA and instability may be subtle and unrecognized until the process is advanced, which may ultimately limit therapeutic options to salvage procedures. It is important to understand the abilities and limitations of various imaging modalities used to assess ankle, hindfoot, and midfoot OA, and to be familiar with the imaging findings of OA and instability patterns.

Meta-analysis of salt marsh vegetation impacts and recovery: a synthesis following the Deepwater Horizon oil spill.

Marine oil spills continue to be a global issue, heightened by spill events such as the 2010 Deepwater Horizon spill in the Gulf of Mexico, the largest marine oil spill in US waters and among the largest worldwide, affecting over 1,000 km of sensitive wetland shorelines, primarily salt marshes supporting numerous ecosystem functions. To synthesize the effects of the oil spill on foundational vegetation species in the salt marsh ecosystem, Spartina alterniflora and Juncus roemerianus, we performed a meta-analysis using data from 10 studies and 255 sampling sites over seven years post-spill. We examined the hypotheses that the oil spill reduced plant cover, stem density, vegetation height, aboveground biomass, and belowground biomass, and tracked the degree of effects temporally to estimate recovery time frames. All plant metrics indicated impacts from oiling, with 20-100% maximum reductions depending on oiling level and marsh zone. Peak reductions of ~70-90% in total plant cover, total aboveground biomass, and belowground biomass were observed for heavily oiled sites at the marsh edge. Both Spartina and Juncus were impacted, with Juncus affected to a greater degree. Most plant metrics had recovery time frames of three years or longer, including multiple metrics with incomplete recovery over the duration of our data, at least seven years post-spill. Belowground biomass was particularly concerning, because it declined over time in contrast with recovery trends in most aboveground metrics, serving as a strong indicator of ongoing impact, limited recovery, and impaired resilience. We conclude that the Deepwater Horizon spill had multiyear impacts on salt marsh vegetation, with full recovery likely to exceed 10 years, particularly in heavily oiled marshes, where erosion may preclude full recovery. Vegetation impacts and delayed recovery is likely to have exerted substantial influences on ecosystem processes and associated species, especially along heavily oiled shorelines. Our synthesis affords a greater understanding of ecosystem impacts and recovery following the Deepwater Horizon oil spill, and informs environmental impact analysis, contingency planning, emergency response, damage assessment, and restoration efforts related to oil spills.

Musculoskeletal Manifestations of COVID-19: Currently Described Clinical Symptoms and Multimodality Imaging Findings.

COVID-19, the clinical syndrome produced by infection with SARS-CoV-2, can result in multisystem organ dysfunction, including respiratory failure and hypercoagulability, which can lead to critical illness and death. Musculoskeletal (MSK) manifestations of COVID-19 are common but have been relatively underreported, possibly because of the severity of manifestations in other organ systems. Additionally, patients who have undergone sedation and who are critically ill are often unable to alert clinicians of their MSK symptoms. Furthermore, some therapeutic measures such as medications and vaccinations can worsen existing MSK symptoms or cause additional symptoms. Symptoms may persist or occur months after the initial infection, known as post-COVID condition or long COVID. As the global experience with COVID-19 and the vaccination effort increases, certain patterns of MSK disease involving the bones, muscles, peripheral nerves, blood vessels, and joints have emerged, many of which are likely related to a hyperinflammatory host response, prothrombotic state, or therapeutic efforts rather than direct viral toxicity. Imaging findings for various COVID-19-related MSK pathologic conditions across a variety of modalities are being recognized, which can be helpful for diagnosis, treatment guidance, and follow-up. The online slide presentation from the RSNA Annual Meeting is available for this article. ©RSNA, 2022.

Posttreatment Imaging of the Wrist and Hand: Update 2022.

Common indications for surgical procedures of the wrist and hand include acute fractures or fracture-dislocations; nonunited fractures; posttraumatic, degenerative, and inflammatory arthritides and tendinopathies; injuries to tendons, ligaments, and the triangular fibrocartilage complex; and entrapment neuropathies. Soft tissue or osseous infections or masses may also need surgical treatment. Several of these procedures require surgical hardware placement, and most entail clinical follow-up with periodic imaging. Radiography should be the first imaging modality in the evaluation of the postoperative wrist and hand. Computed tomography, magnetic resonance imaging, diagnostic ultrasonography, and occasionally nuclear medicine studies may be performed to diagnose or better characterize suspected postoperative complications. To provide adequate evaluation of postoperative imaging of the wrist and hand, the interpreting radiologist must be familiar with the basic principles of these surgical procedures and both the imaging appearance of normal postoperative findings as well as the potential complications.

Reporting Guideline for RULER: Rasch Reporting Guideline for Rehabilitation Research: Explanation and Elaboration.

The Rasch Reporting Guideline for Rehabilitation Research (RULER) provides peer-reviewed, evidence-based, transparent, and consistent recommendations for reporting studies that apply Rasch Measurement (RM) Theory in a rehabilitation context. The purpose of the guideline is to ensure that authors, reviewers, and editors have uniform guidance about how to write and evaluate research on rehabilitation outcome assessments. The RULER statement includes an organizing framework and a checklist of 59 recommendations. This companion article supports the RULER statement by providing details about the framework, rationale for the domains and recommendations in the checklist and explaining why these considerations are important for improving consistency and transparency in reporting the results of RM studies. This article is not intended to describe how to conduct RM studies but provides rationale for the essential elements that authors should address in each domain. Consistency and transparency in reporting RM studies will advance rehabilitation research if authors consider these issues when planning their study and include the checklist when they submit their manuscript for peer review. A copy of the checklist can be found at [table 2 in https://doi.org/10.1016/j.apmr.2022.03.013].

Rasch Reporting Guideline for Rehabilitation Research (RULER): the RULER Statement.

The application of Rasch Measurement (RM) Theory to rehabilitation assessments has proliferated in recent years. RM Theory helps design and refine assessments so that items reflect a unidimensional construct in an equal interval metric that distinguishes among persons of different abilities in a manner that is consistent with the underlying trait. Rapid growth of RM in rehabilitation assessment studies has led to inconsistent results reporting. Clear, consistent, transparent reporting of RM Theory results is important for advancing rehabilitation science and practice based on precise measures. Precise measures, in turn, provide researchers, practitioners, patients, and other stakeholders with tools for effective decision making. The goal of this Rasch Reporting Guideline for Rehabilitation Research (RULER: Rasch Reporting Guideline for Rehabilitation Research) is to provide peer-reviewed, evidence-based, transparent, and consistent recommendations for reporting studies that apply RM Theory in a rehabilitation context. The purpose of the guideline is to ensure that authors, reviewers, and editors have uniform expectations about how to write and evaluate research on rehabilitation outcome assessments. A task force of rehabilitation researchers, clinicians, and editors met regularly between November 2018 and August 2020 to identify the need for the guideline, develop an organizing framework, identify content areas, and develop the recommendations. This RULER: Rasch Reporting Guideline for Rehabilitation Research statement includes the organizing framework and a checklist of 59 recommendations. The guideline is supported by an Explanation and Elaboration article that provides more detail about the framework and recommendations in the checklist. A glossary of key terms and a recommended iterations table are provided in supplemental online only materials.

Mobility Interventions for Patients With Disorders of Consciousness Following a Traumatic Brain Injury (June 2013-October 2020).

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on the effectiveness of mobility interventions to improve arousal and awareness in people with disorders of consciousness following a traumatic brain injury.

Noninvasive Nerve Stimulation for Patients With Disorders of Consciousness Following a Traumatic Brain Injury (June 2013-October 2020).

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on the effectiveness of noninvasive nerve stimulation to improve arousal and awareness in people with disorders of consciousness following a traumatic brain injury.

Animal-Assisted Therapy for Patients With Disorders of Consciousness Following a Traumatic Brain Injury (June 2013-October 2020).

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on the effectiveness of animal-assisted therapy to improve arousal and awareness for people with disorders of consciousness following a traumatic brain injury.

Sensory Stimulation for Patients With Disorders of Consciousness Following a Traumatic Brain Injury (June 2013-October 2020).

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on the effectiveness of sensory stimulation interventions to improve arousal and awareness in people with disorders of consciousness following a TBI.

Learning Health Systems Can Promote and Sustain High-Value Occupational Therapy.

In the current policy context, the occupational therapy profession must act to promote and sustain high-value care. Stakeholders have delineated efforts, such as defining and measuring high-quality care processes or promoting the adoption of evidence into practice, that can enhance the value of occupational therapy services. There is a growing recognition, however, that low-value care is the product of deficiencies within health care systems and is therefore most amenable to system-level solutions. To date, the specific nature of system-level changes capable of identifying and rectifying low-value occupational therapy has yet to be elucidated. In this "The Issue Is. . ." column, we introduce occupational therapy to the Learning Health System concept and its essential functions. Moreover, we discuss action steps for occupational therapy stakeholders to lay the foundation for Learning Health Systems in their own professional contexts. What This Article Adds: This article is the first to outline concrete action steps needed to transform occupational therapy practice contexts into Learning Health Systems. Such a transformation would represent a system-level change capable of fostering the delivery of high-value occupational therapy services to clients in a variety of practice settings.

Exploring Knowledge Translation Concepts in U.S. Occupational Therapy Research: A Content Analysis.

IMPORTANCE: As a new Accreditation Council for Occupational Therapy Education® standard, knowledge translation (KT) is an important concept to occupational therapy. A better understanding of KT in occupational therapy research could inform its relevance to occupational therapy education, research, and practice. OBJECTIVE: To answer the question "To what extent does published U.S.-based occupational therapy research that is explicitly underpinned by a KT theory, model, or framework reflect processes and concepts outlined in the knowledge-to-action (KTA) framework?" DESIGN: A systematic search was conducted to purposively sample U.S.-based occupational therapy research. A content analysis of 11 articles explored concepts of the KTA framework. OUTCOMES AND MEASURES: KTA was used as a conceptual foundation. RESULTS: Multiple sources of data mapped onto concepts in the knowledge creation cycle and each of the first five concepts of the knowledge action cycle. We found that three concepts from the knowledge action cycle-monitor knowledge use, evaluate outcomes, and sustain knowledge use-were not well represented in the sample. CONCLUSIONS AND RELEVANCE: Future research on the monitoring, evaluation, and sustained use of occupational therapy interventions is needed. The adoption of new interventions is important, and the knowledge of how they are sustained in practice will facilitate the clinical integration of future interventions. What This Article Adds: Occupational therapy research that uses KT lacks an emphasis on monitoring and sustaining evidence-informed interventions. Future research on the integration of such interventions into clinical practice is needed so that best practices in occupational therapy can be promoted.

Perceived changes in social interactions following military psychiatric hospitalization for a suicidal crisis.

Introduction Changes in social interactions following psychiatric hospitalization, a period characterized by heightened suicide risk, are important to understand. OBJECTIVE: We qualitatively explored perceived changes in social interactions one month after inpatient psychiatric discharge following a suicidal crisis. METHODS: A total of 113 United States Service members, recruited in the context of a psychotherapy randomized controlled trial, described the extent to which social interactions with family members, peers, and military commanders had changed. RESULTS: Most participants (82.3%) reported at least some change in social interactions, conveying six common themes. Showing more care and checking in more were frequently reported for family (24.8%, 20.4%), commanders (23.0%, 16.8%), and by peers (12.4%, 10.6%). Showing more concern was most frequently reported for family (13.3%) followed by peers (6.2%) and commanders (6.2%). Participants reported showing more caution from peers (14.2%), commanders (13.3%) and family (6.2%). Acting more distant was reported from commanders (7.1%), peers (7.1%), and family (5.3%). Showing negative reaction(s) was reported from commanders (8.0%), family (3.5%) and rarely for peers (0.9%). CONCLUSION: Inpatient providers are encouraged to prepare patients for potential changes in social interactions following psychiatric discharge and how to best respond to these changes.

Magnetic resonance imaging of rheumatological diseases.

Magnetic resonance imaging (MRI) is extremely useful in the early diagnosis of rheumatologic diseases, as well as in the monitoring of treatment response and disease progression to optimize long-term clinical outcomes. MRI is highly sensitive and specific in detecting the common findings in rheumatologic diseases, such as bone marrow oedema, cartilage disruption, articular erosions, joint effusions, bursal effusions, tendon sheath effusions, and synovitis. This imaging modality can demonstrate structural changes of cartilage and bone destruction years earlier than radiographs. Rheumatoid arthritis, crystal deposition diseases (including gouty arthropathy and calcium pyrophosphate deposition disease), seronegative spondyloarthropathies (including psoriatic arthritis, reactive arthritis, ankylosing spondylitis), and osteoarthritis have characteristic appearances on MRI. Contrast-enhanced MRI and diffusion-weighted imaging can provide additional evaluation of active synovitis. This article describes the MRI findings of normal joints, as well as the pathophysiological mechanisms and typical MRI findings of rheumatoid arthritis, gouty arthritis, calcium pyrophosphate deposition disease, psoriatic arthritis, reactive arthritis, ankylosing spondylitis, and osteoarthritis.