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Asai T1, Murayama I2, Misu S3, Yamauchi M4, Miura A5, Ikemura T6, Takehisa T7, Takehisa Y6
1Kobegakuin University, Kobe, Japan, 2Heisei Rehabilitation College, Hyogo, Japan, 3Konan Women’s University, Hyogo, Japan, 4Higashiura Heisei Hospital, Hyogo, Japan, 5Tamagawa Hospital, Tokyo, Japan, 6Hakuai Memorial Hospital, Tokushima, Japan, 7Setagaya Memorial Hospital, Tokyo, Japan
Background: “Staying away from bed (SaB)” is believed to be essential to recover the physical function and to prevent deconditioning in rehabilitation hospitals. However, its association has not been investigated, and it is unknown if the increase in SaB-time leads to the changes in clinical rehabilitation outcomes (CROs). Additionally, the approach for increase in SaB-time has not been reported.
Purpose: The purpose of the present study was to investigate the association of the SaB-time with CROs, and the effect of our clinical practice, such as the comprehensive team approach for SaB-time (CASaB) on changes in CROs.
Methods: The present study was conducted as a multicenter controlled prospective cohort study (9 Rehabilitation Hospitals). First, the clinical observational data were collected in these hospitals for 6 months (observational phase: between April 2016 and September 2016). Then, the CASaB was introduced as a clinical practice for next 6 months, and the clinical data were collected (CASaB phase: between October 2016 and March 2017). CASaB included
1) placement of special facilitator at floor,
2) setting a goal for increase of SaB-time,
3) planning events for increase of SaB-time.
The definition of SaB was “the postural condition that patients keep any other posture than laying (e.g. sitting and standing) while staying away from bed” in the present study. The SaB-time of each patient was measured at 30 or less minutes intervals using an original SaB management sheet. The CROs included the FIM score at admission, FIM score at discharge, length of hospital stay (LOS), absolute functional gain (AFG), and rehabilitation efficiency (REy). To investigate the association between the CROs and the SaB-time, multiple regression analyses were performed including CROs as the dependent variables and the SaB-time as the independent variable. Next, unpaired t-test and analyses of covariance were performed to compare the SaB time and the CROs between the CASaB phase and the observational phase.
Results: The longer SaB time was significantly correlated with the higher REy, and the association was also observed even after adjusting for confounders (age, sex, disease causing to hospitalization, MMSE, hand-grip strength, and FIM score at admission) in the multiple regression analysis (standardized β = 0.20, p = 0.007, adjusted R2 for the whole model = 0.151). As a result of unpaired t-test, the SaB time in the CASaB phase (8.2 ± 3.7 hours) was longer than that in the observational phase (7.3 ± 2.8 hours, p = 0.008). In the results of analyses of covariance, significant differences in the LOS and the REy were observed after adjustment for confounders (p 0.001 and p = 0.016).
Conclusion(s): The SaB-time is positively associated with CROs in rehabilitation hospitals. A comprehensive team approach is an effective way of increase of SaB-time and promoting improvements of CROs.
Implications: A comprehensive team approach can be easily applied to clinical field, because there is small burden on staff members and many people easily can get involved to it. This approach can be recommended as one of ways for improving CROs, especially in rehabilitation hospitals.
Keywords: staying away from bed, rehabilitation, FIM score
Funding acknowledgements: None
Purpose: The purpose of the present study was to investigate the association of the SaB-time with CROs, and the effect of our clinical practice, such as the comprehensive team approach for SaB-time (CASaB) on changes in CROs.
Methods: The present study was conducted as a multicenter controlled prospective cohort study (9 Rehabilitation Hospitals). First, the clinical observational data were collected in these hospitals for 6 months (observational phase: between April 2016 and September 2016). Then, the CASaB was introduced as a clinical practice for next 6 months, and the clinical data were collected (CASaB phase: between October 2016 and March 2017). CASaB included
1) placement of special facilitator at floor,
2) setting a goal for increase of SaB-time,
3) planning events for increase of SaB-time.
The definition of SaB was “the postural condition that patients keep any other posture than laying (e.g. sitting and standing) while staying away from bed” in the present study. The SaB-time of each patient was measured at 30 or less minutes intervals using an original SaB management sheet. The CROs included the FIM score at admission, FIM score at discharge, length of hospital stay (LOS), absolute functional gain (AFG), and rehabilitation efficiency (REy). To investigate the association between the CROs and the SaB-time, multiple regression analyses were performed including CROs as the dependent variables and the SaB-time as the independent variable. Next, unpaired t-test and analyses of covariance were performed to compare the SaB time and the CROs between the CASaB phase and the observational phase.
Results: The longer SaB time was significantly correlated with the higher REy, and the association was also observed even after adjusting for confounders (age, sex, disease causing to hospitalization, MMSE, hand-grip strength, and FIM score at admission) in the multiple regression analysis (standardized β = 0.20, p = 0.007, adjusted R2 for the whole model = 0.151). As a result of unpaired t-test, the SaB time in the CASaB phase (8.2 ± 3.7 hours) was longer than that in the observational phase (7.3 ± 2.8 hours, p = 0.008). In the results of analyses of covariance, significant differences in the LOS and the REy were observed after adjustment for confounders (p 0.001 and p = 0.016).
Conclusion(s): The SaB-time is positively associated with CROs in rehabilitation hospitals. A comprehensive team approach is an effective way of increase of SaB-time and promoting improvements of CROs.
Implications: A comprehensive team approach can be easily applied to clinical field, because there is small burden on staff members and many people easily can get involved to it. This approach can be recommended as one of ways for improving CROs, especially in rehabilitation hospitals.
Keywords: staying away from bed, rehabilitation, FIM score
Funding acknowledgements: None
Topic: Disability & rehabilitation
Ethics approval required: Yes
Institution: Heisei Hospitasl
Ethics committee: The Research Ethics Committee of Heisei hospital
Ethics number: 160707
All authors, affiliations and abstracts have been published as submitted.
