Improving practice with integration of patient directed activity during inpatient rehabilitation

Abstract

The "Patient Directed Activity Program" includes distinct activity stations designed to increase repetition, stimulation, attention, and activity of the affected upper extremities, lower extremities, and trunk. Each task-specific activity was easily graded to achieve moderate- to high-intensity. The activity program prescribed individuals up to three additional 30-minute bouts of activities daily that were to be completed independently, and in addition to standard of care. Clinical application: After implementing this program in our facility for one year as a quality improvement project, the intervention has been delivered as an Institutional Review Board approved randomized controlled trial (Clinical Trial #NCT02446197). Challenges with people and facilities have been overcome, resulting in a feasible program that can be delivered in an inpatient setting. High satisfaction has been reported by patients and clinicians.

The impact of a patient-directed activity program on functional outcomes and activity participation after stroke during inpatient rehabilitation—a randomized controlled trial

“…The study purpose was to examine the impact of a patient-directed activity program 15 to increase functional outcomes and activity participation after stroke. The additional functional activity via Patient-Directed Activity Program had limited impact on our patients' outcomes beyond those achieved by patients receiving usual care only.…”

“…Baylor Scott & White Institute for Rehabilitation provided oversight for the integrity and conduct of this study as described in our previous paper published in Clinical Rehabilitation. 15 Baylor Scott & White Institute for Rehabilitation is a large free-standing inpatient rehabilitation hospital connected to a level 1 trauma acute care hospital.…”

“…For example, resistance could be added or adjusted to modify the activity workload as necessary. A full description of the Patient-Directed Activity Program is provided in Trammell et al 15 Fidelity of patient compliance with the Patient-Directed Activity Program was determined by recording of completed sessions. Each completed session was recorded by the therapists with details of the date of completion, type of activity, and level of effort as subjectively determined by the patient.…”

Using co-production to increase activity in acute stroke units: the CREATE mixed-methods study

“…A study in Australia 37 concluded that dose-driven interventions, including circuit class therapy and 7-days-a-week therapy, increased the amounts of therapy provided but did not increase meaningful patient activity outside therapy sessions; the researchers called for greater understanding of the drivers of activity outside therapy sessions. Trammell et al 38 found that a programme of physical activities 'prescribed' in addition to structured therapy on a stroke unit was feasible, but again this was overseen and graded by therapists. Although the research team found that staff and patients reported high satisfaction, levels of expectations about activity prior to implementation were not known and the activities consisted of repetitive exercises that required supervision.…”

“…A total of 712 titles and abstracts were identified for screening; of these, 24 papers went forward for full-text review. Eleven publications 18,[30][31][32][33][34][35][36][37][38][39][40] were included in the final evidence synthesis (see Report Supplementary Material 5 for the PRISMA flow diagram and checklist).…”