Comparison of Community Reintegration Interventions When Using a Simulated Environment

Comparison of Community Reintegration Interventions Relative to the Institution of a Simulated Environment in Inpatient Rehabilitation and Pilot Study of the Impact of Simulated Environment on Functional Outcomes

The investigators believe that rehabilitation specialists will use community reintegration treatments more if a simulated environment is available.

Community reintegration training has always been a significant aspect of inpatient rehabilitation recovery. Community reintegration training involved therapists and patients going into the actual community to evaluate and practice their functional tasks such as negotiating curbs, crosswalks, or marketplaces. During the COVID-19 pandemic, this option was not available. The absence of this intervention made it challenging for therapists to evaluate a patient's safety to return home. Creating a simulated environment within the inpatient rehabilitation department became an alternative to taking patients to an outside environment. Saji, et al. (2015) demonstrated that utilization of a simulated environment enhanced functional improvements of post-acute stroke patients at 12 convalescent rehabilitation wards. New York Presbyterian Weill Cornell Medical Center (NYP- WCMC) has constructed a simulated environment for the purposes of enhancing community reintegration training. This project will test its use and efficacy.

The availability of this simulated environment may be more time-efficient and safer than community reintegration training outside of the department or hospital. Training in the simulated environment may improve the functional ability of individuals undergoing inpatient rehabilitation, in accordance with the degree of use of the simulated environment. Greater use of the simulated environment may predict greater functional improvements. This study will collect pilot data about functional outcomes and patient perspectives about their balance confidence, their ability to perform functional tasks, and the efficacy of the use of simulated environment for community reintegration. This pilot data will seed a future efficacy study with a comparison group.

Inclusion Criteria:

• Medical records of patients admitted to the IRU from January 1, 2015 through December 31, 2019 will be queried for number of minutes billed for Community Integration.
• Medical records of patients admitted to the IRU from April 2
• Patients admitted to the Inpatient Rehabilitation Unit (IRU) of at least 18 years of age and older
• Patients who can read and provide informed consent in English.
• Patients who will be discharged to home after inpatient rehabilitation.
• Patients who are ambulatory with a minimal QI score of 3 on "Walk 10 feet".
• Patients who utilized the simulated environment during their inpatient stay.
• Patients who score 8 or greater on the BIMS on initial evaluation.

Exclusion Criteria:

• The investigators will exclude medical records of patients admitted to the IRU from January 1, 2020 through December 31, 2021 because of the COVID restrictions that were in place.
• Patients who are less than 18 years of age.
• Patients who are not ambulatory due to medical reasons.
• Patients who cannot read and provide informed consent in English.
• Patients who were discharged to acute care, skilled nursing facility or long-term care facility after their inpatient rehabilitation stay.
• Patients who did not use the simulated environment during their inpatient stay.
• Patients who score 7 or lower on the BIMS on initial evaluation.