S151 S290
Poster 32:
A Comparison of Early versus Late Unplanned
Transfers from Acute Rehabilitation
Nicole A. Strong, DO (University of Rochester Medical Center,
Rochester, New York, United States), Matthew C. Kruppenbacher, DO,
Sara Salim, MD, Franchesca Konig Toro, MD
Disclosures:
Nicole A. Strong, DO: I Have No Relevant Financial Re-
lationships To Disclose
Objective:
To identify the incidence of unplanned transfer and
characteristics of those patients who required early versus late un-
planned transfer from the acute rehabilitation unit to either a medical
or surgical unit.
Design:
Retrospective Observational Study.
Setting:
Acute rehabilitation unit in a tertiary care hospital.
Participants:
Charts were reviewed for a total of 152 patients who
experienced an unplanned transfer from an acute rehabilitation unit
over a 5-year period.
Interventions:
Not applicable.
Main Outcome Measures:
Time of transfer; early transfer being
within the first 3 days of admission, and late transfer being defined as
anytime after the first 3 days.
Results:
Of 1,961 total patients admitted to acute rehabilitation
during the 5-year study period, 152 required an unplanned transfer
(7.8%). Transferred patients’ diagnoses included debility (21.2%),
ischemic stroke (20.4%), SCI (16.4%), intracranial hemorrhage (11.2%),
and other diagnostic groups (30.9%). Of the transferred patients, 60%
were over age 65 and 61.2% had received a surgery prior to their
rehabilitation admission. In regards to time of transfer, 20.4% were
transferred early and 79.6% were transferred late. The 3 most common
reasons for early transfer were infection (25.8%), ischemic stroke
(19.4%), and intracranial hemorrhage (19.4%). In comparison, the 3
most common reasons for late transfer were ischemic cardiac event
(24.0%), infection (19.0%), and intracranial hemorrhage (14.5%). The
early transfer group trended to have older patients (mean age 69.8)
compared to the late transfer group (mean age 63.5), p
¼
.058.
Conclusions:
Older patients, those with a diagnosis of debility or
ischemic stroke, and patients with an active infection may have a higher
risk of early, unexpected transfer from the acute rehabilitation setting.
Careful assessment of these factors prior to rehabilitation admission
may aid in reducing unplanned transfer rates. Further study of these
populations and potential risk factors may providemore insight into how
to optimize the timing of an acute rehabilitation admission.
Level of Evidence:
Level IV
Poster 33:
The Use of a Virtual Therapy Environment in an
Intensive Care Setting is Safe and Acceptable: A Pilot
Study
Sara Parke, MD (Harborview Medical Center, University of
Washington), Catherine L. Hough, MD, Aaron E. Bunnell, MD
Disclosures:
Sara Parke: I Have No Relevant Financial Relationships To
Disclose
Objective:
Mobilization in critical illness has been documented to
reduce neuromuscular complications, but access to rehabilitation
services is often limited in the intensive care setting. Virtual envi-
ronments designed to deliver therapy may increase access to reha-
bilitation services and improve patient motivation to participate.
Jintronix Kinect software delivers specific therapeutic interventions
using a virtual gaming platform. Here we determine its safety, feasi-
bility and acceptability in the intensive care unit (ICU).
Design:
Cohort Study.
Setting:
Level 1 Trauma Center ICU.
Participants:
19 adults admitted to the ICU between September and
November 2016.
Interventions:
One session with a goal of 14 Jintronix modules tar-
geting arm, leg, and/or trunk strength, range of motion and
endurance.
Main Outcome Measures:
A trained observer recorded events related
to (A) safety (falls, line dislodgement, medical events), and (B)
feasibility (activity completion rate, assistance required, and tech-
nical errors). Patients completed a survey to determine (C) accept-
ability (enjoyment, comfort and perceived therapeutic benefit).
Results:
Mean intervention time was 29 minutes. (A) There were no
falls, lines dislodged, or medical events. (B) Five subjects (27%)
completed all 14 modules. The remaining subjects completed a mean
of 7.8 modules per person. Fatigue was the most common reason for
cessation (11). Subjects required physical assistance or verbal cues in
41% of modules (73). Technical errors affected 24% of modules (44),
and led to activity cessation in 1 case. (C) Nearly all subjects reported
the activity was enjoyable (18), comfortable (16), safe (19), easy to
understand (18), would improve range of motion (17), would improve
strength (18), and would motivate them to continue (18).
Conclusions:
Use of a virtual therapy environment in an intensive care
setting is safe and acceptable. The feasibility of the intervention may
be limited by technical errors.
Level of Evidence:
Level II
Poster 34:
Massage Therapy in Cancer Patients with Venous
Thromboembolism: A Case Series
Amy H. Ng, MD MPH (University of Texas, MD Anderson Cancer
Center), George J. Francis, MD, Pamela A. Sumler, LMT, BCTMB
Disclosures:
Amy Ng: I Have No Relevant Financial Relationships To
Disclose
Objective:
We retrospectively reviewed cancer patients who received
massage therapy following a diagnosis of venous thromboembolism
(VTE). Patients who received massage therapy and completed a pre
and post Edmonton Symptom Assessment Scale (ESAS) were included in
data analysis. Our hypothesis was that massage therapy can be safely
administered in cancer patients with VTE and improve overall
symptoms.
Design:
Retrospective Chart Review.
Setting:
Cancer rehabilitation patients admitted to a tertiary cancer
center.
Participants:
A case series of 24 patients were reviewed from 2014-
2016.
Interventions:
Not applicable.
Main Outcome Measures:
Collected measurements included cancer
diagnosis, VTE diagnosis date and treatment, massage therapy date(s),
ESAS assessments and complications resulting in readmission to hos-
pital within 7 days.
Results:
A total of 24 patients were included in this retrospective
chart review. The top cancer diagnoses included liquid tumor and GI
with 5 patients (20.8%) each. 15 patients (62.5%) completed both pre
and post ESAS scores. 9 patients (37.5%) did not have completed ESAS
scores. Post massage therapy, the greatest area of improvement was
pain, with a mean decrease in ESAS score of -2.8 + 1.2. Other areas of
improvement included Fatigue, Anxiety, Drowsiness and Feeling of
well-being. 1 out of 24 patients (4%) had a complication within 7 days,
with a new DVT, however patient had a known history of Factor V
Leiden variant with multiple DVTs previously despite therapeutic
treatment with anticoagulation.
Conclusions:
Generally, massage therapy is safe for patients who
have cancer and recent history of VTE. Massage therapy has shown
great benefits in symptom relief for cancer patients, especially in pain
relief. Clinical correlation with known risks factors such as Factor V
Leiden or coagulopathy disorders may need to be examined prior to
massage.
Level of Evidence:
Level IV
S151
Abstracts / PM R 9 (2017) S131-S290