Identifying Physical Therapy Activities and Treatment Trends During Acute Inpatient Rehabilitation: Results from the TBI Practice-Based Evidence Project.

Research Report
Population: Adult

Misti Lyn Timpson, PT, NCS, Assistant Faculty, Physical Therapist, Rocky Mountain University of Health Professions mtimpson@rmuohp.edu

Cynthia Beaulieu, PhD, ABPP, Program Director, Brooks Rehabilitation Hospital cynthia.Beaulieu@Brooksrehab.org

Jennifer Bogner, PhD, ABPP, Vice-Chair of Research and Academic Affairs, The Ohio State University Jennifer.Bogner@osumc.edu

Susan Horn, PhD, Senior Scientist and Vice-President of Research, International Severity Information Systems, Inc. Susan.Horn@hsc.utah.edu

Kaiwi Chung-Hoon, PT, PhD, Associate Professor, Physical Therapist, Rocky Mountain University of Physical Therapy kchunghoon@rmuohp.edu

Keywords: Participation, Traumatic Brain Injury, Physical Therapy

Purpose/Background: Approximately 2.5 million individuals sustain a traumatic brain injury (TBI) annually, 17% of which are hospitalized and treated in acute inpatient rehabilitation facilities. Current practice patterns include three hours of daily skilled services provided by physical therapy (PT), occupational therapy (OT), and speech therapy (ST). However, physical therapy (PT) activities tend to vary between individuals due to the level of impairment assessed via cognitive and motor Functional Independence Measure (FIM™) scores. Understanding daily interventions and identifying PT activities that produce desired outcomes is needed.

The purpose of this prospective cohort study is to describe physical therapy activities received by individuals during acute inpatient rehabilitation following TBI based on their admission cognitive FIM scores.

Subjects: 2116

Methods: Participants (n=2,116) ≥14 years old (mean age 44.5 ± 21.3, M=1,534, F= 582) who sustained a TBI and were admitted to one of 10 inpatient rehabilitation facilities, as part of a larger traumatic brain injury-practice based evidence project (TBI-PBE), were included in this study. Briefly, the TBI-PBE project documented therapeutic interventions provided to TBI patients by occupational, physical, and speech therapists spanning a three-year period (2008-2011). The documented data for these skilled services were then compared and categorized into five groups based on their cognitive subscore of the FIM. Further, daily therapeutic interventions for each skilled service were organized into physical therapy activity groups based on their functional similarity. Observations for this study are specific to physical therapy interventions provided to each participant. Additionally, though the length of stay may have varied between participants, the percent of patients performing the various physical therapy activities were also recorded.

Results: Current trends for PT activities included: assessment, preparation time, pre-functional, transitional movement, therapeutic exercise, pre-gait/standing, gait, resting, stairs, wheelchair mobility, equipment management, and advanced gait/community mobility. Specifically, gait, transitional movement, and therapeutic exercise were the most common PT activities that occurred across all groups irrespective of cognitive FIM scores. Interestingly, pre-gait/standing and advanced gait were additional PT activities occurring across all groups, however, they occurred with fewer participants.

Conclusions: PT activities received by TBI participants across all 10 inpatient rehabilitation facilities appeared to be uniform irrespective of cognitive subscore of the FIM. Further research is needed to determine what specific combinations of therapeutic activities, dosages, and dosage times contribute to the greatest gains in cognitive and motor outcomes at discharge from acute rehabilitation.

Citation:
Timpson, Misti Lyn, PT, NCS; Beaulieu, Cynthia L, PhD, ABPP; Bogner, Jennifer , PhD, ABPP; Horn, Susan D, PhD; Chung-Hoon, Kaiwi , PT, PhD. Identifying Physical Therapy Activities and Treatment Trends During Acute Inpatient Rehabilitation: Results from the TBI Practice-Based Evidence Project.. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online. https://u.osu.edu/ivstep/poster/abstracts/017_timpson-et-al/

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