Physical therapy during stroke rehabilitation for people with different walking abilities

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.