Physical Therapy During Stroke Rehabilitation for People With Different Walking Abilities
Abstract
Latham NK, Jette DU, Slavin M, Richards LG, Procino A, Smout RJ, Horn SD. Physical therapy during stroke rehabilitation for people with different walking abilities.
Objective
To describe how physical therapy (PT) activities during poststroke inpatient rehabilitation vary by admission walking ability and over time.
Design
Observational cohort study.
Setting
Six inpatient rehabilitation hospitals in the United States.
Participants
People receiving poststroke PT (N=715) who were classified as walking at admission.
Interventions
Not applicable.
Main Outcome Measures
Percentage of time spent in 11 activities, percentage of patients who participated in each activity, and the FIM instrument scores.
Results
The majority of PT time was spent in gait activities. Even people with the most limited mobility spent 25% to 38% of PT time in gait activities during the first 6-hour treatment block. Treatment progression was evident, and a shift to more advanced activities occurred over time (eg, less bed mobility and more advanced gait). However, even in the final 6-hour block, a small proportion of time was spent on community mobility activities (1.2%–5.2%), and most people received no community mobility training.
Conclusions
PT activities focused on specific functional tasks at the ability level of each individual patient and provided higher-level activities as patients improved their function. However, although there is increasing recognition that the environment influences task performance, little time was spent in community mobility activities before discharge.
cVA Research Service, Brain Rehabilitation Research Center, North Florida/South Georgia Veterans Health System, Gainesville, FL
dOccupational Therapy Department, University of Florida, Gainesville, FL
eNeuro Specialty Rehabilitation Unit, LDS Hospital, Salt Lake City, UT
fInternational Severity Information Systems Inc, Salt Lake City, UT
Reprint requests to Nancy Latham, Health and Disability Research Institute, 53 Bay State Rd, Boston, MA 02446
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 author(s) or upon any organization with which the author(s) is/are associated.
ABSTRACT