Implementing Continuous Heart Rate Monitoring During Physical Therapy Improves Functional Outcomes Following Inpatient Stroke Rehabilitation

Maghan Bretz, Chris Henderson, Jenni Moore, T. George Hornby Hannah LaMar

PURPOSE/HYPOTHESIS: Functional mobility deficits are common following stroke with the recovery of walking being a primary goal of rehabilitation. Although not consistently performed during post-stroke rehabilitation, the best available evidence suggests walking recovery is optimized with interventions that prioritize walking practice, particularly at higher cardiovascular intensities. In order to target these higher cardiovascular intensities, routine monitoring of heart rate is required. Therefore, the purpose of this quality improvement project was first to evaluate the current physical therapy practice patterns and then subsequently attempt to increase the frequency of heart rate monitoring to better align with current best practices. If successful, a secondary aim was to investigate the potential effects on functional outcomes in these individuals.

NUMBER OF SUBJECTS: 80 individuals <30 days post-stroke participating in acute inpatient rehabilitation at a community-based facility.

MATERIALS AND METHODS: Usual care data were collected from May to September 2019 (41 patients, 1068 sessions) and indicated that only 26.2% of sessions were continuously monitored for heart rate. A fidelity target of 65% was set and multiple knowledge translation strategies were applied over the next 6 months to improve compliance with continuous heart rate monitoring during physical therapy sessions. Post-implementation data were collected from June to December 2020 (39 patients, 1208 sessions). Demographics, locomotor (10MWT, 6MWT, IRF-PAI scores for walking and stair negotiation) and non-locomotor (BBS, IRF-PAI scores for sit-to-stand and bed-to-chair transfers) outcomes were also extracted from medical records and evaluated between phases using Chi-Square and Mann-Whitney U tests as indicated. RESULTS: Across phases, patients were similar at admission (p=0.19-0.70). Clinician compliance with continuous heart rate monitoring increased to 92.3% during the post-implementation phase (p<0.001). Significantly greater gains in 10MWT (0.14 [0-0.34] vs 0.25 [0.13-0.48] m/s; p=0.04), 6MWT (24 [0-74] vs 70 [28-108] m; p=0.02), and BBS (11 (5-16) vs 15 (9-23) points; p=0.04) were observed during the post-implementation phase. Additionally, IRF-PAI scores for transfers (p<0.01), walking (p<0.01), and stairs (p=0.01-0.12) also generally improved.

CONCLUSIONS: Implementation of routine continuous heart rate monitoring during inpatient physical therapy was feasible and associated with gains in both locomotor and non-locomotor outcomes suggesting it may be a key barrier to implementation of evidence-based practices. Further investigation is warranted to identify additional factors that may have contributed to observed gains in functional outcomes.

CLINICAL RELEVANCE: Implementation of routine continuous heart rate monitoring during inpatient physical therapy post-stroke is feasible and may contribute to greater gains in both locomotor and non-locomotor outcomes.

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