Heart Failure Hospital Readmissions and Physical Therapy
Heart Failure Hospital Readmissions and Physical Therapy
This is a dissertation study which is divided into three different studies in order to answer
 the main research question (Study 3). The primary aim of this research (dissertation) is to
 investigate all-cause 30-day hospital readmission using functional mobility (5mWT, 30STS,
 6MWT, TUG), psychosocial attributes (KCCQ-12, HADS, ESSI), adherence to home exercise
 program, participation in a supervised exercise program, and number of follow up checkups
 with physicians or advanced health providers of patients with Acute Decompensated Heart
 Failure (ADHF) diagnosis who were discharged from a tertiary teaching hospital.

 Study 1: What is the effect of acute physical therapy on functional ability in individuals
 admitted with ADHF? Study 2: What is the effect of acute physical therapy on psychosocial
 attributes in individuals admitted with ADHF? Study 3: Which factors such as functional
 mobility (5mWT, 30STS, 6MWT, TUG), psychosocial attributes (KCCQ-12, HADS, ESSI), adherence
 to home exercise program, participation in a supervised exercise program, and number of
 follow up checkups with physicians or advanced health providers predict all-cause 30-day
 hospital readmission in patients discharged from a tertiary, teaching hospital with ADHF
 diagnosis?
The research plan is to investigate how acute physical therapy can play a big role in
 lowering 30-day hospital readmission in patients discharged with acute decompensated heart
 failure (ADHF). Several factors will be used to investigate and predict 30-day hospital
 readmission. Such factors are (1) functional mobility; 2) psychosocial attributes; (3) number
 of follow ups with providers; (4) adherence to home exercise program; (5) and participation
 in a supervised exercise program. Functional mobility will be measured by four different
 functional outcome measurements such as 5 meter walk test (5mWT), 30 seconds sit to stand
 test (30STS), six minute walk test (6MWT), and time up and go test (TUG). The psychosocial
 attributes will be measured by three different, pen and paper, self-survey questionnaires
 namely Kansas City Cardiomyopathy Questionnaire-12 (KCCQ12), Hospital Anxiety and Depression
 Scale (HADS), ENRICHD Social Support Instrument (ESSI). Moreover, once the patient returns
 home, two phone surveys will be conducted (every two weeks) for a period of 30 days of
 hospital discharge as a follow up.

 For the outcome measurements, the 5mWT is a simple test to measure individual's gait
 (walking) speed. The 30STS is a simple and easy test to complete in assessing functional
 lower extremity strength. The 30STS asks individual to stand up (assuming erect posture as
 much as possible with or without hands support) as many as possible from a regular chair with
 arm rest within 30 seconds timeframe. The 6MWT is simple and practical test is to measure
 aerobic capacity by measuring distance of an individual's ability to walk for 6 minutes. The
 TUG is to measure the time in seconds for a person to rise from sitting from a standard arm
 chair, rise, walk 10 feet, walk back to the previous arm chair, and sit down. The objective
 of the TUG test is to classify patient's fall risk. In addition, the functional mobility,
 basing on the functional outcome measures conducted, will be further assessed at the end of
 physical therapy service at the hospital by using Global Rating of Scale (GROC). The GROC is
 a self-survey using 5 point Likert scale, measuring how patient perceives the overall degree
 of change of improvement or perhaps a lack of improvement.

 For the Psychosocial Measures, the Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 is a
 shorter version of the original KCCQ tool. The objective of this test is to quantify
 self-measurement of physical function, symptoms, social function, self-efficacy and
 knowledge, and quality of life as it relates to their own heart failure diagnosis. The
 Hospital Anxiety and Depression Scale (HADS) is a self-reported questionnaire designed to
 measure the levels of anxiety and depression that an individual is experiencing. The
 objective of this tool is to serve as a screening tool to identify individuals who may suffer
 from anxiety and depression. The ENRICHD Social Support Instrument (ESSI) is a seven-item
 self-report survey that assesses patient's belief of their social support attributes
 (emotional, instrumental, informational, and appraisal).
Inclusion Criteria:

 -  all admitted at Houston Methodist Hospital with a primary diagnosis of acute heart
 failure or similar type of medical diagnosis

 -  stable medical state (HR equal or greater than 50 bpm, mean BP of 60 mmHg or better,
 Oxygen saturation (with or without oxygen supplement) of 90% or better; RR of 15 or
 better

 -  50 years old and over and able to follow 2 simple commands

 -  establish discharge recommendation to home settings

 -  ambulatory with or without assitive device(s)

 Exclusion Criteria:

 -  history of psychiatric disorder

 -  diagnosis of acute kidney injury requiring continuous renal replacement therapy

 -  diagnosis of major cognitive impairment (dementia, Alzheimer's dse, etc)

 -  inability to read and understand basic english language

 -  establish discharge recommendation to post-acute care settings (e.g. SNF, inpatient
 rehab, LTACH)

 -  inability to complete any functional mobility test due to musculoskeletal or other
 disorders