Stroke Recovery Program with Modified Cardiac Rehabilitation Improves Mortality, Functional &amp; Cardiovascular Performance

Cuccurullo, Sara; Fleming, Talya K.; Zinonos, Stavros; Cosgrove, Nora M.; Cabrera, Javier; Kostis, John B.; Greiss, Christine; Ray, Arlen Razon; Scarpati, Rosann; Park, Mooyeon Oh; Gizzi, Martin; Kostis, William J.

doi:10.1016/j.jstrokecerebrovasdis.2022.106322

Cited by 15 publications

(17 citation statements)

References 30 publications

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“…The purpose of using data from CCHS was to illustrate outcomes that have smooth trendlines along the AM-PAC scores from a health system without an EHR-PT referral tool similar to previous work. 57 Therefore the discontinuous line in UPMC's data may be attributed to a process that aligned with the EHR-PT referral process. UPMC's main control group had no EHR-PT referrals; here differences between groups were controlled for and compared using the regression discontinuity analysis.…”

Section: Discussion: Implications For Ehr-pt Referrals In the Acute C...mentioning

confidence: 99%

“…Importantly, the AM‐PAC score was not clinically different between the CCHS during‐COVID cohort and the UPMC cohort (17.70 vs. 16.69, respectively). The purpose of using data from CCHS was to illustrate outcomes that have smooth trendlines along the AM‐PAC scores from a health system without an EHR‐PT referral tool similar to previous work 57 . Therefore the discontinuous line in UPMC's data may be attributed to a process that aligned with the EHR‐PT referral process.…”

Section: Discussion: Implications For Ehr‐pt Referrals In the Acute C...mentioning

confidence: 99%

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Effects of an electronic health record‐based mobility assessment and automated referral for inpatient physical therapy on patient outcomes: A quasi‐experimental study

Chou

Johnson

Jones

et al. 2022

Health Services Research

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Objective To assess the effectiveness of a hospital physical therapy (PT) referral triggered by scores on a mobility assessment embedded in the electronic health record (EHR) and completed by nursing staff on hospital admission. Data Sources EHR and billing data from 12 acute care hospitals in a western Pennsylvania health system (January 2017–February 2018) and 11 acute care hospitals in a northeastern Ohio health system (August 2019–July 2021). Study Design We utilized a regression discontinuity design to compare patients admitted to PA hospitals with stroke who reached the mobility score threshold for an EHR‐PT referral (treatment) to those who did not (control). Outcomes were hospital length of stay (LOS) and 30‐day readmission or mortality. Control variables included demographics, insurance, income, and comorbidities. Hospital systems with EHR‐PT referrals were also compared to those without (OH hospitals as alternative control). Subgroup analyses based on age were also conducted. Data Extraction We identified adult patients with a primary or secondary diagnosis of stroke and mobility assessments completed by nursing (n = 4859 in PA hospitals, n = 1749 in OH hospitals) who completed their inpatient stay. Principal Findings In the PA hospitals, patients with EHR‐PT referrals had an 11.4 percentage‐point decrease in their 30‐day readmission or mortality rates (95% CI −0.57, −0.01) relative to the control. This effect was not observed in the OH hospitals for 30‐day readmission (β = 0.01; 95% CI −0.25, 0.26). Adults over 60 years old with EHR‐PT referrals in PA had a 26.2 percentage‐point (95% CI −0.88, −0.19) decreased risk of readmission or mortality compared to those without. Unclear relationships exist between EHR‐PT referrals and hospital LOS in PA. Conclusions Health systems should consider methodologies to facilitate early acute care hospital PT referrals informed by mobility assessments.

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Section: Discussion: Implications For Ehr-pt Referrals In the Acute C...mentioning

confidence: 99%

Section: Discussion: Implications For Ehr‐pt Referrals In the Acute C...mentioning

confidence: 99%

Effects of an electronic health record‐based mobility assessment and automated referral for inpatient physical therapy on patient outcomes: A quasi‐experimental study

Chou

Johnson

Jones

et al. 2022

Health Services Research

View full text Add to dashboard Cite

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“…Taken together, these studies suggest that impairment-focused therapy can improve the extent of recovery at any stage, but the dose of therapy required may be far greater in the chronic stage relative to the acute and subacute stages. Furthermore, retraining cardiovascular capacity within 3 mos poststroke may also have a nonspecific effect on mobility, activities of daily living, and cognition as measured by patient-reported outcomes 15,17 . Thus, optimizing high-dose skill training as well as cardiovascular capacity during the period of biologic recovery may be particularly conducive to motor recovery after stroke (Fig.…”

Section: Recovery After Stroke: What Is Needed?mentioning

confidence: 99%

“…It is well known that poststroke immobility can lead to increased risk of falls, fractures, pneumonia, pressure ulcers, and pulmonary embolism and increases healthcare costs substantially, whereas early, high-frequency rehabilitation can reduce these complications and reduce healthcare costs 10–13 . In addition, immobility limits cardiovascular exercise and increases the risk for recurrent stroke or cardiovascular illness, and recent guidelines emphasize the importance of facilitating physical activity poststroke, which in turn has been shown to reduce readmissions, mortality, and healthcare costs 14–18 . Thus, it is now imperative to implement early recovery-focused rehabilitation in the real world to best serve our patients, mitigate disability, and reduce unnecessary long-term healthcare costs 19 .…”

mentioning

confidence: 99%

“…[10][11][12][13] In addition, immobility limits cardiovascular exercise and increases the risk for recurrent stroke or cardiovascular illness, and recent guidelines emphasize the importance of facilitating physical activity poststroke, which in turn has been shown to reduce readmissions, mortality, and healthcare costs. [14][15][16][17][18] Thus, it is now imperative to implement early recovery-focused rehabilitation in the real world to best serve our patients, mitigate disability, and reduce unnecessary long-term healthcare costs. 19 Hence, we-the leaders, faculty, and staff at the Johns Hopkins Sheikh Khalifa Stroke Institute (SKSI)-collaborated to develop the unified SKSI model of recovery and rehabilitation, which we describe here.…”

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confidence: 99%

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A Unified Model for Stroke Recovery and Rehabilitation

Raghavan¹

2023

Am J Phys Med Rehabil

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The current model of stroke care delivery in the United States and in many parts of the world is fragmented, resulting in lack of continuity of care, inability to track recovery meaningfully across the continuum, and lack of access to the frequency, intensity, and duration of high-quality rehabilitation necessary to optimally harness recovery processes. The process of recovery itself has been overshadowed by a focus on length of stay and the movement of patients across levels of care. Here, we describe the rationale behind the recent efforts at the Johns Hopkins Sheikh Khalifa Stroke Institute to define and coordinate an intensive, strategic effort to develop effective stroke systems of care across the continuum through the development of a unified Sheikh Khalifa Stroke Institute model of recovery and rehabilitation.

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Lower extremity physical function and quality of life in patients with stroke: a longitudinal cohort study

Ryan,

Rössler,

Rommers

et al. 2024

Qual Life Res

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Purpose Lower extremity physical function (LEPF) is a key component for mobility and is impacted in stroke-related disability. A reduction in LEPF can have a significant impact on an individual’s Quality of Life (QoL). The aim of this study is to characterise the relationship between LEPF and QoL. Methods The MOBITEC-Stroke Study is a longitudinal cohort-study including patients with their first occurrence of ischaemic stroke. Using a linear mixed-effects model, the relationship between LEPF (timed up-and-go performance (TUG); predictor) and QoL (Stroke Specific Quality of Life scale (SS-QoL); outcome) at 3 and 12 months post stroke was investigated and adjusted for sex, age, Instrumental Activities of Daily Living (IADL), fear of falling (Falls Efficacy Scale-International Version, FES-I), and stroke severity (National Institute of Stroke Severity scale, NIHSS), accounting for the repeated measurements. Results Data of 51 patients (65 % males, 35% females) were analysed. The mean age was 71.1 (SD 10.4) years, median NIHSS score was 2.0. SS-QoL was 201.5 (SD 20.5) at 3 months and 204.2 (SD 17.4) at 12 months; the mean change was 2.7 (95% CI -2.4 to 7.7), p= 0.293. A positive association was found between baseline TUG performance (estimate log score -13.923; 95% CI -27.495 to -0.351; p=0.048) and change in SS-QoL score in multivariate regression analysis. Conclusion Higher LEPF (i.e better TUG performance) at baseline, was associated with an improvement in QoL from 3- to 12-months post stroke. These results highlight the critical role of physical function, particularly baseline LEPF, in influencing the QoL of stroke survivors.

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Stroke Recovery Program with Modified Cardiac Rehabilitation Improves Mortality, Functional & Cardiovascular Performance

Cited by 15 publications

References 30 publications

Effects of an electronic health record‐based mobility assessment and automated referral for inpatient physical therapy on patient outcomes: A quasi‐experimental study

Effects of an electronic health record‐based mobility assessment and automated referral for inpatient physical therapy on patient outcomes: A quasi‐experimental study

A Unified Model for Stroke Recovery and Rehabilitation

Lower extremity physical function and quality of life in patients with stroke: a longitudinal cohort study

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