Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
In an observational study of 88 participants who underwent cardiac surgery, we investigated the relationship among cognition, medication management, and ability to recall postsurgical precautions, as well as hospital readmissions, in order to better understand how OTs can intervene with this population to improve outcomes. Our findings suggest that focusing on functional cognition could allow OTs to bring distinct value to the cardiac surgery multidisciplinary team.
Primary Author and Speaker: Laura Koshewitz
Additional Authors and Speakers: Jennifer Lambarth, Tallat Nadeemullah
PURPOSE: The goal of this study was to guide future occupational therapy assessment and intervention in the cardiac surgery population to optimize independence, health and well-being. Cognitive deficits affect approximately half of all individuals following cardiac surgery (Naglie, et al, 1999) and those with cognitive impairments have an increased risk of death during the first 3 months following surgery (Steinmetz, et al, 2009). Our study was designed to examine cognition as it relates to the ability to recall post-surgical precautions and complete medication management. Our specific research objectives were to: 1.) Examine the relationship between cognition, ability to recall post-surgical precautions, and ability to manage medications in those undergoing planned cardiac surgeries prior to surgery, during hospitalization, and at a clinic follow-up visit; 2.) Determine if hospital readmission is predicted by cognition, medication management skills, and/or the recall of post-surgical precautions. We hypothesized that a difficulty recalling post-surgical precautions during ADL tasks and/or a difficulty with the vital IADL of medication management could be factors related to cognition that contribute to negative outcomes for individuals who undergo cardiac surgery.
DESIGN: This was an observational study. Participants were recruited from the cardiac clinic at Michigan Medicine. Sampling occurred on a voluntary basis from patients meeting the inclusion criteria of: a planned coronary artery bypass graft or valve repair/replacement via sternotomy; ability to follow directions to complete assessments per clinical judgment; independent management of medications prior to surgery; and age of 18 years or older. Participants were excluded if they no longer met these criteria, if they experienced a cardiac arrest or CVA or were requiring intensive care throughout the post-operative assessment window.
METHOD: Cognition was assessed using The Montreal Cognitive Assessment (MoCA) (Nasreddine et al, 2005). Medication management was assessed using The Medication Transfer Screen (MTS) (Anderson, et al, 2008). Recall of post-surgical precautions was assessed using a standard script. The MoCA and MTS were administered during the initial encounter at the patient's pre-operative appointment. The MoCA, MTS, and recall script were administered while the participant was hospitalized (3-6 days following surgery) and at a follow-up appointment in the clinic approximately 30 days after surgery. Repeated measures linear regression was used to model assessment scores across all participant visits.
RESULTS: A total of 88 participants were included in some portion of the analysis. Modest to moderate correlations were found between all measures. MoCA and MTS scores decreased from the first administration prior to surgery to the second administration during hospitalization, then increased at the third administration during the post-operative clinic visit. Median scores for the MoCA and MTS were lower in the readmitted participants (n = 9) compared to those not readmitted (n = 68) but this was not statistically significant, with sample size being a limitation.
CONCLUSION: Our findings were limited by sample size and data collection difficulties but did support the hypothesis that cognition, medication management, and recall of post-surgical precautions are related. More research is needed, but these factors might influence outcomes for cardiac surgery patients. Our findings support that assessment of functional cognition in clients undergoing cardiac surgery could help guide practitioners in establishing distinct, targeted, and effective occupational therapy programs for clients that undergo cardiac surgery.
References
Anderson K, Jue S, Madaras-Kelly K. 2008. Identifying patients at risk for medication mismanagement using cognitive screen to predict a patient’s accuracy in filling a pillbox. The Consultant Pharmacist 23(6): 459, 460-472.
Naglie G, Tansey C, Krahn M, O’Rourke K, Detsky A, Bolley H. 1999. Direct costs of coronary artery bypass grafting in patients aged 65 years or more and those under age 65. Canadian Medical Association Journal 160(6): 805, 806-811.
Nasreddine Z, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, Cummings J, Chertkow, H. 2005. The Montreal cognitive assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society 53(4): 695-9.
Steinmetz J, Christensen KB, Lund, Thomas, Lohse, Nicolai, Rasmussen, Lars, the ISPOCD Group.2009. Long term consequences of postoperative cognitive dysfunction. Anesthesiology 110:548, 549-555.
