Robey Lydia, Schreck Haleigh, Eames Gretchen, Reiling Brittany, Munger Jessica, Mohamed Ashraf
Department of Rehabilitation Service, Cook Children's Medical Center, Fort Worth, TX.
Department of Hematology/Oncology and Stem Cell Transplant, Cook Children's Medical Center, Fort Worth, TX.
JCO Oncol Pract. 2022 Mar;18(3):e420-e425. doi: 10.1200/OP.21.00199. Epub 2021 Oct 29.
Patients undergoing stem-cell transplants endure prolonged hospitalizations and aggressive medical treatments. This combination can quickly evolve into loss of functional strength and physical debilitation. We aimed to promote independent patient activity during hospitalizations, to improve compliance with prescribed physical therapy (PT) sessions, and to focus those sessions on resistance and endurance exercises.
We used the Institute for Healthcare Improvement Model of Improvement as our quality improvement (QI) framework, and we implemented an initiative called Exercise is Medicine. The initiative included three key components: (1) educating staff and caregivers about the importance of early ambulation, (2) incorporating the Miles in Motion (MiM) program to encourage patients' daily activity, and (3) eliminating barriers to allow for higher completion rates of prescribed PT sessions. Data were collected for the completion rate of PT sessions, rate of high-frequency PT sessions, participation in the MiM program, and 1-minute sit-to-stand test scores on admission and discharge.
Before intervention, 42% of patients required high-frequency PT because of significant debilitation, which decreased to 17% after intervention. The completion rate of PT sessions increased from 71% to 87%. By discharge, 79% of patients improved their 1-minute sit-to-stand test scores and 21% returned to baseline score, indicating stable or improved functional strength, and 92% of patients participated in MiM.
The Exercise is Medicine initiative facilitated positive changes with patients showing stable or improved functional strength and endurance and increased participation in independent activity during inpatient stays.
接受干细胞移植的患者要经历长时间住院和积极的药物治疗。这种情况会迅速导致功能力量丧失和身体衰弱。我们旨在促进患者在住院期间的自主活动，提高对规定物理治疗（PT）疗程的依从性，并将这些疗程重点放在抗阻和耐力训练上。
我们采用医疗保健改进研究所的改进模型作为质量改进（QI）框架，并实施了一项名为“运动即良药”的倡议。该倡议包括三个关键组成部分：（1）对工作人员和护理人员进行早期下床活动重要性的教育；（2）纳入“运动里程”（MiM）计划以鼓励患者的日常活动；（3）消除障碍以提高规定PT疗程的完成率。收集了PT疗程完成率、高频PT疗程率、参与MiM计划的情况以及入院和出院时1分钟坐立测试分数的数据。
干预前，42%的患者因严重衰弱需要高频PT，干预后这一比例降至17%。PT疗程的完成率从71%提高到了87%。到出院时，79%的患者1分钟坐立测试分数有所提高，21%的患者恢复到基线分数，表明功能力量稳定或改善，92%的患者参与了MiM。
“运动即良药”倡议促成了积极变化，患者在住院期间功能力量和耐力稳定或改善，参与自主活动的情况增加。
