Occupational therapy predicts post-operative left ventricular assist device (LVAD) self-care, hospital length of stay, and discharge disposition

PurposeUnderstanding LVAD self-care needs is important for candidacy decisions and care planning.This study investigated the association between pre-operative occupational therapy (OT) evaluations and post-operative LVAD self-care, length of stay (LoS), and discharge disposition. Methods Weretrospectively studied medical records of 100 LVAD recipients.OT pre-operative assessments included grip strength, Montreal Cognitive Assessment, Allen Cognitive Level J o u r n a l P r e -p r o o f Screen-5, daily activity performance, vision, and a performance-based LVAD battery management assessment (BMA).Ordinal logistic regression examined the association between OT pre-operative evaluation and actual post-operative LVAD self-care.Linear regression and random forest model classification models evaluated relative contributions of individual OT assessment items on LoS, LVAD self-care, and discharge disposition, respectively. ResultsAt post-implant discharge, 35% of patients were independent with LVAD self-care, 49% required some assistance, and 15% 24/7 assistance.OT pre-operative evaluations predicted postoperative LVAD self-care when controlling for sex, assistive device, setting acuity, and left ventricular ejection fraction (OR = 9.05, 95% CI: 2.70-30.29,p < 0.001).LVAD BMA was the sole significant predictor of LoS ( = 1.94, 95% CI 0.78 -3.10).For LVAD self-care, the random forest classification model demonstrated 62.5% accuracy (95% CI: 0.41-0.81),with vision and cognition the most influential items.For discharge disposition, the model demonstrated 56% accuracy (95% CI: 0.35-0.76),with LVAD BMA most important. ConclusionPre-operative OT evaluations of anticipated post-operative LVAD self-care, particularly vision and cognition assessments, were associated with actual post-operative LVAD self-care.Performance-based assessments provided insights for LoS and discharge disposition.