Recording the Gait of Stroke Patients to Improve
Motivation, Satisfaction and Outcome
P Jayabalan MD, PhD1, T Breisinger PT2, R Kaplan PT2, K Vitti PT2, E Greene PT2, R Donlan DO1 JA Lanphere DO1,
J Shen MD1
1Department of Physical Medicine & Rehabilitation, University of Pittsburgh Medical Center
2Department of Physical Therapy, University of Pittsburgh Medical Center
THE STROKE PATIENT
Significant negative impact on their lives(Thomas et al, 2006)
Rehab progress can plateau(Hallams & Baker, 2009)
‘Lack of understanding’ (Rudd, 2009)
‘Lose motivation & give up’(Hallams & Baker, 2009)
MOTIVATION is a critical factor in outcome(Griffiths 1993, Mclean et al 2000)
STANDARD OF CARE
OBSERVATIONAL GAIT ANALYSIS
Visual inspection of walkingOnce/week in most rehab unitsAssess neuromuscular and behavioral factors affecting gaitMonitor spasticity, pain and contractureSubjective assessment of motivationEvaluate interventionsEducational benefit to clinicians
Findings are NOT conveyed to the patients visually
THE CONCEPT
THERAPY
RECOVERY
THE AMOTIVATED INDIVIDUAL
- COMMUNICATE
- EDUCATE
- MOTIVATE
Lack of encouragement from therapy staff can demotivate patients in
rehabilitation- British Medical Journal, 2010
IMPROVE:
MOTIVATION SATISFACTION
ADHERENCE TO THERAPY
OUTCOME
GOAL
OBJECTIVE
Improve patient motivation, satisfaction and outcome by showing them:1)Video tapes of their gait progression2)Graphical representations of their change in gait ability
1) IMPROVE PATIENT: Motivation Satisfaction Outcome
2) INTERVENTION: Time efficient Educational Easy to perform Inexpensive
CHECKLIST FOR SUCCESS
Include• Acute stroke• Complete gait training as part of rehab
VIDEO GROUPVideo taping of gait rounds + graphical representation of progressn = 15
Standard of care Regular gait rounds No provision of videos or graphical representations of progressAll UPMC rehab facilities except MercyN=11
PROJECT OUTLINE
Cartilage Layer
OUTCOME MEASURES
MOTIVATIONPITTSBURGH REHABILITATION
PARTICIPATION SCALE (Lenze et al, 2004)
SATISFACTION
PATIENT OUTCOME
PRESS GANEY SATISFACTIONSTRUCTURED QUESTIONNAIRE
(Leichert scale)
TUG and 10m WALK TESTSLENGTH OF STAY
+Patient Counseling Session
Video and graphical progress reviewed with the patient 1x/week
Identified patients consent to video Timed up and go test
1x/week
10m walk test 1x/week
Video recorded during gait rounds 2x/week
1.
2.
Assess motivation, satisfaction and patient outcome
METHODS
ON ADMISSION 3 WEEKS LATER
RESULTS - PARTICIPATION
*
RESULTS - SATISFACTION
- 93% felt that the interventions directly improved their satisfaction with their rehab stay
- 92% felt the videos in particular helped them during their rehab admission.
- 100% would strongly recommend these interventions to other patients
iPAD Group
RESULTS – TUG TEST
RESULTS – LENGTH OF STAY
N=6 Standard of CareN=10 iPad Group
RESULTS
N=6 Standard of CareN=10 iPad Group
PATIENT COMMENTS- ‘It gave me confidence to know that when I go home I can cross the
street safely’
- ‘Seeing the areas in which I can improve my walking and then correcting them with rehab was greatly beneficial’
- ‘I never believed I would get better – if I was shown this at the beginning I would believe’
- ‘Was great to see where I was struggling with walking – wish I had 2 more weeks to participate!’
- ‘Great for my motivation and to see how far I’ve come’
DID THIS WORK?1) IMPROVE PATIENT: Motivation Satisfaction Outcome/LOS
2) INTERVENTION: Time efficient Easy to perform Educational Inexpensive Electronic record Strong support from team
Limitations Small sample size Not specific findings Variability between patients
Bottom Line – The intervention improved the patient experience
THE WAY FORWARD
CONCLUSION
Why did it work?
As an INTERVENTION it is:Time efficientEasy to performEducationalInexpensiveStrongly supported by rehab teamCould be part of electronic record
What did it improve?Motivation of our patientsSatisfaction and OutcomeRecord improvements visuallyReduce variations in treatmentImprove patient care deliveryImproved communication and efficiencyEducated patients and treatment team
FIRST OF ITS KIND!
THE STROKE REHAB TEAM
THE PATIENT
THE PATIENT
Physicians
PT
OT
ST
NursingCase Manager
Aides
Social worker
AAPM&R Presentation 2014
University of Pittsburgh Medical Center (UPMC)
T Breisinger DPTR Kaplan PT
K Vitti PTR Donlan DO
JA Lanphere DJ Shen MD
Stroke Unit, Mercy HospitalDepartment of PM&R