Return to the Primary Acute Care Service Among Patients With Multiple Myeloma on an Acute Inpatient Rehabilitation Unit

Fu, Jack B.; Lee, Jay; Shin, Ben C.; Silver, Julie K.; Smith, Dennis W.; Shah, Jatin J.; Bruera, Éduardo

doi:10.1016/j.pmrj.2016.12.007

Cited by 22 publications

(42 citation statements)

References 27 publications

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“…The return to primary acute care service percentage in our LMD group was considerably higher (9/30 or 30%). However, our LMD study was heavily represented by hematologic malignancies (25/30) and is more consistent with their reported return to the primary acute care service rates of between 26% and 38% . Their medical complexity and perhaps the need for ongoing frequent treatments could discourage their acceptance to rehabilitation facilities.…”

Section: Discussionsupporting

confidence: 73%

“…Despite their poor clinical prognosis, those who completed inpatient rehabilitation did demonstrate statistically significant functional gains that could have enabled them to undergo further cancer treatment. Fu et al, in a study of multiple myeloma acute rehabilitation inpatients and their transfer rates to the primary acute care service, found a statistically significant better survival in patients who were discharged from acute inpatient rehab versus those who had to return to the primary acute care service . Our study found a similar relationship; however, the difference was not statistically significant perhaps due to our smaller sample size.…”

Section: Discussionmentioning

confidence: 65%

“…However, our LMD study was heavily represented by hematologic malignancies (25/30) and is more consistent with their reported return to the primary acute care service rates of between 26% and 38%. [23][24][25] Their medical complexity and perhaps the need for ongoing frequent treatments could discourage their acceptance to rehabilitation facilities. A total of 37% (11/30) of patients in our study population received LMD or ongoing cancer treatment while on our acute inpatient rehabilitation unit located within the larger cancer hospital.…”

Section: Discussionmentioning

confidence: 99%

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Retrospective Analysis of Acute Rehabilitation Outcomes of Cancer Inpatients with Leptomeningeal Disease

Molinares

Morishita

et al. 2019

PM&R

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Objective Evaluate Functional Independence Measure (FIM) changes and incidence of serious medical complications requiring return to the primary acute care service of acute rehabilitation cancer inpatients with leptomeningeal disease (LMD). Design Retrospective chart review. Setting Tertiary referral based comprehensive cancer center acute inpatient rehabilitation unit. Participants Thirty cancer patients admitted to acute inpatient rehabilitation between 8 January 2014 and 8 August 2018 with pathology confirmed LMD within 6 months. Interventions Not applicable. Main Outcome Measures FIM and incidence of return to the primary acute care service. Results Twenty five of 30 (83.3%) patients were noted to have neurologic impairments and 13/30 (43.3%) were noted to have cognitive impairments. Five of 30 patients (16.7%) received intrathecal chemotherapy and 4/30 (13.3%) received radiation during acute inpatient rehabilitation for LMD treatment. Median days in acute care prior to acute inpatient rehabilitation was 22.5. Median days from acute inpatient rehabilitation admission until death of the 23 deceased patients as of 1 January 2019 was 180.00. Twenty of 30 (66.7%) patients were discharged home, 9/30 (30%) transferred to the primary acute care service, and 1/30 (3.3%) discharged to a skilled nursing facility. Reasons for return to the primary acute care service included additional chemotherapy 3/9 (33%), neurologic decline 2/9 (22%), fever 2/9 (22%), altered mental status 1/9 (11%), and progressive polyarthritis 1/9 (11%). Of the 21 patients who completed acute inpatient rehabilitation without return to the primary acute care service, mean FIM subscore changes from admission to discharge for Activities of Daily Living, Mobility, and Motor were 5.1 (P < .001), 4.8 (P < .001) and 11.7 (P < .001), respectively (Wilcoxon signed rank test, significance P < .05). Conclusion LMD patients who completed acute inpatient rehabilitation made statistically significant improvements on the majority of FIM items. Most patients were discharged home. Our data suggest LMD should not be a reason for exclusion from acute inpatient rehabilitation. Level of Evidence III.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

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Retrospective Analysis of Acute Rehabilitation Outcomes of Cancer Inpatients with Leptomeningeal Disease

Molinares

Morishita

et al. 2019

PM&R

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“…Leukopenia from chemotherapy or during hematopoietic stem cell transplant engraftment and the use of immunosuppressant agents such as steroids or antigraft versus host disease medications can contribute to an increased likelihood of infection. Infection has been reported in a number of cancer IRF studies as the most common reason for transfer to the primary acute care service [61‐65]. Thrombocytopenia from chemotherapy can lead to an increased risk of bleeding complications.…”

Section: Medical Fragilitymentioning

confidence: 99%

“…In a series of studies by Fu et al [64], frequencies and risk factors for return to the primary acute care service of different hematologic malignancy populations were explored. Return to the primary acute care service rates comprised 41% of hematopoietic stem cell transplant (with 38% of those who transferred back dying in the hospital), 37% of leukemia [63], 27% of lymphoma (unplanned only) [65], and 26% of multiple myeloma patients (unplanned only) [62]. Table 5 [62‐67] summarizes the results of statistically significant or near‐significant variables associated with return to the primary acute care service of various cancer IRF population studies.…”

Section: Medical Fragilitymentioning

confidence: 99%

A Guide to Inpatient Cancer Rehabilitation: Focusing on Patient Selection and Evidence‐Based Outcomes

Raj

Guo

2017

PM&R

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Cancer inpatients commonly suffer from impairments that can prohibit safe discharge home from the acute care inpatient medical service and thus require transfer to a post-acute inpatient rehabilitation facility. It has been demonstrated in multiple studies that cancer rehabilitation inpatients are able to make statistically significant functional improvements and at a similar pace as their non-cancer counterparts. Medical fragility and reimbursement regulations are concerns that affect acceptance and triage of cancer rehabilitation inpatients. Strategies to rehabilitate these challenging patients include considering risk factors for medical complications, consult based inpatient rehabilitation and improved communication and coordination with oncology teams.

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Factors associated with unplanned transfers among cancer patients at a freestanding acute rehabilitation facility

Bhakta

Roy

Huang

et al. 2021

PM&R

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Background: Cancer patients undergoing inpatient rehabilitation often have high risk of complications leading to unplanned transfer to acute care. Prior studies have identified factors associated with these transfers but have been limited to examining factors that pertain to initial admission to rehabilitation and were not conducted in a freestanding inpatient rehabilitation facility.Objective: The study aimed to include these prerehabilitation factors in addition to factors upon initial assessment in rehabilitation. It was hypothesized that specific factors from each of these periods would be associated with unplanned transfer to acute care. Design: Retrospective cohort study. Setting: Freestanding academic inpatient rehabilitation facility affiliated with an academic tertiary care facility with a comprehensive cancer center. Patients: Retrospective review of 330 specific encounters unique to 250 patients from March 2017 to September 2018. Main Outcome Measures: The outcome measure was unplanned transfer to acute care. A binary logistic regression model was used to examine the relationship between factors from oncologic history, acute care course, and factors upon admission to rehabilitation to unplanned transfer to acute care. Results: From 330 encounters, there were 111 unplanned transfers (34%). Unplanned transfer to acute care was independently associated with gastrointestinal malignancy (odds ratio [OR] 4.4, p = .01), 6-minute walk test less than 90 m (OR 4.6, p = .003), and prior unplanned transfer (OR 3.5, p = .007). Conclusions:The study suggests that oncologic and functional prerehabilitation markers are associated with an increased likelihood of unplanned transfer during inpatient cancer rehabilitation. These findings will provide a framework for creating predictive tools for unplanned transfers in cancer rehabilitation patients.

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Return to the Primary Acute Care Service Among Patients With Multiple Myeloma on an Acute Inpatient Rehabilitation Unit

Abstract: IV.

Cited by 22 publications

References 27 publications

Retrospective Analysis of Acute Rehabilitation Outcomes of Cancer Inpatients with Leptomeningeal Disease

Retrospective Analysis of Acute Rehabilitation Outcomes of Cancer Inpatients with Leptomeningeal Disease

A Guide to Inpatient Cancer Rehabilitation: Focusing on Patient Selection and Evidence‐Based Outcomes

Factors associated with unplanned transfers among cancer patients at a freestanding acute rehabilitation facility

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