Group Therapy Utilization in Inpatient Spinal Cord Injury Rehabilitation.

Published April 13, 2013

Group therapy utilization in inpatient spinal cord injury rehabilitation.

Arch Phys Med Rehabil. 2013 Apr; 94(4 Suppl): S145-53
Zanca JM, Dijkers MP, Hsieh CH, Heinemann AW, Horn SD, Smout RJ, Backus D

To describe group therapy utilization in spinal cord injury (SCI) inpatient rehabilitation.Prospective observational study.Six inpatient rehabilitation facilities.Patients (N=1376) receiving initial rehabilitation after traumatic SCI.Not applicable.Time spent in group versus individual therapy for physical therapy (PT), occupational therapy (OT), therapeutic recreation (TR), and psychology (PSY) therapies.The majority (98%) of patients participated in at least 1 group therapy session, with 83%, 81%, 80%, and 54% of patients receiving group PT, OT, TR, and PSY, respectively. On average, 24% of treatment sessions and 27% of treatment time was provided in group sessions, with TR providing the greatest percent of its time in groups. Group therapy time and time spent in specific activities varied among patient subgroups with different injury characteristics. Group therapy time also varied widely among centers (range, 1.2-6.6h/wk). Across all injury subgroups, individual and group therapy hours per week were negatively correlated for OT and positively correlated for TR. Patient characteristics, clinician experience, and treatment center predicted 32% of variance in group hours per week. PT and OT strengthening/endurance interventions and TR outings were the most common group activities overall.While the majority of inpatient SCI rehabilitation consists of individual sessions, most patients participate in group therapy, which contributes significantly to total therapy time. Patterns of group utilization fit with functional expectations and clinical goals. A trade-off between group and individual therapy may occur in some disciplines. Utilization of group therapy varies widely among centers, and further study is needed to identify optimal patterns of group therapy utilization. HubMed – rehab centers

Missed therapy time during inpatient rehabilitation for spinal cord injury.

Arch Phys Med Rehabil. 2013 Apr; 94(4 Suppl): S106-14
Hammond FM, Lieberman J, Smout RJ, Horn SD, Dijkers MP, Backus D

To investigate the frequency of and reasons for missed therapy sessions during inpatient rehabilitation after traumatic spinal cord injury (SCI), and to assess the influence of demographic, medical, and injury factors on the missing of therapy sessions.Prospective cohort study.Six inpatient rehabilitation centers.Individuals with SCI (N=1376) consecutively admitted for inpatient rehabilitation at participating sites; 1032 participants were randomly selected for model development, and 344 participants were selected for model cross-validation.Not applicable.Total hours of missed therapy; total minutes missed per week; and reason for missed therapy.Patients missed an average of 153 minutes of therapies per week, or a total of 20 hours over their rehabilitation stay. Common reasons for missing physical, occupational, and speech therapy were lack of patient readiness and medical reasons. Therapeutic recreation sessions were commonly missed because of patient refusal. More missed therapy (for any reason) was predicted by having C5-8 tetraplegia, paraplegia, greater morbidity, higher motor and cognitive functional independence, higher percent of sessions limited by fatigue, violent SCI etiology, longer rehabilitation length of stay, and treatment center. Older age, ventilator use, and percent of sessions limited by spasticity were predictive of less therapy time missed.On average, patients missed about 2.5 hours of therapy weekly. In view of the potential impact on rehabilitation outcomes and given the potential cost of lost resources, missed therapy deserves further study and administrative attention. In addressing this issue, there may be potential for the rehabilitation facility to intervene to reduce such lost time, including addressing equipment/therapist availability, patient readiness, patient engagement, and center-specific approaches. HubMed – rehab centers

Depression, activities of daily living and quality of life in patients with stroke.

J Neurol Sci. 2013 May 15; 328(1-2): 87-91
Haghgoo HA, Pazuki ES, Hosseini AS, Rassafiani M

Stroke patients are dealing with a wide variety of physical and psychological problems influencing their ability to carry out activities of daily living (ADL). The aim of the present study was to examine the relationship between the activity of daily living performances and degree of after stroke depression (ASD), as well as, the quality of life (QOL) in Iranian stroke survivors.In a cross sectional study, 40 patients with stroke in two Rehabilitation Centers for Stroke Patients, were recruited consecutively. They were assessed using the Modified Barthel Index, the Beck Depression Inventory-II (BDI-II), and a quality of life questionnaire (SF-36). Data were analyzed using Pearson and Spearman correlation coefficient.Sixty five and one-half percent (65.5%) of the studied participants were either fully dependent or needed help in ADL. Also, 72.5% of the participants showed mild to severe ASD. There was a significant negative correlation between ADL performances and ASD and also between QOL and ASD. Furthermore a strong correlation was found between ADL and QOL.ADL have a strong relationship with both level of depression and QOL in patients with stroke. It appears that motivating to perform ADL may enhance QOL. Further investigation with a larger sample size is required to better understand the causal relationship of these factors. HubMed – rehab centers

Psychometric Analyses to Improve the Dutch ICF Activity Inventory.

Optom Vis Sci. 2013 Mar 20;
Bruijning JE, van Rens G, Knol D, van Nispen R

PURPOSE: In the past, rehabilitation centers for the visually impaired used unstructured or semistructured methods to assess rehabilitation needs of their patients. Recently, an extensive instrument, the Dutch ICF Activity Inventory (D-AI), was developed to systematically investigate rehabilitation needs of visually impaired adults and to evaluate rehabilitation outcomes. The purpose of this study was to investigate the underlying factor structure and other psychometric properties to shorten and improve the D-AI. METHODS: The D-AI was administered to 241 visually impaired persons who recently enrolled in a multidisciplinary rehabilitation center. The D-AI uses graded scores to assess the importance and difficulty of 65 rehabilitation goals. For high-priority goals (e.g., daily meal preparation), the difficulty of underlying tasks (e.g., read recipes, cut vegetables) was assessed. To reduce underlying task items (>950), descriptive statistics were investigated and factor analyses were performed for several goals. The internal consistency reliability and test-retest reliability of the D-AI were investigated by calculating Cronbach ? and Cohen (weighted) ?. Finally, consensus-based discussions were used to shorten and improve the D-AI. RESULTS: Except for one goal, factor analysis model parameters were at least reasonable. Internal consistency reliability was satisfactory (range, 0.74 to 0.93). In total, 60% of the 65 goal importance items and 84.4% of the goal difficulty items showed moderate to almost perfect ? values (?0.40). After consensus-based discussions, a new D-AI was produced, containing 48 goals and less than 500 tasks. CONCLUSIONS: The analyses were an important step in the validation process of the D-AI and to develop a more feasible assessment tool to investigate rehabilitation needs of visually impaired persons in a systematic way. The D-AI is currently implemented in all Dutch rehabilitation centers serving all visually impaired adults with various rehabilitation needs. HubMed – rehab centers