ArticlesSignificance of poor patient participation in physical and occupational therapy for functional outcome and length of stay
Section snippets
Methods
We studied a sample of 242 patients admitted between November 2001 and February 2002 to a university-associated, freestanding rehabilitation hospital. The study was approved by the university’s institutional review board. Subjects were consecutive admissions to the orthopedic and neurologic units. All admissions during the enrollment were included (ie, there were no refusals or deaths during this period).
Subjects had 3 hours of rehabilitation therapies per day, typically a 1-hour session of OT
Results
In the overall sample of 242 subjects, we found that 57% (n=139) were good participators (ie, <5% of therapy sessions rated ≤3 on the PRPS), whereas 22% of subjects (n=53) were occasional poor participators (5%–25% of sessions rated ≤3), and 21% of subjects (n=50) were frequent poor participators (≥25% of sessions rated ≤3). In the good group, all subjects had a good participation score in all therapy sessions. In the occasional poor group, we found decreased participation scores in an average
Discussion
This study is the first to examine the extent and clinical effects of poor patient participation in PT and OT during inpatient rehabilitation. By using the PRPS, we found that subjects who occasionally participated in the fair to poor range for therapy sessions (≈20% of the sample) had the same overall FIM improvement as those who participated well but took an additional 3 days of inpatient rehabilitation on average to attain that same improvement. Those who frequently participated in the fair
Conclusions
We found that poor participation in inpatient therapy sessions was common and was associated with longer inpatient rehabilitation stay; lower likelihood of discharge to home; and, in those with frequent poor participation, poorer functional outcome. These findings highlight the need to improve rehabilitation participation.
Acknowledgments
We thank the PT and OT staff, and the medical records department, of the UPMC Rehabilitation Hospital for their time and effort participating in this study.
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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.