OBJECTIVE:To determine whether a multidisciplinary mobility promotion quality-improvement (QI) project would increase patient mobility and reduce hospital length of stay (LOS). PATIENTS AND METHODS:Implemented using a structured QI model, the project took place between March 1, 2013 and March 1, 2014 on 2 general medicine units in a large academic medical center. There were 3352 patients admitted during the QI project period. The Johns Hopkins Highest Level of Mobility (JH-HLM) scale, an 8-point ordinal scale ranging from bed rest (score 5 1) to ambulating 250 feet (score 5 8), was used to quantify mobility. Changes in JH-HLM scores were compared for the first 4 months of the project (ramp-up phase) versus 4 months after project completion (post-QI phase) using generalized estimating equations. We compared the relative change in median LOS for the project months versus 12 months prior among the QI units, using multivariable linear regression analysis adjusting for 7 demographic and clinically relevant variables. RESULTS:Comparing the ramp-up versus post-QI phases, patients reaching JH-HLM's ambulation status increased from 43% to 70% (P < 0.001), and patients with improved JH-HLM mobility scores between admission and discharge increased from 32% to 45% (P < 0.001). For all patients, the QI project was associated with an adjusted median LOS reduction of 0.40 (95% confidence interval [CI]: 20.57 to 20.21, P < 0.001) days compared to 12 months prior. A subgroup of patients expected to have a longer LOS (expected LOS >7 days), were associated with a significantly greater adjusted median reduction in LOS of 1.11 (95% CI: 21.53 to 20.65, P < 0.001) days. Increased mobility was not associated with an increase in injurious falls compared to 12 months prior on the QI units (P 5 0.73).

OBJECTIVE To determine whether functional status near the time of discharge from acute care hospitalization is associated with acute care readmission. PATIENTS AND METHODS Retrospective cohort study of 9405 consecutive patients admitted from an acute care hospital to an inpatient rehabilitation facility between July 1, 2006 and December 31, 2012. Patients’ functional status at admission to the rehabilitation facility was assessed by the Functional Independence Measure (FIM) score, and divided into low, middle, or high functional status. The main outcome was readmission to an acute care hospital within 30 days of acute care discharge (for all patients and by subgroup according to diagnostic group: medical, orthopedic, or neurologic). RESULTS There were 1182 (13%) readmissions. FIM score was significantly associated with readmission, with adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for low and middle versus high FIM score category of 3.0 (2.5-3.6; P < 0.001) and 1.5 (95% CI: 1.3-1.8; P < 0.001), respectively. This relationship between FIM score and read-mission held across diagnostic category. Medical patients with low functional status had the highest readmission rate (OR: 29%; 95% CI: 25%-32%) and an adjusted OR for readmission of 3.2 (95% CI: 2.4-4.3, P < 0.001) compared to medical patients with high FIM scores. CONCLUSIONS AND RELEVANCE For patients admitted to an acute inpatient rehabilitation facility, functional status near the time of discharge from an acute care hospital is strongly associated with acute care readmission, particularly for medical patients with greater functional impairments. Reducing functional status decline during acute care hospitalization may be an important strategy to lower readmissions.

Dysphagia affects the vast majority of acute stroke patients. Although it improves within 2 weeks for most, some face longstanding swallowing problems that place them at risk for pneumonia, malnutrition, dehydration, and significantly affect quality of life. This paper discusses the scope, the disease burden, and the tools available for screening and formal evaluation of dysphagia. The most common and recently developed treatment interventions that might be useful in the treatment of this population are discussed.

Background: Despite evidence suggesting that lower-limb related factors may contribute to fall-risk in older adults, lower-limb and footwear influences on fall-risk have not been systematically summarized. This study was undertaken to systematically review the literature related to lower-limb and footwear factors that may increase fall-risk among community-dwelling older adults. To facilitate the transfer of findings to clinical care, the literature was synthesized and used to inform recommendations as well as the development of clinical pathways for each factor found to be an influence on fall risk. Methods: PubMed, Embase, PsycINFO, CINAHL, Web of Science, Cochrane Library, and AgeLine were searched for articles pertaining to age-related changes in the lower-limb and their association with fall-risk. To describe the trajectory leading or potentially leading to increased fall-risk, we examined articles that linked age-related changes in the lower-limb, footwear and orthoses to evidence-based fall-risk factors (e.g., balance impairment) or prospectively demonstrated a relationship with falls. Results: The systematic review consisted of 81 articles that met the inclusion criteria. Our results reflect a narrative review of the appraised literature for 8 pathways of lower-limb related influences on fall-risk in older adults. Six out of the eight pathways, including range of motion, orthoses, strength, footwear, pain, and deformity support a direct link with fall-risk. The two other pathways, including plantar skin/soft-tissue and sensory-loss, are connected via intermediate factors but lack studies that provide evidence of a direct link. The overall strength of the evidence available varied considerably for the 8 pathways presented. Conclusions: Findings provide much needed guidance supporting the identification and management of lower-limb and footwear-related influences on fall risk among older adults. Due to the lack or low quality of the evidence in specific areas, some recommendations should be applied with caution until more robust evidence is available.