Archives of Physical Medicine and Rehabilitation
Volume 85, Issue 10 , Pages 1599-1601, October 2004

Significance of poor patient participation in physical and occupational therapy for functional outcome and length of stay

Presented in part to the American Academy of Physical Medicine and Rehabilitation, November 2002, Orlando, FL.

  • Eric J. Lenze, MD

      Affiliations

    • Intervention Research Center in Late-Life Mood Disorders, Department of Psychiatry, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
    • Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
    • Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, USA
    • Corresponding Author InformationReprint requests to Eric Lenze, MD, Western Psychiatric Institute and Clinic, Rm E1124, 3811 O’Hara St, Pittsburgh, PA 15213
    • ,
  • Michael C. Munin, MD

      Affiliations

    • Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
    • ,
  • Tanya Quear, BS

      Affiliations

    • Intervention Research Center in Late-Life Mood Disorders, Department of Psychiatry, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
    • ,
  • Mary Amanda Dew, PhD

      Affiliations

    • Intervention Research Center in Late-Life Mood Disorders, Department of Psychiatry, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
    • ,
  • Joan C. Rogers, PhD

      Affiliations

    • Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, USA
    • ,
  • Amy E. Begley, MA

      Affiliations

    • Intervention Research Center in Late-Life Mood Disorders, Department of Psychiatry, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
    • ,
  • Charles F. Reynolds III, MD

      Affiliations

    • Intervention Research Center in Late-Life Mood Disorders, Department of Psychiatry, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

Abstract 

Lenze EJ, Munin MC, Quear T, Dew MA, Rogers JC, Begley AE, Reynolds CF III. Significance of poor patient participation in physical and occupational therapy for functional outcome and length of stay. Arch Phys Med Rehabil 2004;85:1599–601.

Objectives

To determine the frequency of poor patient participation during inpatient physical (PT) and occupational therapy (OT) sessions and to examine the influence of poor participation on functional outcome and length of stay (LOS).

Design

Prospective observational study.

Setting

University-based, freestanding acute rehabilitation hospital.

Participants

Two hundred forty-two inpatients, primarily elderly (age range, 20–96y), with a variety of impairment diagnoses (eg, stroke), who were admitted for inpatient rehabilitation.

Interventions

Not applicable.

Main outcome measures

The Pittsburgh Rehabilitation Participation Scale, the 13 motor items from the FIM instrument (FIM motor), LOS, and discharge disposition.

Results

We categorized the sample into 3 groups: “good” participators were those for whom all inpatient PT and OT sessions were rated 4 or greater (n=139), “occasional poor” participators were those with less than 25% of scores rated below 4 (n=53), and “frequent poor” participators were those with 25% or more of scores rated below 4 (n=50). Change in FIM motor scores during the inpatient rehabilitation stay was significantly better for good and occasional poor participators, compared with frequent poor participators (mean FIM improvement: 23.2, 22.8, and 17.6, respectively; repeated-measures analysis of variance group by time interaction, P<.002). LOS was significantly longer for occasional poor participators, compared with good and frequent poor participators controlling for admission FIM differences (adjusted means: 13.9d, 11.0d, and 10.9d, respectively; analysis of covariance, P<.001).

Conclusions

Poor participation in therapy is common during inpatient rehabilitation and has important clinical implications, in terms of lower improvement in FIM scores and longer LOS. These results suggest that poor inpatient rehabilitation participation and its antecedents deserve further attention.

Key words:  Motivation , Patient participation , Rehabilitation , Treatment outcome

 

 Supported by the National Institute of Mental Health (grant nos. K23 MH64196, P30 MH52247).No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated.

PII: S0003-9993(04)00430-7

doi:10.1016/j.apmr.2004.03.027

Archives of Physical Medicine and Rehabilitation
Volume 85, Issue 10 , Pages 1599-1601, October 2004

Article Tools