Background: Care transitions are a common and frequently adverse aspect of health care, resulting in a high-risk period for both care quality and patient safety (Coleman, 2003; Forster et al., 2003; Picker Institute 1999; van Walraven et al., 2004; Cook et al., 2000). Patients who have complex care needs and undergo treatment from multiple care settings may be at a greater risk for poor care transitions (Coleman et al., 2004). Using quantitative performance measurement scales is one method that can assess the quality of care transitions, and identify areas for improvement. The psychometric properties of the primary performance measurement scale, the Care Transitions Measure (CTM), have not been rigorously assessed, particularly within a higher risk, medically complex population such as older adults with musculoskeletal (MSK) disorders. Furthermore, despite the negative health implications that can result from poor transitions and the commonality of care transitions among persons with complex care needs, there is a significant dearth of research on this crucial aspect of health care. Methods: This research examines the ability of the CTM to adequately assess the quality of care transitions among a complex population of older MSK rehabilitation patients and explores care transitions from the perspective of the patient and the health care provider. Information was gathered through telephone administration of the CTM to MSK patients after they transitioned from inpatient rehabilitation units to home, and through a series of qualitative key informant interviews with a range of health care professionals in care settings relevant to the care continuum of older MSK patients. Inter-rater reliability, a type of reliability that has never been tested with the CTM, and construct validity were assessed and qualitative analyses were used to examine qualitative information obtained through the CTM administration to patients and through the interviews with health care providers. Results: The CTM demonstrated excellent inter-rater reliability for the overall score (intraclass correlation coefficient = 0.77; p=0.03) despite only fair agreement between each item. Internal consistency of the CTM was high (Cronbach’s alpha = 0.94). The construct validity of the CTM was supported; however qualitative data from the patient and health care provider perspectives suggest additional items should be considered for inclusion. Qualitative information from patients also suggests the need for revisions to the wording of some items and the response options. Health care provider interviews suggest that issues surrounding transitional care are similar regardless of the care setting involved. Conclusions: Although the CTM proved to be reliable, qualitative data suggests that the addition of items should be considered to improve the content validity of the CTM, which would in turn improve its construct validity as well. Recommendations for scale improvement are made, as are recommendations for an alternative scale to assess care transition quality from a health care provider perspective. The results of this study support efforts to improve the outcomes of care transitions, care planning, and the overall quality of life for older rehabilitation patients.

Background: Care transitions are a common and frequently adverse aspect of health care, resulting in a high-risk period for both care quality and patient safety (Coleman, 2003; Forster et al., 2003; Picker Institute 1999; van Walraven et al., 2004; Cook et al., 2000). Patients who have complex care needs and undergo treatment from multiple care settings may be at a greater risk for poor care transitions (Coleman et al., 2004). Using quantitative performance measurement scales is one method that can assess the quality of care transitions, and identify areas for improvement. The psychometric properties of the primary performance measurement scale, the Care Transitions Measure (CTM), have not been rigorously assessed, particularly within a higher risk, medically complex population such as older adults with musculoskeletal (MSK) disorders. Furthermore, despite the negative health implications that can result from poor transitions and the commonality of care transitions among persons with complex care needs, there is a significant dearth of research on this crucial aspect of health care. Methods: This research examines the ability of the CTM to adequately assess the quality of care transitions among a complex population of older MSK rehabilitation patients and explores care transitions from the perspective of the patient and the health care provider. Information was gathered through telephone administration of the CTM to MSK patients after they transitioned from inpatient rehabilitation units to home, and through a series of qualitative key informant interviews with a range of health care professionals in care settings relevant to the care continuum of older MSK patients. Inter-rater reliability, a type of reliability that has never been tested with the CTM, and construct validity were assessed and qualitative analyses were used to examine qualitative information obtained through the CTM administration to patients and through the interviews with health care providers. Results: The CTM demonstrated excellent inter-rater reliability for the overall score (intraclass correlation coefficient = 0.77; p=0.03) despite only fair agreement between each item. Internal consistency of the CTM was high (Cronbach’s alpha = 0.94). The construct validity of the CTM was supported; however qualitative data from the patient and health care provider perspectives suggest additional items should be considered for inclusion. Qualitative information from patients also suggests the need for revisions to the wording of some items and the response options. Health care provider interviews suggest that issues surrounding transitional care are similar regardless of the care setting involved. Conclusions: Although the CTM proved to be reliable, qualitative data suggests that the addition of items should be considered to improve the content validity of the CTM, which would in turn improve its construct validity as well. Recommendations for scale improvement are made, as are recommendations for an alternative scale to assess care transition quality from a health care provider perspective. The results of this study support efforts to improve the outcomes of care transitions, care planning, and the overall quality of life for older rehabilitation patients.

Patients with brain injuries can encounter several neurological symptoms that affect physical and psychological functioning. This change in function can impact sexual health and intimacy. Patients with brain injuries who are referred to acute rehabilitation hospitals spend three hours a day in therapy. These patients develop rapport with their occupational therapy practitioners (OTPs) who are in a unique position to address sexual health and intimacy concerns. There is limited research on occupational therapy (OT) interventions for sexual health and intimacy with adults after brain injury. This paper proposes an application program that addresses sexual health and intimacy education for patients with brain injuries receiving occupational therapy. The smartphone application, Comfort, will assist occupational therapists to overcome barriers to include sexual health and intimacy in client-centered and occupation-based care.

Patient satisfaction has a significant role in the healthcare industry, as high patient satisfaction can improve quality outcomes. Hospital leadership is responsible for the culture, outcomes, and patient experience, which can involve different leadership styles. The purpose of this quantitative study was to examine the relationship between leadership style of senior leaders and patient satisfaction in inpatient rehabilitation facilities (IRFs). Through the theoretical framework of transformational and transactional leadership theories, the research questions were designed to determine whether a statistically significant relationship existed between leadership style (transformational, transactional, and laissez-faire leadership) and patient satisfaction. The Multifactor Leadership Questionnaire was administered electronically to senior leaders in an IRF system and combined with secondary patient satisfaction data obtained from the IRF system. Senior leaders from 72 IRFs completed the online survey. Pearson's correlation and multiple linear regression revealed mixed results. The Pearson's correlation indicated small negative linear correlations between transformational leadership and laissez-faire leadership with patient satisfaction as well as a small positive linear correlation between transactional leadership and patient satisfaction. For multiple regression, none of the tests produced statistically significant results, which led to a failure to reject the null hypotheses and inconclusive findings. Through the further examination of the relationship between the leadership subscales and patient satisfaction, healthcare administrators can impact patient satisfaction through education and trainings for senior leaders.

No description available.

During inpatient rehabilitation, arm-ergometry training is utilized to improve the physical capacity of patients with a sub-acute spinal cord injury (SCI) to a level that is desirable for performing activities of daily living (ADLs). Previous work has demonstrated that ≥ 20 minutes of moderate-intensity continuous training (MICT) during inpatient rehabilitation, at a frequency of ≥ 3 times per week, is useful for increasing the physical capacity of these patients. However, considering that inpatient rehabilitation is an intensive program, and given the trend towards a shortened length of stay during inpatient rehabilitation, performing MICT on the arm-ergometer can consume a valuable amount of therapy time. Low-volume sprint interval training (SIT) is a time-efficient alternative to MICT for improving indices of physical fitness in healthy and diseased populations. To date, however, there are no published studies comparing SIT to MICT in persons with sub-acute SCI undergoing inpatient rehabilitation.The purpose of this thesis was to evaluate the efficacy of a five-week, thrice weekly low-volume SIT protocol on the arm-ergometer and compare fitness outcomes to traditional MICT in patients with sub-acute SCI undergoing inpatient rehabilitation. Participants with sub-acute SCI undergoing inpatient rehabilitation were recruited and randomly allocated to the SIT or MICT training group. Both types of training utilized the same 2 min. warm-up and 3 min. cool-down. SIT consisted of 3 x 20 sec. “all-out” cycle sprints (≥ 100% of peak power output [POpeak]), interspersed with 2 min. of low activerecovery (≈ 10% of POpeak; total time commitment, 10 mins). MICT involved 20 min. of arm cycling (45 – 60% of POpeak; total time commitment, 25 mins). SIT elicited a higher relativheart rate response, and ratings of perceived exertion than MICT. Following training, we found similar improvements in maximal and sub-maximal physical capacity across groups. Both exercise modes were equally well tolerated, and enjoyable, and there were no differences in self-efficacy across groups. The significance of this work is that it is the first randomized-controlled trial comparing SIT to MICT on the arm-ergometer in individuals with sub-acute SCI undergoing inpatient rehabilitation. The fact that SIT is palatable and can promote similar increases in physical capacity as MICT, despite less than half the time commitment and training volume, means that clinical rehabilitation specialists can now offer a new, more time-efficient, exercise training strategy to elicit improvements in their patients. / Thesis / Master of Science (MSc)

No description available.

Background: Total knee arthroplasty (TKA) is the treatment of choice for end-stage knee osteoarthritis. Growth in the number of procedures performed annually in the United States is expected to increase steadily. Post-operative rehabilitation settings vary and include both institutional and community based physical therapy (PT) services. Despite access to PT, deficits in gait often persist for months and even years after surgery. Slow gait speed, asymmetrical walking patterns, and prolonged time in double-limb support following the TKA often lead to the need for an assistive device for walking and prolong the rehabilitation phase. Purpose: The purpose of this study is to analyze early gait during inpatient rehabilitation to quantify both the improvements made and deficits that remain in important gait variables. This study identifies predictor variables that contribute to the variance in discharge ambulation device use and IRF length of stay. Subjects: A convenience sample of 230 patients discharged to an IRF following a TKA (160 following a single TKA and 70 following a bilateral procedure) was used for this analysis. Method: Paired t-tests were used to compare temporal and spatial gait variables from the initial gait assessment compared to the discharge gait assessment in patients following single TKA to determine remaining deficits. Right vs left comparisons were made for patients following a bilateral procedure. A binary logistic regression was used to identify predictors associated with the need for a two-handed ambulation device at discharge. A multiple linear regression developed a model to assess predictors of the inpatient rehabilitation length of stay. Finally, a self-assessment to evaluate patient confidence with walking (mGES scale) was correlated to actual gait speed performed on the gait analysis in a sample of patients from our study population. Findings: Deficits in step length, step time and percent of single limb support remained in the involved limb compared to uninvolved limb at discharge from inpatient rehabilitation following single TKA; no limb differences between the right and left side were noted in patients after bilateral TKA. The discharge gait speed of 54.6 cm/sec for single TKA patients and discharge speed of 61.5 cm/sec for bilateral TKA patients is within the classification of limited community ambulators and making them appropriate for a home discharge. But despite improvement from admission to discharge, the gait speed for both groups in our study remain below the gait speed identified by prior studies 3-months following TKA surgery where speed reached 135 cm/sec. The need for a two-handed ambulation device, such as bilateral canes or a walker, was associated with slow walking speed and prior use of a device before surgery. A longer rehabilitation length of stay was associated with slower initial gait speed, lower motor FIM scores and reduced knee extension at admission. The mGES patient self-report conducted at the time of the discharge gait assessment showed a moderate correlation to the discharge gait speed; however, the pairing of the admission mGES with the admission gait speed was not significantly correlated.