S284 S290
Objective:
Improving PM&R residents’ ability to teach patients MSK
exercises in the clinic setting. Increase treatment outcomes in an
outpatient PM&R Clinic where physical therapy wait times are over 3
months.
Design:
An educational pamphlet was created under the guidance of a
physical therapist to aid residents in the outpatient setting with
instructing patients on exercises they can perform independently,
without need for equipment. Handouts were made available in clinic
to any patient requiring, but not able to, obtain formal physical
therapy. Pre- and post-test surveys were given to the residents to
assess if the intervention met the stated objectives.
Setting:
Outpatient PM&R Clinic, University Based Academic Medical
Center.
Participants:
PM&R Residents.
Interventions:
1. Resident pamphlet of therapeutic exercises 2. Pa-
tient musculoskeletal exercise handouts.
Main Outcome Measures:
1. Improvement of PM&R resident’s
knowledge of exercises and their ability to teach MSK exercises to
patients. 2. Improvement in patient outcomes in General PM&R
outpatient clinic.
Results:
In the pre-intervention survey, greater than 30% of residents
who consulted PT, had “no idea” what that would entail, 70% had
“somewhat an idea”, and no resident felt completely confident.
Greater than 40% of residents admitted that if patients were not
eligible for therapy, they were simply sent home. In the post-inter-
vention survey, after giving out the resident handouts and making
patient handouts available, positive improvements were seen. Only
15% of residents had “no idea” what PT would entail. The residents
who simply sent patients home without any form of intervention,
dropped from over 40% to 15%. 100% of residents felt the patient
handouts adequately provided good treatment to those patients who
could not get formal physical therapy.
Conclusions:
The objective of improving resident knowledge with
providing exercises to patients with common musculoskeletal disor-
ders was achieved. Residents felt the handouts resulted in the
improvement of quality of care offered in the PM&R clinic.
Level of Evidence:
Level V
CATEGORY: GENERAL REHABILITATION
Poster 476:
Bleeding Events Among Hematologic Inpatient Rehabilitation
Patients with Severe Thrombocytopenia
Jack B. Fu, MD, FAAPMR (UT MD Anderson Cancer Center, Houston,
Texas, United States), Jegy M. Tennison, MD, Isabel M. Rutzen, MD,
Shinichiro Morishita, PhD, Julie K. Silver, MD, FAAPMR, Seyedeh Dibaj,
PhD
Disclosures:
Jack Fu: I Have No Relevant Financial Relationships To
Disclose
Objective:
To identify the frequency and characteristics of bleeding
events during acute inpatient rehabilitation of hematologic malig-
nancy patients with severe thrombocytopenia.
Design:
Retrospective descriptive analysis.
Setting:
National Cancer Institute Comprehensive Cancer Center.
Participants:
All hematologic malignancy patients admitted with a
platelet count of less than or equal to 20,000/microliter on the day of
rehab transfer to the acute inpatient rehabilitation unit from 1/1/2005
through 8/31/2016.
Interventions:
Medical records were retrospectively analyzed for
demographic, laboratory and medical data. Patients were rehabili-
tated using the following institutional exercise guidelines for throm-
bocytopenic patients:
>
20,000/microliter
e
No additional
restrictions. 10,000-20,000/microliter
e
No resistive exercise. If a
high fall risk, avoid standing/ambulating. 5,000-10,000/microliter
e
No resistive exercises and minimal activity (limit the exercises to in
bed or chair).
<
5,000/microliter
e
will discuss with medical team
OR consider deferring treatment.
Main Outcome Measures:
Bleeding events noted in the medical
record.
Results:
135 inpatient rehabilitation admissions of 133 unique patients
were analyzed with a total of 851 inpatient rehabilitation days. The
mean platelet count was 14,000/microliter on the day of admission and
22,000/microliter over the course of the rehabilitation admission. A
total of 98 bleeding events were documented in 77/135 (57%) admis-
sions. Most bleeding events (66/98, 67.3%) were minor and 3/98 (3.1%)
bleeding events were severe enough to require transfer to the primary
acute care service. There were 3/98 (3.1%) bleeding events that were
highly likely attributable to physical activity. However, only 1/3 was
considered severe, requiring transfer to the primary acute care service.
Bleeding rates were .09, .08, .17 and .37 for
>
20,000/microliter,
15-20,000/microliter, 10-15,000/microliter and less than 10,000/
microliter mean platelet counts respectively (P
¼
.003).
Conclusions:
Bleeding rates increased with lower mean platelet
counts. However, using our institutional exercise guidelines for
severely thrombocytopenic patients, the risk of severe bleeding events
in these severely thrombocytopenic hematologic malignancy acute
rehabilitation inpatients was low.
Level of Evidence:
Level III
CATEGORY: MSK & SPORTS MEDICINE
Poster 477:
Clinicians Using Hemoanalytic Data Can Apply the Method of
Ratios to Balance Platelet Concentration Against
Other Cellular Components in Platelet-Rich Plasma
David C. Karli, MD (The Steadman Clinic, Vail, CO, Avon, CO, United
States), Theodore Sand, PhD
Disclosures:
David Karli: Ownership or partnership - Greyledge
Technologies
Objective:
Platelet-rich plasma (PRP) contains positive therapeutic
components [platelets (Plts)] and negative components [red blood cells
(RBCs), white blood cells (WBCs), neutrophils (NEU)]. Past attempts to
categorize PRP samples have relied on binary assessments: RBC andWBC
content above or below 1%, etc. Binary characterization doesn’t help a
clinician balance the level of Plts versus the negative components pre-
sent in PRP. The goal of introducing the method of ratios is to help
standardize and simplify a physician’s assessment of the therapeutic
potential of PRP, allowing greater control in treating patients with PRP.
Design:
Hemoanalytic data from PRP preparations was evaluated to
provide discrete values for Platelet Ratio-RBC (PRR), Platelet Ratio-
WBC (PRW) and Platelet Ratio-NEU (PRN).
Setting:
Method of ratios analysis of PRP preparations was conducted
at a sports medicine clinic.
Participants:
PRP preparations used to treat patients seeking non-
surgical pain relief for soft tissue pathology as a standard of care were
evaluated.
Interventions:
Not applicable.
Main Outcome Measures:
PRR, PRW and PRN were calculated from
hemoanalyticdataobtained on PRPpreparations; data routinely provided
to the attending physician. Each ratio involves dividing the Plt concen-
tration by the concentration of RBCs, WBCs, or NEUs in a patient’s PRP.
Results:
Ratios were calculated for 32 PRP preparations. The mean
(range) of PRR was 16.4 (3.0-77.7), PRW was 361 (12-1443), and PRN
was 3104 (239-24333).
Conclusions:
Method of ratios provides a straight forward comparison
of the number of Plts present per unit RBC, WBC or NEU. Reducing
neutrophils appears to be more efficient compared to WBC reduction
in the assessed PRP preparations, since the average PRN was greater
S284
Abstracts / PM R 9 (2017) S131-S290