Physical Therapy and Occupational Therapy After Transcatheter Aortic Valve Replacement
NCT ID: NCT03117296
Last Updated: 2023-01-20
Study Results
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View full resultsBasic Information
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COMPLETED
189 participants
OBSERVATIONAL
2014-12-03
2017-12-31
Brief Summary
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Detailed Description
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Aim: • Create a standardized pathway for new transcatheter aortic valve replacement patients in the Structural Heart Division (SHD)
* Improve patient outcomes including increasing the percentage of patients returning to home rather than a rehab facility destination at discharge
* Decrease length of stay
Implementation:
* Plan: PT and OT identified a gap in consults and need for specific education targeted at a new surgeries population (tAVR); Structural Heart division of CV institute identified an increase LOS and decreased activity of their patients in the hospital. In October 2014 planning began to introduce a SHD tAVR pathway that would include post procedure day number 0 nursing requirements and training, post procedure day number 1-3 PT and OT assessment and interventions.
* Do: Implemented pathway in November 2014.
* Check: Order set revision; Patient handouts ; Cardiac Rehab; Weekend criteria; staff training
* Act: February 2015, order sets in place, patient handouts finalized and full pathway finalized for post op tAVR patients.
* Continued checks identified additional SHD procedures and team determined that Mitral Clips and LARIATs were not criteria for tAVR pathway but would receive routine PT and OT consults.
Intervention: • Added PT and OT to Structural Heart Order Set.
* PT and OT assessments completed on post procedure day number day 1.
* PT and OT follow up treatments post procedure day number 2, 3 and beyond as appropriate.
* Patient education handouts individualized for patient population
* Pre-op education handouts individualized for patient population
Outcome measures: Hospital Length of stay, discharge disposition. Data Analysis: Chi-square tests are used to compare proportions between groups, while Wilcoxon two-sample tests are used to compare distributions of continuous variables between groups. This nonparametric test was chosen due to non-Gaussian distribution of the continuous outcomes within groups. Statistical significance was set at p\<0.05. All analyses were performed using SAS 9.4 (SAS Institute Inc, Cary, North Carolina, USA).
Conditions
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Study Design
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COHORT
OTHER
Study Groups
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Post procedure routine PT and or OT
Routine PT and or OT
Routine PT or OT
Routine PT or OT consulted by physician when identified discharge disposition of home
Post Procedure PT and OT pathway
Post procedure day zero nursing mobilization; post procedure day one PT and OT assessment and intervention, daily PT and OT intervention
Post procedure daily PT and OT
PT evaluation and treatment on post procedure day zero: Nurses mobility patient using egress testing one time
PT post procedure
post procedure day one: PT and OT assessment, education and intervention.
OT post procedure
PT and OT Daily until goals met or patient discharge.
Interventions
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Post procedure daily PT and OT
PT evaluation and treatment on post procedure day zero: Nurses mobility patient using egress testing one time
PT post procedure
post procedure day one: PT and OT assessment, education and intervention.
OT post procedure
PT and OT Daily until goals met or patient discharge.
Routine PT or OT
Routine PT or OT consulted by physician when identified discharge disposition of home
Eligibility Criteria
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Inclusion Criteria
* status post transcatheter aortic valve replacement via transfemoral catheter approach, with or without minor intra or post procedure events (GI bleeds, minor access bleeds, afib, etc)
Exclusion Criteria
* procedure via appropriate other than femoral access (transapical, transcaval)
ALL
No
Sponsors
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Henry Ford Hospital
OTHER
Henry Ford Health System
OTHER
Responsible Party
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Adele Myszenski
Supervisor, Physical Therapist
Principal Investigators
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Adele Myszenski, MPT
Role: PRINCIPAL_INVESTIGATOR
Henry Ford Health System
Locations
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Henry Ford Hospital
Detroit, Michigan, United States
Countries
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References
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Babaliaros V, Devireddy C, Lerakis S, Leonardi R, Iturra SA, Mavromatis K, Leshnower BG, Guyton RA, Kanitkar M, Keegan P, Simone A, Stewart JP, Ghasemzadeh N, Block P, Thourani VH. Comparison of transfemoral transcatheter aortic valve replacement performed in the catheterization laboratory (minimalist approach) versus hybrid operating room (standard approach): outcomes and cost analysis. JACC Cardiovasc Interv. 2014 Aug;7(8):898-904. doi: 10.1016/j.jcin.2014.04.005. Epub 2014 Jul 30.
Marcantuono R, Gutsche J, Burke-Julien M, Anwaruddin S, Augoustides JG, Jones D, Mangino-Blanchard L, Hoke N, Houseman S, Li R, Patel P, Stetson R, Walsh E, Szeto WY, Herrmann HC. Rationale, development, implementation, and initial results of a fast track protocol for transfemoral transcatheter aortic valve replacement (TAVR). Catheter Cardiovasc Interv. 2015 Mar;85(4):648-54. doi: 10.1002/ccd.25749. Epub 2014 Nov 29.
Reardon MJ, Van Mieghem NM, Popma JJ, Kleiman NS, Sondergaard L, Mumtaz M, Adams DH, Deeb GM, Maini B, Gada H, Chetcuti S, Gleason T, Heiser J, Lange R, Merhi W, Oh JK, Olsen PS, Piazza N, Williams M, Windecker S, Yakubov SJ, Grube E, Makkar R, Lee JS, Conte J, Vang E, Nguyen H, Chang Y, Mugglin AS, Serruys PW, Kappetein AP; SURTAVI Investigators. Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med. 2017 Apr 6;376(14):1321-1331. doi: 10.1056/NEJMoa1700456. Epub 2017 Mar 17.
Other Identifiers
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10437
Identifier Type: -
Identifier Source: org_study_id
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