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Grant MC, Crisafi C, Alvarez A, Arora RC, Brindle ME, Chatterjee S, Ender J, Fletcher N, Gregory AJ, Gunaydin S, Jahangiri M, Ljungqvist O, Lobdell KW, Morton V, Reddy VS, Salenger R, Sander M, Zarbock A, Engelman DT. Perioperative Care in Cardiac Surgery: A Joint Consensus Statement by the Enhanced Recovery After Surgery (ERAS) Cardiac Society, ERAS International Society, and The Society of Thoracic Surgeons (STS). Ann Thorac Surg 2024; 117:669-689. [PMID: 38284956 DOI: 10.1016/j.athoracsur.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/27/2023] [Accepted: 12/09/2023] [Indexed: 01/30/2024]
Abstract
Enhanced Recovery After Surgery (ERAS) programs have been shown to lessen surgical insult, promote recovery, and improve postoperative clinical outcomes across a number of specialty operations. A core tenet of ERAS involves the provision of protocolized evidence-based perioperative interventions. Given both the growing enthusiasm for applying ERAS principles to cardiac surgery and the broad scope of relevant interventions, an international, multidisciplinary expert panel was assembled to derive a list of potential program elements, review the literature, and provide a statement regarding clinical practice for each topic area. This article summarizes those consensus statements and their accompanying evidence. These results provide the foundation for best practice for the management of the adult patient undergoing cardiac surgery.
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Affiliation(s)
- Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Cheryl Crisafi
- Heart and Vascular Program, Baystate Health, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts
| | - Adrian Alvarez
- Department of Anesthesia, Hospital Italiano, Buenos Aires, Argentina
| | - Rakesh C Arora
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mary E Brindle
- Departments of Surgery and Community Health Services, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
| | - Subhasis Chatterjee
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Joerg Ender
- Department of Anaesthesiology and Intensive Care Medicine, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Nick Fletcher
- Institute of Anesthesia and Critical Care, Cleveland Clinic London, London, United Kingdom; St George's University Hospital, London, United Kingdom
| | - Alexander J Gregory
- Department of Anesthesia, Perioperative and Pain Medicine, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
| | - Serdar Gunaydin
- Department of Cardiovascular Surgery, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Marjan Jahangiri
- Department of Cardiac Surgery, St George's Hospital, London, United Kingdom
| | - Olle Ljungqvist
- Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Kevin W Lobdell
- Regional Cardiovascular and Thoracic Quality, Education, and Research, Atrium Health, Charlotte, North Carolina
| | - Vicki Morton
- Clinical and Quality Outcomes, Providence Anesthesiology Associates, Charlotte, North Carolina
| | - V Seenu Reddy
- Centennial Heart & Vascular Center, Nashville, Tennessee
| | - Rawn Salenger
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael Sander
- Department of Anaesthesiology, Operative Intensive Care Medicine and Pain Therapy, Justus Liebig University of Giessen, Giessen, Germany
| | - Alexander Zarbock
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Daniel T Engelman
- Heart and Vascular Program, Baystate Health, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts
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Dijkstra S, Hartog J, Fleer J, van der Harst P, van der Woude LHV, Mariani MA. Feasibility of preoperative and postoperative physical rehabilitation for cardiac surgery patients - a longitudinal cohort study. BMC Sports Sci Med Rehabil 2023; 15:173. [PMID: 38115103 PMCID: PMC10731823 DOI: 10.1186/s13102-023-00786-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND This study aimed to determine the feasibility of a preoperative and postoperative (in- and outpatient) physical rehabilitation program, the Heart-ROCQ-pilot program. METHODS This cohort study included patients undergoing cardiac surgery (including coronary artery bypass graft surgery, valve surgery, aortic surgery, or combinations of these surgeries) and participated in the Heart-ROCQ-pilot program. Feasibility involved compliance and characteristics of bicycle and strength training sessions in the three rehabilitation phases. RESULTS Of the eligible patients, 56% (n = 74) participated in the program (41% of exclusions were due to various health reasons). On average across the rehabilitation phases, the compliance rates of bicycle and strength training were 88% and 83%, respectively. Workload to heart rate (W/HR) ratio and total absolute volume load for bicycle and strength training, respectively, improved in each rehabilitation phase (P < 0.05). The W/HR-ratio was higher during the last postoperative session compared to the first preoperative session (0.48 to 0.63 W/beat, P < 0.001) and similar to the last preoperative session (0.65 to 0.64 W/beat, P < 0.497). During less than 1% of the bicycle sessions, patients reported discomfort scores of 5 to 6 (scale 0-10, with higher scores indicating a higher level). CONCLUSIONS The Heart-ROCQ-pilot program was feasible for patients awaiting cardiac surgery. Patients were very compliant and were able to safely increase the training load before surgery and regained this improvement within eight weeks after surgery.
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Affiliation(s)
- Sandra Dijkstra
- Department of Cardio-Thoracic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Johanneke Hartog
- Department of Cardio-Thoracic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Joke Fleer
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Lucas H V van der Woude
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Massimo A Mariani
- Department of Cardio-Thoracic Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Kinsey D, Febrey S, Briscoe S, Kneale D, Thompson Coon J, Carrieri D, Lovegrove C, McGrath J, Hemsley A, Melendez-Torres GJ, Shaw L, Nunns M. Impact of interventions to improve recovery of older adults following planned hospital admission on quality-of-life following discharge: linked-evidence synthesis. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-164. [PMID: 38140881 DOI: 10.3310/ghty5117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Objectives To understand the impact of multicomponent interventions to improve recovery of older adults following planned hospital treatment, we conducted two systematic reviews, one of quantitative and one of qualitative evidence, and an overarching synthesis. These aimed to: • understand the effect of multicomponent interventions which aim to enhance recovery and/or reduce length of stay on patient-reported outcomes and health and social care utilisation • understand the experiences of patients, carers and staff involved in the delivery of interventions • understand how different aspects of the content and delivery of interventions may influence patient outcomes. Review methods We searched bibliographic databases including MEDLINE ALL, Embase and the Health Management Information Consortium, CENTRAL, and Cumulative Index to Nursing and Allied Health Literature and Allied and Complementary Medicine Database, conducted forward and backward citation searching and examined reference lists of topically similar qualitative reviews. Bibliographic database searches were completed in May/June 2021 and updated in April 2022. We sought primary research from high-income countries regarding hospital inpatients with a mean/median age of minimum 60 years, undergoing planned surgery. Patients experienced any multicomponent hospital-based intervention to reduce length of stay or improve recovery. Quantitative outcomes included length of stay and any patient-reported outcome or experience or service utilisation measure. Qualitative research focused on the experiences of patients, carers/family and staff of interventions received. Quality appraisal was undertaken using the Effective Public Health Practice Project Quality Assessment Tool or an adapted version of the Wallace checklist. We used random-effects meta-analysis to synthesise quantitative data where appropriate, meta-ethnography for qualitative studies and qualitative comparative analysis for the overarching synthesis. Results Quantitative review: Included 125 papers. Forty-nine studies met criteria for further synthesis. Enhanced recovery protocols resulted in improvements to length of stay, without detriment to other outcomes, with minimal improvement in patient-reported outcome measures for patients admitted for lower-limb or colorectal surgery. Qualitative review: Included 43 papers, 35 of which were prioritised for synthesis. We identified six themes: 'Home as preferred environment for recovery', 'Feeling safe', 'Individualisation of structured programme', 'Taking responsibility', 'Essential care at home' and 'Outcomes'. Overarching synthesis: Intervention components which trigger successful interventions represent individualised approaches that allow patients to understand their treatment, ask questions and build supportive relationships and strategies to help patients monitor their progress and challenge themselves through early mobilisation. Discussion Interventions to reduce hospital length of stay for older adults following planned surgery are effective, without detriment to other patient outcomes. Findings highlight the need to reconsider how to evaluate patient recovery from the perspective of the patient. Trials did not routinely evaluate patient mid- to long-term outcomes. Furthermore, when they did evaluate patient outcomes, reporting is often incomplete or conducted using a narrow range of patient-reported outcome measures or limited through asking the wrong people the wrong questions, with lack of longer-term evaluation. Findings from the qualitative and overarching synthesis will inform policy-making regarding commissioning and delivering services to support patients, carers and families before, during and after planned admission to hospital. Study registration This trial is registered as PROSPERO registration number CRD42021230620. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 130576) and is published in full in Health and Social Care Delivery Research; Vol. 11, No. 23. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Debbie Kinsey
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Samantha Febrey
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Simon Briscoe
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Dylan Kneale
- EPPI-Centre, UCL Social Research Institute, University College London, London, UK
| | - Jo Thompson Coon
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Daniele Carrieri
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Christopher Lovegrove
- School of Health Professions, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
| | - John McGrath
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Anthony Hemsley
- Department of Healthcare for Older People, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - Liz Shaw
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Michael Nunns
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
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Réhabilitation améliorée après chirurgie cardiaque adulte sous CEC ou à cœur battant 2021. ANESTHÉSIE & RÉANIMATION 2022. [DOI: 10.1016/j.anrea.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kushwaha P, Moiz JA, Mujaddadi A. Exercise training and cardiac autonomic function following coronary artery bypass grafting: a systematic review and meta-analysis. Egypt Heart J 2022; 74:67. [PMID: 36138168 PMCID: PMC9500144 DOI: 10.1186/s43044-022-00306-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 09/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exercise training improves cardiac autonomic function is still debatable in patients with coronary artery bypass grafting (CABG). The aim of the present review is to assess the effect of exercise on CABG patient's heart rate variability (HRV) and heart rate recovery (HRR) parameters. MAIN BODY Databases (PubMed, Web of Science and PEDro) were accessed for systematic search from inception till May 2022. Eleven potential studies were qualitatively analyzed by using PEDro and eight studies were included in the quantitative synthesis. Meta-analysis was conducted by using a random-effect model, inverse-variance approach through which standardized mean differences (SMDs) were estimated. The analysis of pooled data showed that exercise training improved HRV indices of standard deviation of the R-R intervals (SDNN) [SMD 0.44, 95% CI 0.17, 0.71, p = 0.002], square root of the mean squared differences between adjacent R-R intervals (RMSSD) [SMD 0.68, 95% CI 0.28, 1.08, p = 0.0008], high frequency (HF) [SMD 0.58, 95% CI 0.18, 0.98, p = 0.005] and low frequency-to-high frequency (LF/HF) ratio [SMD - 0.34, 95% CI - 0.65, - 0.02, p = 0.03]. CONCLUSIONS Exercise training enhances cardiac autonomic function in CABG patients. Owing to the methodological inconsistencies in assessing HRV, the precise effect on autonomic function still remains conflicted. Future high-quality trials are needed focusing on precise methodological approach and incorporation of various types of exercise training interventions will give clarity regarding autonomic adaptations post-exercise training in CABG. Trial registration CRD42021230270 , February 19, 2021.
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Affiliation(s)
- Purnima Kushwaha
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, 110025, India
| | - Jamal Ali Moiz
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, 110025, India
| | - Aqsa Mujaddadi
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, 110025, India.
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Mertes PM, Kindo M, Amour J, Baufreton C, Camilleri L, Caus T, Chatel D, Cholley B, Curtil A, Grimaud JP, Houel R, Kattou F, Fellahi JL, Guidon C, Guinot PG, Lebreton G, Marguerite S, Ouattara A, Provenchère Fruithiot S, Rozec B, Verhoye JP, Vincentelli A, Charbonneau H. Guidelines on enhanced recovery after cardiac surgery under cardiopulmonary bypass or off-pump. Anaesth Crit Care Pain Med 2022; 41:101059. [PMID: 35504126 DOI: 10.1016/j.accpm.2022.101059] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To provide recommendations for enhanced recovery after cardiac surgery (ERACS) based on a multimodal perioperative medicine approach in adult cardiac surgery patients with the aim of improving patient satisfaction, reducing postoperative mortality and morbidity, and reducing the length of hospital stay. DESIGN A consensus committee of 20 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société française d'anesthésie et de réanimation, SFAR) and the French Society of Thoracic and Cardiovascular Surgery (Société française de chirurgie thoracique et cardio-vasculaire, SFCTCV) was convened. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. The entire guideline process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide the assessment of the quality of evidence. METHODS Six fields were defined: (1) selection of the patient pathway and its information; (2) preoperative management and rehabilitation; (3) anaesthesia and analgesia for cardiac surgery; (4) surgical strategy for cardiac surgery and bypass management; (5) patient blood management; and (6) postoperative enhanced recovery. For each field, the objective of the recommendations was to answer questions formulated according to the PICO model (Population, Intervention, Comparison, Outcome). Based on these questions, an extensive bibliographic search was carried out and analyses were performed using the GRADE approach. The recommendations were formulated according to the GRADE methodology and then voted on by all the experts according to the GRADE grid method. RESULTS The SFAR/SFCTCV guideline panel provided 33 recommendations on the management of patients undergoing cardiac surgery under cardiopulmonary bypass or off-pump. After three rounds of voting and several amendments, a strong agreement was reached for the 33 recommendations. Of these recommendations, 10 have a high level of evidence (7 GRADE 1+ and 3 GRADE 1-); 19 have a moderate level of evidence (15 GRADE 2+ and 4 GRADE 2-); and 4 are expert opinions. Finally, no recommendations were provided for 3 questions. CONCLUSIONS Strong agreement existed among the experts to provide recommendations to optimise the complete perioperative management of patients undergoing cardiac surgery.
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Affiliation(s)
- Paul-Michel Mertes
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, FMTS de Strasbourg, Strasbourg, France
| | - Michel Kindo
- Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, FMTS de Strasbourg, Strasbourg, France
| | - Julien Amour
- Institut de Perfusion, de Réanimation, d'Anesthésie de Chirurgie Cardiaque Paris Sud, IPRA, Hôpital Privé Jacques Cartier, Massy, France
| | - Christophe Baufreton
- Department of Cardiovascular and Thoracic Surgery, University Hospital, Angers, France; MITOVASC Institute CNRS UMR 6214, INSERM U1083, University, Angers, France
| | - Lionel Camilleri
- Department of Cardiovascular Surgery, CHU Clermont-Ferrand, T.G.I, I.P., CNRS, SIGMA, UCA, UMR 6602, Clermont-Ferrand, France
| | - Thierry Caus
- Department of Cardiac Surgery, UPJV, Amiens University Hospital, Amiens Picardy University Hospital, Amiens, France
| | - Didier Chatel
- Department of Cardiac Surgery (D.C.), Institut du Coeur Saint-Gatien, Nouvelle Clinique Tours Plus, Tours, France
| | - Bernard Cholley
- Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges-Pompidou, AP-HP, Université de Paris, INSERM, IThEM, Paris, France
| | - Alain Curtil
- Department of Cardiac Surgery, Clinique de la Sauvegarde, Lyon, France
| | | | - Rémi Houel
- Department of Cardiac Surgery, Saint Joseph Hospital, Marseille, France
| | - Fehmi Kattou
- Department of Anaesthesia and Intensive Care, Institut Mutualiste Montsouris, Paris, France
| | - Jean-Luc Fellahi
- Service d'Anesthésie-Réanimation, Hôpital Universitaire Louis Pradel, Hospices Civils de Lyon, Lyon, France; Faculté de Médecine Lyon Est, Université Claude-Bernard Lyon 1, Lyon, France
| | - Catherine Guidon
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Aix Marseille University, Marseille, France
| | - Pierre-Grégoire Guinot
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, Dijon, France; University of Bourgogne and Franche-Comté, LNC UMR1231, Dijon, France; INSERM, LNC UMR1231, Dijon, France; FCS Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France
| | - Guillaume Lebreton
- Sorbonne Université, INSERM, Unité mixte de recherche CardioMetabolisme et Nutrition, ICAN, AP-HP, Hôpital Pitié-Salpétrière, Paris, France
| | - Sandrine Marguerite
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, FMTS de Strasbourg, Strasbourg, France
| | - Alexandre Ouattara
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, F-33000 Bordeaux, France; Univ. Bordeaux, INSERM, UMR 1034, Biology of Cardiovascular Diseases, F-33600 Pessac, France
| | - Sophie Provenchère Fruithiot
- Department of Anaesthesia, Université de Paris, Bichat-Claude Bernard Hospital, Paris, France; Centre d'Investigation Clinique 1425, INSERM, Université de Paris, Paris, France
| | - Bertrand Rozec
- Service d'Anesthésie-Réanimation, Hôpital Laennec, CHU Nantes, Nantes, France; Université de Nantes, CHU Nantes, CNRS, INSERM, Institut duDu Thorax, Nantes, France
| | - Jean-Philippe Verhoye
- Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - André Vincentelli
- Department of Cardiac Surgery, University of Lille, CHU Lille, Lille, France
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Jacob P, Gupta P, Shiju S, Omar AS, Ansari S, Mathew G, Varghese M, Pulimoottil J, Varkey S, Mahinay M, Jesus D, Surendran P. Multidisciplinary, early mobility approach to enhance functional independence in patients admitted to a cardiothoracic intensive care unit: a quality improvement programme. BMJ Open Qual 2021. [PMID: 34535456 DOI: 10.1136/bmjoq-2020-001256.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Early mobilisation following cardiac surgery is vital for improved patient outcomes, as it has a positive effect on a patient's physical and psychological recovery following surgery. We observed that patients admitted to the cardiothoracic intensive care unit (CTICU) following cardiac surgery had only bed exercises and were confined to bed until the chest tubes were removed, which may have delayed patients achieving functional independence. Therefore, the CTICU team implemented a quality improvement (QI) project aimed at the early mobilisation of patients after cardiac surgery.A retrospective analysis was undertaken to define the current mobilisation practices in the CTICU. The multidisciplinary team identified various practice gaps and tested several changes that led to the implementation of a successful early mobility programme. The tests were carried out and reported using rapid cycle changes. A model for improvement methodology was used to run the project. The outcomes of the project were analysed using standard 'run chart rules' to detect changes in outcomes over time and Welch's t-test to assess the significance of these outcomes.This project was implemented in 2015. Patient compliance with early activity and mobilisation gradually reached 95% in 2016 and was sustained over the next 3 years. After the programme was implemented, the mean hours required for initiating out-of-bed-mobilisation was reduced from 22.77 hours to 11.74 hours. Similarly, functional independence measures and intensive care unit mobility scores also showed a statistically significant (p<0.005) improvement in patient transfers out of the CTICU.Implementing an early mobility programme for post-cardiac surgery patients is both safe and feasible. This QI project allowed for early activity and mobilisation, a substantial reduction in the number of hours required for initiating out-of-bed mobilisation following cardiac surgery, and facilitated the achievement of early ambulation and functional milestones in our patients.
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Affiliation(s)
- Prasobh Jacob
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Poonam Gupta
- Performance Improvement Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Shiny Shiju
- Nursing Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Amr Salah Omar
- Senior Consultant, Cardiac Anesthesia Department, Heart Hospital, Hamad Medical Corporaton, Doha, Qatar
| | - Syed Ansari
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Gigi Mathew
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Miki Varghese
- Nursing Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Sumi Varkey
- Nursing Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Menandro Mahinay
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Darlene Jesus
- Data Informatics Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Praveen Surendran
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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Jacob P, Gupta P, Shiju S, Omar AS, Ansari S, Mathew G, Varghese M, Pulimoottil J, Varkey S, Mahinay M, Jesus D, Surendran P. Multidisciplinary, early mobility approach to enhance functional independence in patients admitted to a cardiothoracic intensive care unit: a quality improvement programme. BMJ Open Qual 2021; 10:bmjoq-2020-001256. [PMID: 34535456 PMCID: PMC8451290 DOI: 10.1136/bmjoq-2020-001256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 08/29/2021] [Indexed: 01/17/2023] Open
Abstract
Early mobilisation following cardiac surgery is vital for improved patient outcomes, as it has a positive effect on a patient's physical and psychological recovery following surgery. We observed that patients admitted to the cardiothoracic intensive care unit (CTICU) following cardiac surgery had only bed exercises and were confined to bed until the chest tubes were removed, which may have delayed patients achieving functional independence. Therefore, the CTICU team implemented a quality improvement (QI) project aimed at the early mobilisation of patients after cardiac surgery.A retrospective analysis was undertaken to define the current mobilisation practices in the CTICU. The multidisciplinary team identified various practice gaps and tested several changes that led to the implementation of a successful early mobility programme. The tests were carried out and reported using rapid cycle changes. A model for improvement methodology was used to run the project. The outcomes of the project were analysed using standard 'run chart rules' to detect changes in outcomes over time and Welch's t-test to assess the significance of these outcomes.This project was implemented in 2015. Patient compliance with early activity and mobilisation gradually reached 95% in 2016 and was sustained over the next 3 years. After the programme was implemented, the mean hours required for initiating out-of-bed-mobilisation was reduced from 22.77 hours to 11.74 hours. Similarly, functional independence measures and intensive care unit mobility scores also showed a statistically significant (p<0.005) improvement in patient transfers out of the CTICU.Implementing an early mobility programme for post-cardiac surgery patients is both safe and feasible. This QI project allowed for early activity and mobilisation, a substantial reduction in the number of hours required for initiating out-of-bed mobilisation following cardiac surgery, and facilitated the achievement of early ambulation and functional milestones in our patients.
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Affiliation(s)
- Prasobh Jacob
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Poonam Gupta
- Performance Improvement Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Shiny Shiju
- Nursing Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Amr Salah Omar
- Senior Consultant, Cardiac Anesthesia Department, Heart Hospital, Hamad Medical Corporaton, Doha, Qatar
| | - Syed Ansari
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Gigi Mathew
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Miki Varghese
- Nursing Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Sumi Varkey
- Nursing Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Menandro Mahinay
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Darlene Jesus
- Data Informatics Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Praveen Surendran
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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Salenger R, Holmes SD, Rea A, Yeh J, Knott K, Born R, Boss MJ, Barr LF. Cardiac Enhanced Recovery After Surgery: Early Outcomes in a Community Setting. Ann Thorac Surg 2021; 113:2008-2017. [PMID: 34352198 DOI: 10.1016/j.athoracsur.2021.06.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 06/04/2021] [Accepted: 06/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) programs have demonstrated improved outcomes in non-cardiac surgery. More recently, ERAS has been applied to cardiac surgery with promising results. We have implemented cardiac ERAS at our community-based program, aiming to improve all phases of care, and now report our early results. METHODS We retrospectively analyzed 73 consecutive patients treated with ERAS care compared to 74 patients treated prior to implementing ERAS. Our ERAS program consisted of 6 perioperative care bundles including enhanced patient education, shortened preoperative fasting period and oral carbohydrate load, postoperative nausea prophylaxis, multimodal opioid-sparing analgesia, early extubation, and early mobilization. RESULTS ERAS patients required significantly less opioids captured as total milligram morphine equivalents (MME; median: 35.0 versus 75.3, P < .001), less nausea as determined by fewer total ondansetron rescue doses (median 0 versus 0.5, P = .011), and less lightheadedness (P = .028) compared with pre-ERAS patients. Postoperative mobility was significantly better (POD 4: 95% vs 81%, P = .013) and postoperative length of stay was lower for ERAS care, but did not reach statistical significance (median 4 vs 5 days, P = .06). There was no difference in pain or glucose control or in early extubation. CONCLUSIONS Cardiac ERAS significantly decreased opioid use, nausea, lightheadedness and improved functional outcome for cardiac surgical patients in a community hospital.
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Affiliation(s)
- Rawn Salenger
- Division of Cardiac Surgery, University of Maryland Saint Joseph Medical Center, Towson, MD; Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD.
| | - Sari D Holmes
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Amanda Rea
- Division of Cardiac Surgery, University of Maryland Saint Joseph Medical Center, Towson, MD
| | - Jennifer Yeh
- Pharmacy Department, University of Maryland Saint Joseph Medical Center, Towson, MD
| | - Kate Knott
- Division of Cardiac Surgery, University of Maryland Saint Joseph Medical Center, Towson, MD
| | - Rachel Born
- Department of Rehabilitation, University of Maryland Saint Joseph Medical Center, Towson, MD
| | - Michael J Boss
- Division of Cardiac Anesthesia, University of Maryland Saint Joseph Medical Center, Towson, MD
| | - Linda F Barr
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine
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10
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Giacchi M, Nguyen MT, Gaudin J, Bergin M, Collicoat O, Armstrong B, Jennings S, El-ansary D, Lee AL. The relationship between cardiorespiratory parameters, mobilisation and physical function following cardiac surgery. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2021.1942195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Matthew Giacchi
- Department of Medicine, Monash University, Clayton, Australia
| | - My-Thao Nguyen
- Department of Medicine, Monash University, Clayton, Australia
| | - James Gaudin
- Centre for Allied Health Research and Education, Cabrini Health, Malvern, Australia
| | - Miles Bergin
- Centre for Allied Health Research and Education, Cabrini Health, Malvern, Australia
| | - Olivia Collicoat
- Centre for Allied Health Research and Education, Cabrini Health, Malvern, Australia
| | - Bronte Armstrong
- Centre for Allied Health Research and Education, Cabrini Health, Malvern, Australia
| | - Sophie Jennings
- Centre for Allied Health Research and Education, Cabrini Health, Malvern, Australia
| | - Doa El-ansary
- Physiotherapy, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia
- Department of Surgery, Royal Melbourne Hospital, School of Medicine, University of Melbourne, Parkville, Australia
| | - Annemarie L. Lee
- Centre for Allied Health Research and Education, Cabrini Health, Malvern, Australia
- Department of Physiotherapy, Monash University, Frankston, Australia
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11
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Morisawa T, Saitoh M, Takahashi T, Watanabe H, Mochizuki M, Kitahara E, Fujiwara T, Fujiwara K, Nishitani-Yokoyama M, Minamino T, Shimada K, Honzawa A, Shimada A, Yamamoto T, Asai T, Amano A, Daida H. Association of phase angle with hospital-acquired functional decline in older patients undergoing cardiovascular surgery. Nutrition 2021; 91-92:111402. [PMID: 34364266 DOI: 10.1016/j.nut.2021.111402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/14/2021] [Accepted: 06/20/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this study was to examine whether preoperative phase angle (PhA) measured by bioelectrical impedance analysis was associated with a hospital-acquired functional decline in older patients undergoing cardiovascular surgery. METHODS This was an observational study of prospectively collected data of 114 patients (>65 y of age) with cardiovascular disease who underwent elective cardiovascular surgery between September 2019 and August 2020. Patients were classified into tertiles based on PhA levels. Factors associated with the occurrence of hospital-acquired functional decline (postoperative recovery to preoperative physical function was not possible) were analyzed using univariate and multivariate analyses. RESULTS Patients in the low PhA group were significantly older than those in the middle and high PhA groups; were predominantly women; had higher New York Heart Association cardiovascular and EuroSCORE severity scores; and had significantly lower levels of body mass index, Geriatric Nutritional Risk Index, hemoglobin, and albumin. There was a significant correlation between PhA and nutrition and physical function. The incidence of hospital-acquired functional decline occurred in 26.3% of all patients, with a significantly higher incidence in patients in the low PhA group. Multivariate analysis showed that PhA was extracted as a factor for the hospital-acquired functional decline in all the models. CONCLUSIONS PhA was associated with hospital-acquired functional decline in older patients undergoing cardiovascular surgery. PhA is likely to be a comprehensive indicator of physical health that indicates nutritional status, physical function, and geriatric syndrome (frailty/sarcopenia), and is an important predictor of hospital-acquired functional decline in this group of older patients.
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Affiliation(s)
- Tomoyuki Morisawa
- Faculty of Health Science, Juntendo University, Tokyo, Japan; Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan.
| | - Masakazu Saitoh
- Faculty of Health Science, Juntendo University, Tokyo, Japan; Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan
| | - Tetsuya Takahashi
- Faculty of Health Science, Juntendo University, Tokyo, Japan; Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan
| | - Hidetaka Watanabe
- Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan
| | | | - Eriko Kitahara
- Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan
| | - Toshiyuki Fujiwara
- Faculty of Health Science, Juntendo University, Tokyo, Japan; Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan; Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kei Fujiwara
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Miho Nishitani-Yokoyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | | | - Akio Honzawa
- Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, Tokyo, Japan
| | - Akie Shimada
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Taira Yamamoto
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Faculty of Health Science, Juntendo University, Tokyo, Japan; Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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12
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Chen B, Xie G, Lin Y, Chen L, Lin Z, You X, Xie X, Dong D, Zheng X, Li D, Lin W. A systematic review and meta-analysis of the effects of early mobilization therapy in patients after cardiac surgery. Medicine (Baltimore) 2021; 100:e25314. [PMID: 33847630 PMCID: PMC8051976 DOI: 10.1097/md.0000000000025314] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/03/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Prolonged hospitalization and immobility of critical care patients elevate the risk of long-term physical and cognitive impairments. However, the therapeutic effects of early mobilization have been difficult to interpret due to variations in study populations, interventions, and outcome measures. We conducted a meta-analysis to assess the effects of early mobilization therapy on cardiac surgery patients in the intensive care unit (ICU). METHODS PubMed, Excerpta Medica database (EMBASE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), and the Cochrane Library were comprehensively searched from their inception to September 2018. Randomized controlled trials were included if patients were adults (≥18 years) admitted to any ICU for cardiac surgery due to cardiovascular disease and who were treated with experimental physiotherapy initiated in the ICU (pre, post, or peri-operative). Data were extracted by 2 reviewers independently using a pre-constructed data extraction form. Length of ICU and hospital stay was evaluated as the primary outcomes. Physical function and adverse events were assessed as the secondary outcomes. Review Manager 5.3 (RevMan 5.3) was used for statistical analysis. For all dichotomous variables, relative risks or odds ratios with 95% confidence intervals (CI) were presented. For all continuous variables, mean differences (MDs) or standard MDs with 95% CIs were calculated. RESULTS The 5 studies with a total of 652 patients were included in the data synthesis final meta-analysis. While a slight favorable effect was detected in 3 out of the 5 studies, the overall effects were not significant, even after adjusting for heterogeneity. CONCLUSIONS This population-specific evaluation of the efficacy of early mobilization to reduce hospitalization duration suggests that intervention may not universally justify the labor barriers and resource costs in patients undergoing non-emergency cardiac surgery. PROSPERO RESEARCH REGISTRATION IDENTIFYING NUMBER CRD42019135338.
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Affiliation(s)
- Bin Chen
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine
- National Clinical Research Base of Traditional Chinese Medicine, Fuzhou 350004, Fujian Province
| | - Guanli Xie
- Yunnan University of Traditional Chinese Medicine, Kunming 650500, Yunnan Province, China
| | - Yuan Lin
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine
| | - Lianghua Chen
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine
| | - Zhichen Lin
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine
| | - Xiaofang You
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine
| | - Xuemin Xie
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine
| | - Danyu Dong
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine
| | - Xinyi Zheng
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine
| | - Dong Li
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine
| | - Wanqing Lin
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine
- National Clinical Research Base of Traditional Chinese Medicine, Fuzhou 350004, Fujian Province
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Halfwerk FR, van Haaren JHL, Klaassen R, van Delden RW, Veltink PH, Grandjean JG. Objective Quantification of In-Hospital Patient Mobilization after Cardiac Surgery Using Accelerometers: Selection, Use, and Analysis. SENSORS 2021; 21:s21061979. [PMID: 33799717 PMCID: PMC7999757 DOI: 10.3390/s21061979] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/03/2021] [Accepted: 03/07/2021] [Indexed: 01/06/2023]
Abstract
Cardiac surgery patients infrequently mobilize during their hospital stay. It is unclear for patients why mobilization is important, and exact progress of mobilization activities is not available. The aim of this study was to select and evaluate accelerometers for objective qualification of in-hospital mobilization after cardiac surgery. Six static and dynamic patient activities were defined to measure patient mobilization during the postoperative hospital stay. Device requirements were formulated, and the available devices reviewed. A triaxial accelerometer (AX3, Axivity) was selected for a clinical pilot in a heart surgery ward and placed on both the upper arm and upper leg. An artificial neural network algorithm was applied to classify lying in bed, sitting in a chair, standing, walking, cycling on an exercise bike, and walking the stairs. The primary endpoint was the daily amount of each activity performed between 7 a.m. and 11 p.m. The secondary endpoints were length of intensive care unit stay and surgical ward stay. A subgroup analysis for male and female patients was planned. In total, 29 patients were classified after cardiac surgery with an intensive care unit stay of 1 (1 to 2) night and surgical ward stay of 5 (3 to 6) nights. Patients spent 41 (20 to 62) min less time in bed for each consecutive hospital day, as determined by a mixed-model analysis (p < 0.001). Standing, walking, and walking the stairs increased during the hospital stay. No differences between men (n = 22) and women (n = 7) were observed for all endpoints in this study. The approach presented in this study is applicable for measuring all six activities and for monitoring postoperative recovery of cardiac surgery patients. A next step is to provide feedback to patients and healthcare professionals, to speed up recovery.
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Affiliation(s)
- Frank R. Halfwerk
- Thoraxcentrum Twente, Medisch Spectrum Twente, P.O. Box 50 000, 7500 KA Enschede, The Netherlands; (J.H.L.v.H.); (J.G.G.)
- Department of Biomechanical Engineering, TechMed Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
- Correspondence:
| | - Jeroen H. L. van Haaren
- Thoraxcentrum Twente, Medisch Spectrum Twente, P.O. Box 50 000, 7500 KA Enschede, The Netherlands; (J.H.L.v.H.); (J.G.G.)
| | - Randy Klaassen
- Human Media Interaction Lab, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands; (R.K.); (R.W.v.D.)
| | - Robby W. van Delden
- Human Media Interaction Lab, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands; (R.K.); (R.W.v.D.)
| | - Peter H. Veltink
- Department of Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands;
| | - Jan G. Grandjean
- Thoraxcentrum Twente, Medisch Spectrum Twente, P.O. Box 50 000, 7500 KA Enschede, The Netherlands; (J.H.L.v.H.); (J.G.G.)
- Department of Biomechanical Engineering, TechMed Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
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14
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Baldwin CE, Parry SM, Norton L, Williams J, Lewis LK. A scoping review of interventions using accelerometers to measure physical activity or sedentary behaviour during hospitalization. Clin Rehabil 2020; 34:1157-1172. [DOI: 10.1177/0269215520932965] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To identify interventions using wearable accelerometers to measure physical activity and/or sedentary behaviour in adults during hospitalization for an acute medical/surgical condition. Data sources: Four databases were searched in August 2019 (MEDLINE, CINAHL, Scopus, EMBASE). Review methods: Studies were selected if they described an intervention in adults with a medical/surgical condition, and concurrently reported an accelerometer-derived measure of physical activity and/or sedentary behaviour while participants were admitted. Items were screened for eligibility in duplicate. Included studies were synthesized to describe intervention types, feasibility and potential effectiveness. Results: Twenty-two studies were included, reporting on 3357 participants (2040 with accelerometer data). Identified types of interventions were: pre-habilitation ( n = 2) exercise ( n = 3), patient behaviour change with self-monitoring ( n = 6), models of care ( n = 5), implementing system change ( n = 2), surgical technique ( n = 2) patients wearing day clothes ( n = 1) and education about activity in hospital ( n = 1). Of 16 studies that reported intervention effects on physical activity, 11 reported a favourable impact including studies of: pre-habilitation, self-monitoring (accelerometry or an activity whiteboard), physiotherapy, an early mobility bundle, minimally invasive surgery, an education booklet and by implementing system change. Of the six studies that reported intervention effects on sedentary behaviour, there was a favourable impact with an activity whiteboard, models of care and an education booklet. Conclusion: Accelerometer-derived measures of physical activity and/or sedentary behaviour have been used to describe sample characteristics and intervention effects in studies of hospitalized adults. Interventions may involve a range of health professionals, but less is known about sedentary behaviour in this setting.
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Affiliation(s)
- Claire E Baldwin
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Selina M Parry
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Lynda Norton
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Sport, Health, Activity, Performance and Exercise (SHAPE) Research Centre, Flinders University, Adelaide, SA, Australia
| | - Jill Williams
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Lucy K Lewis
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Sport, Health, Activity, Performance and Exercise (SHAPE) Research Centre, Flinders University, Adelaide, SA, Australia
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15
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Nunns M, Shaw L, Briscoe S, Thompson Coon J, Hemsley A, McGrath JS, Lovegrove CJ, Thomas D, Anderson R. Multicomponent hospital-led interventions to reduce hospital stay for older adults following elective surgery: a systematic review. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BackgroundElective older adult inpatient admissions are increasingly common. Older adults are at an elevated risk of adverse events in hospital, potentially increasing with lengthier hospital stay. Hospital-led organisational strategies may optimise hospital stay for elective older adult inpatients.ObjectivesTo evaluate the effectiveness and cost-effectiveness of hospital-led multicomponent interventions to reduce hospital stay for older adults undergoing elective hospital admissions.Data sourcesSeven bibliographic databases (MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, Health Management Information Consortium, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature and Allied and Complementary Medicine Database) were searched from inception to date of search (August 2017), alongside carrying out of web searches, citation searching, inspecting relevant reviews, consulting stakeholders and contacting authors. This search was duplicated, with an additional cost-filter, to identify cost-effectiveness evidence.Review methodsComparative studies were sought that evaluated the effectiveness or cost-effectiveness of relevant interventions in elective inpatients with a mean or median age of ≥ 60 years. Study selection, data extraction and quality assessment were completed independently by two reviewers. The main outcome was length of stay, but all outcomes were considered. Studies were sorted by procedure, intervention and outcome categories. Where possible, standardised mean differences or odds ratios were calculated. Meta-analysis was performed when multiple randomised controlled trials had the same intervention, treatment procedure, comparator and outcome. Findings were explored using narrative synthesis.FindingsA total of 218 articles were included, with 80 articles from 73 effectiveness studies (n = 26,365 patients) prioritised for synthesis, including 34 randomised controlled trials conducted outside the UK and 39 studies from the UK, of which 12 were randomised controlled trials. Fifteen studies included cost-effectiveness data. The evidence was dominated by enhanced recovery protocols and prehabilitation, implemented to improve recovery from either colorectal surgery or lower limb arthroplasty. Six other surgical categories and four other intervention types were identified. Meta-analysis found that enhanced recovery protocols were associated with 1.5 days’ reduction in hospital stay among patients undergoing colorectal surgery (Cohen’sd = –0.51, 95% confidence interval –0.78 to –0.24;p < 0.001) and with 5 days’ reduction among those undergoing upper abdominal surgery (Cohen’sd = –1.04, 95% confidence interval –1.55 to –0.53;p < 0.001). Evidence from the UK was not pooled (owing to mixed study designs), but it echoed findings from the international literature. Length of stay usually was reduced with intervention or was no different. Other clinical outcomes also improved or were no worse with intervention. Patient-reported outcomes were not frequently reported. Cost and cost-effectiveness evidence came from 15 highly heterogeneous studies and was less conclusive.LimitationsStudies were usually of moderate or weak quality. Some intervention or treatment types were under-reported or absent. The reporting of variance data often precluded secondary analysis.ConclusionsEnhanced recovery and prehabilitation interventions were associated with reduced hospital stay without detriment to other clinical outcomes, particularly for patients undergoing colorectal surgery, lower limb arthroplasty or upper abdominal surgery. The impacts on patient-reported outcomes, health-care costs or additional service use are not well known.Future workFurther studies evaluating of the effectiveness of new enhanced recovery pathways are not required in colorectal surgery or lower limb arthroplasty. However, the applicability of these pathways to other procedures is uncertain. Future studies should evaluate the implementation of interventions to reduce service variation, in-hospital patient-reported outcomes, impacts on health and social care service use, and longer-term patient-reported outcomes.Study registrationThis study is registered as PROSPERO CRD42017080637.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Michael Nunns
- Exeter Health Services and Delivery Research Evidence Synthesis Centre, Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Liz Shaw
- Exeter Health Services and Delivery Research Evidence Synthesis Centre, Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Simon Briscoe
- Exeter Health Services and Delivery Research Evidence Synthesis Centre, Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Jo Thompson Coon
- Exeter Health Services and Delivery Research Evidence Synthesis Centre, Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Anthony Hemsley
- Department of Healthcare for Older People, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - John S McGrath
- Exeter Health Services and Delivery Research Evidence Synthesis Centre, Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
- Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Christopher J Lovegrove
- Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
- School of Health Professions, Faculty of Health & Human Sciences, University of Plymouth, Plymouth, UK
| | - David Thomas
- Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Rob Anderson
- Exeter Health Services and Delivery Research Evidence Synthesis Centre, Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
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16
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Effects of Different Rehabilitation Protocols in Inpatient Cardiac Rehabilitation After Coronary Artery Bypass Graft Surgery. J Cardiopulm Rehabil Prev 2019; 39:E19-E25. [DOI: 10.1097/hcr.0000000000000431] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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17
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Hartog J, Blokzijl F, Dijkstra S, DeJongste MJL, Reneman MF, Dieperink W, van der Horst ICC, Fleer J, van der Woude LHV, van der Harst P, Mariani MA. Heart Rehabilitation in patients awaiting Open heart surgery targeting to prevent Complications and to improve Quality of life (Heart-ROCQ): study protocol for a prospective, randomised, open, blinded endpoint (PROBE) trial. BMJ Open 2019; 9:e031738. [PMID: 31537574 PMCID: PMC6756317 DOI: 10.1136/bmjopen-2019-031738] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION The rising prevalence of modifiable risk factors (eg, obesity, hypertension and physical inactivity) is causing an increase in possible avoidable complications in patients undergoing cardiac surgery. This study aims to assess whether a combined preoperative and postoperative multidisciplinary cardiac rehabilitation (CR) programme (Heart-ROCQ programme) can improve functional status and reduce surgical complications, readmissions and major adverse cardiac events (MACE) as compared with standard care. METHODS AND ANALYSIS Patients (n=350) are randomised to the Heart-ROCQ programme or standard care. The Heart-ROCQ programme consists of a preoperative optimisation phase while waiting for surgery (three times per week, minimum of 3 weeks), a postoperative inpatient phase (3 weeks) and an outpatient CR phase (two times per week, 4 weeks). Patients receive multidisciplinary treatment (eg, physical therapy, dietary advice, psychological sessions and smoking cessation). Standard care consists of 6 weeks of postsurgery outpatient CR with education and physical therapy (two times per week). The primary outcome is a composite weighted score of functional status, surgical complications, readmissions and MACE, and is evaluated by a blinded endpoint committee. The secondary outcomes are length of stay, physical and psychological functioning, lifestyle risk factors, and work participation. Finally, an economic evaluation is performed. Data are collected at six time points: at baseline (start of the waiting period), the day before surgery, at discharge from the hospital, and at 3, 7 and 12 months postsurgery. ETHICS AND DISSEMINATION This study will be conducted according to the principles of the Declaration of Helsinki (V.8, October 2013). The protocol has been approved by the Medical Ethical Review Board of the UMCG (no 2016/464). Results of this study will be submitted to a peer-reviewed scientific journal and can be presented at national and international conferences. TRIAL REGISTRATION NUMBER NCT02984449.
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Affiliation(s)
- Johanneke Hartog
- Department of Cardio-thoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Fredrike Blokzijl
- Department of Cardio-thoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sandra Dijkstra
- Department of Cardio-thoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mike J L DeJongste
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel F Reneman
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Willem Dieperink
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Iwan C C van der Horst
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joke Fleer
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lucas H V van der Woude
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Massimo A Mariani
- Department of Cardio-thoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Fazio S, Stocking J, Kuhn B, Doroy A, Blackmon E, Young HM, Adams JY. How much do hospitalized adults move? A systematic review and meta-analysis. Appl Nurs Res 2019; 51:151189. [PMID: 31672262 DOI: 10.1016/j.apnr.2019.151189] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/22/2019] [Accepted: 09/02/2019] [Indexed: 01/04/2023]
Abstract
AIM To quantify the type and duration of physical activity performed by hospitalized adults. BACKGROUND Inactivity is pervasive among hospitalized patients and is associated with increased mortality, functional decline, and cognitive impairment. Objective measurement of activity is necessary to examine associations with clinical outcomes and quantify optimal inpatient mobility interventions. METHODS We used PRISMA guidelines to search three databases in December 2017 to retrieve original research evaluating activity type and duration among adult acute-care inpatients. We abstracted data on inpatient population, measurement method, monitoring time, activity duration, and study quality. RESULTS Thirty-eight articles were included in the review and 7 articles were included in the meta-analysis. Study populations included geriatric (n = 5), surgical (n = 5), medical (n = 12), post-stroke (n = 10), psychiatric (n = 2), and critical care inpatients (n = 4). To measure activity, 29% of studies used human observation and 71% used activity monitors. Among inpatient populations, 87-100% of time was spent sitting or lying in-bed. Among medical inpatients monitored over a continuous 24-hour period (n = 7), 70 min per day was spent standing/walking (95% CI 57-83 min). CONCLUSIONS This review provides a baseline assessment and benchmark of inpatient activity, which can be used to compare inpatient mobility practices. While there is substantial heterogeneity in how researchers measure and define how much inpatients move, there is consistent evidence that patients are mostly inactive and in-bed during hospitalization. Future research is needed to establish standardized methods to accurately and consistently measure inpatient mobility over time.
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Affiliation(s)
- Sarina Fazio
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, 2570 48th Street, CA 95817, United States of America; UC Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817, United States of America; Division of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, University of California, Davis, Sacramento, 4150 V Street, Suite 3400, CA 95817, United States of America.
| | - Jacqueline Stocking
- Division of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, University of California, Davis, Sacramento, 4150 V Street, Suite 3400, CA 95817, United States of America
| | - Brooks Kuhn
- Division of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, University of California, Davis, Sacramento, 4150 V Street, Suite 3400, CA 95817, United States of America
| | - Amy Doroy
- UC Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817, United States of America
| | - Emma Blackmon
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, 2570 48th Street, CA 95817, United States of America; UC Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817, United States of America
| | - Heather M Young
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, 2570 48th Street, CA 95817, United States of America
| | - Jason Y Adams
- Division of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, University of California, Davis, Sacramento, 4150 V Street, Suite 3400, CA 95817, United States of America
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Hegewald J, Wegewitz UE, Euler U, van Dijk JL, Adams J, Fishta A, Heinrich P, Seidler A. Interventions to support return to work for people with coronary heart disease. Cochrane Database Syst Rev 2019; 3:CD010748. [PMID: 30869157 PMCID: PMC6416827 DOI: 10.1002/14651858.cd010748.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND People with coronary heart disease (CHD) often require prolonged absences from work to convalesce after acute disease events like myocardial infarctions (MI) or revascularisation procedures such as coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Reduced functional capacity and anxiety due to CHD may further delay or prevent return to work. OBJECTIVES To assess the effects of person- and work-directed interventions aimed at enhancing return to work in patients with coronary heart disease compared to usual care or no intervention. SEARCH METHODS We searched the databases CENTRAL, MEDLINE, Embase, PsycINFO, NIOSHTIC, NIOSHTIC-2, HSELINE, CISDOC, and LILACS through 11 October 2018. We also searched the US National Library of Medicine registry, clinicaltrials.gov, to identify ongoing studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) examining return to work among people with CHD who were provided either an intervention or usual care. Selected studies included only people treated for MI or who had undergone either a CABG or PCI. At least 80% of the study population should have been working prior to the CHD and not at the time of the trial, or study authors had to have considered a return-to-work subgroup. We included studies in all languages. Two review authors independently selected the studies and consulted a third review author to resolve disagreements. DATA COLLECTION AND ANALYSIS Two review authors extracted data and independently assessed the risk of bias. We conducted meta-analyses of rates of return to work and time until return to work. We considered the secondary outcomes, health-related quality of life and adverse events among studies where at least 80% of study participants were eligible to return to work. MAIN RESULTS We found 39 RCTs (including one cluster- and four three-armed RCTs). We included the return-to-work results of 34 studies in the meta-analyses.Person-directed, psychological counselling versus usual careWe included 11 studies considering return to work following psychological interventions among a subgroup of 615 participants in the meta-analysis. Most interventions used some form of counselling to address participants' disease-related anxieties and provided information on the causes and course of CHD to dispel misconceptions. We do not know if these interventions increase return to work up to six months (risk ratio (RR) 1.08, 95% confidence interval (CI) 0.84 to 1.40; six studies; very low-certainty evidence) or at six to 12 months (RR 1.24, 95% CI 0.95 to 1.63; seven studies; very low-certainty evidence). We also do not know if psychological interventions shorten the time until return to work. Psychological interventions may have little or no effect on the proportion of participants working between one and five years (RR 1.09, 95% CI 0.88 to 1.34; three studies; low-certainty evidence).Person-directed, work-directed counselling versus usual careFour studies examined work-directed counselling. These counselling interventions included advising patients when to return to work based on treadmill testing or extended counselling to include co-workers' fears and misconceptions regarding CHD. Work-directed counselling may result in little to no difference in the mean difference (MD) in days until return to work (MD -7.52 days, 95% CI -20.07 to 5.03 days; four studies; low-certainty evidence). Work-directed counselling probably results in little to no difference in cardiac deaths (RR 1.00, 95% CI 0.19 to 5.39; two studies; moderate-certainty evidence).Person-directed, physical conditioning interventions versus usual careNine studies examined the impact of exercise programmes. Compared to usual care, we do not know if physical interventions increase return to work up to six months (RR 1.17, 95% CI 0.97 to 1.41; four studies; very low-certainty evidence). Physical conditioning interventions may result in little to no difference in return-to-work rates at six to 12 months (RR 1.09, 95% CI 0.99 to 1.20; five studies; low-certainty evidence), and may also result in little to no difference on the rates of patients working after one year (RR 1.04, 95% CI 0.82 to 1.30; two studies; low-certainty evidence). Physical conditioning interventions may result in little to no difference in the time needed to return to work (MD -7.86 days, 95% CI -29.46 to 13.74 days; four studies; low-certainty evidence). Physical conditioning interventions probably do not increase cardiac death rates (RR 1.00, 95% CI 0.35 to 2.80; two studies; moderate-certainty evidence).Person-directed, combined interventions versus usual careWe included 13 studies considering return to work following combined interventions in the meta-analysis. Combined cardiac rehabilitation programmes may have increased return to work up to six months (RR 1.56, 95% CI 1.23 to 1.98; number needed to treat for an additional beneficial outcome (NNTB) 5; four studies; low-certainty evidence), and may have little to no difference on return-to-work rates at six to 12 months' follow-up (RR 1.06, 95% CI 1.00 to 1.13; 10 studies; low-certainty evidence). We do not know if combined interventions increased the proportions of participants working between one and five years (RR 1.14, 95% CI 0.96 to 1.37; six studies; very low-certainty evidence) or at five years (RR 1.09, 95% CI 0.86 to 1.38; four studies; very low-certainty evidence). Combined interventions probably shortened the time needed until return to work (MD -40.77, 95% CI -67.19 to -14.35; two studies; moderate-certainty evidence). Combining interventions probably results in little to no difference in reinfarctions (RR 0.56, 95% CI 0.23 to 1.40; three studies; moderate-certainty evidence).Work-directed, interventionsWe found no studies exclusively examining strictly work-directed interventions at the workplace. AUTHORS' CONCLUSIONS Combined interventions may increase return to work up to six months and probably reduce the time away from work. Otherwise, we found no evidence of either a beneficial or harmful effect of person-directed interventions. The certainty of the evidence for the various interventions and outcomes ranged from very low to moderate. Return to work was typically a secondary outcome of the studies, and as such, the results pertaining to return to work were often poorly reported. Adhering to RCT reporting guidelines could greatly improve the evidence of future research. A research gap exists regarding controlled trials of work-directed interventions, health-related quality of life within the return-to-work process, and adverse effects.
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Affiliation(s)
- Janice Hegewald
- Faculty of Medicine Carl Gustav Carus, TU DresdenInstitute and Policlinic of Occupational and Social MedicineFetscherstrasse 74DresdenGermany01307
| | - Uta E Wegewitz
- Federal Institute for Occupational Safety and Health (BAuA)Division 3: Work and HealthNöldnerstr. 40‐42BerlinGermanyD‐10317
| | - Ulrike Euler
- Faculty of Medicine Carl Gustav Carus, TU DresdenInstitute and Policlinic of Occupational and Social MedicineFetscherstrasse 74DresdenGermany01307
| | - Jaap L van Dijk
- Dutch Institute of Clinical Occupational MedicineHilversumNetherlands
| | - Jenny Adams
- Baylor Hamilton Heart and Vascular HospitalCardiac Rehabilitation Unit411 N Washington, Suite 3100DallasTexasUSA75218
| | - Alba Fishta
- Federal Institute for Occupational Safety and Health (BAuA)Evidence Based Medicine, OH ManagementNöldnerstr. 40‐42BerlinGermanyD‐10317
| | - Philipp Heinrich
- Faculty of Medicine Carl Gustav Carus, TU DresdenInstitute and Policlinic of Occupational and Social MedicineFetscherstrasse 74DresdenGermany01307
| | - Andreas Seidler
- Faculty of Medicine Carl Gustav Carus, TU DresdenInstitute and Policlinic of Occupational and Social MedicineFetscherstrasse 74DresdenGermany01307
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Szylińska A, Listewnik M, Rotter I, Rył A, Kotfis K, Mokrzycki K, Kuligowska E, Walerowicz P, Brykczyński M. The Efficacy of Inpatient vs. Home-Based Physiotherapy Following Coronary Artery Bypass Grafting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2572. [PMID: 30453599 PMCID: PMC6266912 DOI: 10.3390/ijerph15112572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/08/2018] [Accepted: 11/11/2018] [Indexed: 11/16/2022]
Abstract
Background: Intensive post-operative physiotherapy after cardiac surgery helps to reduce the number of complications, accelerating convalescence and decreasing peri-operative mortality. Cardiac rehabilitation is aimed at regaining lost function and sustaining the effect of cardiac surgery. The aim of this study was to compare the efficacy of inpatient and home-based phase II physiotherapy following coronary artery bypass grafting, and inpatient phase II post-operative physiotherapy based on the analysis of the spirometry results. Methods: A prospective observational study included 104 adult patients of both sexes undergoing planned coronary artery bypass grafting and were randomized to one of the two groups-inpatients (InPhysio) and home-based (HomePhysio) at a 1:1 ratio. All patients had undergone spirometry testing prior to surgery (S1) and on the fifth day after the operation (S2), i.e., on the day of completion of the first phase (PI) of physiotherapy. Both the study group (InPhysio) and the control group (HomePhysio) performed the same set of exercises in the second phase (PII) of cardiac physiotherapy, either in the hospital or at home, respectively, according to the program obtained in the hospital. Both groups have undergone spirometry testing (S3) at 30 days after the operation. Results: The demographic and peri-operative data for both groups were comparable and showed no statistically significant differences. An analysis of gradients between the results of spirometry tests before surgery and at 30 days after the surgery showed a smaller decrease in forced vital capacity (FVC) in the study group than in the control group (p < 0.001). The results at five and 30 days after the surgery showed a greater increase in FVC in the study group than in the control group (680 mL vs. 450 mL, p = 0.009). There were no statistically significant differences in other parameters studied. Conclusions: The advantage of inpatient over home-based physiotherapy was evidenced by much smaller decreases in FVC between the initial and final tests, and greater increases between the fifth day after surgery and the final test. Our analysis showed greater efficacy of inpatient physiotherapy as compared with home-based exercises and raises concerns about patient adherence.
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Affiliation(s)
- Aleksandra Szylińska
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, ul. Żołnierska 54, 70-204 Szczecin, Poland.
| | - Mariusz Listewnik
- Department of Cardiac Surgery, Pomeranian Medical University in Szczecin, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland.
| | - Iwona Rotter
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, ul. Żołnierska 54, 70-204 Szczecin, Poland.
| | - Aleksandra Rył
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University in Szczecin, ul. Żołnierska 54, 70-204 Szczecin, Poland.
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland.
| | - Krzysztof Mokrzycki
- Department of Cardiac Surgery, Pomeranian Medical University in Szczecin, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland.
| | - Ewelina Kuligowska
- Department of Cardiac Surgery, Pomeranian Medical University in Szczecin, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland.
| | - Paweł Walerowicz
- Department of Cardiac Surgery, Pomeranian Medical University in Szczecin, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland.
| | - Mirosław Brykczyński
- Department of Cardiac Surgery, Pomeranian Medical University in Szczecin, al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland.
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21
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Doyle MP, Indraratna P, Tardo DT, Peeceeyen SC, Peoples GE. Safety and efficacy of aerobic exercise commenced early after cardiac surgery: A systematic review and meta-analysis. Eur J Prev Cardiol 2018; 26:36-45. [PMID: 30188177 DOI: 10.1177/2047487318798924] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Aerobic exercise is a critical component of cardiac rehabilitation following cardiac surgery. Aerobic exercise is traditionally commenced 2-6 weeks following hospital discharge and most commonly includes stationary cycling or treadmill walking. The initiation of aerobic exercise within this early postoperative period not only introduces the benefits associated with aerobic activity sooner, but also ameliorates the negative effects of immobilization associated with the early postoperative period. METHODS A systematic review identified all studies reporting safety and efficacy outcomes of aerobic exercise commenced within two weeks of cardiac surgery. A meta-analysis was performed comparing functional, aerobic and safety outcomes in patients receiving early postoperative aerobic exercise compared with usual postoperative care. RESULTS Six-minute walk test distance at hospital discharge was 419 ± 88 m in early aerobic exercise patients versus 341 ± 81 m in those receiving usual care (mean difference 69.5 m, 95% confidence interval (CI) 39.2-99.7 m, p < 0.00001). Peak aerobic power was 18.6 ± 3.8 ml·kg-1·min-1 in those receiving early exercise versus 15.0 ± 2.1 ml·kg-1·min-1 in usual care (mean difference 3.20 ml·kg-1·min-1, 95% CI 1.45-4.95, p = 0.0003). There was no significant difference in adverse events rates between the two groups (odds ratio 0.41, 95% CI 0.12-1.42, p = 0.16). CONCLUSION Aerobic exercise commenced early after cardiac surgery significantly improves functional and aerobic capacity following cardiac surgery. While adverse event rates did not differ significantly, patients included were very low risk. Further studies are required to adequately assess safety outcomes of aerobic exercise commenced early after cardiac surgery.
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Affiliation(s)
- Mathew P Doyle
- 1 School of Medicine, University of Wollongong, Wollongong, Australia.,2 Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia
| | - Praveen Indraratna
- 3 Department of Cardiology, St George Hospital, Sydney, Australia.,4 Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Daniel T Tardo
- 3 Department of Cardiology, St George Hospital, Sydney, Australia.,5 School of Medicine, University of Notre Dame, Sydney, Australia
| | - Sheen Cs Peeceeyen
- 2 Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia
| | - Gregory E Peoples
- 1 School of Medicine, University of Wollongong, Wollongong, Australia
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22
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Haas R, O’Brien L, Bowles KA, Haines T. Effectiveness of a weekend physiotherapy service on short-term outcomes following hip and knee joint replacement surgery: a quasi-experimental study. Clin Rehabil 2018; 32:1493-1508. [DOI: 10.1177/0269215518779647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Romi Haas
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
- Allied Health Research Unit, Monash Health, Melbourne, VIC, Australia
| | - Lisa O’Brien
- Allied Health Research Unit, Monash Health, Melbourne, VIC, Australia
- Department of Occupational Therapy, Monash University, Melbourne, VIC, Australia
| | - Kelly-Ann Bowles
- Allied Health Research Unit, Monash Health, Melbourne, VIC, Australia
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, VIC, Australia
| | - Terry Haines
- Allied Health Research Unit, Monash Health, Melbourne, VIC, Australia
- School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia
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23
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Peiris CL, Shields N, Brusco NK, Watts JJ, Taylor NF. Additional Physical Therapy Services Reduce Length of Stay and Improve Health Outcomes in People With Acute and Subacute Conditions: An Updated Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2018; 99:2299-2312. [PMID: 29634915 DOI: 10.1016/j.apmr.2018.03.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 02/06/2018] [Accepted: 03/05/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To update a previous review on whether additional physical therapy services reduce length of stay, improve health outcomes, and are safe and cost-effective for patients with acute or subacute conditions. DATA SOURCES Electronic database (AMED, CINAHL, EMBASE, MEDLINE, Physiotherapy Evidence Database [PEDro], PubMed) searches were updated from 2010 through June 2017. STUDY SELECTION Randomized controlled trials evaluating additional physical therapy services on patient health outcomes, length of stay, or cost-effectiveness were eligible. Searching identified 1524 potentially relevant articles, of which 11 new articles from 8 new randomized controlled trials with 1563 participants were selected. In total, 24 randomized controlled trials with 3262 participants are included in this review. DATA EXTRACTION Data were extracted using the form used in the original systematic review. Methodological quality was assessed using the PEDro scale, and the Grading of Recommendation Assessment, Development, and Evaluation approach was applied to each meta-analysis. DATA SYNTHESIS Postintervention data were pooled with an inverse variance, random-effects model to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs). There is moderate-quality evidence that additional physical therapy services reduced length of stay by 3 days in subacute settings (mean difference [MD]=-2.8; 95% CI, -4.6 to -0.9; I2=0%), and low-quality evidence that it reduced length of stay by 0.6 days in acute settings (MD=-0.6; 95% CI, -1.1 to 0.0; I2=65%). Additional physical therapy led to small improvements in self-care (SMD=.11; 95% CI, .03-.19; I2=0%), activities of daily living (SMD=.13; 95% CI, .02-.25; I2=15%), and health-related quality of life (SMD=.12; 95% CI, .03-.21; I2=0%), with no increases in adverse events. There was no significant change in walking ability. One trial reported that additional physical therapy was likely to be cost-effective in subacute rehabilitation. CONCLUSIONS Additional physical therapy services improve patient activity and participation outcomes while reducing hospital length of stay for adults. These benefits are likely safe, and there is preliminary evidence to suggest they may be cost-effective.
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Affiliation(s)
- Casey L Peiris
- La Trobe University, College of Science, Health and Engineering, Department of Rehabilitation, Nutrition and Sport, School of Allied Health(Physiotherapy), Melbourne.
| | - Nora Shields
- La Trobe University, College of Science, Health and Engineering, Department of Rehabilitation, Nutrition and Sport, School of Allied Health(Physiotherapy), Melbourne; Northern Health, Northern Centre for Health Education and Research, Epping
| | - Natasha K Brusco
- La Trobe University, College of Science, Health and Engineering, Department of Rehabilitation, Nutrition and Sport, School of Allied Health(Physiotherapy), Melbourne; Cabrini Health, Physiotherapy, Malvern
| | - Jennifer J Watts
- Deakin University, School of Health and Social Development, Faculty of Health, Burwood
| | - Nicholas F Taylor
- La Trobe University, College of Science, Health and Engineering, Department of Rehabilitation, Nutrition and Sport, School of Allied Health(Physiotherapy), Melbourne; Eastern Health, Eastern Health Clinical Research Office, Box Hill, Australia
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Johnson AM, Henning AN, Morris PE, Tezanos AGV, Dupont-Versteegden EE. Timing and Amount of Physical Therapy Treatment are Associated with Length of Stay in the Cardiothoracic ICU. Sci Rep 2017; 7:17591. [PMID: 29242519 PMCID: PMC5730602 DOI: 10.1038/s41598-017-17624-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 11/15/2017] [Indexed: 01/06/2023] Open
Abstract
Significant variability exists in physical therapy early mobilization practice. The frequency of physical therapy or early mobilization of patients in the cardiothoracic intensive care unit and its effect on length of stay has not been investigated. The goal of our research was to examine variables that influence physical therapy evaluation and treatment in the intensive care unit using a retrospective chart review. Patients (n = 2568) were categorized and compared based on the most common diagnoses or surgical procedures. Multivariate semi-logarithmic regression analyses were used to determine correlations. Differences among patient subgroups for all independent variables other than age and for length of stay were found. The regression model determined that time to first physical therapy evaluation, Charlson Comorbidity Index score, mean days of physical therapy treatment and mechanical ventilation were associated with increased hospital length of stay. Time to first physical therapy evaluation in the intensive care unit and the hospital, and mean days of physical therapy treatment associated with hospital length of stay. Further prospective study is required to determine whether shortening time to physical therapy evaluation and treatment in a cardiothoracic intensive care unit could influence length of stay.
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Affiliation(s)
- Audrey M Johnson
- Department of Rehabilitation Sciences, College of Health Sciences, University of Kentucky, Lexington, Kentucky, United States of America.
| | - Angela N Henning
- Rehabilitation Department, UK HealthCare, Lexington, Kentucky, United States of America
| | - Peter E Morris
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Lexington, Kentucky, United States of America
| | - Alejandro G Villasante Tezanos
- Department of Statistics, College of Arts and Sciences, University of Kentucky, Lexington, Kentucky, United States of America
| | - Esther E Dupont-Versteegden
- Department of Rehabilitation Sciences, College of Health Sciences, University of Kentucky, Lexington, Kentucky, United States of America
- Center for Muscle Biology, College of Health Sciences, University of Kentucky, Lexington, Kentucky, United States of America
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25
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Baldwin C, van Kessel G, Phillips A, Johnston K. Accelerometry Shows Inpatients With Acute Medical or Surgical Conditions Spend Little Time Upright and Are Highly Sedentary: Systematic Review. Phys Ther 2017; 97:1044-1065. [PMID: 29077906 DOI: 10.1093/ptj/pzx076] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 07/21/2017] [Indexed: 11/13/2022]
Abstract
BACKGROUND Physical inactivity and sedentary behaviors have significant and independent effects on health. The use of wearable monitors to measure these constructs in people who are hospitalized with an acute illness is rapidly expanding, but has not been systematically described. PURPOSE The purpose of this study was to review the use of accelerometer monitoring with inpatients who are acutely ill, including what activity and sedentary behaviors have been measured and how active or sedentary inpatients are. DATA SOURCES Databases used were MEDLINE, EMBASE, CINAHL, and Scopus. STUDY SELECTION Quantitative studies of adults with an acute medical or surgical hospital admission, on whom an accelerometer was used to measure a physical activity or sedentary behavior, were selected. DATA EXTRACTION AND DATA SYNTHESIS Procedures were completed independently by 2 reviewers, with differences resolved and cross-checked by a third reviewer. Forty-two studies were identified that recruited people who had medical diagnoses (n = 10), stroke (n = 5), critical illness (n = 3), acute exacerbations of lung disease (n = 7), cardiac conditions (n = 7), or who were postsurgery (n = 10). Physical activities or sedentary behaviors were reported in terms of time spent in a particular posture (lying/sitting, standing/stepping), active/inactive, or at a particular activity intensity. Physical activity was also reported as step count, number of episodes or postural transitions, and bouts. Inpatients spent 93% to 98.8% (range) of their hospital stay sedentary, and in most studies completed <1,000 steps/day despite up to 50 postural transitions/day. No study reported sedentary bouts. Many studies controlled for preadmission function as part of the recruitment strategy or analysis or both. LIMITATIONS Heterogeneity in monitoring devices (17 models), protocols, and variable definitions limited comparability between studies and clinical groups to descriptive synthesis without meta-analysis. CONCLUSIONS Hospitalized patients were highly inactive, especially those with medical admissions, based on time and step parameters. Accelerometer monitoring of sedentary behavior patterns was less reported and warrants further research.
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Affiliation(s)
- Claire Baldwin
- Sansom Institute of Health Research, School of Health Sciences, Division of Health Sciences, University of South Australia, City East Campus, Centenary Building, Adelaide, South Australia 5000, Australia
| | - Gisela van Kessel
- Sansom Institute of Health Research, School of Health Sciences, Division of Health Sciences, University of South Australia
| | - Anna Phillips
- Sansom Institute of Health Research, School of Health Sciences, Division of Health Sciences, University of South Australia
| | - Kylie Johnston
- Sansom Institute of Health Research, School of Health Sciences, Division of Health Sciences, University of South Australia
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Does body mass index influence pulmonary function test values and functional exercise capacity after chest physiotherapy following coronary artery bypass graft. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-017-0528-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abeles A, Kwasnicki RM, Pettengell C, Murphy J, Darzi A. The relationship between physical activity and post-operative length of hospital stay: A systematic review. Int J Surg 2017; 44:295-302. [PMID: 28689861 DOI: 10.1016/j.ijsu.2017.06.085] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/14/2017] [Accepted: 06/28/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recovery from surgery has traditionally been measured using specific outcome measures, such as length of hospital stay. However, advances in technology have enabled the measurement of continuous, objective physical activity data in the perioperative period. The aim of this systematic review was to determine the relationship between length of hospital stay and physical activity data for patients undergoing surgery. METHODS A systematic search of EMBASE, Medline and the Cochrane Library, from inception until January 2017, was performed to identify all study designs that evaluated physical activity after surgery. Studies were included if a wearable sensor measured patient activity as an in-patient and the length of hospital stay was reported. Only English articles were included. RESULTS Six studies with a total of 343 participants were included in this review. All the studies were prospective observational studies. Each study used a different sensor, with the commonest being a tri-axial accelerometer, and multiple different physical activity outcome measures were used, thereby prohibiting meta-analysis. Four of the studies demonstrated a relationship between physical activity levels and length of hospital stay, while two studies did not show any significant relationship. CONCLUSION The amount of physical activity performed post-operatively negatively correlates with the length of hospital stay. This suggests that objective physical activity data collected by body worn sensors may be capable of predicting functional recovery post-operatively.
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Affiliation(s)
- Aliza Abeles
- Department of Surgery and Cancer, St Mary's Hospital, 10th Floor QEQM Building, St Mary's Hospital, Praed Street, London W2 1NY, United Kingdom.
| | - Richard M Kwasnicki
- Department of Surgery and Cancer, St Mary's Hospital, 10th Floor QEQM Building, St Mary's Hospital, Praed Street, London W2 1NY, United Kingdom
| | - Chris Pettengell
- Department of Surgery and Cancer, St Mary's Hospital, 10th Floor QEQM Building, St Mary's Hospital, Praed Street, London W2 1NY, United Kingdom
| | - Jamie Murphy
- Department of Surgery and Cancer, St Mary's Hospital, 10th Floor QEQM Building, St Mary's Hospital, Praed Street, London W2 1NY, United Kingdom
| | - Ara Darzi
- Department of Surgery and Cancer, St Mary's Hospital, 10th Floor QEQM Building, St Mary's Hospital, Praed Street, London W2 1NY, United Kingdom
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O'Brien L, Mitchell D, Skinner EH, Haas R, Ghaly M, McDermott F, May K, Haines T. What makes weekend allied health services effective and cost-effective (or not) in acute medical and surgical wards? Perceptions of medical, nursing, and allied health workers. BMC Health Serv Res 2017; 17:345. [PMID: 28494806 PMCID: PMC5427575 DOI: 10.1186/s12913-017-2279-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 04/27/2017] [Indexed: 12/11/2022] Open
Abstract
Background There is strong public support for acute hospital services to move to genuine 7-day models, including access to multidisciplinary team assessment. This study aimed to identify factors that might enable an effective and cost-effective weekend allied health services on acute hospital wards. Methods This qualitative study included 22 focus groups within acute wards with a weekend allied health service and 11 telephone interviews with weekend service providers. Data were collected from 210 hospital team members, including 17 medical, 97 nursing, and 96 allied health professionals from two Australian tertiary public hospitals. All were recorded and imported into nVivo 10 for analysis. Thematic analysis methods were used to develop a coding framework from the data and to identify emerging themes. Results Key themes identified were separated into issues perceived as being enablers or barriers to the effective or cost-effective delivery of weekend allied health services. Perceived enablers of effectiveness and cost-effectiveness included prioritizing interventions that prevent decline, the right person delivering the right service, improved access to the patient’s family, and ability to impact patient flow. Perceived barriers were employment of inexperienced weekend staff, insufficient investment to see tangible benefit, inefficiencies related to double-handling, unnecessary interventions and/or inappropriate referrals, and difficulty recruiting and retaining skilled staff. Conclusions Suggestions for ensuring effective and cost effective weekend allied health care models include minimization of task duplication and targeting interventions so that the right patients receive the right interventions at the right time. Further research into the effectiveness and cost effectiveness of these services should factor in hidden costs, including those associated with managing the service.
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Affiliation(s)
- Lisa O'Brien
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, PO Box 527, Frankston, VIC, 3199, Australia.
| | - Deb Mitchell
- Allied Health Workforce, Innovation, Strategy, Education and Research Unit, Monash Health, Moorabbin, Australia
| | | | - Romi Haas
- Allied Health Research Unit Kingston Centre, Monash Health, Melbourne, Australia
| | - Marcelle Ghaly
- Western Centre for Health Research and Education, Melbourne, Australia
| | - Fiona McDermott
- Department of Social Work, Monash University, Melbourne, Australia
| | | | - Terry Haines
- Allied Health Research Unit Kingston Centre, Melbourne, Australia
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Effects of early mobilisation in patients after cardiac surgery: a systematic review. Physiotherapy 2017; 103:1-12. [DOI: 10.1016/j.physio.2016.08.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 08/03/2016] [Indexed: 11/22/2022]
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Devroey M, Buyse C, Norrenberg M, Ros AM, Vincent JL. Cardiorespiratory Physiotherapy around the Clock: Experience at a University Hospital. Physiother Can 2016; 68:254-258. [PMID: 27909374 DOI: 10.3138/ptc.2015-40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: To document and describe the use of a hospital-wide, 24-hour cardiorespiratory physiotherapy service run by an intensive care unit (ICU) team of physiotherapists. Methods: We prospectively collected data on all non-ICU hospital patients who used the 24-hours-per-day cardiorespiratory physiotherapy service over a 1-year period between July 2013 and June 2014. The ICU physiotherapists documented the reason, origin of referral, time of call, and type and frequency of treatment of each patient. Results: Over the 1-year period, the ICU physiotherapists administered 2,192 out-of-hours cardiorespiratory physiotherapy treatments (n=685 patients) outside the ICU. Most referrals originated from the emergency department (25%), the cardiopulmonary transplant unit (20%), and the pulmonology department (16%). Referrals were from a physiotherapist in 49% of cases, from a nurse in 32%, and from a physician in 19%. Of these, 89% were made between 4:00 p.m. and 8:00 a.m., and sputum retention was the most frequent reason (86%). Conclusion: Although proving its cost effectiveness is difficult, organizing a 24-hours-per-day, 7-days-per-week cardiorespiratory physiotherapy service in a large hospital is feasible.
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Affiliation(s)
- Marianne Devroey
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Belgium
| | - Catherine Buyse
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Belgium
| | - Michelle Norrenberg
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Belgium
| | - Anne-Marie Ros
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Belgium
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Belgium
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The Effects of Chronic Exercise Training in Individuals With Permanent Atrial Fibrillation: A Systematic Review. Can J Cardiol 2013; 29:1721-8. [DOI: 10.1016/j.cjca.2013.09.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 09/20/2013] [Accepted: 09/22/2013] [Indexed: 12/19/2022] Open
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Is a sedentary lifestyle an independent predictor for hospital and early mortality after elective cardiac surgery? Neth Heart J 2013; 21:439-45. [PMID: 23821496 PMCID: PMC3776070 DOI: 10.1007/s12471-013-0444-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective This study evaluates whether a sedentary lifestyle is an independent predictor for increased mortality after elective cardiac surgery. Methods Three thousand one hundred fifty patients undergoing elective cardiac surgery between January 2007 and June 2012 completed preoperatively the Corpus Christi Heart Project questionnaire concerning physical activity (PA). Based on this questionnaire, 1815 patients were classified as active and 1335 patients were classified as sedentary. The endpoints of the study were hospital mortality and early mortality. Results The study population had a mean age of 69.7 ± 10.1 (19–95) years and a mean logistic EuroSCORE risk of 5.1 ± 5.6 (0.88–73.8). Sedentary patients were significantly older (p = 0.001), obese (p = 0.001), had a higher EuroSCORE risk (p = 0.001), and a higher percentage of complications. Hospital mortality (1.1 % versus 0.4 % (p = 0.014)) and early mortality (1.5 % versus 0.6 % (p = 0.006)) were significantly higher in the sedentary group compared with the active group. However, a sedentary lifestyle was not identified as an independent predictor for hospital mortality (p = 0.61) or early mortality (p = 0.70). Conclusion Sedentary patients were older, obese and had a higher EuroSCORE risk. They had significantly more postoperative complications, higher hospital mortality and early mortality. Despite these results, sedentary behaviour could not be identified as an independent predictor for hospital or early mortality.
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Patients value patient-therapist interactions more than the amount or content of therapy during inpatient rehabilitation: a qualitative study. J Physiother 2013. [PMID: 23177229 DOI: 10.1016/s1836-9553(12)70128-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
QUESTION How do patients receiving inpatient rehabilitation experience physiotherapy and does their experience differ if they receive extra Saturday physiotherapy? DESIGN Qualitative study using in-depth interviews and thematic analysis. Interviews were audio-taped, transcribed, member checked and coded independently by two researchers. Data were triangulated using published quantitative data. PARTICIPANTS Nineteen adults undergoing inpatient rehabilitation for neurological and musculoskeletal impairments who received either usual care (Monday to Friday therapy) or additional Saturday therapy. RESULTS One main theme (personal interactions), and five sub-themes (empathetic and caring physiotherapists, socialisation with other patients, alleviated boredom, changed perceptions of the weekend, and contentment with amount of therapy) emerged from the data. Patients valued interacting with physiotherapists and other patients. Patients were content with the amount of physiotherapy whether or not they had additional Saturday physiotherapy. However, having additional Saturday physiotherapy changed the patients' perceptions of Saturdays; patients who received Saturday physiotherapy viewed Saturday as a day where they would be working towards improving their function, while patients who did not receive Saturday physiotherapy expected to rest on the weekend. CONCLUSION The patient-therapist interaction was more important to the patient than the amount or content of their physiotherapy, but Saturday therapy changed patients' perceptions of weekends in rehabilitation.
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Shaw KD, Taylor NF, Brusco NK. Physiotherapy services provided outside of business hours in Australian hospitals: a national survey. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2012; 18:115-23. [PMID: 23038214 DOI: 10.1002/pri.1537] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 08/18/2012] [Accepted: 08/23/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND PURPOSE Physiotherapy services provided outside of business hours may improve patient and hospital outcomes, but there is limited understanding of what services are provided. This study described current services provided outside of business hours across Australian hospitals. METHODS Design Descriptive, cross-sectional, Web-based survey. Participants A random sample of Australian hospitals from the public or private sector located in either metropolitan or rural/regional areas. RESULTS A total of 112 completed surveys were submitted. The most common service outside of business hours was a Saturday service, provided by 61% of participating hospitals with a median (interquartile range [IQR]) of 1.0 hour (0.0 and 3.4) of physiotherapy per 30 beds. Sunday services were provided by 43% of hospitals, and services provided outside of business hours from Monday to Friday were provided by 14% of hospitals. More private hospitals provided some form of physiotherapy service outside of business hours (91%) than public hospitals (48%). More metropolitan hospitals provided some form of physiotherapy service outside of business hours (90%) than rural/regional hospitals (28%). Few of the hospitals providing sub-acute services had weekend physiotherapy (30%), but the majority of highly acute wards provided weekend physiotherapy (81%). Highly acute wards also provided more hours of service on a Saturday (median 8.1 hours per 30 beds, IQR 0.6-22.5) compared with acute wards (median 0.8 hours per 30 beds, IQR 0.0-2.8). CONCLUSION There is limited availability of physiotherapy services in Australian hospitals outside of business hours. There are inequalities in physiotherapy services provided outside of business hours, with public, rural/regional and sub-acute facilities receiving fewer services outside of business hours than private, metropolitan and highly acute facilities.
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Affiliation(s)
- Kathryn D Shaw
- Department of Physiotherapy, La Trobe University, Bundoora, VIC 3086, Australia.
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Ottensmeyer CA, Chattha S, Jayawardena S, McBoyle K, Wrong C, Ellerton C, Mathur S, Brooks D. Weekend physiotherapy practice in community hospitals in Canada. Physiother Can 2012; 64:178-87. [PMID: 23449882 DOI: 10.3138/ptc.2011-19] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze weekend physiotherapy services in acute-care community hospitals across Canada. METHOD Questionnaires were mailed to acute-care community hospitals (institutions with >100 inpatient beds, excluding psychiatric, mental health, paediatric, rehabilitation, tertiary, and long-term care facilities) across Canada from January to April 2010. The questionnaire collected information on patient referral criteria, staffing, workload, and compensation for weekend physiotherapy services and on the availability of other rehabilitation health professionals. RESULTS Of 146 community hospitals deemed eligible, 104 (71%) responded. Weekend physiotherapy was offered at 69% of hospitals across Canada, but this rate varied: ≥75% in all regions except Quebec (30%). Hospitals with a high proportion of acute-care beds were more likely to offer weekend physiotherapy services (logistic regression, p=0.021). Services differed among Saturdays, Sundays, and holidays in terms of the numbers of both physiotherapists and physiotherapy assistants working (Kruskal-Wallis, p<0.02 for each). Physiotherapists were predominantly compensated via time off in lieu. Of hospitals not offering weekend physiotherapy, 53% reported that it would benefit patients; most perceived staffing and financial barriers. Social-work services were offered on the weekend at 24% of hospitals and occupational therapy at 16%. CONCLUSIONS Substantial regional variation exists in access to weekend physiotherapy services in acute-care community hospitals. To address the importance of this variation, research on the efficacy and cost-effectiveness of such services is required. Purpose: To analyze weekend physiotherapy services in acute-care community hospitals across Canada. Method: Questionnaires were mailed to acute-care community hospitals (institutions with >100 inpatient beds, excluding psychiatric, mental health, paediatric, rehabilitation, tertiary, and long-term care facilities) across Canada from January to April 2010. The questionnaire collected information on patient referral criteria, staffing, workload, and compensation for weekend physiotherapy services and on the availability of other rehabilitation health professionals. Results: Of 146 community hospitals deemed eligible, 104 (71%) responded. Weekend physiotherapy was offered at 69% of hospitals across Canada, but this rate varied: ≥75% in all regions except Quebec (30%). Hospitals with a high proportion of acute-care beds were more likely to offer weekend physiotherapy services (logistic regression, p=0.021). Services differed among Saturdays, Sundays, and holidays in terms of the numbers of both physiotherapists and physiotherapy assistants working (Kruskal–Wallis, p<0.02 for each). Physiotherapists were predominantly compensated via time off in lieu. Of hospitals not offering weekend physiotherapy, 53% reported that it would benefit patients; most perceived staffing and financial barriers. Social-work services were offered on the weekend at 24% of hospitals and occupational therapy at 16%. Conclusions: Substantial regional variation exists in access to weekend physiotherapy services in acute-care community hospitals. To address the importance of this variation, research on the efficacy and cost-effectiveness of such services is required.
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de Macedo RM, Faria Neto JR, Costantini CO, Olandoski M, Casali D, de Macedo ACB, Muller A, Costantini CR, do Amaral VF, de Carvalho KAT, Guarita-Souza LC. A periodized model for exercise improves the intra-hospital evolution of patients after myocardial revascularization: a pilot randomized controlled trial. Clin Rehabil 2012; 26:982-9. [PMID: 22412081 DOI: 10.1177/0269215512439727] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare models of the postoperative hospital treatment phase after myocardial revascularization. DESIGN A pilot randomized controlled trial. SETTING Hospital patients in a hospital setting. SUBJECTS Thirty-two patients with indications for myocardial revascularization were included between January 2008 and December 2009, with a left ventricular ejection fraction (LVEF) ≥50%, 1-second forced expiratory volume (FEV(1)) ≥60 and forced vital capacity (FVC) ≥60% of predicted value. INTERVENTIONS Patients were randomly placed into two groups: one performed prescribed exercises according to the model proposed by the American College of Sports Medicine (ACSM) and the other according to a periodized model. MAIN MEASURES Partial pressure of O(2) (P o (2)) and arterial O(2) saturation (Sao (2)), percentage of predicted FVC and total distance on the six-minute walking test (6MWT). RESULTS Twenty-seven patients were re-evaluated upon release from the hospital (ACSM = 14 and PP = 13). Five patients extubated for more than 6 hours in the postoperative period were excluded from the sample. In the preoperative period the variables P o (2), Sao (2), % FVC and 6MWT were similar. In the postoperative period, a reduction was observed for all parameters in both groups. Upon comparison of the groups, a difference was observed in P o (2) (ACSM = 68.0 ± 4.3 vs. PP = 75.9 ± 4.8 mmHg; P < 0.001), Sao (2) (ACSM = 93.5 ± 1.4 vs. PP = 94.8 ± 1.2%; P = 0.018) and 6MWT (ACSM = 339.3 ± 41.7 vs. PP = 393.8 ± 25.7 m; P < 0.001). There was no difference in % FVC. CONCLUSION Patients after myocardial revascularization following a periodized model of exercise presented a better intra-hospital evolution when compared to those using the ACSM model.
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Peiris CL, Taylor NF, Shields N. Extra physical therapy reduces patient length of stay and improves functional outcomes and quality of life in people with acute or subacute conditions: a systematic review. Arch Phys Med Rehabil 2011; 92:1490-500. [PMID: 21878220 DOI: 10.1016/j.apmr.2011.04.005] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 03/21/2011] [Accepted: 04/01/2011] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To investigate whether extra physical therapy intervention reduces length of stay and improves patient outcomes in people with acute or subacute conditions. DATA SOURCES Electronic databases CINAHL, MEDLINE, AMED, PEDro, PubMed, and EMBASE were searched from the earliest date possible through May 2010. Additional trials were identified by scanning reference lists and citation tracking. STUDY SELECTION Randomized controlled trials evaluating the effect of extra physical therapy on patient outcomes were included for review. Two reviewers independently applied the inclusion and exclusion criteria, and any disagreements were discussed until consensus could be reached. Searching identified 2826 potentially relevant articles, of which 16 randomized controlled trials with 1699 participants met inclusion criteria. DATA EXTRACTION Data were extracted using a predefined data extraction form by 1 reviewer and checked for accuracy by another. Methodological quality of trials was assessed independently by 2 reviewers using the PEDro scale. DATA SYNTHESIS Pooled analyses with random effects model to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs) were used in meta-analyses. When compared with standard physical therapy, extra physical therapy reduced length of stay (SMD=-.22; 95% CI, -.39 to -.05) (mean difference of 1d [95% CI, 0-1] in acute settings and mean difference of 4d [95% CI, 0-7] in rehabilitation settings) and improved mobility (SMD=.37; 95% CI, .05-.69), activity (SMD=.22; 95% CI, .07-.37), and quality of life (SMD=.48; 95% CI, .29-.68). There were no significant changes in self-care (SMD=.35; 95% CI, -.06-.77). CONCLUSIONS Extra physical therapy decreases length of stay and significantly improves mobility, activity, and quality of life. Future research could address the possible benefits of providing extra services from other allied health disciplines in addition to physical therapy.
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Affiliation(s)
- Casey L Peiris
- Musculoskeletal Research Centre and School of Physiotherapy, La Trobe University, Victoria, Australia.
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Filbay SR, Hayes, K, Holland, AE. Physiotherapy for patients following coronary artery bypass graft (CABG) surgery: Limited uptake of evidence into practice. Physiother Theory Pract 2011; 28:178-87. [DOI: 10.3109/09593985.2011.582231] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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de Macedo RM, Faria-Neto JR, Costantini CO, Casali D, Muller AP, Costantini CR, de Carvalho KAT, Guarita-Souza LC. Phase I of cardiac rehabilitation: A new challenge for evidence based physiotherapy. World J Cardiol 2011; 3:248-55. [PMID: 21860705 PMCID: PMC3158872 DOI: 10.4330/wjc.v3.i7.248] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 05/16/2011] [Accepted: 05/23/2011] [Indexed: 02/06/2023] Open
Abstract
Cardiac rehabilitation protocols applied during the in-hospital phase (phase I) are subjective and their results are contested when evaluated considering what should be the three basic principles of exercise prescription: specificity, overload and reversibility. In this review, we focus on the problems associated with the models of exercise prescription applied at this early stage in-hospital and adopted today, especially the lack of clinical studies demonstrating its effectiveness. Moreover, we present the concept of "periodization" as a useful tool in the search for better results.
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Affiliation(s)
- Rafael Michel de Macedo
- Rafael Michel de Macedo, José Rocha Faria-Neto, Costantino Ortiz Costantini, Dayane Casali, Andrea Pires Muller, Costantino Roberto Costantini, Luiz César Guarita-Souza, Department of Rehabilitation, Costantini Cardiological Hospital, Curitiba, 80320-320, Brazil
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Campbell L, Bunston R, Colangelo S, Kim D, Nargi J, Hill K, Brooks D. The provision of weekend physiotherapy services in tertiary-care hospitals in Canada. Physiother Can 2010; 62:347-54. [PMID: 21886374 DOI: 10.3138/physio.62.4.347] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe the provision of weekend physiotherapy (PT) services in tertiary-care hospitals in Canada. METHODS A prospective cross-sectional survey was conducted across tertiary-care hospitals, defined as those with university affiliation and at least one intensive care unit (ICU). Data were collected via telephone-administered questionnaires addressing hospital demographics, weekend staffing, workload, and weekend referral criteria. RESULTS A response rate of 84% (n=36) was obtained. Of facilities providing weekend PT services (97%), 35 (100%) provided care on Saturdays, 32 (91%) on Sundays, and 33 (94%) on statutory holidays. Weekend services were staffed using permanent full-time (n=35; 100%) or part-time (n=28; 80%) in-patient staff or outsourced staff (n=1; 3%). The number of physiotherapists available on the weekend was smaller than the number available during the week (p<0.001). Common weekend referral criteria included cardiorespiratory problems (n=35; 100%), postoperative assessment of patients at risk for deterioration (n=32; 91%), and patients scheduled for discharge pending PT assessment (n=30; 86%). CONCLUSION Both the scope and the number of staff available to provide PT services were less on the weekend than during the week. Despite the use of common criteria for weekend referral, variability in this service exists. Knowledge pertaining to current weekend PT services provides opportunities for harmonization of service delivery.
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Affiliation(s)
- Lauren Campbell
- Lauren Campbell, MScPT: Student, Department of Physical Therapy, University of Toronto, Toronto, Ontario
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Brusco NK, Paratz J. The effect of additional physiotherapy to hospital inpatients outside of regular business hours: A systematic review. Physiother Theory Pract 2009; 22:291-307. [PMID: 17166820 DOI: 10.1080/09593980601023754] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Provision of out of regular business hours (OBH) physiotherapy to hospital inpatients is widespread in the hospital setting. This systematic review evaluated the effect of additional OBH physiotherapy services on patient length of stay (LOS), pulmonary complications, discharge destination, discharge mobility status, quality of life, cost saving, adverse events, and mortality compared with physiotherapy only within regular business hours. A literature search was completed on databases with citation tracking using key words. Two reviewers completed data extraction and quality assessment independently by using modified scales for historical cohorts and case control studies as well as the PEDro scale for randomized controlled trials and quasi-randomised controlled trials. This search identified nine articles of low to medium quality. Four reported a significant reduction in LOS associated with additional OBH physiotherapy, with two articles reporting overall significance and two reporting only for specific subgroups. Two studies reported significant reduction in pulmonary complications for two different patient groups in an intensive care unit (ICU) with additional OBH physiotherapy. Three studies accounted for discharge destination and/or discharge mobility status with no significant difference reported. Quality of life, adverse events, and mortality were not reported in any studies. Cost savings were considered in three studies, with two reporting a cost saving. This systematic review was unable to conclude that the provision of additional OBH physiotherapy made significant improvement to patient outcomes for all subgroups of inpatients. One study in critical care reported that overnight physiotherapy decreased LOS and reduced pulmonary complications of patients in the ICU. However, the studies in the area of orthopaedics, neurology, postcardiac surgery, and rheumatology, which all considered additional daytime weekend physiotherapy intervention, did not provide strong evidence to indicate effective reduction in patient LOS or improving patient discharge mobility status or discharge destination. Investigation should continue in this area, but future trials should ensure factors such as random allocation, groups equal at baseline, blinded investigators, and proven intervention are included in the study design.
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Mittrach R, Grill E, Walchner-Bonjean M, Scheuringer M, Boldt C, Huber EO, Stucki G. Goals of physiotherapy interventions can be described using the International Classification of Functioning, Disability and Health. Physiotherapy 2008. [DOI: 10.1016/j.physio.2007.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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