Article

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.
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.

Langue : ANGLAIS