Abstract

Latham NK, Jette DU, Slavin M, Richards LG, Procino A, Smout RJ, Horn SD. Physical therapy during stroke rehabilitation for people with different walking abilities.

OBJECTIVE:

To describe how physical therapy (PT) activities during post-stroke inpatient rehabilitation vary by admission walking ability and over time.

DESIGN:

Observational cohort study.

SETTING:

Six inpatient rehabilitation hospitals in the United States.

PARTICIPANTS:

People receiving post-stroke PT (N=715) who were classified as walking at admission.

INTERVENTIONS:

Not applicable.

MAIN OUTCOME MEASURES:

Percentage of time spent in 11 activities, percentage of patients who participated in each activity, and the FIM instrument scores.

RESULTS:

The majority of PT time was spent in gait activities. Even people with the most limited mobility spent 25% to 38% of PT time in gait activities during the first 6-hour treatment block. Treatment progression was evident, and a shift to more advanced activities occurred over time (eg, less bed mobility and more advanced gait). However, even in the final 6-hour block, a small proportion of time was spent on community mobility activities (1.2%-5.2%), and most people received no community mobility training.

CONCLUSIONS:

PT activities focused on specific functional tasks at the ability level of each individual patient and provided higher-level activities as patients improved their function. However, although there is increasing recognition that the environment influences task performance, little time was spent in community mobility activities before discharge.