National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Back Health and Pain (1)
- Brain Injury (1)
- Cardiovascular Conditions (3)
- Chronic Conditions (1)
- Communication (1)
- COVID-19 (1)
- Disabilities (1)
- Elderly (2)
- Evidence-Based Practice (1)
- Healthcare Delivery (1)
- Health Information Technology (HIT) (2)
- Home Healthcare (1)
- Inpatient Care (1)
- Neurological Disorders (1)
- Orthopedics (4)
- Outcomes (4)
- Pain (1)
- Patient-Centered Healthcare (2)
- Patient-Centered Outcomes Research (3)
- Quality Improvement (1)
- Quality of Care (1)
- Quality of Life (1)
- (-) Rehabilitation (13)
- Research Methodologies (1)
- Screening (1)
- Sex Factors (1)
- Shared Decision Making (1)
- Stroke (2)
- Surgery (3)
- Transitions of Care (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 13 of 13 Research Studies DisplayedGraber J, Juarez-Colunga E, Thigpen C
Development of reference charts for monitoring quadriceps strength with handheld dynamometry after total knee arthroplasty.
This retrospective analysis’ purpose was to develop reference charts that describe normative quadriceps strength recovery after total knee arthroplasty (TKA) as measured by handheld dynamometry (HHD). The authors analyzed post-TKA quadriceps strength recovery using a longitudinal dataset consisting of both clinical and research HHD data. They created sex-specific models for recovery using Generalized Additive Models for Location, Scale, and Shape and reference charts from the models to display the recovery of population centiles over the first six postoperative months. They analyzed a total of 588 patient records with 1176 observations. There was a rapid increase in quadriceps strength for both sexes over the first 60 postoperative days followed by a more gradual increase over the next 120 days. They found that males appeared to demonstrate faster recovery and greater strength on average compared to females. The reference charts may aid clinicians’ ability to monitor and intervene upon quadriceps weakness-a pronounced and debilitating post-TKA impairment-throughout rehabilitation.
AHRQ-funded; HS025692.
Citation: Graber J, Juarez-Colunga E, Thigpen C .
Development of reference charts for monitoring quadriceps strength with handheld dynamometry after total knee arthroplasty.
Disabil Rehabil 2022 Dec;44(24):7535-42. doi: 10.1080/09638288.2021.1995054..
Keywords: Surgery, Orthopedics, Rehabilitation
Morrow EL, Duff MC, Mayberry LS
Mediators, moderators, and covariates: matching analysis approach for improved precision in cognitive-communication rehabilitation research.
This tutorial’s goals were to (a) increase awareness and use of mediation and moderation models in cognitive-communication rehabilitation research by describing options, benefits, and attainable analytic approaches for researchers with limited resources and sample sizes and (b) describe how these findings may be interpreted for clinicians consuming research to inform clinical care. The authors discuss the potential of mediation and moderation analyses to reduce the research-to-practice gap and describe how researchers may begin to implement these models, even in smaller sample sizes. They describe how researchers may begin to implement these models, even in smaller sample sizes. They believe it is critical to harness new approaches to advance clinical-translational research results for complex, heterogeneous groups with cognitive-communication disorders.
AHRQ-funded; HS026122.
Citation: Morrow EL, Duff MC, Mayberry LS .
Mediators, moderators, and covariates: matching analysis approach for improved precision in cognitive-communication rehabilitation research.
J Speech Lang Hear Res 2022 Nov 17;65(11):4159-71. doi: 10.1044/2022_jslhr-21-00551..
Keywords: Communication, Rehabilitation, Research Methodologies
Thompson MP, Yaser JM, Forrest A
Evaluating the feasibility of a statewide collaboration to improve cardiac rehabilitation participation: the Michigan Cardiac Rehab Network.
The purpose of this study as to assess the feasibility of the Michigan Cardiac Rehab Network to improve Cardiac Rehabilitation (CR) participation. The researchers utilized Multipayer claims data from the Michigan Value Collaborative to identify 95 hospitals and 84 CR facilities and convene a multidisciplinary group of advisors. Three CR facilities were selected for virtual site visits to identify areas of success and barriers to improvement. The study found that 51% of hospitals provided interventional cardiology services and 35% provided cardiac surgical services. The multidisciplinary group of advisors was convened and represented a broad range of roles within 13 institutions. CR enrollment statewide among eligible admissions was 33.4%, with broad differences in CR performance measures among participating hospitals and eligible admissions. Virtual site visits highlighted successes in increasing CR participation but an array of barriers to participation associated with referrals, capacity and staffing constraints, and geographic and financial barriers.
AHRQ-funded; HS027830.
Citation: Thompson MP, Yaser JM, Forrest A .
Evaluating the feasibility of a statewide collaboration to improve cardiac rehabilitation participation: the Michigan Cardiac Rehab Network.
J Cardiopulm Rehabil Prev 2022 Nov 1;42(6):e75-e81. doi: 10.1097/hcr.0000000000000706..
Keywords: Cardiovascular Conditions, Rehabilitation, Quality Improvement, Quality of Care
Keeney T, Kumar A, Erler KS
Making the case for patient-reported outcome measures in big-data rehabilitation research: implications for optimizing patient-centered care.
This article discussed the potential of patient-reported outcome measures (PROMs) to transform clinical practice. It also provided examples of health systems that use PROMs to guide care and identified barriers to aggregating data from PROMs in conducting health services research. The authors proposed two priority areas which could help advance rehabilitation health services research: standardization of collecting PROMs data in electronic health records and increased partnerships between rehabilitation providers, researchers, and payors.
AHRQ-funded; HS000011.
Citation: Keeney T, Kumar A, Erler KS .
Making the case for patient-reported outcome measures in big-data rehabilitation research: implications for optimizing patient-centered care.
Arch Phys Med Rehabil 2022 May; 103(5s):S140-s45. doi: 10.1016/j.apmr.2020.12.028..
Keywords: Rehabilitation, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Health Information Technology (HIT), Outcomes
Evans E, Krebill C, Gutman R
Functional motor improvement during inpatient rehabilitation among older adults with traumatic brain injury.
This retrospective cohort study’s goal was to describe the proportion of older adults with traumatic brain injury (TBI) who exhibited minimal detectable change (MDC) and a minimally clinically important difference (MCID) in motor function from inpatient rehabilitation facility (IRF) admission to discharge; and to identify characteristics associated with clinically meaningful improvement in motor function and better discharge functional status. This study used Medicare administrative data probabilistically linked to the National Trauma Data Bank. The authors found that from IRF admission to discharge 84% of patients achieved the MDC threshold, and 68% of patients achieved the MCID threshold for FIM-M scores. A higher probability of achieving the MCID for IM-M scores included better admission motor and cognitive function, lower comorbidity burden, and a length of stay longer than 10 days but only among individuals with lower admission motor function. Older age was associated with a lower FIM-M discharge score but was not associated with the probability of achieving the MCID in FIM-M score.
AHRQ-funded; HS000011.
Citation: Evans E, Krebill C, Gutman R .
Functional motor improvement during inpatient rehabilitation among older adults with traumatic brain injury.
PM R 2022 Apr; 14(4):417-27. doi: 10.1002/pmrj.12644..
Keywords: Elderly, Rehabilitation, Brain Injury, Inpatient Care
Graber J, Lockhart S, Matlock DD
"This is not negotiable. You need to do this…": a directed content analysis of decision making in rehabilitation after knee arthroplasty.
In this qualitative study, researchers sought to understand patients' and physical therapists' perspectives related to decision making during outpatient rehabilitation after total knee arthroplasty (TKA) and further to describe potential barriers and opportunities for shared decision making (SDM) in this setting. They found that physical therapists described using decision-making strategies with varying levels of patient involvement, while both patients and physical therapists described barriers to routine use of SDM in the outpatient setting. They also presented actionable strategies for overcoming these barriers for providers and organizations seeking consistently to use SDM in outpatient TKA rehabilitation.
AHRQ-funded; HS025692.
Citation: Graber J, Lockhart S, Matlock DD .
"This is not negotiable. You need to do this…": a directed content analysis of decision making in rehabilitation after knee arthroplasty.
J Eval Clin Pract 2022 Feb;28(1):99-107. doi: 10.1111/jep.13591..
Keywords: Shared Decision Making, Rehabilitation, Orthopedics, Surgery, Patient-Centered Healthcare
Bell KM, Onyeukwu C, Smith CN
A portable system for remote rehabilitation following a total knee replacement: a pilot randomized controlled clinical study.
The authors have developed and previously validated the accuracy of a remote (wearable) rehabilitation monitoring platform (interACTION). The present study's objective was to assess the feasibility of utilizing interACTION for the remote management of rehabilitation after total knee replacement (TKR) and to determine a preliminary estimate of the effects of the interACTION system on the value of rehabilitation. Findings showed that all patients and physical therapists in the interACTION Group indicated that they would use the system again in the future. Therefore, the next steps are to address the concerns identified in this pilot study and to expand the platform to include behavioral change strategies prior to conducting a full-scale randomized controlled trial.
Citation: Bell KM, Onyeukwu C, Smith CN .
A portable system for remote rehabilitation following a total knee replacement: a pilot randomized controlled clinical study.
Sensors 2020 Oct 27;20(21). doi: 10.3390/s20216118..
Keywords: Orthopedics, Rehabilitation, Health Information Technology (HIT)
Hsieh CJ, DeJong G, Vita M
AHRQ Author: Hsieh CJ
Effect of outpatient rehabilitation on functional mobility after single total knee arthroplasty: a randomized clinical trial.
Researchers compared post-total knee arthroplasty (TKA) functional mobility outcomes among 3 newly-developed physical therapy protocols with a standard-of-care post-TKA rehabilitation protocol. They found no statistically or clinically significant differences in outcomes across the 4 study arms (control, treadmill, neuromuscular stimulation device, and combination intervention). As outcomes were similar among arms, they recommended that clinicians instead consider relative cost in tailoring TKA rehabilitation.
AHRQ-authored.
Citation: Hsieh CJ, DeJong G, Vita M .
Effect of outpatient rehabilitation on functional mobility after single total knee arthroplasty: a randomized clinical trial.
JAMA Netw Open 2020 Sep;3(9):e2016571. doi: 10.1001/jamanetworkopen.2020.16571..
Keywords: Rehabilitation, Orthopedics, Surgery, Outcomes, Evidence-Based Practice
Khan U, Stoff L, Yahuaca JD
Evaluation of an interdisciplinary screening program for people with Parkinson disease and movement disorders.
Researchers described the characteristics of people with Parkinson disease and movement disorders referred by neurologist to a physiatrist-led interdisciplinary rehabilitation screening program. They found that the interdisciplinary rehabilitation screening program was sustained with increased numbers of referrals over time, occurring earlier in the disease in more recent years. Further, key strategies used to sustain the program over time included development of a unique referral order set for the neurologists, implementation of a comprehensive screen tool in the rehabilitation hospital electronic health records, and centralized communication through social workers at both facilities.
AHRQ-funded; HS025077.
Citation: Khan U, Stoff L, Yahuaca JD .
Evaluation of an interdisciplinary screening program for people with Parkinson disease and movement disorders.
Arch Rehabil Res Clin Transl 2020 Sep;2(3):100067. doi: 10.1016/j.arrct.2020.100067..
Keywords: Neurological Disorders, Rehabilitation, Screening
Rundell SD, Resnik L, Heagerty PJ
Performance of the Functional Comorbidity Index (FCI) in prognostic models for risk adjustment in patients with back pain.
The Functional Comorbidity Index (FCI) is a comorbidity measure associated with physical function and may contribute to risk adjustment models in rehabilitation settings, but an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) of the FCI has not been tested in outpatient settings. The purpose of this cohort study was to examine the ability of an ICD-9-CM- based FCI to predict function, health-related quality of life, and overall health care use.
AHRQ-funded; HS01922201; HS022972.
Citation: Rundell SD, Resnik L, Heagerty PJ .
Performance of the Functional Comorbidity Index (FCI) in prognostic models for risk adjustment in patients with back pain.
Pm r 2020 Sep;12(9):891-98. doi: 10.1002/pmrj.12315..
Keywords: Back Health and Pain, Pain, Chronic Conditions, Quality of Life, Rehabilitation
Keeney T
Physical therapy in the COVID-19 pandemic: forging a paradigm shift for rehabilitation in acute care.
This point-of-view article discusses the importance of physical therapy for COVID-19 survivors in home and community-based settings as well as in post-acute care facilities, concluding that it is necessary to react to new and difficult circumstances with growth and self-advocacy in order to forge a future characterized by intensive skilled rehabilitation services in the inpatient setting, simultaneously benefiting the health care systems and the patient populations.
AHRQ-funded; HS000011.
Citation: Keeney T .
Physical therapy in the COVID-19 pandemic: forging a paradigm shift for rehabilitation in acute care.
Phys Ther 2020 Aug 12;100(8):1265-67. doi: 10.1093/ptj/pzaa097..
Keywords: Rehabilitation, COVID-19, Transitions of Care, Home Healthcare, Healthcare Delivery
Capo-Lugo CE, Askew RL, Muldoon K
Longer time before acute rehabilitation therapy worsens disability after intracerebral hemorrhage.
This study examines the association of time to initiation of acute rehabilitation therapy to increases in disability after intracerebral hemorrhage (ICH), and identifies predictors of time to initiation of rehabilitation therapy. Retrospective data analysis was conducted using ICH patients from a large comprehensive stroke center in a metropolitan area. Disability was assessed using a modified Rankin Scale (mRS) with poor outcome defined as mRS 4-6. There was a median time of 3 days from hospital admission and the first consult by any rehabilitation therapy specialist. Each additional day between admission and initiation of acute rehabilitation therapy was associated with odds of poor outcome at 30 days and at 90 days. Predictors of later initiation of acute rehabilitation therapy included heavy drinking (>5 drinks per day), premorbid mRS<4, presence of pulmonary embolism and longer length of stay in the intensive care unit.
AHRQ-funded; HS024366; HS023437; HS000078.
Citation: Capo-Lugo CE, Askew RL, Muldoon K .
Longer time before acute rehabilitation therapy worsens disability after intracerebral hemorrhage.
Arch Phys Med Rehabil 2020 May;101(5):870-76. doi: 10.1016/j.apmr.2019.11.006..
Keywords: Rehabilitation, Disabilities, Stroke, Cardiovascular Conditions, Outcomes, Patient-Centered Outcomes Research
Hay CC, Graham JE, Pappadis MR
The impact of one's sex and social living situation on rehabilitation outcomes after a stroke.
The goal of this retrospective observational study was to investigate sex differences and the impact of social living situation on individual functional independence measure outcomes after stroke rehabilitation. Subjects were Medicare fee-for-service beneficiaries discharged from inpatient rehabilitation facilities after a stroke. Results showed that when sociodemographic and clinical factors were controlled, females were more likely to discharge from inpatient rehabilitation at a supervision level or better for most functional independence measure items. Individuals who lived alone before their stroke had higher odds of discharging at a supervision level or better.
AHRQ-funded; HS022134.
Citation: Hay CC, Graham JE, Pappadis MR .
The impact of one's sex and social living situation on rehabilitation outcomes after a stroke.
Am J Phys Med Rehabil 2020 Jan;99(1):48-55. doi: 10.1097/phm.0000000000001276..
Keywords: Stroke, Rehabilitation, Elderly, Patient-Centered Outcomes Research, Sex Factors, Cardiovascular Conditions, Outcomes