improving functional outcomes of ace unit patients by … · 2016-03-07 · improving functional...
TRANSCRIPT
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
P14527_0216
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.