Predicting occupational therapy service utilization in agitated or sedated patients in the neurocritical care unit
Date
2020
Authors
Messenger, Lindsey, author
Malcolm, Matthew, advisor
Graham, James, committee member
Davalos, Deana, committee member
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Abstract
Purpose: The extent by which patient arousal levels relate to occupational therapy (OT) utilization in the neurocritical care unit (NCCU) is unknown. Understanding how arousal levels in patients influence their ability to engage with OT interventions will better equip therapists to provide appropriate treatments to patients. This study sought to examine whether the Richmond Agitation and Sedation Scale (RASS) is independently associated with OT service utilization. Methods: This cross-sectional retrospective study utilized data obtained from electronic health records from 1,134 patients admitted to the neurocritical care unit at an academic acute care hospital between May 2013 and September 2015. Separate regression models identified the predictive ability of the RASS and other patient factors in relationship to the dependent variables of receipt of OT in the neurocritical care unit (NCCU) and OT intervention categories. The independent variable was initial RASS score. Covariates included patient age, gender, minority status, Charlson Comorbidity Index, and initial Glasgow Coma Scale (GCS). OT intervention categories were: (1) self-care/home management, (2) functional-cognitive, and (3) therapeutic exercise. Results: 420 patients received OT in the NCCU (37.0%). The initial RASS score was not a significant predictor of receipt of OT, however, higher initial GCS and CCI scores and patient age were associated with greater odds of receiving OT. The initial RASS score was not a significant predictor of OT intervention type Higher CCI and initial GCS scores and increased patient age were associated with greater odds of receiving therapeutic exercise intervention. Increased initial GCS score was found to be associated wither greater odds for receiving self-care/home management interventions. Higher patient age was found to be associated with a higher odd of receiving functional-cognitive interventions. Conclusion: The initial RASS score was not a significant predictor of OT receipt or intervention type, suggesting that there may be other factors that are more influential for therapists to use for clinical reasoning. There could be a need for a different measures or education on potential OT roles related to different on patient arousal levels. Keywords: neurological rehabilitation, occupational therapy, arousal levels, agitation, sedation, neuro-intensive care, intervention
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Subject
arousal level
neurological rehabilitation
sedation
intervention
agitation
occupational therapy