Method of Therapy Delivery in the Inpatient Rehabilitation Setting Affects Functional Change Outcomes in Stroke

Background and/or Objectives: For patients admitted to the postacute setting for stroke inpatient rehabilitation, the method by which therapy is administered (individual, group, concurrent or co-treatment) may impact clinical outcomes, but this is not yet clear. This investigation compared therapy delivery methods to patients with stroke on selective functional gains from admission to discharge.

Design: Retrospective cohort analysis.

Setting : Inpatient rehabilitation hospital (IRF), quaternary care facility

Participants : 603 patients admitted with cerebral infarction (61.2±10.1 yrs; 30.2±7.8 kg/m2; 45.8% female).

Interventions: NA

Main Outcome Measures: IRF Patient Assessment Instrument GG Functional change scores for toilet hygiene (self-care), sit-to-stand (transfers) and walking 10ft (ambulation) from admission to discharge. Two-week Physical therapy (PT), Occupational Therapy (OT) and Speech Language Therapy (SLT) volume and type totals were obtained. Stepwise linear regression analyses were used to determine relative contributions of therapy on functional change for each GG score ( coefficient, standardized). Models were adjusted for case mix index, sex, age, BMI, pre-hospital living setting, marital status, insurance status, brain injury side, aphagia/dysphagia, depression and ataxia.

Results: Significant contributors to toilet hygiene were PT time (individual, group), OT and SLT individual time (B coefficient values range 0.112-0.300 PT, 0.364 OT and 0.143 SLT; all p< 0.05). Individual PT and group OT time contributed to Sit-to-stand improvement (B coefficient values 0.111 PT, 0.123 OT; both p< 0.05). Finally, group PT and individual OT times contributed to improvements in GG Scores for walking 10ft (B values 0.113 PT, 0.099 OT; both p< 0.05).

Conclusions: Among delivery methods, a combination of individual and group delivery appears to contribute most to improvements among these functional tasks after accounting for numerous patient factors. Despite time saving or multitasking benefits, concurrent or co-treatment delivery may not facilitate the same specific functional improvements for this patient population.