Recording the Gait of Stroke Patients to Improve

Motivation, Satisfaction and Outcome

P Jayabalan MD, PhD1, T Breisinger PT2, R Kaplan PT2, K Vitti PT2, E Greene PT2, R Donlan DO1 JA Lanphere DO1,

J Shen MD1

1Department of Physical Medicine & Rehabilitation, University of Pittsburgh Medical Center

2Department of Physical Therapy, University of Pittsburgh Medical Center

THE STROKE PATIENT

Significant negative impact on their lives(Thomas et al, 2006)

Rehab progress can plateau(Hallams & Baker, 2009)

‘Lack of understanding’ (Rudd, 2009)

‘Lose motivation & give up’(Hallams & Baker, 2009)

MOTIVATION is a critical factor in outcome(Griffiths 1993, Mclean et al 2000)

STANDARD OF CARE

OBSERVATIONAL GAIT ANALYSIS

Visual inspection of walkingOnce/week in most rehab unitsAssess neuromuscular and behavioral factors affecting gaitMonitor spasticity, pain and contractureSubjective assessment of motivationEvaluate interventionsEducational benefit to clinicians

Findings are NOT conveyed to the patients visually

THE CONCEPT

THERAPY

RECOVERY

THE AMOTIVATED INDIVIDUAL

- COMMUNICATE

- EDUCATE

- MOTIVATE

Lack of encouragement from therapy staff can demotivate patients in

rehabilitation- British Medical Journal, 2010

IMPROVE:

MOTIVATION SATISFACTION

ADHERENCE TO THERAPY

OUTCOME

GOAL

OBJECTIVE

Improve patient motivation, satisfaction and outcome by showing them:1)Video tapes of their gait progression2)Graphical representations of their change in gait ability

1) IMPROVE PATIENT: Motivation Satisfaction Outcome

2) INTERVENTION: Time efficient Educational Easy to perform Inexpensive

CHECKLIST FOR SUCCESS

Include• Acute stroke• Complete gait training as part of rehab

VIDEO GROUPVideo taping of gait rounds + graphical representation of progressn = 15

Standard of care Regular gait rounds No provision of videos or graphical representations of progressAll UPMC rehab facilities except MercyN=11

PROJECT OUTLINE

Cartilage Layer

OUTCOME MEASURES

MOTIVATIONPITTSBURGH REHABILITATION

PARTICIPATION SCALE (Lenze et al, 2004)

SATISFACTION

PATIENT OUTCOME

PRESS GANEY SATISFACTIONSTRUCTURED QUESTIONNAIRE

(Leichert scale)

TUG and 10m WALK TESTSLENGTH OF STAY

+Patient Counseling Session

Video and graphical progress reviewed with the patient 1x/week

Identified patients consent to video Timed up and go test

1x/week

10m walk test 1x/week

Video recorded during gait rounds 2x/week

1.

2.

Assess motivation, satisfaction and patient outcome

METHODS

ON ADMISSION 3 WEEKS LATER

RESULTS - PARTICIPATION

*

RESULTS - SATISFACTION

- 93% felt that the interventions directly improved their satisfaction with their rehab stay

- 92% felt the videos in particular helped them during their rehab admission.

- 100% would strongly recommend these interventions to other patients

iPAD Group

RESULTS – TUG TEST

RESULTS – LENGTH OF STAY

N=6 Standard of CareN=10 iPad Group

RESULTS

N=6 Standard of CareN=10 iPad Group

PATIENT COMMENTS- ‘It gave me confidence to know that when I go home I can cross the

street safely’

- ‘Seeing the areas in which I can improve my walking and then correcting them with rehab was greatly beneficial’

- ‘I never believed I would get better – if I was shown this at the beginning I would believe’

- ‘Was great to see where I was struggling with walking – wish I had 2 more weeks to participate!’

- ‘Great for my motivation and to see how far I’ve come’

DID THIS WORK?1) IMPROVE PATIENT: Motivation Satisfaction Outcome/LOS

2) INTERVENTION: Time efficient Easy to perform Educational Inexpensive Electronic record Strong support from team

Limitations Small sample size Not specific findings Variability between patients

Bottom Line – The intervention improved the patient experience

THE WAY FORWARD

CONCLUSION

Why did it work?

As an INTERVENTION it is:Time efficientEasy to performEducationalInexpensiveStrongly supported by rehab teamCould be part of electronic record

What did it improve?Motivation of our patientsSatisfaction and OutcomeRecord improvements visuallyReduce variations in treatmentImprove patient care deliveryImproved communication and efficiencyEducated patients and treatment team

FIRST OF ITS KIND!

THE STROKE REHAB TEAM

THE PATIENT

THE PATIENT

Physicians

PT

OT

ST

NursingCase Manager

Aides

Social worker

AAPM&R Presentation 2014

University of Pittsburgh Medical Center (UPMC)

T Breisinger DPTR Kaplan PT

K Vitti PTR Donlan DO

JA Lanphere DJ Shen MD

Stroke Unit, Mercy HospitalDepartment of PM&R