ABSTRACT Purpose/Introduction: U.S. Emergency departments (EDs) face challenges related to patient volume, wait times, and resource utilization. Although physical therapists (PTs) are increasingly integrated into ED settings, the characteristics of this specialty practice remain widely unknown. Existing literature demonstrates that PT involvement in EDs can positively impact wait times, length of stay, imaging use, hospital admissions, and patient satisfaction. However, how PTs are currently utilized within U.S. EDs remains poorly understood. The purpose of this study was to provide an in-depth exploration and analysis of PT practice in U.S. EDs. Methods: A cross-sectional observational study was conducted using a convenience sample of PTs practicing in U.S. EDs. Data were collected via a 47-item web-based survey and analyzed using descriptive statistics and chi-square analyses. Qualitative responses were analyzed using thematic analysis. Results: Seventy-nine participants completed the survey with 55 reporting at least 15 hours/week of ED practice. Findings demonstrated variability in practice models, referral processes, and scope of practice. PTs most frequently managed musculoskeletal, balance/fall, and vestibular conditions and reported high confidence in performing components of medical screening examinations. Strong interprofessional collaboration was reported, although barriers included underutilization and limited understanding of PT knowledge and skills. Respondents expressed support for expanded practice privileges, including imaging and independent management of low-acuity conditions. Conclusion: PT practice in U.S. EDs is an evolving and variable specialty area. PTs are highly involved in patient care and are valued members of the ED provider team. These findings provide foundational insight to support future standardization, education, and research to optimized ED PT practice.
ABSTRACT Background and Purpose: Literature has shown that interprofessional simulation-based learning experiences (Sim IPE) are effective at preparing future healthcare providers for interprofessional practice and an impactful way to meet health professions’ accreditation standards. However, there is a lack of literature examining outcomes of Sim IPE among entry-level Doctor of Physical Therapy (DPT) and Master of Science Speech-Language Pathology (MS-SLP) learners. The purpose of this study is to examine how participation in Sim IPE influences DPT and MS-SLP students’ development of interprofessional practice competencies utilizing the Interprofessional Collaborative Competencies Attainment Survey (ICCAS) and 4 open-response questions. Methods: Convenience sampling was used to recruit 46 students (20 DPT; 26 MS-SLP) at the authors’ institution who participated in Sim IPE for the evaluation of a person who was post-stroke and had a communication disorder. Quantitative data analysis included descriptive statistics for the mean, standard deviation, and range for each item on the ICCAS. Additionally, each item was analyzed using the non-parametric Wilcoxon signed-rank test and bivariate ordinal logistic regression analysis. The average overall scores, grouped by pre, post, and the average difference, were then used to conduct two-way ANOVAs to compare ICCAS scores for participants from different disciplines and for learning style during the Sim IPE, either active participant or observer learner. Qualitative data generated via open response questions were analyzed using an inductive conventional content analysis approach. Results: A significant change in ICCAS scores were found on 14 out of 20 items. Analyses revealed that discipline and learning style (active participant vs. observer learner) resulted in no significant differences in scores on the ICCAS despite the fact that the DPT students had previous experience in simulation while MS-SLP students did not. Qualitative analyses revealed 3 main themes: Patient Care is Enhanced Through Collaboration, Communication with Team Members is Key to Success, and Professional Roles and Scope of Practice. Discussion and Conclusions: Findings of this study align with previous literature showing that well-designed Sim IPE that adhere to standards of best practice are effective for educating health professions’ students in interprofessional competencies and support expansion of the use of this andragogy in health professions training programs.
ABSTRACT Purpose: The integration of physical therapists (PTs) as collaborating clinicians in emergency departments (EDs) has expanded globally. Prior studies demonstrate benefits at the patient, provider, and institutional levels, including reduced imaging and opioid use, improved patient education, and enhanced functional outcomes. Despite this, PT utilization remains highly variable across health care systems. In Wisconsin, little is known about how PTs are currently incorporated into EDs. This cross-sectional study examines the prevalence and characteristics of PT integration in Wisconsin EDs. Subjects/Methods: This exploratory descriptive study used a mixed-methods survey distributed to 138 unique EDs across Wisconsin. Survey data were analyzed using Fisher exact tests to identify associations between PT integration and hospital characteristics, including trauma level, bed count, and urbanicity. Results: Sixty-seven percent of EDs reported some degree of PT integration. Adoption was significantly higher in Level II (88.9%) and Level III (84.1%) trauma centers compared with Level IV or unclassified centers. Mid-sized EDs (10-49 beds) demonstrated the highest implementation rates (80%-86%). Clinical encounters were primarily driven by falls (>33%), musculoskeletal complaints (25%), and vestibular conditions. The most significant barriers to implementation were limited leadership endorsement and staffing capacity, rather than a lack of awareness of the model. Seventy-six percent of EDs not offering PT plan to do so within 5 years. Conclusion: PT integration within Wisconsin emergency departments has expanded over the past 5 years, driven by experienced clinicians and adaptable staffing models. Implementation has occurred across diverse hospital types and community settings, demonstrating this practice is feasible in a wide range of contexts. Although dedicated FTEs for PT in the ED are not the norm, there is substantial interest among EDs that do not yet offer these services. Targeted efforts to enhance leadership understanding and address staffing concerns may facilitate broader adoption of ED-based physical therapy.
Introduction: The purpose of this study was to examine the effect of a rehabilitation and mobility-focused clinical pathway (RCP) on timing and frequency of physical therapy, functional mobility scores, discharge locations, and length of stay (LOS) for lung transplant recipients. Review of Literature: Research investigating clinical pathways involving physical therapy for lung transplant recipients is limited. Subjects: The control group (n = 68) received lung transplants pre-RCP, and the intervention group (n = 71) received lung transplants post-RCP. Methods: The RCP was implemented at a large academic hospital as a quality improvement initiative. This retrospective study included 139 lung transplant recipients. Time to physical therapy evaluation, frequency of physical therapy sessions, Activity Measure for Post-Acute Care "6-clicks" scores, Johns Hopkins Highest Level of Mobility Scores, discharge locations, and LOS were measured. Results: The intervention group demonstrated a 27.3% decrease in time from consult to physical therapy evaluation (95% confidence interval [CI]:-39.9%,-11.9%; P < .001), an increase of 1.14 physical therapy sessions per week (95% CI: 0.78, 1.49; P < .0001) greater improvements in functional mobility outcomes on the Activity Measure for Post-Acute Care (1.08; 95% CI: 0.49, 1.67; P = .0004) and Johns Hopkins Highest Level of Mobility Scores (0.23; 95% CI: 0.09, 0.36; P = .001). LOS and discharge location remained similar. Discussion and Conclusions: The RCP led to improved timing and frequency of physical therapy services and improved functional mobility scores. Future studies should investigate the impact of the multidisciplinary interventions in the RCP and outcomes such as quality of life and readmission rates.
Background and Purpose: Currently, there are few long-term advanced therapies options for managing biventricular heart failure. If traditional therapies fail, the off-label use of 2 ventricular assist devices to create a durable biventricular assist device (BiVAD) may be an option. Durable BiVAD is rare, so this case aims to outline the multidisciplinary rehabilitation approach, safety parameters, and functional outcomes throughout each phase of the patient's complex hospitalization.Case Description: A 40-year-old patient was admitted with cardiogenic shock requiring multiple forms of temporary and durable mechanical circulatory support before the decision to place her on durable BiVAD as destination therapy. The patient participated in physical, occupational, and speech therapies throughout her entire hospitalization, with rehabilitation strategies adapting to accommodate her medical limitations and current goals of care.Outcomes: The patient demonstrated improved functional mobility, independence with self-care tasks, and lower extremity strength and was able to discharge home with her family and begin cardiac rehabilitation.Discussion and Conclusion: This case emphasizes the importance of multidisciplinary collaboration and patient-centered care throughout a complex, dynamic hospital course.
Background and Purpose: Mobilization of patients with critical illness in the intensive care unit (ICU) is often hindered by the complexity of managing multiple life-support and monitoring devices, leading to limited ambulation opportunities. The purpose of this pilot study was to evaluate the feasibility of portable treadmill ambulation for patients requiring life-support and monitoring devices.Methods: Six participants (age 37-80 years) admitted to the cardiac ICU with critical illness requiring numerous life-support and monitoring devices ambulated on a portable treadmill under the supervision of a physical therapist. Setup time, staffing requirements, walking duration, ambulation distance, vital signs, and adverse events were recorded. Data were analyzed descriptively using medians and interquartile ranges (IQRs).Results: Participants had a median of 9 life-support and monitoring devices. Ambulation required a median of 1 physical therapist (IQR 1-2), with a median setup time of 6.5 minutes (IQR 4.9-7.8). The median walking distance was 42.7 m (IQR 13.7-56.8; range 6.1-91.4), and the median treadmill time was 5.1 minutes (IQR 3.1-6.9). No major adverse events occurred, and 1 minor adverse event was documented across all treadmill trials.Discussion and Conclusions: Based on our pilot study, the use of portable treadmill ambulation in the ICU appears to be feasible and well tolerated as an adjunct to traditional overground walking, even among patients with substantial life-support and monitoring device burdens. This approach may help streamline mobilization efforts, reduce staff demands, and support continuous physiological monitoring. Future studies should compare portable treadmill and overground ambulation outcomes and evaluate clinical effectiveness in larger, multicenter cohorts.
Background and Purpose: Verticalization therapy (VT) using tilt beds can improve feasibility of early mobility (EM) for critically ill patients. Limited research exists regarding the functional outcomes of patients treated with VT in the intensive care unit (ICU). We reviewed patient records to identify the functional impact of a VT procedure implemented in the ICU.Approach: We conducted a retrospective record review of the medical records of 38 consecutive patients who received VT during their ICU stay. Data included demographics, verticalization and rehabilitation therapy session data, and functional outcomes. We hypothesized that earlier and more consistent verticalization and increased tolerance for verticalization based on physiological responses would yield greater positive changes on the Johns Hopkins Highest Level of Mobility scale. Nonparametric tests investigated hypotheses and group differences.Outcomes: Of the 79% of patients (n = 30) who survived to hospital discharge, 90% (n = 27) stood during their hospital stay and 67% (n = 20) ambulated. Average Johns Hopkins Highest Level of Mobility scale scores increased by 3.14 from the first VT session to hospital discharge. We identified a trend toward improved functional outcomes when VT was initiated within 21 days of hospital admission and a statistically significant inverse relationship between the frequency of minor adverse events during VT sessions and functional improvement (rho = -0.37, P = .028). No major adverse events occurred across 514 VT sessions. Therapists' decisions to adapt, proceed, or terminate VT sessions indicated efforts to overcome barriers to mobility and optimize patient participation.Discussion and Conclusion: VT can support functional recovery in critically ill patients with barriers to traditional early mobility interventions. This study offers guidance for clinical decision making for VT as a component of EM for critically ill patients. More research is needed to determine optimal utilization of VT in the ICU.
Introduction: Individuals with COVID-19 often have functional deficits across multiple domains (activity, cognition, and mobility) which may prompt the need for postacute care, and little is known about the association between multiple domains of function and discharge disposition. The purpose of this study was to examine the association between patients' functional status across multiple domains and discharge disposition for those hospitalized with COVID-19.Methods: This was a retrospective study of records for adult patients with COVID-19 admitted between May 2020 and February 2022, who had a complete set of scores for the Activity Measure for Post-Acute Care (AM-PAC) 6-Clicks applied cognition, daily activity, and basic mobility measures. To identify functional profiles, latent profile analysis (LPA) was conducted using the AM-PAC 6-Clicks scores for all 3 domains. The association between functional profile and discharge to home versus a facility was examined using a modified Poisson regression model to estimate relative risk.Results: One hundred twenty-four records were available for analysis. Five distinct profiles were identified that differentiated the sample by 4 levels of AM-PAC 6-Clicks scores. Patients in the moderate, low, and very low physical function profiles were more likely to be discharged to a facility than those with high physical function. Patients with high levels of physical function, even when cognitively impaired, were more likely to be discharged home.Discussion/Conclusion: Physical function, more than cognitive function, influenced patients' disposition after hospitalization for COVID-19.
Purpose: The science that should inform the practice of physical therapists in the acute hospital is rapidly evolving. To ensure clinicians can deliver the most current and effective treatments they must have access to scientific literature. Access refers to the design of products, services, and information for use by relevant populations, to the greatest extent possible. Clinicians often cannot access scientific literature for various reasons. The purpose of this article was to highlight selected acute care physical therapy literature published in 2024 in an accessible form for all members of the acute care physical therapy community.Methods: In this perspective report, peer-reviewed publications relevant to acute care physical therapy from the year 2024 were identified and reviewed. Articles were selected based on relevance to today's health care environment, hot topics, and the anticipated future of acute care physical therapy.Results: Articles were grouped into (1) clinical practice including differential diagnoses and treatment dosage, (2) patient care related to social determinants of health, (3) physical therapy operations, and (4) entry level Doctor of Physical Therapy didactic and clinical education. Following the summary of each topic's articles, clinical relevance and future directions are discussed.Conclusions: The authors' perspective of acute care physical therapy research from 2024 was that it provided an overview of current, clinically relevant topics that are useful to a variety acute care clinicians and educators. This review was presented at the 2025 Combined Sections Meeting.
ABSTRACT Background and Purpose: Balance impairments are common in critically ill patients and may limit progression within early mobilization programs. Although international guidelines support early rehabilitation in the intensive care unit (ICU), structured balance training approaches tailored to this setting remain poorly described. This case report describes the implementation of the U-Balance protocol within early mobilization in the ICU. Case Description: An 85-year-old man was admitted to the ICU after emergency abdominal surgery and required reoperation and invasive mechanical ventilation. The patient was cooperative, able to follow commands, and screened negative for delirium using the CAM-ICU. At the initiation of physiotherapy, he presented with intensive care unit–acquired weakness, marked balance deficits, and functional limitations restricting mobility. Intervention: The U-Balance protocol was incorporated into the patient's early mobilization program and delivered daily by physiotherapists. Balance performance and progression were monitored using selected items of the Berg Balance Scale (sit-to-stand, standing unsupported, and sitting without trunk support). Muscle strength, mobility, and overall physical function were assessed using the Medical Research Council sum score, ICU Mobility Scale, and Chelsea Critical Care Physical Assessment Tool, respectively. Outcomes: Clinically meaningful improvements were observed in muscle strength, mobility, physical function, and balance, enabling progression to upright postures, transfers, and assisted ambulation. No adverse events occurred, and implementation required no additional equipment or staffing. Discussion and Conclusion: This case report demonstrates that structured balance training can be safely and feasibly integrated within early mobilization in the ICU and may contribute to functional recovery in critically ill patients.
Introduction: The purpose of this study was to examine the incidence of adverse events (AE) when physical therapists mobilized hospitalized patients with acute lower extremity (LE) deep vein thrombosis (DVT) at subtherapeutic versus therapeutic anticoagulation levels.Review of Literature: The 2022 Clinical Practice Guideline supported by the American Physical Therapy Association's Academy of Cardiovascular and Pulmonary Physical Therapy and the Academy of Acute Care provides recommendations for physical therapy management of venous thromboembolism (VTE). The guideline advises initiating mobility once anticoagulation reaches a therapeutic level in patients with acute DVT. However, limited evidence exists regarding AE during mobilization, suggesting a potential gap between stated recommendations and clinical practice. The aim of this study was to describe the incidence of AE during physical therapy sessions in hospitalized patients with acute LE DVT who were at subtherapeutic anticoagulation levels.Subjects and Methods: A retrospective review of medical records from 30 hospitalized patients across 60 physical therapy sessions was conducted. Convenience sampling was used. Data included demographics, Charlson Comorbidity Index score, anticoagulation status, level of mobility during therapy, and presence of AE. Between-group differences in continuous variables were assessed using independent-samples t tests. Differences in session-level mobility distributions were evaluated using the Fisher-Freeman-Halton exact test.Results: Of the 60 sessions, 29 occurred when patients were at a therapeutic level of anticoagulation and 31 when patients were at a subtherapeutic level. No AE occurred in the therapeutic level group (0%). Three AE (9.7%) occurred in the subtherapeutic level group. There was no association between anticoagulation status and AE (P = .238), and no patient required escalation in level of care, intubation, or rapid response activation within 12 hours of physical therapy intervention.Discussion and Conclusion: Adverse events observed during the mobilization of patients with acute LE DVT were not clearly associated with anticoagulation status alone, highlighting the importance of patient-specific clinical factors when assessing mobility risk.
ABSTRACT Background Study: The COVID-19 pandemic and needs of learners required novel strategies to achieve learning outcomes. Virtual reality simulation–based learning experiences (VR SBLE) have emerged as valuable tools to meet learning needs. There is limited research on the use of this teaching modality in physical therapy education. Objectives: This educational innovation project aimed to assess the impact of an interprofessional VR SBLE to increase Doctor of Physical Therapy (DPT) student confidence and proficiency in performing acute care–related skills. Methods: The study (pretest, study phase, post-test) involved 130 DPT students who used a VR SBLE as an activity in an acute care–related course. Outcome measures included surveys to assess confidence in skills, satisfaction with experience, and differences in practical examination scores between cohorts. Results: Significant differences were found within and between cohorts and at different time points on the Acute Care Confidence Survey, P ≤ .001. No differences were found between cohort practical examination scores, P = .215. DPT students reported VR to be a helpful tool to improve acute care skills and confidence. Conclusions: This study highlights the satisfaction and improved confidence with acute care skills using interprofessional VR SBLE for DPT students. Results demonstrate that VR SBLE is a feasible alternative learning activity for educators to consider in health care education programs. Future studies will be needed to explore the long-term outcomes of this novel educational modality.
Background: Early identification of postacute care needs after total hip arthroplasty (THA) and total knee arthroplasty (TKA) is essential to optimize resource utilization, reduce length of stay (LOS), and ensure safe discharge planning in the acute care setting. Although the AM-PAC "6-Clicks" Basic Mobility Score (BMS) is routinely used to guide discharge decisions, the predictive value of the 10-Meter Walk Test (10MWT), an objective gait-speed measure, remains unclear in this population. Objective: To evaluate the 10MWT as a stand-alone predictor of discharge disposition, LOS, and 30-day readmission after elective THA or TKA and compare its predictive validity with the AM-PAC BMS. Methods: A retrospective observational study was conducted using data from patients undergoing elective THA or TKA between January and June 2023. Outcomes included discharge destination (home vs facility), LOS, and 30-day readmission. Predictive performance of the 10MWT and AM-PAC was assessed using ROC analyses and multivariable logistic regression controlling for demographic and surgical factors. Results: Among 415 patients, 90% were discharged home. The 10MWT demonstrated good predictive ability for discharge disposition (AUC 0.91 THA; 0.80 TKA) and LOS >= 3 days (AUC similar to 0.78). Faster gait speed strongly increased odds of home discharge (adjusted OR 3.8 per 0.1 m/s increase). An exploratory cutpoint of <0.23 m/s optimized sensitivity and specificity. Neither the 10MWT nor AM-PAC predicted 30-day readmissions .Conclusions: The 10MWT shows strong independent predictive value for discharge disposition and LOS following THA/TKA and may serve as an additional tool for clinical decision-making. Prospective validation of speed thresholds is warranted.
Background and Purpose:Skin lightening compounds are used globally to achieve lighter skin tones to signify a culturally desirable status. These compounds can contain mercury in an inorganic form. Using skin lightening creams, especially unregulated homemade creams, may lead to dermal effects and complications such as nephrotoxicity and neurotoxicity. Prolonged mercury exposure eventually leads to cell death, including neurons and glial cells.Case Description:A 21-year-old patient presented to a tertiary medical center with acute onset of vision changes, dysarthria, sensory deficits, and memory loss. The symptoms initially lacked an identifiable cause, and Functional Neurologic Disorder was the leading differential diagnosis. Further evaluation revealed elevated mercury levels from skin lightening cream leading to the diagnosis of mercury toxicity.Outcomes:Upon interdisciplinary communication, additional testing was completed, and the correct diagnosis was identified. Early in hospitalization, the patient required minimal assist during ambulation; however, after a lengthy hospitalization with worsening symptoms, the patient was discharged at a dependent functional level.Discussion and Conclusion:Despite the patient's unfavorable outcome, collaborative interprofessional communication during the acute care hospitalization was essential for preventing further disability or mortality. Recognition of atypical symptoms by the acute care physical therapist and allied health team were significant in pursuing an alternate diagnosis, leading to a notable change in the treatment plan. Without this effective communication, it is possible that the correct diagnosis would not have been made. It is crucial to continually assess and use critical thinking skills in acute care physical therapy to provide the highest level of care.
Purpose:No published studies have described implementing a Johns Hopkins Activity and Mobility Promotion (JH-AMP) -inspired early mobilization initiative in an intensive care unit (ICU) serving a racially and socioeconomically diverse patient population. We hypothesized that a JH-AMP -modeled intervention would increase the proportion of patients achieving a Johns Hopkins Highest Level of Mobility (JH-HLM) >= 3, a threshold for clinically meaningful mobility in the ICU, compared with pre-intervention care.Methods:We conducted a retrospective review of a multidisciplinary quality improvement project. ICU admissions from April 4, 2021 to April 3, 2022 served as the pre-intervention group (N=769), and admissions from April 4, 2022 to April 4, 2023 served as the intervention group (N=930). The primary outcome was the percentage of patients who achieved JH-HLM >= 3 at any point during their ICU admission.Results:Patients in the intervention group were more likely to achieve JH-HLM >= 3 during their ICU stay (35.0% vs 24.1%; unadjusted OR 1.70, 95% CI 1.37 -2.10; P<.0001). After adjustment for potential confounders, this association remained significant (adjusted OR 2.16, 95% CI 1.58 -2.95; P<.0001).Conclusions:Implementation of this multidisciplinary intervention improved mobility among patients who are critically ill ICU and supports feasibility of early mobility practices in diverse settings.
Background and Purpose:Patients with end-stage renal disease require hemodialysis (HD), often leading to prolonged sedentary periods and missed physical and occupational therapy sessions during hospitalizations. Intradialytic exercise (IDE) - incorporation of exercise programs during hemodialysis sessions - has been shown to improve dialysis adequacy, cardiovascular fitness, muscle strength, and quality of life in the outpatient setting. IDE is widely studied in outpatient care, however this paper introduces a novel acute program implemented at a large, urban, academic medical center. This program was designed to enhance patient access to therapy services during hospitalizations and to demonstrate the feasibility and safety of IDE in the acute care setting.Approach:The Define, Measure, Analyze, Improve, and Control (DMAIC) methodology was utilized to effectively implement IDE in the acute care setting. Quantitative data identified the clinical nursing units with the highest prevalence of patients on dialysis, which determined the pilot units selected for IDE. Clinical guidelines, exclusion criteria, and a competency specific to IDE were developed and utilized to train physical and occupational therapists to perform IDE.Outcomes:Implementing IDE decreased the percentage of missed therapy sessions by 15%.Discussion and Conclusion:This study demonstrates that IDE is feasible and safe in the acute care setting. It is largely based on evidence from the outpatient setting, which demonstrates the safety, feasibility and positive impact of IDE on patient outcomes. Utilizing a competency and clinical guidelines, specifically for IDE, paired with educational sessions and in-person observation is an effective way to train therapists to perform IDE. IDE reduces the number of missed therapy sessions, allowing patients on dialysis increased access to therapy services while hospitalized. There is an opportunity to evaluate the impact of IDE on patient-specific outcomes in the acute care setting in the future.
Background:Co-treatment (CoTx) is defined as when 2 or more providers choose to combine services and provide a single evaluation or treatment session simultaneously. This is most commonly seen in acute care hospital rehabilitation as physical and occupational therapists working with a single patient concurrently.Purpose:This clinical perspective critically examines the practice of CoTx, including drivers of CoTx in the acute care hospital setting, perspectives on why reducing CoTx usage will lead to improved care, and opportunities for creating a decrease in CoTx volume in clinical practice.Conclusion:Reducing the volume of CoTx is necessary to facilitate the shift toward high-value care, improving both the real and perceived value of physical and occupational therapies in acute care hospitals. The acute care hospital rehabilitation community is encouraged to act now to create this change through education, training, and removing barriers to best practice.
Introduction: The purpose of our study was to explore what characteristics impact access and utilization of physical therapy (PT) for people with sickle cell disease (SCD). Review of Literature: SCD causes functional impairments and decreases quality of life. PT can reduce complications; however, it is unknown what variables impact access and utilization. Subjects: People with SCD who received care in acute care or outpatient settings between 2016-2024. Methods: Variables retrieved included age, race, gender, insurance, area deprivation index, admission type, diagnosis, pain, PT referral and evaluation, and medications. Logistic regression identified factors for predicting access and utilization. Results: Retrieval identified 55 926 episodes with a diagnosis of SCD. Being uninsured decreased referrals (odds ratio [OR] 0.106). Variables that increased referral included age (age 41-60 years, OR 2.166; age >60, OR 3.329), presence of pain (OR 2.131), and access to hydroxyurea (OR 3.196). Age <20 years (OR 0.519) decreased utilization, whereas access to medication (hydroxyurea, OR 4.993; voxelotor, OR 2.719); pain (OR 66.424) and being in the acute care setting (OR 18.403) increased utilization. Conclusion: Variables were found to impact access and utilization. Implementation of these findings may aid in the development of clinical pathways and improve quality of life.
Background/Purpose: Studies on the implementation of high-intensity gait training (HIT) post-stroke have been conducted in inpatient rehabilitation facilities (IRF). However, implementation of HIT in acute care has not been reported. Research indicates that early mobility 48 hours after stroke onset is safe, but the ability to achieve higher targeted intensities remains undefined. This case series examined HIT implementation and outcomes in the acute care setting. Case Description: Five individuals with acute stroke (four ischemic, one hemorrhagic) initiated HIT > 48 hours after stroke onset. Four licensed physical therapists (PTs) delivered HIT 4-5 days/week, for 30 minutes/session while targeting 70-85% age-predicted heart rate maximum (HRmax) or the rating of perceived exertion (RPE) scale of 15-17. Barriers to delivering HIT were documented. Clinical measures of walking and balance function were assessed at baseline and discharge. Outcomes: Participants completed 4-10 sessions with a median session time of 43 minutes. Session characteristics included a peak RPE of 11-17, and peak HRmax of 65%-88%. Greater than 70% HR(max )was achieved in 52% of sessions. Changes in Berg Balance Scale were greater than published MCIDs, with the range of improvements from 8 to 31 points (median 24.5 points). Gait speed gains ranged from 0.0 m/s to 0.82 m/s (median .19 m/s). Barriers included the patients' functional dependency, lack of dedicated training space, and unexpected session interruptions. Discussion/Conclusion: This case series details potential benefits and barriers to HIT implementation in the acute care setting. The data illustrated that initiation of HIT in acute care is feasible. Future research should confirm safety in larger cohorts, establish efficacy through controlled trials, define optimal training parameters, and explore strategies to overcome implementation barriers.
Introduction:The purpose of the present study was to describe the implementation of high-intensity gait training (HIGT) in the acute care setting and its potential impact on functional status and discharge disposition. Review of Literature:Early intensive rehabilitation after stroke, including HIGT, is critical for the recovery of walking function. However, no prior research has investigated the implementation of HIGT in the acute care setting. Subjects:A total of 159 patients with acute stroke and those who received HIGT were included in this study. Methods:A retrospective medical record review collected data on potential adverse events and information about HIGT intensity, duration, and timing of initiation. The potential effect of HIGT timing and dosing on the change in Activity Measure for Post-Acute Care basic mobility short form (AM-PAC 6-Clicks) and discharge disposition was examined using multivariate regression. Results:Most patients required an assist of 1 person (79.9%). Of the 335 HIGT sessions examined, there were only 23 adverse events (6.86%). Of those, 12 (3.6%) occurred during or immediately after a HIGT session. No adverse event resulted in a change of clinical status. No falls occurred during HIGT. When controlling for length of stay, HIGT dose was a statistically significant, independent predictor of change in AM-PAC 6-Clicks (adjusted R2 = 0.22, beta = 0.43, P < .001). HIGT dose was not a statistically significant predictor of change in discharge disposition. Discussion and Conclusion:HIGT appears to be feasible and safe for patients post stroke in the acute care setting. Although a greater dose of HIGT may be associated with greater improvement in functional status, these results need to be replicated and the long-term impact needs to be investigated.
