Characterizing occupational therapy practice in stroke rehabilitation.
Richards LG, Latham NK, Jette DU, Rosenberg L, Smout RJ, DeJong G. Characterizing occupational therapy practice in stroke rehabilitation.


OBJECTIVE
To describe how occupational therapy (OT) activities during stroke inpatient rehabilitation vary by admission functional status and over time and how time spent in these various activities relates to functional status at discharge.


METHODS
Observational cohort study.


METHODS
Six inpatient rehabilitation hospitals in the United States.


METHODS
People (N=713) receiving 4 to 19 hours of post-stroke OT.


METHODS
Not applicable.


METHODS
Patients were categorized by number of 4-hour blocks of OT received and by admission upper-extremity (UE) dressing score on the FIM instrument. In each group, the percentage of time spent in 16 activities and the percentage of patients who received each activity were calculated. The amount of time in activities was compared for those patients scoring 1 or 2 at admission who achieved at least a level of supervision for UE dressing (a score of >or=5) using Wilcoxon 2-sample tests.


RESULTS
The majority of OT time was spent in impairment-focused activities (37.5%) or training basic activities of daily living (31.9%). Treatment progressed to more advanced activities over time (eg, less bed mobility, more home management), yet little time was spent on community integration or leisure activities and with very few patients. Successful patients received more higher-level activities, whereas unsuccessful patients received larger amounts of basic-level activities.


CONCLUSIONS
OT activities focused on a combination of remediating impairments and retraining specific functional tasks, at the ability level of each individual patient, and provided higher-level activities as patients improved their function. More time in higher-level activities was related to greater success in rehabilitation. However, higher-level activities remain the least common activities provided during inpatient rehabilitation.
Richards
Lorie G
LG
North Florida/South Georgia Veterans Health System, Gainesville, FL 32608-1197, USA. lrichard@phhp.ufl.edu
Latham
Nancy K
NK
Jette
Diane U
DU
Rosenberg
Lauren
L
Smout
Randall J
RJ
DeJong
Gerben
G
D000203:Activities of Daily Living; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D009788:Occupational Therapy / Q000379:methods*; D012047:Rehabilitation Centers; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome