In the abstracts cited above, an author, A. Vatwani, was inadvertently omitted from the byline of the abstract, “Formal Balance Assessment and Intervention in Patients With Newly Implanted Left Ventricular Assist Device (LVAD),” on page 30 of the January 2016 issue of Cardiopulmonary Physical Therapy Journal. The corrected abstract appears below.
FORMAL BALANCE ASSESSMENT AND INTERVENTION IN PATIENTS WITH NEWLY IMPLANTED LEFT VENTRICULAR ASSIST DEVICE (LVAD)
Appel J, Vatwani A, Sutton AK, Hall S, Russel S, Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD
PURPOSE/HYPOTHESIS: Patients status post LVAD implantation are at risk for balance deficits due to the additional weight and positioning of the LVAD, premorbid deconditioning and hospital acquired complications due to prolonged length of stay. In the post-operative phase, physical therapy is indicated in the majority of patients with newly implanted LVADs. Depending on a patient’s premorbid level of function and post-operative course, patients often demonstrate a variety of functional impairments, with some patients requiring more intensive physical therapy (PT) interventions than others. The objectives of this study were to determine the association between newly implanted LVADs and balance deficits; determine the effectiveness of balance interventions in patients with newly implanted LVADs; and to determine the association between balance and overall function, and length of stay in patients with LVADs. NUMBER OF SUBJECTS: Current data analyzed for 12 patients. Data collection ongoing at this time. MATERIALS/METHODS: Medical records of patients with newly implanted LVADs were retrospectively reviewed following a quality improvement project. Balance and fall risk were assessed using the Tinetti Performance Oriented Mobility Assessment (Tinetti) and overall function was assessed using the Activity Measure for Post-Acute Care (AM-PAC) Inpatient Basic Mobility Short Form. Patients were assessed upon transfer out of the intensive care unit (ICU), on a step down surgery floor, at discharge and every two weeks as needed. Patients participated in standardized balance interventions two times per week, in addition to regular PT plan of care. RESULTS: Average initial Tinetti score = 13.7; average final Tinetti score = 24.3; average change in Tinetti score = 11 (out of 28 total points)- 11 (92%) patients at fall risk initially-9 (75%) patients at high fall risk initially -At discharge, 5 (42%) patients were a fall risk, and only 1 (8%) were high fall risk-10 (83%) had significant increase in Tinetti score Average initial AM-PAC score = 15.0; average final AM-PAC score = 19.8 points; average change in AM-PAC score = 12.3 (out of 24 total points)-9 (75%) patients initially at high fall risk also had an AM-PAC of 18 or lower, corresponding to 46.58% or great disability. CONCLUSIONS: Based on data from 12 patients, implementation of standardized balance interventions in this patient population have resulted in meaningful change in Tinetti score and AM-PAC mobility scale, indicating decreased fall risk and reduced functional impairment. CLINICAL RELEVANCE: Patients requiring LVAD placement are predisposed to physical deconditioning, given past medical history and associated symptoms, as well as other hospital acquired complications due to longer length of stay. Potential balance deficits exist as a result of weight and position of the LVAD, along with sternal precautions. Standardized assessment and outcome measures provide objective data to improve care and communication with multidisciplinary team.
Abstracts of Poster Presentations at the 2016 Combined Sections Meeting [abstracts].Cardiopulm Phys Ther J. 2016;27(1):29–40.