Choosing Wisely Together: Physical and Occupational Therapy Consultation for Acute Neurology Inpatients

Probasco, John C.; Lavezza, Annette; Cassell, Andre; Shakes, Tenise; Feurer, Angie; Russell, Holly Ann; Sporney, Hilary; Burnett, Margie; Maritim, Chepkorir; Urrutia, Victor C.; Püttgen, H. Adrian; Friedman, Michael; Hoyer, Erik H.

doi:10.1177/1941874417729981

Cited by 23 publications

(19 citation statements)

References 16 publications

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“…Previous research has examined methods for reducing therapy consults among patients with little to no physical impairment (Probasco et al, 2018). The results of the current study may further inform these efforts by showing that patients with goals of six or higher on the JH-HLM scale may not require physical therapy services to reach these goals, as nurses helped patients achieve these types of goals at similar rates in our sample.…”

Section: Discussionsupporting

confidence: 51%

“…Studies have shown the benefits of interprofessional (i.e., nursing, physical therapy) approaches to mobility promotion among hospitalized patients, including decreased lengths of stay and fewer discharges to postacute care settings (Hoyer et al, 2016; Matharsa et al, 2021; van Delft et al, 2020). By engaging disciplines other than physical therapy (i.e., nursing) in mobility promotion efforts, patients can be mobilized more frequently and limited physical therapy resources can be targeted toward those in greatest need of their services (Probasco et al, 2018). Although this type of approach has been shown to be beneficial in postoperative populations (van Delft et al, 2020), it is unclear if patients with different mobility levels are more likely to achieve their mobility goals when seeing a physical therapist or a nurse.…”

Section: Introductionmentioning

confidence: 99%

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An interprofessional examination of the Johns Hopkins Mobility Goal Calculator among hospitalized postsurgical patients

McLaughlin

Young

Friedman

et al. 2022

Nursing & Health Sciences

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Individualized mobility goals created using a goal calculator have been shown to increase patient mobility on medical nursing units, but have not been studied among postoperative populations. This study aimed to examine the feasibility of an automated mobility goal calculator on a postoperative nursing unit. To examine this, we used the goal calculator to create goals for patients (N = 128) following surgery and mobilized each patient with either a nurse or physical therapist. Each patient's highest level of mobility was recorded and providers completed surveys on the appropriateness of calculated goals. Overall, 94% of patients achieved calculated goals. Patients with more pain achieved goals significantly less often than those with less pain. Those with higher mobility achieved their goals similarly with either provider. Providers reported 47% of goals were appropriate, with goals being set too low as the primary reason for goals being inappropriate. We conclude that the automated goal calculator can be used on postoperative nursing units to set realistic goals for patients after surgery.

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Section: Discussionsupporting

confidence: 51%

Section: Introductionmentioning

confidence: 99%

An interprofessional examination of the Johns Hopkins Mobility Goal Calculator among hospitalized postsurgical patients

McLaughlin

Young

Friedman

et al. 2022

Nursing & Health Sciences

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“…Moreover, the domains Beliefs about Consequences, Memory, Attention and Decision Process, and Social/Professional Role & Identity also contained many barriers. Several studies have targeted these domains to improve patients' physical activity levels, such as providing education to counter the belief that physical activity will result in injuries [86,88], using shift huddles to address prioritizing physical activity [89], or mapping the therapy consultation process within a multidisciplinary team to create role clarity and avoid unnecessary treatments [90]. Likewise, the domains Goals and Behavioural Regulation contained many enablers.…”

Section: Discussionmentioning

confidence: 99%

Barriers and enablers to physical activity in patients during hospital stay: a scoping review

et al. 2021

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Background Low levels of physical activity are common during the hospital stay and have been associated with negative health outcomes. Understanding barriers and enablers to physical activity during a hospital stay can improve the development and implementation of tailored interventions aimed at improving physical activity. Previous studies have identified many barriers and enablers, but a comprehensive overview is lacking. This study aimed to identify and categorize all published patient- and healthcare professional-reported barriers and enablers to physical activity during a hospital stay for acute care, using the Theoretical Domains Framework (TDF). Methods We conducted a scoping review of Dutch and English articles using MEDLINE, CINAHL Plus, EMBASE, PsycINFO, and Cochrane Library (inception to September 2020), which included quantitative, qualitative, and mixed-methods studies reporting barriers and enablers to physical activity during a hospital stay for acute care, as perceived by patients or healthcare professionals. Two reviewers systematically extracted, coded, and categorized all barriers and enablers into TDF domains. Results Fifty-six articles were included in this review (32 qualitative, 7 quantitative, and 17 mixed-methods). In total, 264 barriers and 228 enablers were reported by patients, and 415 barriers and 409 enablers by healthcare professionals. Patient-reported barriers were most frequently assigned to the TDF domains Environmental Context & Resources (ECR, n = 148), Social Influences (n = 32), and Beliefs about Consequences (n = 25), while most enablers were assigned to ECR (n = 67), Social Influences (n = 54), and Goals (n = 32). Barriers reported by healthcare professionals were most frequently assigned to ECR (n = 210), Memory, Attention and Decision Process (n = 45), and Social/Professional Role & Identity (n = 31), while most healthcare professional-reported enablers were assigned to the TDF domains ECR (n = 143), Social Influences (n = 76), and Behavioural Regulation (n = 54). Conclusions Our scoping review presents a comprehensive overview of all barriers and enablers to physical activity during a hospital stay and highlights the prominent role of the TDF domains ECR and Social Influences in hospitalized patients’ physical activity behavior. This TDF-based overview provides a theoretical foundation to guide clinicians and researchers in future intervention development and implementation. Scoping review registration No protocol was registered for this review.

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“…5 The AM-PAC score has been used to predict discharge destination within 48 hours of admission 6 and as a guide to allocate inpatient therapy referrals on a medical and a neurosurgical service. 7,8 To date, however, no studies have used AM-PAC scores to evaluate overutilization of physical therapy consults on direct care hospital medicine services. In this study, we aimed to assess the potential overutilization of physical therapy consults on direct care hospital medicine services using validated AM-PAC score cutoffs.…”

mentioning

confidence: 99%

“…The Activity Measure‐Post Acute Care Inpatient Mobility Short Form (AM‐PAC IMSF) is a validated tool for measuring physical function 5 . The AM‐PAC score has been used to predict discharge destination within 48 hours of admission 6 and as a guide to allocate inpatient therapy referrals on a medical and a neurosurgical service 7 , 8 . To date, however, no studies have used AM‐PAC scores to evaluate overutilization of physical therapy consults on direct care hospital medicine services.…”

mentioning

confidence: 99%

Defining Potential Overutilization of Physical Therapy Consults on Hospital Medicine Services

Martinez

Cerasale

Baig³

et al. 2021

Journal of Hospital Medicine

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Appropriate use of inpatient physical therapy services is important for preventing hospital-associated disability (HAD). We assessed potential overutilization of physical therapy consults on hospital medicine services using the Activity Measure-Post Acute Care (AM-PAC) score. Our sample included 3592 unique admissions (mean age, 66 years; 48% women) at a large academic medical center. Based on an AM-PAC cutoff of >43.63 (raw score, 18) in patients who were discharged to home, 38% of physical therapy consults were considered “potential overutilization.” Combined with age <65 years, 18% of consults remained “potential overutilization.” After adjustment for age, sex, and length of stay, patients admitted with high mobility scores were 5.38 times more likely to be discharged to home (95% CI, 4.36-2.89) compared with those with low mobility scores. Being more judicious with physical therapy consults and reserving skilled therapy for at-risk patients could help prevent HAD while also having a positive impact on healthcare systems.

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Choosing Wisely Together: Physical and Occupational Therapy Consultation for Acute Neurology Inpatients

Abstract: A multifaceted intervention led to improved utilization of acute inpatient rehabilitation consultation while increasing the frequency of rehabilitation treatment for patients with highest functional impairment.

Cited by 23 publications

References 16 publications

An interprofessional examination of the Johns Hopkins Mobility Goal Calculator among hospitalized postsurgical patients

An interprofessional examination of the Johns Hopkins Mobility Goal Calculator among hospitalized postsurgical patients

Barriers and enablers to physical activity in patients during hospital stay: a scoping review

Defining Potential Overutilization of Physical Therapy Consults on Hospital Medicine Services

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