The Outcomes of Seamless ADL Training Between Occupational Therapist and Nurse in Stroke Patients
Phase: NA
Conditions: Stroke
Sponsor: Mahidol University

The Outcomes of Seamless Self-care Training between Occupational Therapist and 
Nurse in Stroke Patients 
Poungkaew Thitisakulchai1 e-mail addresses: poungkaew.thi@mahidol.ac.th 
Piyapat Dajpratham1 e-mail addresses: piyapat.daj@mahidol.ac.th 
Nisakorn Kongsri2 e-mail addresses: nisakorn.khong@gmail.com 
Warinda Onkampa2 e-mail addresses: warinda.on@gmail.com  
Kanjana Rawainok3 e-mail addresses: kanrawai1@gmail.com 
 
1 Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital,  
   Mahidol University, 2 Wanglang Rd., Bangkoknoi, Bangkok, Thailand 10700 
2 Division of Occupational therapy, Department of Rehabilitation Medicine,  
   Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Rd., Bangkoknoi,  
   Bangkok, Thailand 10700 
3 Department of Nursing Siriraj Hospital, Faculty of Medicine Siriraj Hospital, Mahidol University,  
   2 Wanglang Rd., Bangkoknoi, Bangkok, Thailand 10700 
 
Correspondence author: Piyapat Dajpratham, MD 
1 Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University 
   2 Wanglang Road, Bangkoknoi, Bangkok, Thailand 10700 
E-mail: piyapat.daj@mahidol.ac.th 
 
This study was registered with the Thai Clinical Trials Registry NCT02361307 
Date 24/07/2020 
 

Study protocol 
The conventional group received washing oneself and dressing training from the same OT in the occupational 
therapy unit for 3 days. On the 4th day of training, the OT supervised the patients while performing these tasks in the 
rehabilitation ward. After that, a nursing staff took responsibility for these activities in a traditional way of nursing care until day 
14. Duration of training session was one hour per day. 
The experimental group received the new “seamless self-care training” technique, which was characterized by a 
collaboration between OTs and nurses. The training team consisted of two OTs with standardized training skills according to 
the self-care checklist for dressing and washing oneself (see appendix). The patients received training in the occupational 
therapy unit for 2 days and then were supervised by OTs at the rehabilitation ward for the next 2 days. On the 4th day of the 
training, one nursing staff came along with the OT in order to learn how to facilitate the patients according to their abilities to 
carry out these tasks. After that, the patients received further training from the nursing staff until day 14. Duration of training 
session was one hour per day. In this group, the nursing staff guided the patients to perform dressing and washing oneself 
according to the self-care checklist for dressing and washing oneself.  
In both groups, each patient was in contact with and trained by only one OT and one nurse throughout the period of 
the study. 
In order to reduce cross-contamination of the training techniques, each technique was delivered in separate 
periods of time. We first finished collecting data in the conventional group for one month and then conduct the seamless 
self-care training technique with the experimental group. During the study, patients received physical therapy or other 
treatments that did not affect dressing and washing oneself abilities. 
Outcome measurement 
For the main outcome, patients’ abilities in dressing and washing oneself were evaluated by another OT on day 1 
and day 14 of the program in both groups. However, since there were no specific detailed measurements for assessing such 
abilities after a stroke, the authors developed steps of dressing and washing oneself, so called “Self-care checklist for 
dressing and washing oneself”. Based on task analysis, these two self-care activities consisted of 5 sequential activities: 
taking off a shirt, taking off pants, washing oneself, putting on a shirt and putting on pants. Each activity was composed of 4 
steps, so there were 20 steps in total. Each step could be scored as 0, 1, or 2. A score of 2 meant the patients could perform 
the task independently, while 1 meant the patients could do the task with verbal cueing, and 0 meant the patients could not 
perform the task within 5 minutes or needed assistance to complete the task. Therefore, the maximum score was 40 for the 
independent performance measurements of dressing and washing oneself. This checklist had a high correlation with the 
Modified Barthel Index as analyzed with Spearman’s correlation r = 0.764, p < 0.001. 
 
Statistical analysis plan 
Demographic and clinical variables were summarized using descriptive statistics. Continuous variables were 
described as mean with standard deviation (SD) and median with an interquartile range (IQR). Categorical variables were 
described by frequency and percentage. Statistical data analysis was performed using SPSS, Version 18.0, and a p-value of 
0.05 was considered to be statistically significant. The differences in the outcome of self-care training and self-efficacy 

between the two groups were analyzed by independent t-test, or within group by paired t-test, while differences between 
groups covariate by day 1 were analyzed by analysis of covariance (ANCOVA). The gain level was analyzed by chi-square 
test for assessing trends.