An Ngo-Huang

An Analysis of Inpatient Rehabilitation Approval Among Private Insurance Carriers at a Cancer Center

Acute inpatient rehabilitation is often used by cancer patients to assist with discharge home and/or preparation for further treatment. Private insurance patients often require approval before transfer to acute inpatient rehabilitation.

Poster 68 Feasibility of a Prehabilitation Program for Patients with Potentially Resectable Pancreatic Cancer: Pilot Study

over the 4-year period. Pressure ulcer incidence and healing rate were reviewed by multidisciplinary team. Setting: A 90-bed acute rehabilitation institute affiliated with medical school. Participants: All admissions from 2012 through 2015. Interventions: Risk assessment, tracking system, staff and patient education, supplies accessibility, wound rounds, therapeutic surfaces, positioning, unit-based skin champions, orthotic assessment, nutritional management, performance monitoring and reporting, treatment guidelines. Main Outcome Measures: Pressure ulcer incidence per 1000 patient days, and healing rate of existing pressure ulcer each year from 2012 through 2015. Results: Pressure ulcer incidence was reduced by 50% in 2012 following the initiation of the multidisciplinary program, and maintained at 0-0.09 through the following years. Pressure ulcer healing rate was 76.92% in 2012, increased to 97.15% in 2013 after improvement in assessment/tracking system, staff/patient education, nutritional assessment, treatment supplies accessibility and collaboration with physicians. In 2014 we found no significant improvement after implementation of safe patient handling equipment and surfacing modification. In late 2014 we started developing the skin champions who were experts on skin care and acted as resources for their peers, we also enhanced multidisciplinary team with involvement of prosthetic and orthotic clinic to evaluate and adjust braces and casts. In 2015 healing rate reached 98.04%. Conclusions: Pressure ulcer prevention and treatment in acute rehabilitation represent a challenging problem. Successful implementation of a multidisciplinary team is crucial for effectively reducing pressure ulcer incidence, improving healing process, ensuring maximal functional gain and reasonable length of stay in acute rehabilitation centers. Level of Evidence: Level I

Evaluating Disability Insurance Assistance as a Specific Intervention by Physiatrists at a Cancer Center

Abstract Because of their expertise, physiatrists provide disability insurance assistance for cancer survivors. In this brief report, we perform a descriptive retrospective analysis of all new (354) outpatient physiatry consultations from January 1, 2009, to December 31, 2013, at a National Cancer Institute Comprehensive Cancer Center. Disability and/or work accommodations were brought up at some point with the physiatrist during the duration of their care for 131 (37%) of 354 patients. More than 90% of the discussions took place during the first visit. Of those patients who had a documented disability/employment discussion, 58 (44.3%) of 131 patients were originally referred for disability assistance specifically, and 58 (44.3%) of 131 also had disability insurance paperwork completed by the physiatrist. Outcomes of initial physiatry disability insurance assistance were 45 (77.6%) of 58 approved/renewed, 5 (8.6%) of 58 denied, and 8 (13.8%) of 58 unknown/died during the disability application process. The median form size was 33 (SD, 25.95) items. This study is the first of its kind and provides an initial look at work-related discussions and support with disability insurance paperwork as a specific intervention provided by physiatrists at a cancer center. The results are compelling and demonstrate that physiatrists frequently provide these interventions. These interventions take considerable time and effort but are generally successful.

Frequency and Characteristics of Recommendations from Interdisciplinary Outpatient Cancer Rehabilitation Monthly Team Meetings

Ambulatory cancer rehabilitation programs vary widely in the types of services offered, and there is a lack of consistency with respect to the coordination of rehabilitation with oncologic treatment plans. There are no guidelines for outpatient interdisciplinary rehabilitation team meetings, and the types and characteristics of recommendations that a physiatrist can provide during these meetings have not been reported.

A Survey Regarding the Knowledge, Attitudes, and Beliefs of Graduates of Cancer Rehabilitation Fellowship Program

Currently there are limited options for physiatrists to further subspecialize in cancer rehabilitation. Since 2007, few cancer rehabilitation fellowship programs have been started. There is currently absolutely no information about such training programs and their graduates. This study is the first to survey a small number of graduates from two cancer rehabilitation fellowship programs. The purpose of this study was to report characteristics, attitudes, and beliefs of cancer rehabilitation fellowship graduates. Graduates of cancer rehabilitation fellowship programs from 2008 through 2015 responded to a 26-question survey. Information collected included exposure to cancer rehabilitation prior to fellowship training, usefulness of fellowship training program, information about current practice, and suggested areas of improvement. The setting of the study is online survey. Participants were graduates of two cancer rehabilitation fellowship programs from 2008 through 2015. Participants were contacted via email about completion of an online survey and information was collected anonymously. Primary outcome measure was satisfaction of respondents with their fellowship training program in meeting the rehabilitation needs of their cancer patients. Sixteen responses, with a response rate of 89%, were recorded. Sixty-three percent of the respondents had exposure to cancer rehabilitation prior to post-graduate year 3 (PGY-3). Majority of graduates had practice involving at least 50% of care to cancer patients. Fifty percent indicated that their position was specifically created after their job interview. Career development was one of the major areas of suggested improvement in training. Graduates of cancer rehabilitation fellowship programs strongly value their training. Majority of the graduates were able to continue their career into jobs that were primarily cancer rehabilitation related. Further work needs to be done to define this subspecialty further and incorporate building practice as part of this training.

Mobility Functional Outcomes of Neurofibromatosis Patients: A Preliminary Report

Objective The aim of the study was to describe the mobility outcomes of neurofibromatosis (NF) patients who received acute inpatient rehabilitation. Design This is a retrospective study of 62 consecutive neurofibromatosis patients of any age who received physical medicine and rehabilitation consultations at a comprehensive cancer center. Postoperative, inpatient rehabilitation admission and discharge functional independence measures (FIM scores) of transfers and gait and length of hospital stay were obtained from 37 patients who were transferred to inpatient rehabilitation (acute rehabilitation) and 25 who had an alternative disposition (consultation only). Results Mean age was 34 yrs. Both groups had similar postoperative FIM transfer and gait scores; however, at approximately postoperative day 10, the consultation only group was discharged with median FIM of 5 (supervision level) as compared with the acute rehabilitation group FIM of 4 (P = 0.000). The acute rehabilitation group had improved mobility FIM scores from postoperative to rehabilitation admission and again from rehabilitation admission to discharge (P < 0.0001). At discharge, the acute rehabilitation group ambulated a significantly longer distance (500 f. vs. 300 ft) (P = 0.04). The median length of hospital stay for the acute rehabilitation and consultation only groups was 20 and 10 days, respectively (P = 0.004). Conclusions Acute inpatient rehabilitation leads to improvement in mobility-associated FIM scores for neurofibromatosis patients minimizing caregiver needs at home.

Poster 28: A Survey Regarding the Knowledge, Attitudes, and Beliefs of Graduates of Cancer Rehabilitation Fellowship Programs

Currently there are limited options for physiatrists to further subspecialize in cancer rehabilitation. Since 2007, few cancer rehabilitation fellowship programs have been started. There is currently absolutely no information about such training programs and their graduates. This study is the first to survey a small number of graduates from two cancer rehabilitation fellowship programs. The purpose of this study was to report characteristics, attitudes, and beliefs of cancer rehabilitation fellowship graduates. Graduates of cancer rehabilitation fellowship programs from 2008 through 2015 responded to a 26-question survey. Information collected included exposure to cancer rehabilitation prior to fellowship training, usefulness of fellowship training program, information about current practice, and suggested areas of improvement. The setting of the study is online survey. Participants were graduates of two cancer rehabilitation fellowship programs from 2008 through 2015. Participants were contacted via email about completion of an online survey and information was collected anonymously. Primary outcome measure was satisfaction of respondents with their fellowship training program in meeting the rehabilitation needs of their cancer patients. Sixteen responses, with a response rate of 89%, were recorded. Sixty-three percent of the respondents had exposure to cancer rehabilitation prior to post-graduate year 3 (PGY-3). Majority of graduates had practice involving at least 50% of care to cancer patients. Fifty percent indicated that their position was specifically created after their job interview. Career development was one of the major areas of suggested improvement in training. Graduates of cancer rehabilitation fellowship programs strongly value their training. Majority of the graduates were able to continue their career into jobs that were primarily cancer rehabilitation related. Further work needs to be done to define this subspecialty further and incorporate building practice as part of this training.

Poster 306 Rehabilitation of Patients Undergoing Sacrectomies: A Case Report

Disclosures: George Francis: I Have No Relevant Financial Relationships To Disclose Case/Program Description: Sacral neoplasms often present as large masses refractory to chemotherapy and radiation, requiring a sacrectomy. Multiple sacral nerve roots and vessels may be compromised, resulting in immobility, pressure ulcers, orthostasis, and neurogenic bowel and bladder. Our goal is to review the rehabilitative needs and outcomes post-sacrectomy via two inpatient case presentations. A 58-year-old woman with a solitary fibrous tumor underwent an en bloc resection involving a subtotal sacrectomy from S2 to coccyx, an L5-S1 laminectomy, ligation of her bilateral S2-5 nerve roots, neurolysis of bilateral S1 and sciatic nerve roots, and bilateral gluteal flap closures. Post-operatively, activity precautions included no walking initially and no hip flexion for two weeks. She required tilt table treatments and was ambulating at post-op Day 8. The rehabilitation challenges included: training on the management of her neurogenic bowel and bladder, controlling her neuropathic and somatic pain, and mobilizing her despite the hip restrictions. The second case includes a 67-year-old male with a sacral chordoma who underwent a two-stage surgery. Stage one involved preparation for the en bloc resection of the sacral tumor. One day later, stage two involved an L5-S1 laminectomy, ligation of the S2-5 nerve roots, en bloc resection of the sacral, bilateral S1 root and sciatic neurolysis, and bilateral gluteus muscle flaps for closure. His rehabilitation challenges included: severe protein malnutrition, orthostatic hypotension, delayed wound healing, fluid collection, uncontrolled pain, and neurogenic bowel and bladder. Setting: Tertiary cancer center. Results: Highly functional outcomes are seen in these patients, including independent bowel and bladder management and return to pre-operative ambulatory status. Discussion: Rehabilitation interventions for these patients include: medical stabilization, pain management, wound healing, transfers, mobility, and neurogenic bowel and bladder management. Conclusions: These are highly complex surgical patients with extensive rehabilitation needs that require the management by a physiatrist. Level of Evidence: Level V