Date Presented 03/28/20
With an increased emphasis on evidence-based practice, documentation, and justification of services in the current healthcare system, this feeding group study serves as a model of the effectiveness of interdisciplinary collaboration, demonstrating the value of OT services to proficiently address feeding skills that strongly impact a stroke patient’s functional performance, return to the community, and quality of life.
Primary Author and Speaker: Amanda Romano
Additional Authors and Speakers: Charlene Wong, Jeanina Miller
Contributing Authors: Miriam Ringel, Kara Nizolek
PURPOSE: The goal of an Inpatient Rehabilitation Facility (IRF) is to prepare patients for a safe and smooth return to the community. This study demonstrates the value of interdisciplinary ancillary services to impact functional gains specifically in the area of feeding, and highlights the value of Occupational Therapy services within an interdisciplinary model of care. Feeding as an ADL not only facilitates nutritional sustenance required for physical survival, but is also an everyday, meaningful occupation that informs quality of life and serves as the context of human interaction. Feeding involves a complex integration of motor and cognitive demands and skills that OTs are uniquely prepared to address.
DESIGN: NYU Langone Hospital – Brooklyn’s (NYULB) IRF unit is the only facility in the Northeast possessing both The Joint Commission, Disease Specific Stroke Rehabilitation Certification and Comprehensive Stroke Center Certification. In response to their data showing lower than national average feeding FIM score changes, the OTs and SLPs initiated a “Feeding Group” in September 2018 in an effort to incorporate a team approach and collaboratively address the multifaceted dynamics of feeding skills. They launched an experimental study to assess and improve the effectiveness of their interventions in promoting independence in feeding, specifically in stroke patients. The participants of this study has a diagnosis of stroke (Rehab Impairment Category 1 under the Uniform Data Systems), and based on recommendations of the interdisciplinary team. Participation was voluntary- indiscriminate of age, gender, creed, and medical history.
METHOD: This study utilizes a quantitative method of analysis, comparing FIM score changes from time of admission to discharge. The FIM, has historically been identified as the universal tool for quantifying patient performance, was selected for its strong inter-rater reliability and industry-centered and measurable means of determining functional changes in feeding.
This Feeding Group study occurs twice weekly addressing common stroke impairments, including hemiparesis, postural instability, motor and ideational apraxia, neglect and other visual-perceptual deficits, aphasia, dysphagia, decreased activity tolerance, and executive functioning.
With the incorporation of the Feeding Group, a careful analysis of the Eating FIM changes at NYULB indicated a statistically robust improvement in patient feeding performance. Eating FIM scores increased from 0.7 points in September 2018 to 1.3 points in August 2019, with a cumulative 2018 fiscal year change of 1.2 points (National average:1.3; Regional average: 1.1). This research clearly demonstrates the strong potential of incorporating interdisciplinary groups in an IRF setting.
CONCLUSION: Feeding involves a complex integration of motor and cognitive skills that are impacted by the interactions of client factors, performance skills, and the environment. An interdisciplinary approach to address feeding impairments acknowledges these complexities and has the potential to more effectively complement traditional acute rehab services.
IMPACT STATEMENT: With an increased emphasis on evidence-based practice, documentation and justification of services in the current healthcare system, this Feeding Group study serves as a model of the effectiveness of interdisciplinary collaboration, demonstrating the value of OT services to proficiently address feeding skills which strongly impact a stroke patient’s functional performance, return to the community, and quality of life.
References
Mehdizadeh, M., Hassani Mehraban A., & Zahediyannasab R. (2017). The effect of group-based occupational therapy on performance and satisfaction of stroke survivors: pilot trial, neuro-occupational view. Basic Clin Neurosci: 8(1):69-76. doi: 10.15412/J.BCN.03080109.
Renner, C., Outermans,J., Ludwig, R, Brendel, C., Kwakkel, G., & Hummelsheim, H. (2016). Group therapy task training versus individual task training during inpatient stroke rehabilitation: a randomised controlled trial. Clin Rehabil.(7):637-48. doi: 10.1177/0269215515600206.
Hammond, M., Barrett, R., Dijkers, P., Zanca, M., Horn, D 2, Smout J.,...Dunning, R. (2015). Group therapy use and its impact on the outcomes of inpatient rehabilitation after traumatic brain injury: data from traumatic brain injury-practice based evidence project. Arch Phys Med Rehabil.;96(8 Suppl): S282-92.e5. doi: 10.1016/j.apmr.2014.11.029.
