Enhanced Medical Rehabilitation: Effectiveness of a clinical training model.
BACKGROUND
Patient engagement in medical rehabilitation can be greatly influenced by their provider during therapy sessions. We developed Enhanced Medical Rehabilitation (EMR), a set of provider skills grounded in theories of behavior change. EMR utilizes 18 motivational techniques focused on providing frequent feedback to patients on their effort and progress and linking these to patient goals.


OBJECTIVE
To examine the effectiveness of a clinical training protocol for clinicians to do EMR, as measured by clinician adherence.


METHODS
A physical therapist, physical therapist assistant, occupational therapist, and certified occupational therapist assistant were trained in EMR. Training consisted of five formal training sessions and individual and group coaching. Adherence to EMR techniques was measured during two phases: Pre-Training and Maintenance, with an a priori target of 90% adherence by clinicians to each EMR technique.


RESULTS
With training and coaching, clinician adherence per therapeutic activity significantly improved in 13 out of 18 items (p < 0.05). The target of 90% adherence was not achieved for many items.


CONCLUSIONS
Our training and coaching program successfully trained clinicians to promote patient engagement during therapeutic service delivery, although not typically to 90% or greater adherence. Ongoing coaching efforts were necessary to increase adherence.
Program in Physical Therapy, Washington University, Saint Louis, MO, USA.|Department of Neurology, Washington University, Saint Louis, MO, USA.|Program in Occupational Therapy, Washington University, Saint Louis, MO, USA.
Marghuretta D
MD
Bland
Program in Occupational Therapy, Maryville University, Saint Louis, MO, USA.
Rebecca L
RL
Birkenmeier
Program in Occupational Therapy, Washington University, Saint Louis, MO, USA.
Peggy
P
Barco
Department of Psychiatry, Healthy Mind Laboratory, Washington University, Saint Louis, MO, USA.
Emily
E
Lenard
Program in Physical Therapy, Washington University, Saint Louis, MO, USA.|Department of Neurology, Washington University, Saint Louis, MO, USA.|Program in Occupational Therapy, Washington University, Saint Louis, MO, USA.
Catherine E
CE
Lang
Department of Psychiatry, Healthy Mind Laboratory, Washington University, Saint Louis, MO, USA.
Eric J
EJ
Lenze
D000328:Adult; D002985:Clinical Protocols; D005081:Exercise Therapy / Q000193:education* / Q000639:trends; D005260:Female; D019983:Guideline Adherence / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D000072087:Occupational Therapists / Q000193:education* / Q000639:trends; D009788:Occupational Therapy / Q000193:education / Q000379:methods / Q000639:trends; D010358:Patient Participation / Q000379:methods* / Q000639:trends; D059825:Physical Therapists / Q000193:education* / Q000639:trends; D016896:Treatment Outcome
Therapeutic engagement; rehabilitation; skilled nursing facility
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