Pamela Roberts PhD, OTR/L, SCFES, FAOTA, CPHQ, FNAP
Adjunct Assistant Professor of Clinical Occupational Therapy
Room: CHP 133
Phone: (323) 442-2850
Doctor of Philosophy (PhD) in Health Sciences
Touro University International
Master of Science (MS) in Health Administration
California State University, Northridge
Bachelor of Science (BS) in Occupational Therapy
Washington University School of Medicine
Black, T. M., Roberts, P. S., Livesay, S. L., & Hickey, J. V. (2016). Stroke rehabilitation. In J. V. Hickey & S. L. Livesay (Eds.), The continuum of stroke care: An interprofessional approach to evidence-based care. Philadelphia, PA: Wolters Kluwer. Link to full text
Phipps, S. C., & Roberts, P. (2013). Motor learning. In H. M. Pendleton & W. Schultz-Krohn (Eds.), Pedretti's occupational therapy practice skills for physical dysfunction (7th ed.). (pp. 831-843). St. Louis, MO: Elsevier Mosby.
Roberts, P. S., Rizzo, J. R., Hreha, K., Wertheimer, J., Kaldenberg, J., Hironaka, D., Riggs, R., & Colenbrander, A. (2016). A conceptual model for vision rehabilitation. Journal of Rehabilitation Research & Development, 53, 693-704. http://dx.doi.org/10.1682/JRRD.2015.06.0113. Link to full text Abstract →
Vision impairments are highly prevalent after acquired brain injury (ABI). Conceptual models that focus on constructing intellectual frameworks greatly facilitate comprehension and implementation of practice guidelines in an interprofessional setting. The purpose of this article is to provide a review of the vision literature in ABI, describe a conceptual model for vision rehabilitation, explain its potential clinical inferences, and discuss its translation into rehabilitation across multiple practice settings and disciplines.
Roberts, P. S., Mix, J., Rupp, K., Younan, C., Mui, W., Riggs, R. V., & Niewczyk, P. (2016). Using functional status in the acute hospital to predict discharge destination for stroke patients. American Journal of Physical Medicine & Rehabilitation, 95, 416-424. http://dx.doi.org/10.1097/PHM.0000000000000412. Link to full text Abstract →
OBJECTIVE: The aim of this study was to determine whether functional status, as measured by the AcuteFIM instrument, can be used to predict discharge destination of stroke patients from the acute hospital setting.
DESIGN: A retrospective cohort study was carried out in an urban academic medical center. Data were collected on 481 new-onset stroke patients 18 yrs or older in an acute hospital between January 1 and September 30, 2013. Functional Independence Measure (FIM) instrument data were linked to a subset of 54 patients who received additional services at an inpatient rehabilitation facility. A receiver operator characteristic curve was constructed to validate the predictive ability of the AcuteFIM instrument and to determine the optimal cutoff score associated with discharge to a community setting.
RESULTS: All AcuteFIM items in stroke patients at admission demonstrated strong interitem correlation coefficients (all above 0.6) and high internal consistency (Cronbach a = 0.94). The AcuteFIM total score was positively associated with discharge to the community from the acute hospital (odds ratio, 1.06; 95% confidence interval, 1.05-1.07). Receiver operator characteristic curve analysis generated a c statistic of 0.89 (95% confidence interval, 0.87-0.92), indicating that the AcuteFIM instrument is predictive of patient discharge to the community setting.
CONCLUSION: This study suggests that the AcuteFIM instrument is a reliable tool that can be used to predict discharge destination from the acute hospital among stroke patients.
Siebens, H. C., Sharkey, P., Aronow, H. U., Deutscher, D., Roberts, P., Munin, M. C., Radnay, C. S., & Horn, S. D. (2016). Variation in rehabilitation treatment patterns for hip fracture treated with arthroplasty. PM&R, 8, 191-207. http://dx.doi.org/10.1016/j.pmrj.2015.07.005. Link to full text Abstract →
BACKGROUND: Recommendations for health care redesign often advocate for comparative effectiveness research that is patient-centered. For patients who require rehabilitation services, a first step in this research process is to understand current practices for specific patient groups.
OBJECTIVE: To document in detail the physical and occupational therapy treatment activities for inpatient hip fracture rehabilitation among 3 patient subgroups distinguished by their early rate of functional recovery between time of surgery to rehabilitation admission.
DESIGN: Multicenter prospective observational cohort, practice-based evidence, study.
SETTING: Seven skilled nursing facilities and 11 inpatient rehabilitation facilities across the United States.
PARTICIPANTS: A total of 226 patients with hip fractures treated with hip arthroplasty.
METHODS: Comparisons of physical and occupational therapy treatment activities among 3 groups with different initial recovery trajectory (IRT) rates (slower, moderate, faster).
MAIN OUTCOME MEASURE(S): Percent of patients in each IRT group exposed to each physical and occupational therapy activity (exposure), and mean minutes per week for each activity (intensity).
RESULTS: The number of patients exposed to different physical or occupational therapy activities varied within the entire sample. More specifically, among the 3 IRT groups, significant differences in exposure occurred for 44% of physical therapy activities and 39% of occupational therapy activities. More patients in the slower recovery group, IRT 1, received basic activities of daily living treatments and more patients in the faster recovery group, IRT 3, received advanced activities. The moderate recovery group, IRT 2, had some treatments similar to IRT 1 group and others similar to IRT 3 group.
CONCLUSIONS: Analyses of practice-based evidence on inpatient rehabilitation of hip fracture patients treated with arthroplasty identified differences in therapy activities among three patient groups classified by IRT rates. These results may enhance physiatrists', other physicians', and rehabilitation teams' understanding of inpatient rehabilitation for these patients and help design future comparative effectiveness research.
McLafferty, F. S., Barmparas, G., Ortega, A., Roberts, P., Ko, A., Harada, M., Nuno, M., Black, K. L., & Ley, E. J. (2016). Predictors of improved functional outcome following inpatient rehabilitation for patients with traumatic brain injury. NeuroRehabilitation, 39, 423-430. http://dx.doi.org/10.3233/NRE-161373. Link to full text Abstract →
OBJECTIVE: To determine factors associated with response to inpatient rehabilitation treatment among TBI patients.
SETTING: Inpatient rehabilitation service at a Level I trauma center.
PARTICIPANTS: Moderate-severe TBI patients ages = 18 years old admitted between January 1, 2002 and December 31, 2012.
MAIN MEASURES: Response to inpatient rehabilitation, measured by the Functional Independence Measure (FIM) score.
DESIGN: Retrospective cohort study.
RESULTS: Of 1,984 patients treated for TBI, 184 (10.8%) underwent inpatient rehabilitation. The largest proportion of patients improved in mobility (98.9%), followed by self-care (93.7%), communication/social cognition (84.0%), and sphincter control (65.7%). Of these, 99 (53.8%) improved by 2 or more levels of functional independence and were considered rehabilitation responders. Responders were younger (53.1 years vs. 63.8, p<0.01), had longer average rehabilitation stays (15.4 days vs. 12.2, p<0.01), and were less likely to have an admission SBP <100mmHg (7.1% vs. 17.1%, p<0.01). On multivariate analysis, normotension at admission (AOR 0.06, p<0.01) and longer rehabilitation LOS (AOR 1.11, p<0.01) were associated with a response to inpatient rehabilitation.
CONCLUSION: Of the TBI patients who qualified for same-center inpatient rehabilitation, approximately half responded to treatment. Longer rehabilitation time and normotension at admission predicted response to rehabilitation. Further efforts are necessary to identify and optimize TBI patients for inpatient rehabilitation.
Riggs, R. V., & Roberts, P. (2015). Initiatives toward creating a true value equation for brain injury. Brain Injury Professional, 12(2), 22-24. Link to full text
Leland, N. E., Crum, K., Phipps, S., Roberts, P., & Gage, B. (2015). Advancing the value and quality of occupational therapy in health service delivery. American Journal of Occupational Therapy, 69, 6901090010p1-6901090010p7. http://dx.doi.org/10.5014/ajot.2015.691001. Link to full text
Asher, A., Roberts, P. S., Bresee, C., Zabel, G., Riggs, R. V., & Rogatko, A. (2014). Transferring inpatient rehabilitation facility cancer patients back to acute care (TRIPBAC). PM&R, 6, 808-813. http://dx.doi.org/10.1016/j.pmrj.2014.01.009. Link to full text Abstract →
OBJECTIVE: To determine predictive factors for TRansferring Inpatient rehabilitation facility (IRF) cancer Patients Back to Acute Care (TRIPBAC).
DESIGN: A retrospective chart review of patients with cancer admitted to an IRF from 2009 to 2010 because of a functional impairment that developed as a direct consequence of their cancer or its treatment.
SETTING: IRF of a community-based, academic, tertiary care facility.
METHODS: The characterization of patients with cancer in the IRF was primarily based on analysis of the IRF Patient Assessment Instrument and other internal IRF data logs.
MAIN OUTCOME MEASUREMENT: Frequency and reasons for TRIPBAC.
RESULTS: The TRIPBAC rate in our IRF was 17.4%. The most common reasons for TRIPBAC were postneurosurgical complications (31%). Factors associated with TRIPBAC were a motor Functional Independence Measure score of 35 points or lower on admission (odds ratio 4.01, 95% confidence interval 1.79-8.98; P = .001) and the presence of a feeding tube or a modified diet (odds ratio 3.18, 95% confidence interval 1.44-7.04; P = .004).
CONCLUSIONS: Motor Functional Independence Measure score on admission is the best predictor for TRIPBAC in patients with cancer admitted to our IRF, followed by the presence of a feeding tube or a modified diet.
Riggs, R. V., Roberts, P. S., DiVita, M. A., Niewczyk, P., & Granger, C. V. (2014). Perceptions of inpatient rehabilitation changes after the Centers for Medicare and Medicaid Service 2010 regulatory updates contrasted with actual performance. PM&R, 6, 44-49. http://dx.doi.org/10.1016/j.pmrj.2013.08.591. Link to full text Abstract →
OBJECTIVES: To compare and contrast subjective perceptions with objective compliance of the impact of the 2010 Centers for Medicare and Medicaid Service updates of the Medicare Benefit Policy Manual.
DESIGN OR SETTING: Cross-sectional survey.
PARTICIPANTS AND METHODS: An electronic survey was sent by the Uniform Data System for Medical Rehabilitation to all enrolled inpatient rehabilitation facility subscribers (n = 817). The survey was sent April 15, 2011, and responses were tabulated if they were received by May 15, 2011.
MAIN OUTCOME MEASUREMENTS: Comparing and contrasting of the subjective perception to objective evaluation and/or compliance with the Medicare Benefit Policy Manual on case mix index, length of stay, admissions by diagnostic category as well as perception of preadmission screening, postadmission evaluation, plan of care, and interdisciplinary conferencing.
RESULTS: Twenty-five percent of the 817 facilities responded, for a total of 209 responses. Complete data were present in 148 of the respondents. For most diagnostic categories, perception of change did not mirror reality of change; neither did the perception between change in case mix index and length of stay. Perception did match reality in stroke and multiple trauma cases; respondents perceived an increase in admissions for the 2 impairments, and there was an overall increase in reality.
CONCLUSION: Comparison with actual data identified that gaps exist between diagnostic category perceptions and actual diagnostic category admission performance. Regulations such as the 75%-60% rule and audit focus on non-neurologic conditions as well as actual inpatient rehabilitation facility program payment reports may have influenced respondents perceptions to change associated with the Medicare Benefit Policy Manual modifications. This disparity between perception and actual data may have implications for programmatic planning, forecasting, and resource allocation.
Roberts, P. S., DiVita, M. A., Riggs, R. V., Niewczyk, P., Bergquist, B., & Granger, C. V. (2014). Risk factors for discharge to an acute care hospital from inpatient rehabilitation among stroke patients. PM&R, 6, 50-55. http://dx.doi.org/10.1016/j.pmrj.2013.08.592. Link to full text Abstract →
OBJECTIVE: To identify medical and functional health risk factors for being discharged directly to an acute-care hospital from an inpatient rehabilitation facility among patients who have had a stroke.
DESIGN: Retrospective cohort study.
SETTING: Academic medical center.
PARTICIPANTS: A total of 783 patients with a primary diagnosis of stroke seen from 2008 to 2012; 60 were discharged directly to an acute-care hospital and 723 were discharged to other settings, including community and other institutional settings.
METHODS OR INTERVENTIONS: Logistic regression analysis.
MAIN OUTCOME MEASUREMENTS: Direct discharge to an acute care hospital compared with other discharge settings from the inpatient rehabilitation unit.
RESULTS: No significant differences in demographic characteristics were found between the 2 groups. The adjusted logistic regression model revealed 2 significant risk factors for being discharged to an acute care hospital: admission motor Functional Independence Measure total score (odds ratio 0.97, 95% confidence interval 0.95-0.99) and enteral feeding at admission (odds ratio 2.87, 95% confidence interval 1.34-6.13). The presence of a Centers for Medicare and Medicaid-tiered comorbidity trended toward significance.
CONCLUSION: Based on this research, we identified specific medical and functional health risk factors in the stroke population that affect the rate of discharge to an acute-care hospital. With active medical and functional management, early identification of these critical components may lead to the prevention of stroke patients from being discharged to an acute-care hospital from the inpatient rehabilitation setting.
Roberts, P. S., & Robinson, M. R. (2014). Occupational therapy's role in preventing acute readmissions. American Journal of Occupational Therapy, 68, 254-259. http://dx.doi.org/10.5014/ajot.2014.683001. Link to full text
Roberts, P. S., Nuno, N., Sherman, D., Asher, A., Wertheimer, J., Riggs, R. V., & Patil, C. G. (2014). The impact of inpatient rehabilitation on function and survival of newly diagnosed patients with glioblastoma. PM&R, 6, 514-521. http://dx.doi.org/10.1016/j.pmrj.2013.12.007. Link to full text Abstract →
OBJECTIVE: To examine the impact of an inpatient rehabilitation program on functional improvement and survival among patients with newly diagnosed glioblastoma multiforme (GBM) who underwent surgical resection of the brain tumor.
DESIGN: A retrospective cohort study of newly diagnosed patients with GBM between 2003 and 2010, with survival data updated through January 23, 2013.
SETTING: An urban academic nonprofit medical center that included acute medical and inpatient rehabilitation.
PARTICIPANTS: Data for newly diagnosed patients with GBM were examined; of these patients, 100 underwent inpatient rehabilitation after resection, and 312 did not undergo inpatient rehabilitation.
MAIN OUTCOME MEASUREMENTS: Overall functional improvement and survival time for patients who participated in the inpatient rehabilitation program.
RESULTS: A total of 89 patients (93.7%) who underwent inpatient rehabilitation improved in functional status from admission to discharge, with the highest gain observed in mobility (96.8%), followed by self-care (88.4%), communication/social cognition (75.8%), and sphincter control (50.5%). The median overall survival among inpatient rehabilitation patients was 14.3 versus 17.9 months for patients who did not undergo inpatient rehabilitation (P = .03). However, after we adjusted for age, extent of resection, and Karnofsky Performance Status Scale scores, we found no statistical difference in the survival rate between patients who did and did not undergo inpatient rehabilitation (hazard ratio [HR], 0.84; P = .16). Among the patients who underwent inpatient rehabilitation, older age (HR, 2.24; P = .0006), a low degree of resection (HR, 1.67; P = .02), and lack of a Stupp regimen (HR, 1.71; P = .05) were associated with greater hazard of mortality.
CONCLUSIONS: Patients who undergo inpatient rehabilitation demonstrate significant functional improvements, primarily in the mobility domain. Confounder adjusted multivariate analysis showed no survival difference between patients who did and did not undergo inpatient rehabilitation; this finding suggests that a structured inpatient rehabilitation program may level the survival field in lower-functioning patients who otherwise may be faced with a dismal prognosis.
Phipps, S., & Roberts, P. (2012). Predicting the effects of cerebral palsy severity on self-care, mobility, and social function. American Journal of Occupational Therapy, 66, 422-429. http://dx.doi.org/10.5014/ajot.2012.003921. Link to full text Abstract →
In this retrospective, longitudinal cohort study, the Pediatric Evaluation of Disability Inventory was used to predict the effects of cerebral palsy (CP) on self-care, mobility, and social function for 2,768 children, adolescents, and young adults with CP. Multiple linear regression was used to predict functional performance and level of caregiver assistance and found that CP severity, as measured by the Gross Motor Function Classification System and the Manual Ability Classification System, had the strongest effect. More severe levels of gross motor and fine motor dysfunction resulted in lower levels of self-care, mobility, and social function and increased levels of caregiver assistance. This study provides critical evidence regarding the importance of CP severity as a predictor of self-care, mobility, and social function that can be tested in future research to improve therapy treatment planning, caregiver education, and clinical resource utilization.