Robert Sandstrom

Discharge Destination and Motor Function Outcome in Severe Stroke as Measured by the Functional Independence Measure/Function-Related Group Classification System

OBJECTIVES Function-related groups based on the Functional Independence Measure have been proposed as a model for a prospective payment system for medical rehabilitation. This study describes discharge destination and motor function outcomes in a sample of patients with stroke from the FIM-FRG STR1 classification. STUDY DESIGN A retrospective review of 293 cases of stroke from the years 1993 to 1995. The demographic and outcome characteristics of this sample were described. RESULTS/CONCLUSIONS Forty-five percent of the patients were discharged to home after a mean length of stay of 23.8 days in acute medical rehabilitation. Patients who were discharged home had higher admission and discharge motor FIM scores than those discharged to a subacute facility or long-term care facility, although the correlation between motor FIM score and discharge destination was low to moderate. Median discharge motor FIM scores indicate considerable residual disability in this classification after rehabilitation. Research problems that address methods to improve the usefulness of the FIM-FRG system in a prospective payment system are discussed.

The Meanings of Autonomy for Physical Therapy

The purpose of this article is to explore the social context and meanings of autonomy to physical therapy. Professional autonomy is a social contract based on public trust in an occupation to meet a significant social need and to preserve individual autonomy. Professional autonomy includes control over the decisions and procedures related to one’s work (technical autonomy) and control over the economic resources necessary to complete one’s work (socioeconomic autonomy). Professional autonomy is limited and weakened by the relationship of one profession to another (dominance), by the influence of other social institutions (rationalization and deprofessionalization), and by the internal disposition of the profession itself (insularity). Professional autonomy for physical therapists is increasing as medical dominance has declined but is limited by the trends of rationalization and deprofessionalization in health care. Physical therapists must recognize that professional autonomy represents a social contract based on public trust and service to meet the health needs of people who are experiencing disablement in order to maintain their individual autonomy. Correction In Figure 2 of the print version of this article, “Physical” was incorrectly typeset as “Physician.” This error has been corrected in both the PDF and full-text versions of the article.

Predicting discharge destination for patients with severe motor stroke: important functional tasks.

Many patients with severe stroke are capable of returning to the community after receiving rehabilitation services. The purpose of this study was to describe outcomes of patients with stroke in FIM-FRG STR1, a classification based on the Functional Independence Measure, and identify important functional tasks associated with discharge to home. FIM-FRG STR1 is one of nine subpopulations of stroke that have been identified based on motor/cognitive FIM subscale score and age. We reviewed the program evaluation data of 259 cases of stroke from 1993 to 1996. We performed a descriptive analysis of the data and a logistic regression analysis to determine which tasks measured by the FIM were associated with discharge destination, a key indicator of rehabilitation success. We found that three admission FIM variables (bladder management, toilet transfers, memory) and three discharge FIM variables (upper body dressing, bed/chair transfers, comprehension) were associated with discharge destination with up to 75% accuracy. The implications of these findings are discussed.

Structure of the Physical Therapy Benefit in a Typical Blue Cross Blue Shield Preferred Provider Organization Plan Available in the Individual Insurance Market in 2011

Background The Affordable Care Act of 2010 establishes American Health Benefit Exchanges. The benefit design of insurance plans in state health insurance exchanges will be based on the structure of existing small-employer–sponsored plans. Objective The purpose of this study was to describe the structure of the physical therapy benefit in a typical Blue Cross Blue Shield (BCBS) preferred provider organization (PPO) health insurance plan available in the individual insurance market in 2011. Design A cross-sectional survey design was used. Methods The physical therapy benefit within 39 BCBS PPO plans in 2011 was studied for a standard consumer with a standard budget. First, whether physical therapy was a benefit in the plan was determined. If so, then the structure of the benefit was described in terms of whether the physical therapy benefit was a stand-alone benefit or part of a combined-discipline benefit and whether a visit or financial limit was placed on the physical therapy benefit. Results Physical therapy was included in all BCBS plans that were studied. Ninety-three percent of plans combined physical therapy with other disciplines. Two thirds of plans placed a limit on the number of visits covered. Limitations The results of the study are limited to 1 standard consumer, 1 association of insurance companies, 1 form of insurance (a PPO), and 1 PPO plan in each of the 39 states that were studied. Conclusions Physical therapy is a covered benefit in a typical BCBS PPO health insurance plan. Physical therapy most often is combined with other therapy disciplines, and the number of covered visits is limited in two thirds of plans.

Commentary on "use of demographic and quantitative admissions data ..."

Student recruitment and selection into professional physical therapist education programs is an issue of contemporary importance to the profession and especially to the physical therapy academic community. On an annual basis, academic programs are charged with evaluating the credentials of applicants to programs and to make predictive judgments about applicant appropriateness and likelihood for success as a physical therapist. The outcomes of these decisions have enormous effects on the applicant, on the program, on the institution where the program resides, and, ultimately, on the physical therapy profession and the community. It is to this process that Utzman and colleagues make timely and important contributions. The authors address 2 important questions facing admissions committees: (1) Will this student complete the program without academic difficulty? and (2) Once graduated, will this student pass the National Physical Therapist Examination (NPTE)? The answers to these questions are determined by the ability and motivation of the applicant and the strength and expectations of the faculty and curriculum. It is examining these questions using a national representative sample of physical therapist education programs and a systematic method to study demographic, program, and academic variables affecting student outcomes where the authors shine a light on these issues. The focus of these studies is to identify predictive characteristics of applicants that can assist with admissions decision making. In doing so, they affirm some basic tenets of admissions decision making related to applicant qualifications and also uncover some issues that need the attention of the profession. The authors affirm some basic dogma ascribed to by physical therapy admissions committees. Students need to be well prepared academically to learn in a physical therapist education program. This is the message that needs to be understood by people who are considering physical therapy as a career choice. In the first study,1 …

Need Factors Associated With the Intensity of Outpatient Therapy in the Medicare Population

ABSTRACT Aims: Concerns have been raised about unnecessary utilization of outpatient therapy in the U.S. Medicare program. The purpose of this study was to determine if demographic factors, functional limitations and medical conditions are associated with the number (intensity) of outpatient therapy visits. Methods: Data about number of outpatient Medicare visits, demographic information, functional limitations and medical conditions for 2009-2011 was downloaded from the MEPS-HC data files. Descriptive statistics of the dataset were calculated. The relationship between the intensity of therapy services and the variables was determined using a negative binomial regression analysis (p < .05). Results: Worse perceived health status, cognitive limitations, need for activities of daily living and instrumental activities of daily living help and physical function limitations are associated with greater therapy utilization. Conclusions: Greater intensity of outpatient therapy services is associated with need for assistance with physical, cognitive, and functional limitations in the Medicare population.