Community Discharge After Hip Fracture
Principal Investigator: Kenneth Ottenbacher (University of Texas Medical Branch at Galveston)
K12 Scholar: Natalie Leland PhD, OTR/L, BCG, FAOTA
Sep 2011 – Aug 2014
Among community-dwelling older adults who experience an acute hospitalization and are discharged to post-acute care, the primary rehabilitation goal is community discharge. Yet, little is known about getting post-acute care Medicare beneficiaries back to the community and have them remain there. Re-hospitalization often limits the time spent at home. The goal of this K12 mentored research project is to further develop quantitative methodological skills to examine the national and temporal variation in the patient outcome of getting back to the community and remaining there among post-acute care Medicare patients who have experienced their first hip fracture.
|Federal||NIH / National Institute of Child Health and Human Development (NICHD) / National Institute of Neurological Disorders (NINDS) Rehabilitation Research Career Development Program||5 K12 HD055929-05||$75,000|
Takata, S. C., Wade, E. T., & Roll, S. C. (2019). Hand therapy interventions, outcomes, and diagnoses evaluated over the last 10 years: A mapping review linking research to practice. Journal of Hand Therapy, 32(1), 1–9. https://doi.org/10.1016/j.jht.2017.05.018 Show abstract
Study Design. Mapping review.
Introduction. Although published literature and evidence to support medical practice is becoming more abundant, it is not known how well available evidence supports the full spectrum of hand therapy practice.
Purpose of the Study. The aim of this mapping review was to identify strengths and/or gaps in the available literature as compared with the hand therapy scope of practice to guide future research.
Methods. A systematic search and screening was conducted to identify evidence published from 2006 to 2015. Descriptive data from 191 studies were extracted, and the diagnoses, interventions, and outcomes used in the literature were compared with the hand therapy scope of practice.
Results. Osteoarthritis, tendon surgeries, and carpal tunnel syndrome were most frequently studied. Exercise, education, and orthotic interventions were most common, each used in more than 100 studies; only 12 studies used activity-based interventions. Primary outcome measures included range of motion, pain/symptoms, strength, and functional status.
Discussion. Abundant high-quality research exists for a portion of the hand therapy scope of practice; however, there is a paucity of evidence for numerous diagnoses and interventions.
Conclusions. More evidence is needed for complex diagnoses and activity-based interventions as well as behavioral and quality-of-care outcomes.
Level of Evidence. Not applicable.
Wong, C., & Leland, N. E. (2018). Clinicians' perspectives of patient engagement in post-acute care: A social ecological approach. Physical & Occupational Therapy In Geriatrics, 36(1), 29-42. https://doi.org/10.1080/02703181.2017.1407859 Show abstract
Aims. To identify rehabilitation providers' perspectives on barriers and facilitators of patient engagement in hip fracture patients in skilled nursing facilities (SNFs) within the social ecological model.
Methods. We conducted 13 focus groups in SNFs throughout Los Angeles County comprised of rehabilitation staff (n = 99). Focus groups were audio-recorded and transcribed. A secondary analysis of themes related to patient engagement were identified and organized within the social ecological model.
Results. Clinicians identified barriers and facilitators of patient engagement across all levels of the social ecological model: public policy (e.g., insurance), organizational (e.g., facility culture), interpersonal (e.g., clinicians fostering self-reflection), and intrapersonal (e.g., patients' anxiety).
Conclusions. Examining barriers and facilitators to patient engagement has highlighted areas which need to be sustained and improved. Thus, these findings will inform future efforts to enhance patient engagement in order can to optimize patient healthcare decisions.
Roll, S. C., & Hardison, M. E. (2017). Effectiveness of occupational therapy interventions for adults with musculoskeletal conditions of the forearm, wrist, and hand: A systematic review. American Journal of Occupational Therapy, 71(1), 7101180010p1-7101180010p12. https://doi.org/10.5014/ajot.2017.023234 Show abstract
Occupational therapy practitioners are key health care providers for people with musculoskeletal disorders of the distal upper extremity. It is imperative that practitioners understand the most effective and efficient means for remediating impairments and supporting clients in progressing to independence in purposeful occupations. This systematic review provides an update to a previous review by summarizing articles published between 2006 and July 2014 related to the focused question, What is the evidence for the effect of occupational therapy interventions on functional outcomes for adults with musculoskeletal disorders of the forearm, wrist, and hand? A total of 59 articles were reviewed. Evidence for interventions was synthesized by condition within bone, joint, and general hand disorders; peripheral nerve disorders; and tendon disorders. The strongest evidence supports postsurgical early active motion protocols and splinting for various conditions. Very few studies have examined occupation-based interventions. Implications for occupational therapy practice and research are provided.