Date Presented 04/01/2022
Many patients in inpatient rehabilitation may spend too much time being sedentary. According to our findings of objectively measured physical activity levels, individuals receiving inpatient rehabilitation were most physically active during OT but were more sedentary during nonrehabilitation times and days. Therapists should consider implementing individualized therapy plans for patients to perform independently and safely without a therapist present during inpatient rehabilitation.
Primary Author and Speaker: Young Joo Kim
Additional Authors and Speakers: Carley Overman, Anne E. Dickerson, Xiangming Fang, Heather Panczykowski
PURPOSE: This study aimed to determine the differences in objectively measured physical activity levels among rehabilitation services and between rehabilitation and non-rehabilitation times and days in individuals receiving inpatient rehabilitation. The inpatient rehabilitation team members use different approaches in therapy, yet have a similar aim in the well-being of the patients. The common ground is that the therapy interventions may increase the patient’s total daily energy expenditure through occupational participation and physical activity. More physical activity and less sedentary time may be associated with better functional outcomes (Askim et al., 2014; Mattlage et al., 2015). Despite the opportunity that therapy provides for physical activity, many patients are spending too much time sedentary during their inpatient stay (Dibben et al., 2018; Wondergem et al., 2019). However, studies that investigated the objectively measured physical activity levels in inpatient rehabilitation are scarce.
DESIGN: A prospective, repeated-measures design was used. Forty-six individuals admitted to the inpatient rehabilitation were reruited. Some eligibility criteria included (1) no moderate-to-severe cognitive impairment, (2) no history of spinal cord injuries, and (3) ability to wear ActiGraph on their wrist 24 hours/day during the stay.
METHOD: Participants wore ActiGraph GT9X Link on their non-dominant or less affected wrist for 24 hours per day during their inpatient rehabilitation stay. After discharge, medical information such as past medical history, admission and discharge functional status, and therapy schedules was collected through medical record review. Using ActiLife Data Analysis Software, non-wear times were excluded from the data analyses. A minimum of 3 days of wear time were required for rehabilitation days and 1 day of wear time for non-rehabilitation days. Using the date and time filter options, hourly average total activity counts (TACs) (1) among occupational therapy (OT), physical therapy (PT), and speech-language pathology service (SLP), (2) between rehabilitation and non-rehabilitation times, and (3) between rehabilitation and non-rehabilitation days were compared. Linear mixed model and Wilcoxon Signed Ranks test were used for data analyses.
RESULTS: Although the data collection has just been completed, preliminary results from 38 participants are reported here. The mean age of participants was 63.5 (SD = 12.5) years. On average, participants’ length of stay in inpatient rehabilitation was 13.7 (SD = 3.7) days. TACs were significantly different between OT, PT, and SLP (F = 52.61, p <0.001). Specifically, significant differences were found between OT and PT (p <0.001), between OT and SLP (p <0.001), and between PT and SLP (p = 0.018). OT showed the highest level of TAC out of all therapies followed by PT and lastly SLP. Participants showed a significant difference (Z = 5.373, p <0.001) in TACs between rehabilitation and non-rehabilitation times. Lastly, participants showed a significant difference (Z = 4.488, p < 0.001) in TACs between rehabilitation and non-rehabilitation days.
CONCLUSION: The results preliminarily showed that individuals receiving inpatient rehabilitation are most physically active during OT followed by PT and SLP. In addition, individuals were more sedentary during non-rehabilitation times and days. Occupations used as means and aimed as end may offer a variety intervention options that have the high potential to increase physical activity level. Occupational therapists should consider implementation of individualized therapy plans for patients to perform independently and safely without a therapist present at inpatient rehabilitation.
Askim, T., Berhnhardt, J., Salvesen, O., & Indredavik, B. (2014). Physical activity early after stroke and association to functional outcome 3 months later. Journal of Stroke and Cerebrovascular Diseases, 23(5), e305-e312. https://doi-org.jproxy.lib.ecu.edu/10.1016/j.jstrokecerebrovasdis.2013.12.011
Dibben, G. O., Dalal, H. M., Taylor, R. S., Doherty, P., Tang, L. H., & Hillsdon, M. (2018). Cardiac rehabilitation and physical activity: Systematic review and meta-analysis. Heart, 104, 1394-1402. http://dx.doi.org/10.1136/heartjnl-2017-312832
Mattlage, A. E., Redlin, S. A., Rippee, M. A., Abraham, M. G., Rymer, M. M., & Billinger, S. A. (2015). Use of accelerometers to examine sedentary time on an acute stroke unit. Journal of Neurologic Physical Therapy, 39(3), 166-171. https://doi.org/10.1097/NPT.0000000000000092
Wondergem, R., Veenhof, C., Wouters, E. M. J., de Bie, R. A., Visser-Meily, J. M. A., & Pisters, M. F. (2019). Movement behavior patterns in people with first-ever stroke. Stroke, 50(12), 3553-3560. https://doi.org/10.1161/STROKEAHA.119.027013