Document Detail


Physical therapy activities in stroke, knee arthroplasty, and traumatic brain injury rehabilitation: their variation, similarities, and association with functional outcomes.
MedLine Citation:
PMID:  22003165     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The mix of physical therapy services is thought to be different with different impairment groups. However, it is not clear how much variation there is across impairment groups. Furthermore, the extent to which the same physical therapy activities are associated with functional outcomes across different types of patients is unknown.
OBJECTIVE: The purposes of this study were: (1) to examine similarities and differences in the mix of physical therapy activities used in rehabilitation among patients from different impairment groups and (2) to examine whether the same physical therapy activities are associated with functional improvement across impairment groups.
DESIGN: This was a prospective observational cohort study.
METHODS: The study was conducted in inpatient rehabilitation facilities. The participants were 433 patients with stroke, 429 patients with total knee arthroplasty (TKA), and 207 patients with traumatic brain injury (TBI). Measures used in this study included: (1) the Comprehensive Severity Index to measure the severity of each patient's medical condition, (2) the Functional Independence Measure (FIM) to measure function, and (3) point-of-care instruments to measure time spent in specific physical therapy activities.
RESULTS: All 3 groups had similar admission motor FIM scores but varying cognitive FIM scores. Patients with TKA spent more time on exercise than the other 2 groups (average=31.7 versus 6.2 minutes per day). Patients with TKA received the most physical therapy (average=65.3 minutes per day), whereas the TBI group received the least physical therapy (average=38.3 minutes per day). Multivariate analysis showed that only 2 physical therapy activities (gait training and community mobility) were both positively associated with discharge motor FIM outcomes across all 3 groups. Three physical therapy activities (assessment time, bed mobility, and transfers) were negatively associated with discharge motor FIM outcome.
LIMITATIONS: The study focused primarily on physical therapy without concurrently considering other therapies such as occupational therapy, speech-language pathology, nursing care, and case management or the potential interaction of these inputs. This analysis did not consider the interventions that physical therapists used when patients participated in discrete physical therapy activities.
CONCLUSIONS: All 3 patient groups spent a considerable portion of their physical therapy time in gait training relative to other activities. Both gait training and community mobility are higher-level activities that were positively associated with outcomes, although all 3 groups spent little time in community mobility activities. Further research studies, such as randomized clinical trials and predictive validity studies, are needed to investigate whether higher-level or more-integrated therapy activities are associated with better patient outcomes.
Authors:
Gerben DeJong; Ching-Hui Hsieh; Koen Putman; Randall J Smout; Susan D Horn; Wenqiang Tian
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2011-10-14
Journal Detail:
Title:  Physical therapy     Volume:  91     ISSN:  1538-6724     ISO Abbreviation:  Phys Ther     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-02     Completed Date:  2012-01-27     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  0022623     Medline TA:  Phys Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1826-37     Citation Subset:  AIM; IM    
Affiliation:
Center for Post-acute Innovation & Research, National Rehabilitation Hospital, 102 Irving St NW, Washington, DC 20010, USA. gerben.dejong@medstar.net
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Arthroplasty, Replacement, Knee / rehabilitation*
Brain Injuries / rehabilitation*
Exercise Therapy / utilization*
Female
Gait
Humans
Male
Middle Aged
Mobility Limitation
Multivariate Analysis
Prospective Studies
Regression Analysis
Severity of Illness Index
Stroke / rehabilitation*
Time Factors
Treatment Outcome
Grant Support
ID/Acronym/Agency:
1R01 HD050439/HD/NICHD NIH HHS
Comments/Corrections

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