Comparison of Community Reintegration Interventions When Using a Simulated Environment

Weill Medical College of Cornell University50 enrolled

Overview

The investigators believe that rehabilitation specialists will use community reintegration treatments more if a simulated environment is available.

Community reintegration training has always been a significant aspect of inpatient rehabilitation recovery. Community reintegration training involved therapists and patients going into the actual community to evaluate and practice their functional tasks such as negotiating curbs, crosswalks, or marketplaces. During the COVID-19 pandemic, this option was not available. The absence of this intervention made it challenging for therapists to evaluate a patient's safety to return home. Creating a simulated environment within the inpatient rehabilitation department became an alternative to taking patients to an outside environment. Saji, et al. (2015) demonstrated that utilization of a simulated environment enhanced functional improvements of post-acute stroke patients at 12 convalescent rehabilitation wards. New York Presbyterian Weill Cornell Medical Center (NYP- WCMC) has constructed a simulated environment for the purposes of enhancing community reintegration training. This project will test its use and efficacy. The availability of this simulated environment may be more time-efficient and safer than community reintegration training outside of the department or hospital. Training in the simulated environment may improve the functional ability of individuals undergoing inpatient rehabilitation, in accordance with the degree of use of the simulated environment. Greater use of the simulated environment may predict greater functional improvements. This study will collect pilot data about functional outcomes and patient perspectives about their balance confidence, their ability to perform functional tasks, and the efficacy of the use of simulated environment for community reintegration. This pilot data will seed a future efficacy study with a comparison group.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Simulated Environments for Community Reintegration

Interventions

PT and OT with a simulated environmentBEHAVIORAL

Upon admission to the inpatient rehabilitation unit, participants will undergo a physical and occupational therapy evaluation. The evaluations will include the outcome measures chosen to track for this study (10-meter walk test and Quality Indicators). If a patient meets inclusion/exclusion criteria, informed written consent will be obtained. Throughout the patient's stay, therapists will have the opportunity to perform community integration treatments using the simulated environment. This could include activities such as negotiating a curb, crossing a street, or shopping at a marketplace. The therapist will document the amount of time (units billed) spent performing these interventions. The research investigators will not act as a patient's therapist throughout their admission.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Medical records of patients admitted to the IRU from January 1, 2015 through December 31, 2019 will be queried for number of minutes billed for Community Integration. * Medical records of patients admitted to the IRU from April 2 * Patients admitted to the Inpatient Rehabilitation Unit (IRU) of at least 18 years of age and older * Patients who can read and provide informed consent in English. * Patients who will be discharged to home after inpatient rehabilitation. * Patients who are ambulatory with a minimal QI score of 3 on "Walk 10 feet". * Patients who utilized the simulated environment during their inpatient stay. * Patients who score 8 or greater on the BIMS on initial evaluation. Exclusion Criteria: * The investigators will exclude medical records of patients admitted to the IRU from January 1, 2020 through December 31, 2021 because of the COVID restrictions that were in place. * Patients who are less than 18 years of age. * Patients who are not ambulatory due to medical reasons. * Patients who cannot read and provide informed consent in English. * Patients who were discharged to acute care, skilled nursing facility or long-term care facility after their inpatient rehabilitation stay. * Patients who did not use the simulated environment during their inpatient stay. * Patients who score 7 or lower on the BIMS on initial evaluation.

Locations (1)

NewYork Presbyterian Hospital Baker Pavilion

New York, New York, United States

RECRUITING

Outcomes

Primary Outcomes

Utilization of community reintegration, as measured by number of 15-minute units billed

Current Procedural Terminology (CPT) code 9753, is a billing code where one unit of the code is used for each 15 minutes the provider spends with the patient teaching them return to work and the community. For this measure, the therapist will document the amount of time spent performing each study activity when utilizing the simulated environment, as measured by number of 15-minute units billed.. This will be compared to units billed in 2015 - 2019 prior to the implementation of the simulated environment for this study.