Skilled nursing facilities (SNFs n=5), inpatient rehabilitation facilities (IRFs n=4), and home health agencies (HHAs n=6) from 11 states. To examine differences in outcomes of patients after lower-extremity joint replacement across 3 post-acute care (PAC) rehabilitation settings. This study points to important directions for PAC setting comparative effectiveness studies in the future including uniform measurement, limited consensus on factors influencing recovery, accounting for selection bias, and using end-point data collection that is at the same follow-up time periods for all settings. It remains unclear the extent to which rehabilitation intensity or natural recovery influences changes in functional status for hip fracture patients. Setting-specific effects varied depending on whether self-care or mobility was the outcome of focus. IRF and SNF patients received about the same total minutes of therapy over their PAC stays (approximately 2100 minutes on average), while HHA patients received only about 25% as many minutes. HHA patients' average LOS was 2 weeks longer than SNF patients', whose average LOS was 9 days longer than IRF patients (average 15 days). In contrast, there was no setting-specific advantage in discharge mobility for patients with or without the addition of LOS. Adding length-of-stay (LOS) resulted in non-significant differences between IRFs and SNFs. IRF and HHA patients had lower self-care function at discharge relative to SNF patients controlling for patient characteristics, severity, comorbidities, and services. Not applicable MAIN OUTCOME MEASURE: Self-care and mobility status at PAC discharge measured by the IRF-PAI. Patients receiving PAC rehabilitation following hip fracture with internal fixation (n=116) or total hip replacement (n=64), or no surgical intervention (n=1). Prospective, observational cohort study SETTING: Six skilled nursing facilities (SNFs), 4 inpatient rehabilitation facilities (IRFs), and 8 home health agencies (HHAs) in 10 states. To examine differences in rehabilitation outcomes across 3 post-acute care (PAC) rehabilitation settings for patients following hip fracture repair. Results from this study may support future research by better informing sample size calculations for clinical trials and may also assist clinicians in identifying when variation in level of consciousness is consequential enough to warrant changes in intervention. This is the first study to provide evidence for the size of NBF change that might indicate meaningful recovery in patients with severe TBI. On average, patients that did not improve (n=35), declined by 7.2 units, which exceeds both the MDC95 and the largest distribution-based MCID.Ĭonclusion(s): The DOCS-25 is a responsive, clinician-observed assessment tool for capturing change in neurobehavioral function (NBF) in adults recovering from severe TBI. On average, patients that improved (n=57) gained 14.5 units by week 3, exceeding the anchor-based MCID. Distribution-based MCIDs for small (.20 SD), moderate (.33 SD) and large (.50 SD) differences were 2.6 units, 4.4 units, and 6.6 units, respectively. The MDC95 (95% confidence interval) was 5.6. 45 and 1.3, respectively - moderate to large by Cohen’s criteria. Results: The effect size (ES) and standardized response mean (SRM) of the DOCS-25 for those who improved were. Main Measure(s): Disorders of Consciousness Scale, Glasgow Coma Scale. Ninety-two were included in the DOCS-25 3-week analysis. Participants: One hundred and seventy two patients with severe TBI. Setting: Post-acute rehabilitation hospitals Objectives: To determine the responsiveness, minimal detectable change (MDC95), and minimally clinically important difference (MCID) of the Disorders of Consciousness Scale (DOCS-25) in patients with severe traumatic brain injury (TBI) and to report the percentages of patients’ change scores exceeding MDC and MCID after 3 weeks of inpatient rehabilitation.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |