Rules for rehabilitation: An agenda for research
ABSTRACT Rehabilitation services have grown tremendously in the United States over the past 2 decades. Rules originally designed to guide Medicare reimbursement policies have had substantial effects in shaping the design of clinical services. This article traces the development of the most significant federal rules regarding rehabilitation, outlines the existing empirical evidence to support these rules, and discusses an agenda for research to improve the evidence for future policy development.
SourceAvailable from: Steven L Wolf[Show abstract] [Hide abstract]
ABSTRACT: BACKGROUND: Residual disability after stroke is substantial; 65% of patients at 6 months are unable to incorporate the impaired upper extremity into daily activities. Task-oriented training programs are rapidly being adopted into clinical practice. In the absence of any consensus on the essential elements or dose of task-specific training, an urgent need exists for a well-designed trial to determine the effectiveness of a specific multidimensional task-based program governed by a comprehensive set of evidence-based principles. The Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) Stroke Initiative is a parallel group, three-arm, single blind, superiority randomized controlled trial of a theoretically-defensible, upper extremity rehabilitation program provided in the outpatient setting.The primary objective of ICARE is to determine if there is a greater improvement in arm and hand recovery one year after randomization in participants receiving a structured training program termed Accelerated Skill Acquisition Program (ASAP), compared to participants receiving usual and customary therapy of an equivalent dose (DEUCC). Two secondary objectives are to compare ASAP to a true (active monitoring only) usual and customary (UCC) therapy group and to compare DEUCC and UCC.Methods/design: Following baseline assessment, participants are randomized by site, stratified for stroke duration and motor severity. 360 adults will be randomized, 14 to 106 days following ischemic or hemorrhagic stroke onset, with mild to moderate upper extremity impairment, recruited at sites in Atlanta, Los Angeles and Washington, D.C. The Wolf Motor Function Test (WMFT) time score is the primary outcome at 1 year post-randomization. The Stroke Impact Scale (SIS) hand domain is a secondary outcome measure.The design includes concealed allocation during recruitment, screening and baseline, blinded outcome assessment and intention to treat analyses. Our primary hypothesis is that the improvement in log-transformed WMFT time will be greater for the ASAP than the DEUCC group. This pre-planned hypothesis will be tested at a significance level of 0.05. DISCUSSION: ICARE will test whether ASAP is superior to the same number of hours of usual therapy. Pre-specified secondary analyses will test whether 30 hours of usual therapy is superior to current usual and customary therapy not controlled for dose.Trial registration: www.ClinicalTrials.gov Identifier: NCT00871715.BMC Neurology 01/2013; 13(1):5. DOI:10.1186/1471-2377-13-5 · 2.49 Impact Factor
Pflege 12/2008; 21(06):0404-0422. DOI:10.1024/1012-5302.21.6.404 · 0.47 Impact Factor
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ABSTRACT: Aims: To describe and determine factors predicting utilization of occupational and physical therapy (PT) services in postacute rehabilitation systems over a 1-year period in Medicare beneficiaries. Methods: Data from 1,667 respondents in the 2006 Health and Retirement Study and linked Medicare claims were analyzed. Results: The average length of inpatient rehabilitation stay ranged between 11 and 17 days. Therapeutic procedures were the most commonly claimed Current Procedural Terminology (CPT) codes in outpatient rehabilitation. Very-high level was the mostly claimed resource utilization group (RUG) in skilled nursing facilities. Additionally, the average number of therapy home visit ranged between 31 and 34. Logistic regression analysis showed that greater age and more comorbidities were associated with using therapy services from two or more postacute care (PAC) systems. Conclusion: The study results increase the understanding of the utilization of rehabilitation therapy services across PAC systems and provide basic information for rehabilitation services planning.Physical & Occupational Therapy in Geriatrics 02/2014; 32(1). DOI:10.3109/02703181.2014.883044