Jonathan H. Whiteson

Effects of horticultural therapy on mood and heart rate in patients participating in an inpatient cardiopulmonary rehabilitation program.

PURPOSE To assess the effects of horticultural therapy (HT) on mood state and heart rate (HR) in patients participating in an inpatient cardiac rehabilitation program. METHODS Cardiac rehabilitation inpatients (n = 107) participated in the study. The HT group consisted of 59 subjects (34 males, 25 females). The control group, which participated in patient education classes (PECs), consisted of 48 subjects (31 males, 17 females). Both HT sessions and PEC are components of the inpatient rehabilitation program. Each group was evaluated before and after a class in their respective modality. Evaluation consisted of the completion of a Profile of Mood States (POMS) inventory, and an HR obtained by pulse oximetry. RESULTS Changes in the POMS total mood disturbance (TMD) score and HR between preintervention and postintervention were compared between groups. There was no presession difference in either TMD score (16 +/- 3.6 and 19.0 +/- 3.2, PEC and HT, respectively) or HR (73.5 +/- 2.5 and 79 +/- 1.8, PEC and HT, respectively). Immediately following the intervention, the HT TMD was significantly reduced (post-TMD = 1.6 +/- 3.2, P < .001), while PEC TMD was not significantly changed (TMD = 17.0 +/- 28.5). After intervention, HR fell in HT by 4 +/- 9.6 bpm (P < .001) but was unchanged in PEC. CONCLUSION These findings indicate that HT improves mood state, suggesting that it may be a useful tool in reducing stress. Therefore, to the extent that stress contributes to coronary heart disease, these findings support the role of HT as an effective component of cardiac rehabilitation.

Outcome measurement for COPD: Reliability and validity of the Dyspnea Management Questionnaire

BACKGROUND The Dyspnea Management Questionnaire (DMQ) is a measure of the psychosocial and behavioral responses to dyspnea for adults with COPD. The research objectives were to evaluate the reliability and validity of an expanded DMQ item pool, as a preliminary step for developing a computer adaptive test. METHODS The original 66 items of the DMQ were used for the analyses. The sample included 63 women and 44 men with COPD (n = 107) recruited from two urban medical centers. We used confirmatory factor analysis to test the factor structure of the DMQ and its underlying cognitive-behavioral theoretical base. The internal consistency and test-retest reliability, and breadth of coverage of the expanded DMQ item bank were also evaluated. RESULTS Five distinct dyspnea domains were confirmed using 56 original items of the DMQ: dyspnea intensity, dyspnea anxiety, activity avoidance, activity self-efficacy, and strategy satisfaction. Overall, the breadth of items was excellent with a good match between sample scores and item difficulty. The DMQ-56 showed good internal consistency reliability (α = 0.85-to 0.96) and good preliminary test-retest reliability over a 3-week interval (ICC = 0.69-0.92). CONCLUSIONS The DMQ demonstrated acceptable levels of reliability and validity for measuring multidimensional dyspnea outcomes after medical, psychological, and behavioral interventions for adults with COPD.

Early Rehabilitation in the Medical and Surgical Intensive Care Units for Patients With and Without Mechanical Ventilation: An Interprofessional Performance Improvement Project

Most early mobility studies focus on patients on mechanical ventilation and the role of physical and occupational therapy. This Performance Improvement Project (PIP) project examined early mobility and increased intensity of therapy services on patients in the intensive care unit (ICU) with and without mechanical ventilation. In addition, speech‐language pathology rehabilitation was added to the early mobilization program.

Physical Medicine and Rehabilitation Value in Bundled Payment for Total Joint Replacement and Cardiac Surgery: The Rusk Experience

Physiatry is at a crossroads. We may shortly find that we cannot rely on traditional care structures such as inpatient units, consultancies, and interventional procedures if we are to thrive in a world of value-based care. Pressures on costs, centralization of patient flow, outcomes reporting, and systemic consolidation will all necessitate a new approach. We need to define our role in changing models of payment and care delivery. There are significant threats to the viability of inpatient rehabilitation units and significant competition from other specialties for directing or providing care at skilled nursing facilities. As consolidation of health systems progresses and care is actively directed into discrete service lines, individual providers and specialties need to redefine their role and how they provide value in patient care. Providers will simply not be able to cherry pick only highly reimbursable procedures or even independently define their own paths for care. Physiatrists have a unique perspective on patient care, and our focus on function can translate into highly important outcomes for our patients. We also care for a diverse group of patients who often have little voice in the larger debates on health care access and expenditures, necessitating our role as advocates and leaders in care processes. Bundled care represents one of the dominant mechanisms of payment to which we must adapt. These