Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
In acute care, discharge planning is a primary role of OT for clients with arm impairment after stroke. Discharge planning accounts for many factors, including impairments, function, social supports, insurance, and the input of other disciplines. This research aimed to (1) determine the agreement in discharge recommendations between OT and physical therapy during acute hospitalization and (2) determine the agreement of OT recommendation and actual discharge setting for clients with arm impairment after stroke.
Primary Author and Speaker: Nicole C. Lam
Contributing Authors: Kimberly Erler, Jessica Ranford, Jessica D. Asiello, Kimberly Cortina, Natasha Frazier, Abigail Rude, Caitlin Sadlak, Helena Thorne, Rachel Collins, Erin E. Donovan, Sarah Norris, and David Lin
PURPOSE: Occupational therapy (OT) practitioners are key members of the interprofessional team for clients with upper extremity (UE) impairment after stroke. In acute care, transition and discharge planning is one of the primary roles of OT (AOTA, 2017). OT practitioners comprehensively evaluate a client's current impairment and function to determine the post-acute care setting that will best address their needs and optimize their functional outcomes. Since UE impairment continues to be the most common source of disability after stroke, discharge planning from acute care is of utmost importance during the time of maximal neuroplasticity. Typically, discharge recommendations and actual discharge destination are not tracked systematically. However, OT practitioners should participate in research that longitudinally follows clients with stroke across the continuum of care to further examine practice and understand outcomes (Ranford et al., 2019). By improving transitions in care, OT practitioners can have an impact on reducing hospital length of stay, spending, and readmission rates (Freburger et al., 2018). Discharge planning is a complex process that considers a client's impairments, functional status, social supports, insurance status, and the recommendations of various disciplines which at times may differ. A lack of consensus amongst disciplines may result in delayed or inappropriate transitions in care. However, there is a scarcity of research on the agreement of discharge recommendations between OT and physical therapy (PT) as well as between OT and where a client actually discharges (Stein et al., 2020). To address this gap in knowledge around discharge planning in acute care for clients post stroke with UE impairment, this study aimed to 1) determine the agreement in discharge recommendations between OT and PT during initial inpatient evaluation and 2) determine the agreement of OT recommendation and actual discharge destination.
DESIGN: Participants (N = 124) were enrolled in the Stroke Motor Rehabilitation and Recovery Study, a longitudinal, observational study of stroke motor recovery. Adults, aged 18-90, post stroke with UE impairment were recruited upon admission to the acute inpatient stroke service at Massachusetts General Hospital in Boston, MA. UE impairment was defined by a score of >1 on NIH Stroke Scale Arm Motor Drift Questions 5A or 5B. Discharge destination was coded as home or inpatient setting.
METHOD: OT and PT discharge recommendations during initial inpatient evaluation and actual discharge destination were obtained through medical record review. Percent agreement and Cohen's Kappa were performed to measure agreement between OT and PT recommendations as well as OT recommendation and actual discharge destination.
RESULTS: After adjustment for cases in which either OT or PT did not specify the recommendation, agreement between OT and PT discharge recommendations was found in 111/113 cases (98.2%, ΰ = 0.93) and agreement between OT recommendation and actual discharge destination was found in 106/117 cases (90.6%, ΰ = 0.65), indicating very good and good agreement respectively.
CONCLUSION: The recommendations of OT and PT in acute care for clients with UE impairment after stroke had high levels of agreement. In addition, results suggested that clients post stroke with UE impairment advanced along the continuum of care in accordance with OT recommendations. While this study indicated high levels of agreement, future studies are required to more rigorously understand the factors that predict discharge recommendations and locations. The recommendations of OT practitioners in acute care have implications for client outcomes; therefore, we need to continue to assess and improve our current practices.
References
American Occupational Therapy Association. (2017). Occupational therapy’s role with acute care [Fact sheet]. https://www.aota.org/∼/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/RDP/Facts/Acute-Care.pdf
Freburger, J. K., Li, D., Johnson, A. M., & Fraher, E. P. (2018). Physical and occupational therapy from the acute to community setting after stroke: Predictors of use, continuity of care, and timeliness of care. Archives of Physical Medicine and Rehabilitation, 99(6), 1077-1089.e7. https://doi.org/10.1016/j.apmr.2017.03.007
Ranford, J., Asiello, J., Cloutier, A., Cortina, K., Thorne, H., Erler, K. S., Frazier, N., Sadlak, C., Rude, A., & Lin, D. J. (2019). Interdisciplinary stroke recovery research: The perspective of occupational therapists in acute care. Frontiers in Neurology, 10. https://doi.org/10.3389/fneur.2019.01327
Stein, J., Borg-Jensen, P., Sicklick, A., Rodstein, B. M., Hedeman, R., Bettger, J. P., Hemmitt, R., Silver, B. M., Thode, H. C., & Magdon-Ismail, Z. (2020). Are stroke survivors discharged to the recommended postacute setting? Archives of Physical Medicine and Rehabilitation, 101(7), 1190–1198. https://doi.org/10.1016/j.apmr.2020.03.006
