Gait and Balance Outcome Measures Are Responsive in Severely Impaired Individuals Undergoing Inpatient Stroke Rehabilitation.

Objective: To investigate whether gait and balance outcome measures in patients with severe gait and balance impairments at admission to inpatient rehabilitation provided additional and meaningful information beyond customary measures. Specifically, this study investigated whether individuals who obtained low scores at admission exhibited improvements that exceeded the established minimal detectable change during inpatient rehabilitation. We also investigated whether gait outcomes would capture changes in function not identified by customary measures.

Applying the Knowledge-to-Action Framework to Implement Gait and Balance Assessments in Inpatient Stroke Rehabilitation.

Objectives: The overall objectives of this project were to implement and sustain use of a gait assessment battery (GAB) that included the Berg Balance Scale, 10-meter walk test, and 6-minute walk test during inpatient stroke rehabilitation. The study objective was to assess the effect of the study intervention on clinician adherence to the recommendations and its effect on clinician perceptions and the organization.

Design: Pre- and post-training intervention study.

Commentary on the Challenges and Benefits of Implementing Standardized Outcome Measures.

The Institute of Medicine (now the National Academy of Medicine) has proposed a Learning Heath system (LHS) as a model to improve health care. A LHS focuses on capturing data from the clinical encounter and applying those data to improve practice. The process can be described as an iterative learning cycle composed of 3 areas: performance to data, data to knowledge, and knowledge to performance or often knowledge translation.

Participation by design: Integrating a social ecological approach with universal design to increase participation and add value for consumers.

Background: Physical activity is an essential component of a healthy lifestyle. Health clubs encourage sustained healthy lifestyles but are still largely not accessible to people with disabilities. Cost is a barrier for accessibility enhancements.

Measuring Value in Postacute Care.

The value of postacute care (PAC) is unclear. While experienced clinicians understand the appropriateness of each specific site of PAC, clear evidence-based guidelines are not available, and many referrals to PAC today are made based on bed availability rather than patient need. Measuring value (value=outcomes/cost) for the entire episode of care has been proposed as an effective method to both evaluate and enable faster innovation in care.