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To investigate whether a direct measure of need for physical therapy (PT), mobility status, was associated with acute care PT utilization and whether this relationship differs across sociodemographic factors and insurance type.In a secondary analysis of electronic health records data, we estimated logistic regression models to determine whether mobility status was associated with acute care PT utilization. Interactions between mobility and both sociodemographic factors (sex, age, significant other, minority status) and insurance type were included to investigate whether the relationship between mobility and PT utilization varied across patient characteristics.Five regional hospitals from 1 health system.A total of 60,459 adults admitted between 2014 and 2018 who received a PT evaluation.None.Received acute care PT; Activity Measure for Post-Acute Care "6-Clicks" measure of mobility.Half of patients who received a PT evaluation received subsequent treatment. Patients with mobility limitations were more likely to receive PT. Interaction terms indicated that among patients with mobility limitations, those who (1) were younger, (2) had significant others, and (3) had private insurance (vs public) were more likely to receive PT. Among patients with greater mobility status, older patients and those without a significant other were more likely to receive PT.The relationship between acute care PT need and utilization differed across sociodemographic factors and insurance type. We offer potential explanations for these findings to guide efforts targeting equitable distribution of beneficial PT services.

Research Objectives To adapt a successful outpatient rehabilitation program targeting the prevention of mobility decline among older adults for the post-acute nursing home setting within the Veterans Health Administration (VHA) using the Replicating Effective Programs (REP) Framework. Design Program development. Setting Community Living Center (CLC), the post-acute nursing home setting within VHA. Participants Veterans receiving post-acute CLC rehabilitative care. Interventions We used the REP framework to guide adaptation of the Live Long Walk Strong (LLWS) program for the CLC setting. The original LLWS program treats physiologic impairments associated with mobility decline, promotes behavior change, and links patients to physical activity programs to foster long-term maintenance of health and function. LLWS produces large clinically meaningful improvements in mobility when implemented as an outpatient program for community-dwelling older adults. We adapted the program for the CLC by working through the phases of the REP framework. In the Pre-conditions phase, we identified local champions, developed an understanding of CLC processes, and identified existing resources. In the Pre-implementation phase, we engaged a broader group of stakeholders (CLC providers, CLC administrators, home health agencies), addressed electronic health record logistics, and trained staff. In the Implementation phase, we completed Plan-Do-Study-Act (PDSA) cycles and refined the protocol. Main Outcome Measures Preliminary feasibility. Results The adapted version of LLWS includes novel elements and bridges the inpatient CLC stay and subsequent three months post-discharge. The inpatient component focuses on maximizing functional recovery and includes activities focused on timing and coordination of gait, lower extremity strength and power, and trunk muscle endurance. The care transition and virtual (i.e., telehealth) post-discharge components focus on case management and engagement in physical activity programs. Coaching and behavior change are a consistent focus throughout the program. The adapted program is being rolled out as a clinical demonstration project and demonstrates preliminary feasibility. Conclusions The REP framework provides a useful guide for adapting rehabilitative programs to meet the needs of new populations. Author(s) Disclosures No conflicts of interest to report.

Objective To examine the effect of home- and community-based physical activity interventions on physical functioning among cancer survivors based on the most prevalent physical function measures, randomized trials were reviewed. Data Sources Five electronic databases—Medline Ovid, PubMed, CINAHL, Web of Science, and PsycINFO—were searched from inception to March 2016 for relevant articles. Study Selection Search terms included community-based interventions, physical functioning, and cancer survivors. A reference librarian trained in systematic reviews conducted the final search. Data Extraction Four reviewers evaluated eligibility and 2 reviewers evaluated methodological quality. Data were abstracted from studies that used the most prevalent physical function measurement tools—Medical Outcomes Study 36-Item Short-Form Health Survey, Late-Life Function and Disability Instrument, European Organisation for the Research and Treatment of Cancer Quality-of-Life Questionnaire, and 6-minute walk test. Random- or fixed-effects models were conducted to obtain overall effect size per physical function measure. Data Synthesis Fourteen studies met inclusion criteria and were used to compute standardized mean differences using the inverse variance statistical method. The median sample size was 83 participants. Most of the studies (n=7) were conducted among breast cancer survivors. The interventions produced short-term positive effects on physical functioning, with overall effect sizes ranging from small (.17; 95% confidence interval [CI], .07–.27) to medium (.45; 95% CI, .23–.67). Community-based interventions that met in groups and used behavioral change strategies produced the largest effect sizes. Conclusions Home and community-based physical activity interventions may be a potential tool to combat functional deterioration among aging cancer survivors. More studies are needed among other cancer types using clinically relevant objective functional measures (eg, gait speed) to accelerate translation into the community and clinical practice.

Objectives To model 12-month rehospitalization risk among Medicare beneficiaries receiving inpatient rehabilitation for spinal cord injury (SCI) or traumatic brain injury (TBI) and to create 2 (SCI- and TBI-specific) interactive tools enabling users to generate monthly projected probabilities of rehospitalization on the basis of an individual patient's clinical profile at discharge from inpatient rehabilitation. Design Secondary data analysis. Setting Inpatient rehabilitation facilities. Participants Medicare beneficiaries receiving inpatient rehabilitation for SCI (n=2587) or TBI (n=10,864). Interventions Not applicable. Main Outcome Measures Monthly rehospitalization (yes/no) based on Medicare claims. Results Results are summarized through computer-generated interactive tools, which plot individual level trajectories of rehospitalization probabilities over time. Factors associated with the probability of rehospitalization over time are also provided, with different combinations of these factors generating different individual level trajectories. Four case studies are presented to demonstrate the variability in individual risk trajectories. Monthly rehospitalization probabilities for the individual high-risk TBI and SCI cases declined from 33% to 15% and from 41% to 18%, respectively, over time, whereas the probabilities for the individual low-risk cases were much lower and stable over time: 5% to 2% and 6% to 2%, respectively. Conclusions Rehospitalization is an undesirable and multifaceted health outcome. Classifying patients into meaningful risk strata at different stages of their recovery is a positive step forward in anticipating and managing their unique health care needs over time.

OBJECTIVE: To examine how similar summary scores of physical functioning using the FIM can represent very different patient clinical profiles. DESIGN: Retrospective cohort study. SETTING: Inpatient rehabilitation facilities submitting claims and assessment data to the Centers for Medicare and Medicaid Services in 2012 and 2013. PARTICIPANTS: Medicare fee-for-service beneficiaries discharged from inpatient rehabilitation (N=765,441). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: We used patients’ scores on items from the Functional Independence Measure (FIM) to quantify their level of independence in both self-care and mobility domains. We then identified patients as requiring “No Physical Assistance” at discharge from inpatient rehabilitation using a rule and score-based approach. RESULTS: Among those patients with FIM self-care and mobility summary scores suggesting no physical assistance needed, we found physical assistance was in fact needed frequently in bathroom related activities (e.g., continence, toilet and tub transfers, hygiene, clothes management) and with stairs. In other words, it was not uncommon for actual performance to be lower than what may be suggested by a summary score in those domains. CONCLUSIONS: Further research is needed into creating clinically meaningful descriptions of summary scores from combined performances on individual items of physical functioning.

Objective To determine the feasibility and impact of different dosages of Intensive Mobility Training (IMT) on mobility, balance, and gait speed in individuals with chronic traumatic brain injury (TBI). Design Prospective, single group design with 3-month follow-up. Setting University research laboratory. Participants Volunteer sample of participants with chronic TBI (N=10; ≥3mo post-TBI; able to ambulate 3.05m with or without assistance; median age, 35.4y; interquartile range, 23.5–46y; median time post-TBI, 9.91y; interquartile range, 6.3–14.2y). Follow-up data were collected for all participants. Interventions Twenty days (5d/wk for 4wk), with 150min/d of repetitive, task-specific training equally divided among balance; gait training; and strength, coordination, and range. Main Outcome Measures Pain and fatigue were recorded before and after each session to assess feasibility. Treatment outcomes were assessed before training (pre), after 10 sessions (interim), after 20 sessions (post), and at 3-months follow-up and included the Berg Balance Scale and gait speed. Results Participants averaged 150.1±2.7 minutes per session. Median presession and postsession pain scores were 0 (out of 10) for 20 sessions; median presession fatigue scores ranged from 0 to 2.5 (out of 10); and postsession scores ranged from 3 to 5.5 (out of 10). Four outcome measures demonstrated significant improvement from the pretest to interim, with 7 out of 10 participants exceeding the minimal detectable change (MDC) for fast walking speed. At the posttest, 2 additional measures were significant, with more participants exceeding the MDCs. Changes in fast walking speed and Timed Up and Go test were significant at follow-up. Conclusions Limited fluctuations in pain and fatigue scores indicate feasibility of IMT in this population. Participants demonstrated improvements in walking speed, mobility, and balance postintervention and maintained gains in fast walking speed and mobility at 3 months.