Articles
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.
https://doi.org/10.1016/j.apmr.2004.03.027Get rights and content

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.

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.

References (10)

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    Citation Excerpt :

    Concerning functionality in ADL, the main variable analyzed, in most studies there was an improvement in scores for those patients receiving interventions compared with the control group, irrespective of the fact that not all of them reached statistical significance, due to the limited methodological quality of the analyses that were performed. Given that some authors recommend that these interventions, both for physiotherapy and occupational therapy, should be performed for at least 20 days to be effective [43], the fact that the interventions were short- term could be a limiting factor in attaining statistical significance. Nevertheless, this evidence is in sharp contrast to our recent results [30], where patients hospitalized in an AGU performed a short (4-day-long) multi-component physical exercise program and showed statistically significant improvements in functionality on discharge.

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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.

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