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| Name | Class |
|---|---|
| Nova Southeastern University | OTHER |
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Physical therapy assessments assist in discharge planning along with demographic and social factors for patients with stroke in acute care. Understanding where a patient can be discharged to, based on the patient's functional status post stroke is important to be able to use resources effectively, decrease length of stay, and facilitate early initiation of rehabilitation services if needed. Standardized outcome measures can help quantify functional deficits and the scores on the standardized outcome measures can in turn guide the discharge planning process. The Activity Measure for Post Acute Care "6-Clicks" (AM-PAC "6-Clicks") has been used in the acute care setting to guide discharge planning. Based on its cutoff scores, it also can assist in predicting discharge destination. The Mobility Scale for Acute Stroke (MSAS) has been used to determine discharge to home versus not home in patients with stroke. Understanding the validity of the MSAS in comparison with the Postural Assessment Scale for Stroke (PASS) and the AM-PAC "6-Clicks" can be beneficial as the MSAS is a stroke specific outcome measure which is mainly used in acute care and is easy to administer. It can be administered in a short duration and consists of mobility and balance assessments which can help determine functional deficits.
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| One time Physical Therapy Evaluation | Other | A physical therapist will perform an evaluation which will consist of history taking and assessing the following: strength, endurance, range of motion, sitting/standing balance, sensory testing, and skin integrity. Following these assessments, the physical therapist will assess participant's functional mobility which involves assessing how you get out of bed, standing up, and walking. The physical therapist will also assess the participant on three tests which help determine your balance and assistance required with functional mobility. The tests that will be performed in no particular order are PASS, MSAS, AM-PAC "6-Clicks", OPS, MRS, and FCI. Data for the AM-PAC daily activity and applied cognition domains will be obtained from the patient's chart from the Occupational Therapy evaluation. Discharge destination information will be obtained from the PT evaluation and the discharge destinations will be acute/inpatient rehab, SAR, SNF, Home with or without home PT, and outpatient PT. |
| Measure | Description | Time Frame |
|---|---|---|
| Mobility Scale for Acute Stroke (MSAS) | The MSAS is a six-item scale which consists of components that are routinely assessed in patients by physical therapists. The components are bridging, sit from supine and then return to supine, sitting balance to be held for 3 minutes, sit to stand from a chair without using arms, standing balance for 1 minute, and gait testing for 10 m with or without an assistive device. The scores for each domain range from 6 to 36. The cut off score is 26 with scores above 26 indicating possible discharge to home and below 26 indicating need for institutionalization. | Baseline |
| Postural Assessment Scale for Stroke (PASS) | The PASS consists of 12-items assessing balance ability to maintain postures or while changing postures. The score range for the PASS is 0 to 36 with lower scores indicating greater balance impairments. The 12 items consist of sitting without support, standing with support, standing without support, standing on nonparetic leg, standing on paretic leg, supine to paretic side lateral, supine to nonparetic side lateral, supine to sitting up on edge of the mat, sitting on the edge of the mat to supine, sitting to standing up, standing up to sitting down, and standing - picking up a pencil from the floor. | Baseline |
| Activity Measure for Post-Acute Care "6-Clicks" (AM-PAC "6-Clicks") | The AM-PAC was developed to assess activity level post-acute care. It consists of three domains - basic mobility, daily activity, and applied cognition and each of the three domains consists of six items. The raw scores for each domain range from 6 to 24. A higher raw score indicates less functional limitations. The cutoff score for medically complex patients is 42.9 for the basic mobility domain and 39.4 for the daily activity domain. | Baseline |
| Measure | Description | Time Frame |
|---|---|---|
| Orpington Prognostic Scale (OPS) | The OPS consists of four domains namely deficits in upper extremity strength, upper extremity proprioception, balance, and cognition. The total score consists of adding all four domains together along with 1.6. The total score can range from 1.6 to 6.8. The cutoff scores range from < 3.2 to > 5.2, where < 3.2 indicates a high likelihood of discharge home; a score between 3.2 and 5.2 respond better to inpatient rehabilitation; and a score of > 5.2 indicates increased risk of institutionalization as patients are typically dependent. |
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Inclusion Criteria:
Exclusion Criteria:
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The population of interest is individuals with acute stroke admitted to the neurology unit of New York Presbyterian Brooklyn Methodist hospital in New York. 532 patients with stroke were admitted to the hospital in the year 2022. Participants will be recruited based on a sample of convenience. All people with a diagnosis of stroke admitted to the neurology unit of the acute care hospital will be screened for participation using the medical record. Patients with stroke who meet the inclusion criteria will be offered the opportunity to participate in the research study. Patients who agree to participate will be provided with an informed consent form which will be signed by the patient or health care proxy. If a patient chooses not to participate in the study, the patient will still receive physical therapy services similar to the study participant.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Aniketh M Chavan, DPT | Contact | 3176029203 | dlx9003@nyp.org |
| Name | Affiliation | Role |
|---|---|---|
| Asad Siddiqi, DO | New York Presbyterian Brooklyn Methodist Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| New York Presbyterian Brooklyn Methodist Hospital | Brooklyn | New York | 11215 | United States |
The data will be deidentified and will be saved on a password protected drive. In addition, only personnel who are associated with the study will have access to the study specific records in the database. For any adverse events that happen during the physical therapy assessment, they will be documented, and the medical team will be notified. A data transfer usage agreement will be established between Nova Southeastern University and New York Presbyterian Brooklyn Methodist Hospital.
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| Baseline |
| Modified Rankin Scale (MRS) | The MRS is a global outcomes rating scale which ranges from 0 (no impairment) to 5 (severe disability- patient is bedridden, incontinent, and requires constant nursing care and attention) and 6 (death). A higher score indicates greater impairment. | Baseline |
| Functional Comorbidity Index (FCI) | The FCI was developed to assess comorbidity and used physical function as the outcome. It consists of an 18-item list of diagnoses. The scores range from 0 to 18 which is the cumulative sum of the comorbidities present. | Baseline |
| ID | Term |
|---|---|
| D020521 | Stroke |
| D000083302 | Hemorrhagic Stroke |
| ID | Term |
|---|---|
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
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