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    • #490072
      Harriet Hill
      Participant

      Hey there! I have a quick questions about #11 on practice exam #2. The question reads: “11. An 84-year-old male was admitted to the hospital for a stroke. He participated in an acute physical therapy evaluation on the day of admission, during which his gait speed was calculated to be 0.5 meters per second. Based on this information, what is his most likely discharge disposition?”

      The correct answer is home, however I selected inpatient rehab because based on their gait speed they are more likely to have an adverse event and have reduced independence with ADLs. I know their gait speed qualifies them as a household ambulator, but it doesn’t make sense to me that an 84 year old would go home so soon after acute stroke if their gait speed indicates they are at increased risk for adverse events and that they are not independent with ADLs. Can you help me understand why his most likely d/c dispo would be home? Thanks!

    • #490078

      Hi Harriet,

      This recommendation is based on the Fritz and Lusardi article (walking speed as the sixth vital sign) that indicates walking speeds >0.1 m/s mean a discharge to home is more likely. Keep in mind that this is on day of admission, so it is likely he will improve during this admission. We can’t say for certain and it is quite possible inpatient rehab would serve him best- but, based on the literature available, a prediction of home would be the best choice here.

      Chrissy

    • #490080
      Harriet Hill
      Participant

      Gotcha. So with the >.1 m/s cut off, this indicates that the individual is more likely to discharge directly to home vs. a SNF? I think my perspective is skewed because I work in IPR, so I use this gait speed cut off to inform my home vs. SNF discharge from IPR. Also hard to picture that he would make large gains during a 1-3 day acute rehab stay at 80+ years old to get him beyond a gait speed that didn’t place him at increased risk for adverse events and hospital readmission, but I don’t work in the acute setting either so maybe that is more frequent than I think. This is a very tricky question to answer without more information!

      • #490086

        You’re right- this is tricky without more information! I’m going to copy something over that I just responded to another forum question because I think it applies here:

        As long as you can justify your reasoning, I think you will find you are in great shape for the NCS and clinical practice. Obviously, you can’t make your case on the NCS exam, but there won’t be enough questions like this for them to make or break whether you pass – and being able to defend your answer means it wasn’t a wild guess and that increases your chances of being correct.

        You will find some NCS exam questions are testing whether you’ve read a specific article (like this question). However, that doesn’t mean you should try to read every article. The time spent chasing small details that may or may not appear on the exam would detract from your focus on the big topics that will definitely comprise a large portion of the exam (think your big neuro diagnoses).

        Being able to formulate your best answer to one of those detail questions, then forget about it and move on to the next question with complete focus will serve you well! This is a good practice question to rehearse that skill as much as it is to test whether you’ve read the Fritz and Lusardi article.

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