Hilary C Siebens1, Phoebe Sharkey2, Harriet U Aronow3, Daniel Deutscher4, Pamela Roberts5, Michael C Munin6, Craig S Radnay7, Susan D Horn8. 1. Siebens Patient Care Communications, 13601 Del Monte Dr, Suite 47A, Seal Beach, CA 90740(∗). Electronic address: info@siebenspcc.com. 2. Department of Information Systems and Operations Management, Loyola University Maryland, Baltimore, MD(†). 3. Cedars-Sinai Medical Center, Los Angeles, CA(‡). 4. Maccabi Healthcare Services, Tel Aviv, Israel(‖). 5. Cedars-Sinai Medical Center, Los Angeles, CA(¶). 6. Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA(#). 7. Insall Scott Kelly Institute for Orthopaedics and Sports Medicine, New York, NY(∗∗). 8. Institute for Clinical Outcomes Research, Salt Lake City, UT(§).
Abstract
BACKGROUND: Recommendations for health care redesign often advocate for comparative effectiveness research that is patient-centered. For patients who require rehabilitation services, a first step in this research process is to understand current practices for specific patient groups. OBJECTIVE: To document in detail the physical and occupational therapy treatment activities for inpatient hip fracture rehabilitation among 3 patient subgroups distinguished by their early rate of functional recovery between time of surgery to rehabilitation admission. DESIGN: Multicenter prospective observational cohort, practice-based evidence, study. SETTING: Seven skilled nursing facilities and 11 inpatient rehabilitation facilities across the United States. PARTICIPANTS: A total of 226 patients with hip fractures treated with hip arthroplasty. METHODS: Comparisons of physical and occupational therapy treatment activities among 3 groups with different initial recovery trajectory (IRT) rates (slower, moderate, faster). MAIN OUTCOME MEASURE(S): Percent of patients in each IRT group exposed to each physical and occupational therapy activity (exposure), and mean minutes per week for each activity (intensity). RESULTS: The number of patients exposed to different physical or occupational therapy activities varied within the entire sample. More specifically, among the 3 IRT groups, significant differences in exposure occurred for 44% of physical therapy activities and 39% of occupational therapy activities. More patients in the slower recovery group, IRT 1, received basic activities of daily living treatments and more patients in the faster recovery group, IRT 3, received advanced activities. The moderate recovery group, IRT 2, had some treatments similar to IRT 1 group and others similar to IRT 3 group. CONCLUSIONS: Analyses of practice-based evidence on inpatient rehabilitation of hip fracture patients treated with arthroplasty identified differences in therapy activities among three patient groups classified by IRT rates. These results may enhance physiatrists', other physicians', and rehabilitation teams' understanding of inpatient rehabilitation for these patients and help design future comparative effectiveness research.
BACKGROUND: Recommendations for health care redesign often advocate for comparative effectiveness research that is patient-centered. For patients who require rehabilitation services, a first step in this research process is to understand current practices for specific patient groups. OBJECTIVE: To document in detail the physical and occupational therapy treatment activities for inpatient hip fracture rehabilitation among 3 patient subgroups distinguished by their early rate of functional recovery between time of surgery to rehabilitation admission. DESIGN: Multicenter prospective observational cohort, practice-based evidence, study. SETTING: Seven skilled nursing facilities and 11 inpatient rehabilitation facilities across the United States. PARTICIPANTS: A total of 226 patients with hip fractures treated with hip arthroplasty. METHODS: Comparisons of physical and occupational therapy treatment activities among 3 groups with different initial recovery trajectory (IRT) rates (slower, moderate, faster). MAIN OUTCOME MEASURE(S): Percent of patients in each IRT group exposed to each physical and occupational therapy activity (exposure), and mean minutes per week for each activity (intensity). RESULTS: The number of patients exposed to different physical or occupational therapy activities varied within the entire sample. More specifically, among the 3 IRT groups, significant differences in exposure occurred for 44% of physical therapy activities and 39% of occupational therapy activities. More patients in the slower recovery group, IRT 1, received basic activities of daily living treatments and more patients in the faster recovery group, IRT 3, received advanced activities. The moderate recovery group, IRT 2, had some treatments similar to IRT 1 group and others similar to IRT 3 group. CONCLUSIONS: Analyses of practice-based evidence on inpatient rehabilitation of hip fracturepatients treated with arthroplasty identified differences in therapy activities among three patient groups classified by IRT rates. These results may enhance physiatrists', other physicians', and rehabilitation teams' understanding of inpatient rehabilitation for these patients and help design future comparative effectiveness research.
Authors: Paul Baker; Carol Coole; Avril Drummond; Sayeed Khan; Catriona McDaid; Catherine Hewitt; Lucksy Kottam; Sarah Ronaldson; Elizabeth Coleman; David A McDonald; Fiona Nouri; Melanie Narayanasamy; Iain McNamara; Judith Fitch; Louise Thomson; Gerry Richardson; Amar Rangan Journal: Health Technol Assess Date: 2020-09 Impact factor: 4.014
Authors: Karen I Connor; Hilary C Siebens; Brian S Mittman; Donna K McNeese-Smith; David A Ganz; Frances Barry; Lisa K Edwards; Michael G McGowan; Eric M Cheng; Barbara G Vickrey Journal: BMC Neurol Date: 2020-12-02 Impact factor: 2.474