Increasing the dose of acute rehabilitation: is there a benefit?

Parker, Ann M.; Lord, Robert K.

doi:10.1186/1741-7015-11-199

Cited by 16 publications

(9 citation statements)

References 11 publications

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“…However, increasing the duration and frequency of physical and occupational therapies in inpatients resulted in improved functional independence and better quality of life. 14 An early mobilization protocol significantly reduced patients' total duration of mechanical ventilation and length of stay in the ICU.…”

Section: Emily Castro Is a Critical Care Nurse Educator At Northmentioning

confidence: 99%

Early Mobilization: Changing the Mindset

Castro

Turcinovic

Platz

et al. 2015

Critical Care Nurse

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BACKGROUND Staff in the surgical intensive care unit (SICU) had several concerns about mobilizing patients receiving mechanical ventilation. OBJECTIVE To assess and improve the mindset of SICU staff toward early mobilization of patients receiving mechanical ventilation before, 6 months after, and 1 year after implementation of early mobilization. METHODS The Plan-Do-Study-Act model was used to guide the planning, implementation, evaluation, and interventions to change the mindset and practice of SICU staff in mobilizing patients receiving mechanical ventilation. Interventions to overcome barriers to early mobilization included interdisciplinary collaboration, multimodal education, and operational changes. The mindset of the SICU staff toward early mobilization of patients receiving mechanical ventilation was assessed by using a survey questionnaire distributed 2 weeks before, 6 months after, and 1 year after implementation of early mobilization. RESULTS The median score on 6 of 7 survey questions changed significantly from before, to 6 months after, to 1 year after implementation, indicating a change in the mindset of SICU staff toward early mobilization of patients receiving mechanical ventilation. The SICU staff agreed that most patients receiving mechanical ventilation are able to get out of bed safely with coordination among personnel and that early mobilization of intubated patients decreases length of stay and decreases occurrence of ventilator-associated pneumonia, deep vein thrombosis, and skin breakdown. CONCLUSIONS SICU interdisciplinary team collaboration, multimodal education, and operational support contribute to removing staff bias against mobilizing patients receiving mechanical ventilation. (Critical Care Nurse. 2015;35[4]:e1-e7)

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Section: Emily Castro Is a Critical Care Nurse Educator At Northmentioning

confidence: 99%

Early Mobilization: Changing the Mindset

Castro

Turcinovic

Platz

et al. 2015

Critical Care Nurse

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“…This may be related to increased physical activity among patients who received weekend rehabilitation services, reduced functional decline over the weekend because of increased physical activity, or changes in patient perceptions of no longer associating weekends with rest [ 6 ]. However, in spite of the available evidence, many rehabilitation facilities do not provide weekend services [ 7 - 9 ].…”

Section: Introductionmentioning

confidence: 99%

Are weekend inpatient rehabilitation services value for money? An economic evaluation alongside a randomized controlled trial with a 30 day follow up

Brusco

Watts

Shields

et al. 2014

BMC Med

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BackgroundProviding additional Saturday rehabilitation can improve functional independence and health related quality of life at discharge and it may reduce patient length of stay, yet the economic implications are not known. The aim of this study was to determine from a health service perspective if the provision of rehabilitation to inpatients on a Saturday in addition to Monday to Friday was cost effective compared to Monday to Friday rehabilitation alone.MethodsCost utility and cost effectiveness analyses were undertaken alongside a multi-center, single-blind randomized controlled trial with a 30-day follow up after discharge. Participants were adults admitted for inpatient rehabilitation in two publicly funded metropolitan rehabilitation facilities. The control group received usual care rehabilitation services from Monday to Friday and the intervention group received usual care plus an additional rehabilitation service on Saturday. Incremental cost utility ratio was reported as cost per quality adjusted life year (QALY) gained and an incremental cost effectiveness ratio (ICER) was reported as cost for a minimal clinically important difference (MCID) in functional independence.Results996 patients (mean age 74 (standard deviation 13) years) were randomly assigned to the intervention (n = 496) or the control group (n = 500). Mean difference in cost of AUD$1,673 (95% confidence interval (CI) -271 to 3,618) was a saving in favor of the intervention group. The incremental cost utility ratio found a saving of AUD$41,825 (95% CI -2,817 to 74,620) per QALY gained for the intervention group. The ICER found a saving of AUD$16,003 (95% CI -3,074 to 87,361) in achieving a MCID in functional independence for the intervention group. If the willingness to pay per QALY gained or for a MCID in functional independence was zero dollars the probability of the intervention being cost effective was 96% and 95%, respectively. A sensitivity analysis removing Saturday penalty rates did not significantly alter the outcome.ConclusionsFrom a health service perspective, the provision of rehabilitation to inpatients on a Saturday in addition to Monday to Friday, compared to Monday to Friday rehabilitation alone, is likely to be cost saving per QALY gained and for a MCID in functional independence.Trial registrationAustralian and New Zealand Clinical Trials Registry November 2009 ACTRN12609000973213

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“…There are many challenges in post-stroke rehabilitation. For instance, research investigating different therapies (i.e., physical, occupational, perceptual training) has consistently shown that functional outcome is better when therapy doses are higher ( Lohse et al, 2014 ; Ong et al, 2012 ; Parker et al, 2013 ). However, it is not straightforward to deliver high therapy doses in clinical practice ( Bernhardt et al, 2007 ; Lang et al, 2009 ; Ong et al, 2012 ; Otterman et al, 2012 ).…”

Section: Introductionmentioning

confidence: 99%

The Use of the Term Virtual Reality in Post-Stroke Rehabilitation: A Scoping Review and Commentary

et al. 2021

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Virtual reality (VR) offers many opportunities for post-stroke rehabilitation. However, “VR” can refer to several types of computer-based rehabilitation systems. Since these systems may impact the feasibility and the efficacy of VR interventions, consistent terminology is important. In this study, we aimed to optimize the terminology for VR-based post-stroke rehabilitation by assessing whether and how review papers on this topic defined VR and what types of mixed reality systems were discussed. In addition, this review can inspire the use of consistent terminology for other researchers working with VR. We assessed the use of the term VR in review papers on post-stroke rehabilitation extracted from Scopus, Web of Science and PubMed. We also developed a taxonomy distinguishing 16 mixed reality systems based on three factors: immersive versus semi-immersive displays, the way in which real and virtual information is mixed, and the main input device. 64% of the included review papers (N = 121) explicitly defined VR and 33% of them described different subtypes of VR, with immersive and non-immersive VR as the most common distinction. The most frequently discussed input devices were motion-capture cameras and handheld devices, while regular 2D monitors were the most frequently mentioned output devices. Our analysis revealed that reviews on post-stroke VR rehabilitation did not or only broadly defined “VR” and did not focus on a specific system. Since the efficacy and feasibility of rehabilitation may depend on the specific system, we propose a new data-driven taxonomy to distinguish different systems, which is expected to facilitate communication amongst researchers and clinicians working with virtual reality.

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Increasing the dose of acute rehabilitation: is there a benefit?

Cited by 16 publications

References 11 publications

Early Mobilization: Changing the Mindset

Early Mobilization: Changing the Mindset

Are weekend inpatient rehabilitation services value for money? An economic evaluation alongside a randomized controlled trial with a 30 day follow up

The Use of the Term Virtual Reality in Post-Stroke Rehabilitation: A Scoping Review and Commentary

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