A self-management program increases the dosage of inpatient rehabilitation by 26 minutes per day: a process evaluation
Creators: name: Whittaker, Sara L.
name: Brusco, Natasha K.
name: Hill, Keith D.
name: Ekegren, Christina L.
name: Taylor, Nicholas F.
Publisher: name: Taylor & Francis
Year: 2024
Subjects: subject: Space Science
subject: Medicine
subject: Biological Sciences not elsewhere classified
subject: Science Policy
subject: Infectious Diseases
subject: FOS: Health sciences
subject: Virology

description: To evaluate the implementation of a self-management program, My Therapy, designed to increase inpatient rehabilitation therapy dosage via independent practice. A process evaluation of My Therapy for adult patients admitted for rehabilitation for any condition supervised by physiotherapists and occupational therapists across eight rehabilitation wards compared usual care. Outcomes included <i>reach</i>, <i>dosage</i>, <i>fidelity</i> and <i>adaptation.</i> The mean (SD) age of the process evaluation sample (<i>n</i> = 123) was 73 (11) years with a mean (SD) length of stay of 14.0 (6.6) days. The My Therapy program <i>reached</i> 68% of participants (<i>n</i> = 632/928), and resulted in an average increase in therapy <i>dosage</i> of 26 (95% CI 12 to 40) minutes/day of independent practice. All My Therapy audited programs (<i>n</i> = 28) included body function/structure impairment-based exercises, and half (<i>n</i> = 13/28) included activity/participation-based exercises. On average, participants completed programs 1.8 (SD 1.2) times/day, which were prescribed in accordance with the My Therapy criteria, demonstrating <i>fidelity</i>. There were no between-group differences in daily steps or standing time, however, My Therapy participants spent more time sitting (<i>p</i> ≤ 0.05). Implementation <i>adaptations</i> were minimal. A self-management rehabilitation program was implemented with fidelity for two in three rehabilitation patients, resulting in increased therapy dosage with minimal adaptations. The My Therapy self-management program was implemented with good reach (68% of participants received My Therapy) across four public and private inpatient rehabilitation services.Under My Therapy conditions, the dosage of inpatient rehabilitation therapy participation increased by an average of 26 minutes per day, which will help close the evidence-practice gap between the current rehabilitation dosage of about 1-hour per day, and the recommended rehabilitation dosage of 3-hours per day.My Therapy programs most frequently included impairment-based exercises that were completed in sitting, and did not increase time spent standing and walking.Consideration should be given to prescribing My Therapy (content and dosage) at an optimal level to promote patient functional independence, while maintaining safety. The My Therapy self-management program was implemented with good reach (68% of participants received My Therapy) across four public and private inpatient rehabilitation services. Under My Therapy conditions, the dosage of inpatient rehabilitation therapy participation increased by an average of 26 minutes per day, which will help close the evidence-practice gap between the current rehabilitation dosage of about 1-hour per day, and the recommended rehabilitation dosage of 3-hours per day. My Therapy programs most frequently included impairment-based exercises that were completed in sitting, and did not increase time spent standing and walking. Consideration should be given to prescribing My Therapy (content and dosage) at an optimal level to promote patient functional independence, while maintaining safety.