Characterizing Occupational Therapy Practice in Stroke Rehabilitation
Abstract
Richards LG, Latham NK, Jette DU, Rosenberg L, Smout RJ, DeJong G. Characterizing occupational therapy practice in stroke rehabilitation.
Objectives
To describe how occupational therapy (OT) activities during stroke inpatient rehabilitation vary by admission functional status and over time and how time spent in these various activities relates to functional status at discharge.
Design
Observational cohort study.
Setting
Six inpatient rehabilitation hospitals in the United States.
Participants
People (N=713) receiving 4 to 19 hours of poststroke OT.
Interventions
Not applicable.
Main Outcome Measures
Patients were categorized by number of 4-hour blocks of OT received and by admission upper-extremity (UE) dressing score on the FIM instrument. In each group, the percentage of time spent in 16 activities and the percentage of patients who received each activity were calculated. The amount of time in activities was compared for those patients scoring 1 or 2 at admission who achieved at least a level of supervision for UE dressing (a score of ≥5) using Wilcoxon 2-sample tests.
Results
The majority of OT time was spent in impairment-focused activities (37.5%) or training basic activities of daily living (31.9%). Treatment progressed to more advanced activities over time (eg, less bed mobility, more home management), yet little time was spent on community integration or leisure activities and with very few patients. Successful patients received more higher-level activities, whereas unsuccessful patients received larger amounts of basic-level activities.
Conclusions
OT activities focused on a combination of remediating impairments and retraining specific functional tasks, at the ability level of each individual patient, and provided higher-level activities as patients improved their function. More time in higher-level activities was related to greater success in rehabilitation. However, higher-level activities remain the least common activities provided during inpatient rehabilitation.
fInstitute for Clinical Outcomes Research, International Severity Information Systems Inc, Salt Lake City, UT
gDepartment of Rehabilitation Medicine, Georgetown University, Washington, DC
Reprint requests to Lorie Richards, PhD, OTR, Brain Rehabilitation Research Center, North Florida/South Georgia Veterans Health System, 1601 Archer Rd (151A), Gainesville, FL 32608-1197
Supported by the National Institute on Disability and Rehabilitation Research (grant no. H133B990005), the U.S. Army and Materiel Command (cooperative agreement award no. DAMD17-02-2-0032), and the North Florida/South Georgia Veterans Health System, Gainesville, FL. The views, opinions, and/or findings contained in this article are those of the author(s) and should not be construed as an official Department of the Army position, policy, or decision unless so designated by other documentation.
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 or upon any organization with which the authors are associated.
ABSTRACT