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dorischong
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| Joined: | Sat Jun 14th, 2008 |
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Posted: Thu Feb 5th, 2009 04:20 am |
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Lesley,
Thanks for sharing your ideas. Lack of consistent outcome measures is a barrier, however the biggest barrier in acute care, I think, is the short length of stay. In addition, the fact that it's not guranteed we can follow up with the same patient everyday and patient may be medically unstable to be seen everyday also pose additional barriers. I'm looking forward to next week's CSM to get some ideas from PT colleagues around the nation on acute care studies...
Doris
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Lesley Smith
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| Joined: | Wed Aug 29th, 2007 |
| Location: | Humarock, MA |
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Posted: Sat Jan 3rd, 2009 03:54 pm |
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Hi Doris,
I agree, research in the acute arena isn't quite as prevalent as in other areas. I can't give you an answer to your question but I've got some thoughts that may be helpful.
One of the problems with measuring gait, first of all, is the lack of consistency in measurement parameters; there are as many outcome measures as there are studies, it seems. At a recent conference I attended, Pam Duncan, PT, PhD (Duke University) suggested that gait velocity would be an important and valid parameter because, a) it is pretty universal and b) gives a good indication of a pt's level of function, i.e., household through to community ambulator. However, I understand that insurances/Medicare doesn't recognize gait velocity as a reimbursable outcome.
I also think the FIM could be measure because it is a very practical, functional and meaningful measurement in the IP setting. One of the well-known drawbacks of the FIM is its lack of sensitivity to change. However, if an intervention isn't sufficiently efficacious to demonstrate a change in the FIM (or the study design fails to show it) then it is a difficult 'sell' to the IP therapists. Gait velocity may, however, help to capture the 'sensitivity' lost by the FIM.
One the same vein, I think LOS is a parameter that is meaningful to clinicians as it is difficult, if not impossible, to disseminate research if an outcome such as LOS doesn't mirror clinical practice. Many of the acute rehab studies I've looked at were conducted when LOS was practically twice as long as what is typical now. These studies are, unfortunately, meaningless to the practicing IP PT.
Also, I find an outcome that is usually missing is some sort of Quality of Life indicator, although I couldn't tell you which one to use.
Finally I thought the six month f/u in the McCain et al study was an excellent idea as I think it helped to magnify the benefits of early BWSTT that were not so dramatic in the outcomes measured at DC.
In conclusion, you need parameters to satisfy the scientists that an intervention is statistically significant but, translating this knowledge into practice will not occur without parameters meaningful to clinicians.
It would be interesting to hear others' thoughts...?
Lesley
Last edited on Sat Jan 3rd, 2009 03:55 pm by Lesley Smith
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dorischong
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Posted: Wed Oct 15th, 2008 04:55 am |
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Lesley,
I have the exact same question as yours!!!! I was trying hard to look for research studies done in acute care, few days post-stroke, but have found nothing. I am even thinking of doing some sort of studies in acute care but have limited ideas on how to measure its effects and benefits.
Doris
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shanna
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| Joined: | Fri Jun 2nd, 2006 |
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Posted: Fri Jun 13th, 2008 06:15 pm |
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I'm always looking for research on patients with acute stroke, i.e., days not weeks, and the efficacy of BWSTT within the constraints of the acute IP setting and came across this one in the April edition of the Archives of Physical Medicine & Rehabilitation (Vol 89). It's often difficult to get therapists to invest in the set-up of LG when they have such a short amount of time to work with patients and need to focus on safe transfers/caregiver training. I thought it was interesting that the researchers focused, not on the outcomes at D/C, but rather at six months post-event. In other words, the benefits of BWSTT may not be immediate in terms of higher FIM scores or shorter LOS but are reflected in the longer term in fewer gait abnormalities leading to improved function.
It's a great study - I encourage you to read the full article. Thanks, Lesley
(Lesley, one of our PT trainers asked that I post this)
Attachment: McCain- PWB Gait post acute stroke.pdf (Downloaded 15 times) Last edited on Fri Jun 13th, 2008 06:16 pm by shanna
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