Emily Thorpe, a physical therapist at Mayfair Village Nursing Care Center in Columbus, Ohio, recently had a review published in the Journal of Neurologic Physical Therapy.
The article, “Outcome Measure Scores Predict Discharge Destination in Patients with Acute and Subacute Stroke: A Systematic Review and Series of Meta-analyses” appeared in the January 2018 issue. Katie Garrett, a former physical therapy student at Mayfair, co-authored the paper under Thorpe, along with colleague Ashley Smith.
The project initiated in November 2015 as a research requirement for the ladies’ Doctor of Physical Therapy program at Walsh University in North Canton, Ohio. Upon completion of the systematic review manuscript, the members of the research team discovered their findings to be appropriate to advance to a meta-analysis and decided to pursue this next stage of research along with pursuit of publication.
“All three of us had a strong interest in the patient population with neurologic deficits and witnessed the complexity of treating and managing these patients, particularly those who had a stroke, as this was the most frequent diagnosis seen,” said Thorpe.
“Myself and the two other girls had had previous clinical experiences in the hospital or inpatient rehabilitation setting and were surprised how much physicians, other clinicians and members of the care team sought out our recommendations for appropriate discharge of patients,” she added. “By and large, these recommendations were based on our clinical judgment from the patient’s overall mobility presentation, but we thought, ‘There’s got to be a more objective way to determine their best fit discharge destination.’”
Thorpe and her team completed a systematic search, for which they sought through hundreds of articles by title, then abstract and finally full manuscript for relevant ones that met their study parameters. The search resulted in nine articles eligible for systematic review, of which data were extracted and analyzed.
They looked at how patients with stroke were scored on outcome measures, primarily functional independence measures, or FIM, and National Institutes of Health Stroke Scale, or NIHSS, upon their admission into hospital or inpatient rehabilitation settings. They then looked at whether those patients were discharged home or to a facility, such as assisted living, skilled nursing, etc.
“As expected, we found a natural trend that patients with better scores were more likely to discharge home, but we didn’t realize the significance of that,” said Thorpe. “Among other results, we found that for every point scored on the FIM, patients who had experienced a stroke event were nearly eight percent more likely to be discharged home.”
After the therapy students presented the results and data in the class setting, professors and mentors encouraged them to proceed with submitting their manuscript to JNPT. After their initial submission in February 2017, followed by numerous hours of editing and polishing their meta-analysis, the final manuscript was submitted in summer 2017.
Thorpe sees a value in the research and has applied it to her job at Mayfair.
“We don’t use the FIM here, but it’s often administered at inpatient rehabilitation settings, if not at the hospital upon admission,” said Thorpe. “As an evaluating therapist, when I complete a chart review for a patient and see an FIM score, I have pretty good idea of what that indicates, on what their presentation is going to be. Even more so, I see previous outcome measure performance evaluating patients and administer a variety of measures frequently throughout their plan of care to more objectively assess their progress. It’s nice for me on the receiving end to see the outcome measure scores that were used. It gives me a more objective idea of where they’re coming from as well as assessing their progress here.”
Thorpe, Garrett and their teammate won the university’s Research Excellence Award for 2017 for their work on the project.
Of course, being published is a wonderful feeling too.
“To see all of the hard work, knowing how many hours we spent on it since 2015 and now seeing it in a journal, I just really, really hope it can benefit even one clinician with making a more educated recommendation for a patient’s discharge,” said Thorpe. “If even one patient’s quality of life improves as a result of this work, it was worth it.”