Physical and occupational therapy in inpatient stroke rehabilitation: the contribution of therapy extenders.

Objective: To understand the use of therapy extenders in stroke rehabilitation.
Design: Descriptive analysis of a prospective observational cohort study.
Results: 298 moderate and 284 severe stroke patients from 5 Inpatient Rehabilitation Facilities with complete physical and occupational therapy data are included in the study. Overall, occupational therapists and assistants contributed approximately 70% and 21% of all occupational therapy hours, respectively. For physical therapy, these percentages in moderate group (60% vs. 31%) differ from those in severe group (65% vs. 23%). Some variations in use of therapy extenders are noted in both disciplines across sites. Physical and occupational therapists spend more time in delivery of advanced activities that include ongoing integrated evaluation and treatment planning or modification. Their assistants spend more time delivering lower level activities such as bed mobility, transfers, dressing, or non-functional activities. Therapists also are more likely to assign responsibility to assistants to treat moderate motor impairment among stroke patients.
Conclusions: Characterizing therapy practice in stroke rehabilitation is not straightforward. It is multi-factorial and takes into account (1) type of therapy, (2) therapy activity, (3) therapy provider including extender personnel, (4) specific training in stroke, and (5) years of experience. Future research to examine the association between use of therapy extenders and outcomes is recommended.

Publication year:2010

Keywords:Physical Therapy, Occupational Therapy, Therapy Ex