KATIE SEIDLER PT, DPT
Post-doctoral Fellow, University of Colorado Anschutz Medical Campus, Department of Physical Medicine & Rehabilitation, Physical Therapy Program

Functional recovery during a skilled nursing facility (SNF) stay is poor1,2, likely related to inconsistent rehabilitation practices3-5. This pragmatic study evaluated the feasibility and effectiveness of a high-intensity rehabilitation protocol in improving function during a SNF stay.

Older adults (Veterans) admitted to SNF following a hospitalization.

Data were collected on 103 consecutive Veterans admitted to one SNF (age 77.7 ±10 years; 89% male). The i-STRONGER Program (IntenSive Therapeutic Rehabilitation for Older Skilled NursinG HomE Residents) integrates principles of physiologic tissue overload and strength training into rehabilitation6. A comparison of usual care with i-STRONGER occurred using a staged, 2-independent group design with the SNF serving as its own control. Therapists assessed function at evaluation and discharge via the Short Physical Performance Battery (SPPB) and gait speed 7,8. Treatment fidelity of i-STRONGER was assessed with an observational checklist. Regression analyses evaluated the response of SPPB or gait speed change to treatment group.

i-STRONGER participants exhibited a 0.13 meters/second greater change in gait speed than Usual Care (p=0.05). i-STRONGER demonstrated a 0.64-point greater change in SPPB than Usual Care (p=0.27). The average SNF length of stay was 3.5 days shorter during i- STRONGER (p=0.26), which equated to savings of ~$1537.38 per patient9. Adherence to i- Stronger was 99% over 11 sessions. No treatment-specific adverse events were reported.

High-intensity rehabilitation for patients admitted to a SNF following hospitalization effectively and safely improves function with reduced length of stay. Implications for practice: A high-intensity rehabilitation approach in SNFs appeared to improve functional outcomes in less time.

EMILY BERGLING
DrPH Student, Colorado School of Public Health

Dissemination and implementation (D&I) research addresses the disconnect between evidence-based research and practical application in community settings. Many current evaluation approaches to school-based health programs have a limited focus on outcome measures. This neglects to account for additional factors that influence implementation and program success. The mixed effectiveness of early childhood education (ECE)-based obesity prevention programs and the complexity added by implementing multi-component programs calls for more comprehensive evaluation, and one that includes factors related to D&I.

ECE settings are ideal for the application of D&I research due to their widespread use for implementing health interventions. The Culture of Wellness in Preschools (COWP) is a multi-component early childhood obesity prevention program, which aims to promote a “culture of wellness” in ECE settings by increasing fruit and vegetable consumption and physical activity levels.

The COWP team convened a working group to focus on the D&I constructs that were relevant to the program. An informal literature search was conducted to assess the applicability of existing D&I frameworks. Two frameworks guided the development of the COWP framework, the Consolidated Framework for Implementation Research (CFIR)1 and an obesity-prevention specific framework developed by Dreisinger et al.2 These were supplemented with additional program specific constructs.

The COWP D&I framework was developed to inform the program’s implementation and evaluation efforts. The framework consists of six domains: process, stages of dissemination, system-level and contextual factors, intervention-level factors, structural and participant factors (organizational- and individual-level), and outcomes. Preliminary work applying the framework was conducted in 2019. A mixed-methods evaluation assessed D&I factors related to the one component of the COWP program: the COWP Policy, System and Environment (PSE) Change process. Findings suggest that the successful implementation of the process may be most impacted by staff attitudes and perceived importance, the current status of wellness policies, and the adaptability of the process to align with center culture and norms. Factors most related to the successful sustainability of this process may be skills, attitudes, support and engagement of the staff and leadership, and the quality rating score of the center.

The development of a D&I framework specific to COWP is an initial step in adopting a D&I focused approach to program evaluation and quality improvement. The COWP team plans to build off these preliminary findings to explore how to use this framework to guide the development of research questions, additional data collection, and future analyses related to the overall COWP program.