improving functional outcomes of ace unit patients by … · 2016-03-07 · improving functional...

Purpose The purpose of the Acute Care for Elderly (ACE) Group Exercise Program (“ACE-Ercise”) is to improve patient functional outcomes, increase participation in therapy, decrease fall risk, and increase the patient’s chance of returning home upon discharge.

SynthesisNo formal research studies have assessed group physical therapy (PT) protocols for the acutely ill hospitalized patient.7 Previous research reports:• 1weekofbedrestcanresultin20%lossofmusclemassandprofound

weaknesswhichcanleadtolong-termdisabilityandpoorqualityoflife.1-4

• 68%ofpatientsaredischargedfrompost-acutecaresettingsbelowtheirbaselineleveloffunction,whichcontributestonearly1in5Medicarebeneficiariesbeingre-hospitalizedwithin30daysafteranacutehospitalization.6

• Group-basedexercisehasbeenshowntobeeffectiveforfallprevention,quality-of-lifeenhancement,andbalanceimprovementsinindividuals65yearsandolder.7

• IncreasedPTduringanacutehospitalizationdecreaseshospitallengthofstayaswellasimprovesmobility,activity,andqualityoflife.5

Goals• Improvepatientstrength,endurance,andbalance.• Increasesafetywithfunctionalmobility.• Decreasefallrisk.• Increasepatient

motivation.• Increasedelivery

of therapy services during hospitalization.

• Increaselikelihoodof patients discharging home.

Improving Functional Outcomes of ACE Unit Patients by Optimizing Skilled Therapy Through Group SessionsVanessa Gentry, PT; Alyssa Trotsky, PT, DPT; Tina White, OTR; Kimberly Wilkins, PT, DPTPhysical Medicine and Rehabilitation ■ Beaumont Hospital – Royal Oak, MI

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Figure 1. Average # of Therapy Sessions Per Length of Stay

A baseline data value of 50 patients were included in the Pre-“ACE-Ercise” Group over a period of 4 weeks. A total of 63 patients were included in the Post-“ACE-Ercise” Group over a period of 8 weeks.

Data was collected over an 8 week period. Patients with ≤ 1 gait speed recorded were excluded from this data.

Figure 2. Average Difference Between Initial and Final Gait Speeds

Figure 3. Discharge Disposition: Pre-“ACE-Ercise” Program

Figure 4. Discharge Disposition: Post-“ACE-Ercise” Program

ImplementationEach day an interdisciplinary team consisting of PTs, OTs, PTAs, COTAs, RNs,rehabaides,andphysiciansworktogethertoidentifypatientsappropriateforthe“ACE-Ercise”group.Thesepatientsarethenledby bothaPTandOTthroughanestablishedgroupexerciseprogram.

PATIENT CRITERIA• 65yearsofageorolder• Abletofollow1-stepcommands/gestures/demonstration• Agreeabletoparticipate• Isambulatoryorabletoperformtransfers/ADLsathomewithminimal

assistance or less• Notcombativeoragitated• Negativeforcontact/isolation

precautions• HasactivePT/OTordersand

progressive activity orders• Nosurgicalorweight-bearing

precautions• Notonobservation(OPPM)

status

ACE UNIT EXERCISE PROGRAMEndurance Training:5minuteslowerextremitybike

Strengthening Exercises:ChairPush-Ups:1x10repsLongArcQuad(alternating

LandR):2x10repsBicepCurls(using1-3lb.

Weights):2x10repsHipAbduction(usingtheraband):2x10repsHipAbduction(usingball):2x10repsChairPush-Ups:1x10reps

Standing/Balance Exercises LateralWeightShifting:1x10repsAnterior/PosteriorWeightShifting(stridestanding):1x10repsTrunkRotations:1x10repsHeel/ToeRaises:1x10repsToe Taps (Anterior Lateral Posterior):1x5repsMarches:1x10reps

Data Analysis

ResultsAfter the implementation of “ACE-Ercise” Group Exercise Program:• Averagegaitspeedimprovedby0.064m/s.• ThedeliveryofPT/OTservicesincreasedby1.76treatmentsessions,

however,asmallincreaseinpatientrefusalwasexperienced.• Patientsappearedtobemoremotivatedtoparticipateintherapy

sessionsinagroupsetting.Comraderyaswellasfriendlycompetitionwasnotedbetweenpatients.

• 5%morepatientsweredischargedhomeversussubacuterehab.• 5%ofpatientsweredischargedtoinpatientrehabcomparedto2%

in the pre-“ACE-Ercise” group.

Future Implications• Equalpre-andpost-datagroups.• Largersamplesize.• Evaluatetheeffectsoftheprogramon:lengthofstay,hospitalre-

admissionratewithin30days,independencewithactivitiesofdailyliving,andperceivedqualityoflifepost-discharge.

ACkNOwlEDGEMENT We would like to acknowledge and thank the following people for their contribution to this project: Anne Schram OTR, Evelyn Eames PTA, and Paula Dziurda OTR.