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Brusco NK, Ekegren CL, Morris ME, Hill KD, Lee AL, Somerville L, Lannin NA, Abdelmotaleb R, Callaway L, Whittaker SL, Taylor NF. Outcomes of the My Therapy self-management program in people admitted for rehabilitation: A stepped wedge cluster randomized clinical trial. Ann Phys Rehabil Med 2024; 67:101867. [PMID: 39173328 DOI: 10.1016/j.rehab.2024.101867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/07/2024] [Accepted: 05/19/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Self-management programs can increase the time spent on prescribed therapeutic exercises and activities in rehabilitation inpatients, which has been associated with better functional outcomes and shorter hospital stays. OBJECTIVES To determine whether implementation of a self-management program ('My Therapy') improves functional independence relative to routine care in people admitted for physical rehabilitation. METHODS This stepped wedge, cluster randomized trial was conducted over 54 weeks (9 periods of 6-week duration, April 2021 - April 2022) across 9 clusters (general rehabilitation wards) within 4 hospitals (Victoria, Australia). We included all adults (≥18 years) admitted for rehabilitation to participating wards. The intervention included routine care plus 'My Therapy', comprising a sub-set of exercises and activities from supervised sessions which could be performed safely, without supervision or assistance. The primary outcomes were the proportion of participants achieving a minimal clinically important difference (MCID) in the Functional Independence Measure, (FIM™) and change in total FIM™ score from admission to discharge. RESULTS 2550 participants (62 % women) were recruited (control: n = 1458, intervention: n = 1092), with mean (SD) age 77 (13) years and 37 % orthopedic diagnosis. Under intervention conditions, participants reported a mean (SD) of 29 (21) minutes/day of self-directed therapy, compared to 4 (SD 14) minutes/day, under control conditions. There was no evidence of a difference between control and intervention conditions in the odds of achieving an MCID in FIM™ (adjusted odds ratio 0.93, 95 % CI 0.65 to 1.31), or in the change in FIM™ score (adjusted mean difference: -0.27 units, 95 % CI -2.67 to 2.13). CONCLUSIONS My Therapy was delivered safely to a large, diverse sample of participants admitted for rehabilitation, with an increase in daily rehabilitation dosage. However, given the lack of difference in functional improvement with participation in My Therapy, self-management programs may need to be supplemented with other strategies to improve function in people admitted for rehabilitation. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12621000313831), https://www.anzctr.org.au/.
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Affiliation(s)
- Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC 3199 Australia.
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC 3199 Australia
| | - Meg E Morris
- Academic and Research Collaborative in Health (ARCH), La Trobe University, Bundoora, VIC 3086 Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC 3199 Australia
| | - Annemarie L Lee
- Department of Physiotherapy, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC 3199 Australia
| | | | - Natasha A Lannin
- Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC 3004 Australia; Alfred Health, Melbourne, VIC 3004 Australia
| | | | - Libby Callaway
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC 3199 Australia; Occupational Therapy Department, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC 3199 Australia
| | - Sara L Whittaker
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, 47-49 Moorooduc Hwy, Frankston, VIC 3199 Australia
| | - Nicholas F Taylor
- Academic and Research Collaborative in Health (ARCH), La Trobe University, Bundoora, VIC 3086 Australia; Eastern Health, 2/5 Arnold Street, Box Hill, VIC 3128 Australia
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Dorward E, Devlin A, Brusco NK, Dulfer F, Whittaker SL, Reeder S, Ekegren CL. Patients' perceptions of participating in self-directed activities outside supervised occupational and physiotherapy within inpatient and home-based rehabilitation settings: a qualitative study. Disabil Rehabil 2024:1-9. [PMID: 38625404 DOI: 10.1080/09638288.2024.2341872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 04/06/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE To investigate patients' perceptions of participating in self-directed activities, outside supervised occupational and physiotherapy, within rehabilitation settings. METHODS Semi-structured interviews were undertaken with 16 patients and in three instances, their carers, from three health services in Victoria, Australia, two offering inpatient and one offering home-based rehabilitation care. A thematic analysis was performed using a framework approach. RESULTS Themes identified included the role of the clinicians in encouraging patients and instilling confidence, giving feedback and "just being there"; considerations in program delivery, including different formats, support from peers and relatives, and program familiarity and flexibility; patients' different intrinsic driving and limiting forces, including following orders, seeing results, desiring autonomy and having an "inner athlete"; and the environment, including functional activities, space, equipment, time and availability. CONCLUSIONS Patients and their carers reported positive experiences of participating in self-directed therapy programs within rehabilitation settings, with programs perceived as beneficial in optimising recovery. Patients reported a range of driving and limiting factors in relation to completing self-directed activities. Understanding these factors, relating to the patient, their environment and other people, is critical for clinicians so that they can modify their delivery accordingly, ensuring uptake and sustained implementation of self-directed activities in rehabilitation care.
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Affiliation(s)
- Emma Dorward
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
- Neuroscience Brain Recovery Rehabilitation Team, Alfred Health, Melbourne, Australia
| | - Alicia Devlin
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
- Peter James Centre, Eastern Health, Burwood East, Australia
| | - Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | - Fiona Dulfer
- Physiotherapy Department, Cabrini Health, Malvern, Australia
| | - Sara L Whittaker
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | - Sandra Reeder
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
- Neuroscience Brain Recovery Rehabilitation Team, Alfred Health, Melbourne, Australia
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Brusco N, Ekegren C, Rawson H, Taylor NF, Morphet J, Hill K, Anderson J, Stephen K, Crabtree A, Levinger P, Whittaker SL, Soh SE, Dulfer F, Lawler K. Reforming allied health service provision in residential aged care to improve the rehabilitation reach: a feasibility study. AUST HEALTH REV 2024; 48:66-81. [PMID: 38245911 DOI: 10.1071/ah23206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024]
Abstract
Objective My Therapy is an allied health guided, co-designed rehabilitation self-management program for residents of aged care facilities. This study aimed to determine the feasibility of implementing My Therapy in a residential aged care setting. Methods This observational study was conducted on a 30-bed wing, within a 90-bed metropolitan residential aged care facility, attached to a public health service, in Victoria, Australia. Staff and resident data were collected prospectively over 6 weeks (staff focus groups, patient surveys, and audits) to evaluate the feasibility domains of acceptability , reach and demand , practicality , integration , limited efficacy testing and adaptations . Results Twenty-six residents and five allied health staff (physiotherapy and occupational therapy) participated. My Therapy was acceptable to residents (survey) and staff (focus groups). Via initial My Therapy discussions between the resident and the therapists, to determine goals and resident preferences, My Therapy reached 26 residents (n = 26/26, 100% program reach ), with 15 residents subsequently receiving a rehabilitation program (n = 15/26, 58% program demand ). The remaining 11 residents did not participate due to resident preference or safety issues (n = 11/26, 42%). Collecting physical function outcome measures for limited efficacy testing was practical , and the cost of My Therapy was AUD$6 per resident per day, suggesting financial integration may be possible. Several adaptations were required, due to limited allied health staff, complex resident goal setting and program co-design. Conclusion My Therapy has the potential to improve the rehabilitation reach of allied health services in residential aged care. While introducing this low-cost intervention is feasible, adaptations were required for successful implementation.
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Affiliation(s)
- Natasha Brusco
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Vic., Australia
| | - Christina Ekegren
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Vic., Australia
| | - Helen Rawson
- Nursing and Midwifery, Monash University, Vic., Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, Vic., Australia; and School of Allied Health Human Services and Sport La, Trobe University, Vic., Australia
| | - Julia Morphet
- Nursing and Midwifery, Monash University, Vic., Australia
| | - Keith Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Vic., Australia
| | | | - Kelly Stephen
- murrenda Residential Aged Care, Eastern Health, Vic., Australia
| | - Amelia Crabtree
- Division of Aged Care and Rehabilitation, Monash Health, Vic., Australia; and Monash Ageing Research Centre, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Vic., Australia; and National Centre for Healthy Ageing, Monash University and Peninsula Health, Vic., Australia
| | | | - Sara L Whittaker
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, Monash University, Vic., Australia
| | - Sze-Ee Soh
- Department of Physiotherapy, Monash University and Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Vic., Australia
| | - Fiona Dulfer
- Allied Health Services, Cabrini Health, Malvern, Vic., Australia
| | - Katherine Lawler
- School of Allied Health Human Services and Sport La, Trobe University, Vic., Australia; and Wicking Dementia Research and Education Centre, University of Tasmania, Tas., Australia
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