Simulated Environments for Community Reintegration
Conditions
Keywords
Inpatient Rehabilitation Unit, Community Reintegration, Simulated Environment
Brief summary
The investigators believe that rehabilitation specialists will use community reintegration treatments more if a simulated environment is available.
Detailed description
Community reintegration training has always been a significant aspect of inpatient rehabilitation recovery. Community reintegration training involved therapists and patients going into the actual community to evaluate and practice their functional tasks such as negotiating curbs, crosswalks, or marketplaces. During the COVID-19 pandemic, this option was not available. The absence of this intervention made it challenging for therapists to evaluate a patient's safety to return home. Creating a simulated environment within the inpatient rehabilitation department became an alternative to taking patients to an outside environment. Saji, et al. (2015) demonstrated that utilization of a simulated environment enhanced functional improvements of post-acute stroke patients at 12 convalescent rehabilitation wards. New York Presbyterian Weill Cornell Medical Center (NYP- WCMC) has constructed a simulated environment for the purposes of enhancing community reintegration training. This project will test its use and efficacy. The availability of this simulated environment may be more time-efficient and safer than community reintegration training outside of the department or hospital. Training in the simulated environment may improve the functional ability of individuals undergoing inpatient rehabilitation, in accordance with the degree of use of the simulated environment. Greater use of the simulated environment may predict greater functional improvements. This study will collect pilot data about functional outcomes and patient perspectives about their balance confidence, their ability to perform functional tasks, and the efficacy of the use of simulated environment for community reintegration. This pilot data will seed a future efficacy study with a comparison group.
Interventions
BEHAVIORALPT and OT with a simulated environment
Upon admission to the inpatient rehabilitation unit, participants will undergo a physical and occupational therapy evaluation. The evaluations will include the outcome measures chosen to track for this study (10-meter walk test and Quality Indicators). If a patient meets inclusion/exclusion criteria, informed written consent will be obtained. Throughout the patient's stay, therapists will have the opportunity to perform community integration treatments using the simulated environment. This could include activities such as negotiating a curb, crossing a street, or shopping at a marketplace. The therapist will document the amount of time (units billed) spent performing these interventions. The research investigators will not act as a patient's therapist throughout their admission.
Sponsors
Weill Medical College of Cornell University
Hunter College of The City University of New York
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Medical records of patients admitted to the IRU from January 1, 2015 through December 31, 2019 will be queried for number of minutes billed for Community Integration. * Medical records of patients admitted to the IRU from April 2 * Patients admitted to the Inpatient Rehabilitation Unit (IRU) of at least 18 years of age and older * Patients who can read and provide informed consent in English. * Patients who will be discharged to home after inpatient rehabilitation. * Patients who are ambulatory with a minimal QI score of 3 on "Walk 10 feet". * Patients who utilized the simulated environment during their inpatient stay. * Patients who score 8 or greater on the BIMS on initial evaluation.
Exclusion criteria
* The investigators will exclude medical records of patients admitted to the IRU from January 1, 2020 through December 31, 2021 because of the COVID restrictions that were in place. * Patients who are less than 18 years of age. * Patients who are not ambulatory due to medical reasons. * Patients who cannot read and provide informed consent in English. * Patients who were discharged to acute care, skilled nursing facility or long-term care facility after their inpatient rehabilitation stay. * Patients who did not use the simulated environment during their inpatient stay. * Patients who score 7 or lower on the BIMS on initial evaluation.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Utilization of community reintegration, as measured by number of 15-minute units billed | Duration of IRU stay, an average of 11 days | Current Procedural Terminology (CPT) code 9753, is a billing code where one unit of the code is used for each 15 minutes the provider spends with the patient teaching them return to work and the community. For this measure, the therapist will document the amount of time spent performing each study activity when utilizing the simulated environment, as measured by number of 15-minute units billed.. This will be compared to units billed in 2015 - 2019 prior to the implementation of the simulated environment for this study. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Quality Indicators | Duration of IRU stay, an average of 11 days | Qualitative assessment by the therapist of 1 step onto and off a curb |
| Gait Speed | Duration of IRU stay, an average of 11 days | Meters/second |
| Activities Specific Balance Confidence Scale | Duration of IRU stay, an average of 11 days | The Activities-specific Balance Confidence (ABC) scale is scored by adding up the ratings for each item and dividing by 16, the total number of items. The scale uses a range of 0-100%, with 0 representing no confidence and 100 representing complete confidence. The resulting score indicates the participant's overall balance confidence. 80% or higher: The participant has a high level of physical functioning and is at low risk for falls 50-80%: The participant has a moderate level of physical functioning Less than 50%: The participant has a low level of physical functioning and is at a high risk of falling Less than 67%: The participant has a substantial risk of falling |
| Patient satisfaction | Date of Discharge (at approximately Day 11) | Likert scale, with a low score of 1 and a high score of 5. |
| Length of Stay | Duration of IRU stay, an average of 11 days | Days |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORNasim Chowdhury, MD
Weill Medical College of Cornell University
Outcome results
None listed