Physical and Occupational Therapy in Inpatient Stroke Rehabilitation The Contribution of Therapy Extenders

Hsieh C-H, Putman K, Nichols D, McGinty ME, DeJong G, Smout RJ, Horn S: Physical and occupational therapy in inpatient stroke rehabilitation: The contribution of therapy extenders. Am J Phys Med Rehabil 2010;89:887-898. Objective: To understand the use of therapy extenders in stroke rehabilitation. Design: Descriptive analysis of a prospective observational cohort study. Results: Two hundred ninety-eight patients with moderate stroke and 284 with severe stroke from 5 inpatient rehabilitation facilities with complete physical and occupational therapy data are included in the study. Overall, occupational therapists and assistants contributed similar to 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 the use of therapy extenders are noted in both disciplines across sites. Physical and occupational therapists spend more time in delivering advanced activities that include ongoing integrated evaluation and treatment planning or modification. Their assistants spend more time in delivering lower-level activities, such as bed mobility, transfers, dressing, or nonfunctional activities. Also, therapists are more likely to assign responsibility to assistants to treat moderate motor impairment among patients with stroke. Conclusions: Characterizing therapy practice in stroke rehabilitation is not straightforward. It is multifactorial and takes into account the (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.