S142 S290
discovery of the fall event. After year one (2012) further educational
advances were made in regards to IRF falls such as: patient safety
rounds, improving resident sign outs, educational meetings with fac-
ulty, residents, and house staff of the importance of physical exami-
nation status post fall.
Main Outcome Measures:
The number of CT scans post implementa-
tion of the IRF patient falls education.
Results:
Of a total of 379 patient falls over the course of 5 years there
were 111 head CT scans conducted of which only 1 (0.9%) CT showed
positive intracranial findings. In 2012 before implementation of the IRF
falls education 34.9% of all falls received a CT. Following falls edu-
cation, the number of head CT scans conducted was 44.8% in 2013,
13.7% in 2014, 4% in 2015 and 10% in 2016.
Conclusions:
There is a low diagnostic yield and high cost for head CT
scans as part of the post-fall evaluation in patients not exhibiting
acute neurological changes. Physiatrists should use caution when
ordering these imaging studies and limit their use to occasions when
clinically indicated according to institution guidelines.
Level of Evidence:
Level II
Poster 157:
Descriptive Analysis of Community Dwelling Elderly
Individuals with Low Falls Risk: Utilization of the
STEADI Toolkit from the Center for Disease Control &
Prevention (CDC)
Armando S. Miciano, MD, FAAPMR (Nevada Rehabilitation Institute,
Las Vegas, NV, United States), Chad L. Cross, PhD, PStat(R)
Disclosures:
Armando Miciano: I Have No Relevant Financial Re-
lationships To Disclose
Objective:
To investigate the fall risk and physical performance of
community dwelling elderly individuals with low falls risk using the
CDC’s STEADI (Stopping Elderly Accidents, Deaths, & Injuries) toolkit:
STEADI screening measure and recommended Clinical Observation
Assessments (COA); and to describe the multi-morbidity burden and
physical function of such individuals.
Design:
Retrospective Cross-Sectional Study.
Setting:
Comprehensive outpatient rehabilitation facility.
Participants:
17 elderly community-dwelling subjects (age range 60-
79 years old) admitted to a geriatric rehabilitation program.
Interventions:
Not applicable.
Main Outcome Measures:
The patient-reported STEADI measure
assessed falls risk factors low fall risk defined as STEADI score.
The Self-Administered Co-Morbidity Questionnaire (SCQ) described the
multi-morbidity burden, and the PROMIS-57 v1.0-Physical Function
(PROMIS-PF) quantified the activity limitation.
Results:
Data met normality assumptions. Mean differences were
examined among variables using ANOVA with age as a covariate; age
did not differ significantly among participants. Descriptive statistics
and significant tests are provided for each variable. No variables
demonstrated a gender effect (perhaps because of small n for fe-
males). A Pearson Correlation analysis (p).
The mean (SD) scores were as follows: STEADI 0.944 (1.21); TUG 16.0
(6.79); CST 10.07 (2.73); SCQ 6.47 (3.28); and, PROMIS-PF 41.48 (9.15).
No significant correlations were found, specifically the STEADI score
did not correlate with COA, SCQ, and PROMIS-PF.
Conclusions:
Community dwelling elderly individuals with low falls
risk tend to have low multi-morbidity burden, mild activity limitation,
slow gait speed, and fair lower extremity power
e
independent of age
and gender factors. The study showed the limited use of CDC-recom-
mended COAs in individuals with low falls risk. Future studies should
address the appropriate performance-based assessments (PBA) in
these individuals with low falls risk as categorized by the CDC’s STEADI
measure and contrast these PBA with those current CDC-recommended
COAs.
Level of Evidence:
Level II
Poster 167:
Use of Overnight Pulse Oximetry and Checklists in
Post-Acute Care
Joseph P. Jacob, MD, FAAPMR (Colorado Health Med Group),
Marcus Reinhardt, MD, Rebeaka B. Varghese, RN, Lacie Lame, RN,
Carolyn Smith, RN, Kaitlin Brady, BSW, Deb Majors, LNHA
Disclosures:
Joseph Jacob: I Have No Relevant Financial Relationships
To Disclose
Objective:
Identify patients at high risk of poor outcomes and hospital
readmissions from post-acute and community settings. Review role of
checklists and clinical measures such as overnight pulse oximetry in
post-acute rehab patients.
Design:
Review and analysis of overnight pulse oximetry data on post-
acute rehab patients. Create clinical workflow checklists for safe care
transitions.
Setting:
Subacute rehabilitation.
Participants:
Joseph P. Jacob MD, Marcus Reinhardt MD, Rebeaka
Varghese RN, Lacie Lame RN, Carolyn Smith RN, Kaitlyn Brady Social
Worker, Deb Majors, Administrator.
Interventions:
Use clinical tools such as overnight pulse oximetry, as
well as creating check lists to improve care transitions.
Main Outcome Measures:
Rate of positive overnight pulse oximetry
studies, Re-hospitalization rate, rate of community discharge.
Results:
We found a high incidence of nocturnal hypoxia and apnea in
patients undergoing short-term physical rehabilitation following hos-
pitalization for complex medical problems, trauma, acute MI, cardiac
arrhythmia, heart failure, strokes and COPD.
Conclusions:
The value of Care Transition Interventions using patient
and care giver activation and coaching has been demonstrated
nationwide in reducing re-hospitalization in complex patients. The use
of checklist workflows and clinical measures such as overnight
continuous pulse oximetry studies in post-acute settings may help
identify patients at high risk for poor outcomes and re-hospitalization.
Rehabilitation settings can add value and improve outcomes during
care transitions for complex patients. Further clinical research using
workflow checklists and use of existing clinical tools may be useful in
improving post-acute care.
Level of Evidence:
Level IV
Friday, October 13, 2017
9:00 AM
e
5:30 PM
Saturday, October 14, 2017
9:00 AM
e
2:00 PM
Exhibit Hall C, Exhibit Hall Level
GENERAL REHABILITATION POSTER HALL: ORIGINAL
RESEARCH
Poster 1:
Is Cardiac Rehabilitation Useful for Cardiovascular
Disease Patients Who are Frail?
Geoffrey Henderson, MD (University of Pittsburgh Medical Center,
Pittsburgh, PA, United States), Andrew D. Althouse, PhD, Kelly Allsup,
BS, Daniel E. Forman, MD
Disclosures:
Geoffrey Henderson: I Have No Relevant Financial Re-
lationships To Disclose
Objective:
Many patients eligible for cardiac rehabilitation (CR) are
not referred because they are frail, as physicians assume that the
utility of CR is limited once frailty is manifest. We hypothesized that
CR may benefit frail patients by enabling functional gains that may
even exceed relative improvements among non-frail patients.
Design:
Quality improvement.
Setting:
CR program at a tertiary medical center.
Participants:
60 patients (median age 68.0 years, range 45.0
e
81.0)
with cardiovascular disease of diverse etiologies (CAD, heart failure,
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Abstracts / PM R 9 (2017) S131-S290