Stroke patients receive different amounts of physical therapy – ScienceDaily

The research team, led by Amit Kumar, an badistant professor at Brown's School of Public Health, badyzed data from the 2010 Medicare claims for approximately 104,000 stroke patients . They found that 15% of patients did not receive any physical therapy (PT) or occupational therapy (OT), while on average stroke patients received 2-hour therapy during their stay at the clinic. 39; hospital. Some patients received nearly 4 hours of treatment, but they tended to stay in hospital longer, Kumar added.

"For stroke patients, rehabilitation services are one of the most important elements in providing treatment after stabilization in the context of acute care," he said. said Kumar, an badistant professor of physiotherapy at Northern Arizona University. "This is the only treatment that helps patients resume their daily activities, such as walking or going to the bathroom independently, so it's important to start physiotherapy and occupational therapy as soon as possible."

The results were published Wednesday, April 24 in the newspaper Physiotherapy Journal.

The document is based on additional work of the same group published in January in the Archives of Physical Medicine and Rehabilitation. This study showed that patients with stroke who receive more PT – help patients regain mobility in areas of the body affected by stroke and recover functions such as walking, balancing or moving the muscles. arms – present a lower risk of readmission to the hospital in the following month discharge.

In fact, Medicare patients in whom ischemic stroke has been diagnosed – the most common type of stroke, occurring when a cerebral artery is obstructed, thereby reducing blood flow – that have been received 75 minutes or more of PT while in hospital were 14% less likely to readmit than those who did not. Even 30 minutes reduced the risk of readmission by 10%.

However, researchers found that the number of occupational therapies, which consisted of helping patients find facilities with daily tasks such as dressing or using the toilet, had minimal impact on the risks of readmission. .

Kumar believes that PT treatment reduces the risk of readmission to the hospital in two ways. First, it helps patients regain movement and regain the ability to perform tasks. Second, it allows physiotherapists and occupational therapists to play a role in planning and preparing patients for the next stage of post-acute care – whether it is an inpatient rehabilitation specialized or home care of the patient, with home health care. badistance.

In the second article, the research team found that 61.5% of stroke patients received both physiotherapy and physiotherapy services, 22% only physiotherapists, 1.7%, and 15% patients. For patients who followed a physical or occupational therapy, they received an average of 14 additional minutes of treatment for each additional day spent in the hospital.

Patients who were both enrolled in Medicare and Medicaid, indicating more complex clinical needs and lower socio-economic status, were 16% less likely to receive either of the rehab services. . The researchers found that patients in whom a feeding tube was inserted, indicating a severe stroke, were 53% less likely to receive rehabilitation services. The results indicate an inability to provide rehabilitative care to patients with more complex needs and more severe conditions, they said.

Patients treated in a hospital with more than 370 patients per year were more likely to receive rehabilitation services, but received an average of 6 less treatment minutes compared to hospitals with fewer than 124 patients per year.

Portrait of Amit Kumar, Assistant Professor at the Brown School of Public Health.

Amit Kumar, Assistant Adjunct Professor at the Brown & s School of Public Health and Senior Author.

On the other hand, patients treated in a hospital with an inpatient rehabilitation unit were more likely to receive rehabilitation services and received an average of 8 additional minutes of treatment. This indicates that the financial incentives established by the Centers for Medicare and Medicaid services, such as bundled payment programs, appear to be effective in improving coordination of acute and post-acute care and improving outcomes for patients, Kumar said. In the first study, his team found that patients treated in a hospital with an inpatient rehabilitation unit were 8% less likely to be readmitted.

Now, Kumar is reviewing Medicare claims data for 2017 regarding various potentially disabling conditions, including stroke, heart failure, joint replacements, and hip fractures, to determine if changes to Medicare's policy since 2010 has helped improve the number of rehabilitation services provided to patients. Kumar will also review when rehabilitation services are put in place to determine if this impacts patient outcomes.

Currently, there are no clear guidelines regarding the timing and number of rehabilitation services offered during stays at the hospital, Kumar said. And the current Medicare-based reimbursement model for hospitals does not include measures of the patient's functional status or rehabilitation services, which could dissuade providers from recommending rehabilitation services. he adds.

Kumar thinks that a randomized controlled trial on the amount and timing of hospital rehabilitation services is needed. The results of such a clinical trial could shed light on the American Heart Association / American Stroke Association's clear rehab guidelines, a revised Medicare payment model and, ultimately, better patient outcomes. .