Purpose The purpose of the Acute Care for Elderly (ACE) Group Exercise Program (“ACE-Ercise”) is to improve patient functional outcomes, increase participation in therapy, decrease fall risk, and increase the patient’s chance of returning home upon discharge. Synthesis No formal research studies have assessed group physical therapy (PT) protocols for the acutely ill hospitalized patient. 7 Previous research reports: • 1 week of bedrest can result in 20% loss of muscle mass and profound weakness which can lead to long-term disability and poor quality of life. 1-4 • 68% of patients are discharged from post-acute care settings below their baseline level of function, which contributes to nearly 1 in 5 Medicare beneficiaries being re-hospitalized within 30 days after an acute hospitalization. 6 • Group-based exercise has been shown to be effective for fall prevention, quality-of-life enhancement, and balance improvements in individuals 65 years and older. 7 • Increased PT during an acute hospitalization decreases hospital length of stay as well as improves mobility, activity, and quality of life. 5 Goals • Improve patient strength, endurance, and balance. • Increase safety with functional mobility. • Decrease fall risk. • Increase patient motivation. • Increase delivery of therapy services during hospitalization. • Increase likelihood of patients discharging home. Improving Functional Outcomes of ACE Unit Patients by Optimizing Skilled Therapy Through Group Sessions Vanessa Gentry, PT; Alyssa Trotsky, PT, DPT; Tina White, OTR; Kimberly Wilkins, PT, DPT Physical Medicine and Rehabilitation ■ Beaumont Hospital – Royal Oak, MI P14527_0216 Figure 1. Average # of Therapy Sessions Per Length of Stay A baseline data value of 50 patients were included in the Pre-“ACE-Ercise” Group over a period of 4 weeks. A total of 63 patients were included in the Post-“ACE-Ercise” Group over a period of 8 weeks. Data was collected over an 8 week period. Patients with ≤ 1 gait speed recorded were excluded from this data. Figure 2. Average Difference Between Initial and Final Gait Speeds Figure 3. Discharge Disposition: Pre-“ACE-Ercise” Program Figure 4. Discharge Disposition: Post-“ACE-Ercise” Program Implementation Each day an interdisciplinary team consisting of PTs, OTs, PTAs, COTAs, RNs, rehab aides, and physicians work together to identify patients appropriate for the “ACE-Ercise” group. These patients are then led by both a PT and OT through an established group exercise program. PATIENT CRITERIA • 65 years of age or older • Able to follow 1-step commands/gestures/demonstration • Agreeable to participate • Is ambulatory or able to perform transfers/ADLs at home with minimal assistance or less • Not combative or agitated • Negative for contact/isolation precautions • Has active PT/OT orders and progressive activity orders • No surgical or weight-bearing precautions • Not on observation (OPPM) status ACE UNIT EXERCISE PROGRAM Endurance Training: 5 minutes lower extremity bike Strengthening Exercises: Chair Push-Ups: 1x10 reps Long Arc Quad (alternating L and R): 2x10 reps Bicep Curls (using 1-3 lb. Weights): 2x10 reps Hip Abduction (using theraband): 2x10 reps Hip Abduction (using ball): 2x10 reps Chair Push-Ups: 1x10 reps Standing/Balance Exercises Lateral Weight Shifting: 1x10 reps Anterior/Posterior Weight Shifting (stride standing): 1x10 reps Trunk Rotations: 1x10 reps Heel/Toe Raises: 1x10 reps Toe Taps (Anterior Lateral Posterior): 1x5 reps Marches: 1x10 reps Data Analysis Results After the implementation of “ACE-Ercise” Group Exercise Program: • Average gait speed improved by 0.064 m/s. • The delivery of PT/OT services increased by 1.76 treatment sessions, however, a small increase in patient refusal was experienced. • Patients appeared to be more motivated to participate in therapy sessions in a group setting. Comradery as well as friendly competition was noted between patients. • 5% more patients were discharged home versus subacute rehab. • 5% of patients were discharged to inpatient rehab compared to 2% in the pre-“ACE-Ercise” group. Future Implications • Equal pre- and post-data groups. • Larger sample size. • Evaluate the effects of the program on: length of stay, hospital re- admission rate within 30 days, independence with activities of daily living, and perceived quality of life post-discharge. ACKNOWLEDGEMENT We would like to acknowledge and thank the following people for their contribution to this project: Anne Schram OTR, Evelyn Eames PTA, and Paula Dziurda OTR.
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Purpose The purpose of the Acute Care for Elderly (ACE) Group Exercise Program (“ACE-Ercise”) is to improve patient functional outcomes, increase participation in therapy, decrease fall risk, and increase the patient’s chance of returning home upon discharge.
SynthesisNo formal research studies have assessed group physical therapy (PT) protocols for the acutely ill hospitalized patient.7 Previous research reports:• 1weekofbedrestcanresultin20%lossofmusclemassandprofound
weaknesswhichcanleadtolong-termdisabilityandpoorqualityoflife.1-4
• 68%ofpatientsaredischargedfrompost-acutecaresettingsbelowtheirbaselineleveloffunction,whichcontributestonearly1in5Medicarebeneficiariesbeingre-hospitalizedwithin30daysafteranacutehospitalization.6
• Group-basedexercisehasbeenshowntobeeffectiveforfallprevention,quality-of-lifeenhancement,andbalanceimprovementsinindividuals65yearsandolder.7
• IncreasedPTduringanacutehospitalizationdecreaseshospitallengthofstayaswellasimprovesmobility,activity,andqualityoflife.5
Goals• Improvepatientstrength,endurance,andbalance.• Increasesafetywithfunctionalmobility.• Decreasefallrisk.• Increasepatient
motivation.• Increasedelivery
of therapy services during hospitalization.
• Increaselikelihoodof patients discharging home.
Improving Functional Outcomes of ACE Unit Patients by Optimizing Skilled Therapy Through Group SessionsVanessa Gentry, PT; Alyssa Trotsky, PT, DPT; Tina White, OTR; Kimberly Wilkins, PT, DPTPhysical Medicine and Rehabilitation ■ Beaumont Hospital – Royal Oak, MI
P14527_0216
Figure 1. Average # of Therapy Sessions Per Length of Stay
A baseline data value of 50 patients were included in the Pre-“ACE-Ercise” Group over a period of 4 weeks. A total of 63 patients were included in the Post-“ACE-Ercise” Group over a period of 8 weeks.
Data was collected over an 8 week period. Patients with ≤ 1 gait speed recorded were excluded from this data.
Figure 2. Average Difference Between Initial and Final Gait Speeds
Figure 3. Discharge Disposition: Pre-“ACE-Ercise” Program
Figure 4. Discharge Disposition: Post-“ACE-Ercise” Program
ImplementationEach day an interdisciplinary team consisting of PTs, OTs, PTAs, COTAs, RNs,rehabaides,andphysiciansworktogethertoidentifypatientsappropriateforthe“ACE-Ercise”group.Thesepatientsarethenledby bothaPTandOTthroughanestablishedgroupexerciseprogram.
PATIENT CRITERIA• 65yearsofageorolder• Abletofollow1-stepcommands/gestures/demonstration• Agreeabletoparticipate• Isambulatoryorabletoperformtransfers/ADLsathomewithminimal
assistance or less• Notcombativeoragitated• Negativeforcontact/isolation
precautions• HasactivePT/OTordersand
progressive activity orders• Nosurgicalorweight-bearing
precautions• Notonobservation(OPPM)
status
ACE UNIT EXERCISE PROGRAMEndurance Training:5minuteslowerextremitybike
Strengthening Exercises:ChairPush-Ups:1x10repsLongArcQuad(alternating
LandR):2x10repsBicepCurls(using1-3lb.
Weights):2x10repsHipAbduction(usingtheraband):2x10repsHipAbduction(usingball):2x10repsChairPush-Ups:1x10reps
Standing/Balance Exercises LateralWeightShifting:1x10repsAnterior/PosteriorWeightShifting(stridestanding):1x10repsTrunkRotations:1x10repsHeel/ToeRaises:1x10repsToe Taps (Anterior Lateral Posterior):1x5repsMarches:1x10reps
Data Analysis
ResultsAfter the implementation of “ACE-Ercise” Group Exercise Program:• Averagegaitspeedimprovedby0.064m/s.• ThedeliveryofPT/OTservicesincreasedby1.76treatmentsessions,
however,asmallincreaseinpatientrefusalwasexperienced.• Patientsappearedtobemoremotivatedtoparticipateintherapy
sessionsinagroupsetting.Comraderyaswellasfriendlycompetitionwasnotedbetweenpatients.
• 5%morepatientsweredischargedhomeversussubacuterehab.• 5%ofpatientsweredischargedtoinpatientrehabcomparedto2%
in the pre-“ACE-Ercise” group.
Future Implications• Equalpre-andpost-datagroups.• Largersamplesize.• Evaluatetheeffectsoftheprogramon:lengthofstay,hospitalre-
admissionratewithin30days,independencewithactivitiesofdailyliving,andperceivedqualityoflifepost-discharge.
ACkNOwlEDGEMENT We would like to acknowledge and thank the following people for their contribution to this project: Anne Schram OTR, Evelyn Eames PTA, and Paula Dziurda OTR.
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