Intensity of Rehabilitation Interventions As a Predictor of Outcomes in Skilled Nursing Facility Residents

[摘要] Stroke is the leading cause of disability among adults in the United States.Research that continues to unpack the 'black box’ of rehabilitation services specific to diagnostic groups (such as stroke) will contribute to the development of evidence-based clinical best practices for rehabilitation service provision to improve functional outcomes.The purpose of this study was to describe the types of rehabilitation interventionsimplemented (impairment-based and function-based as derived from Current Procedural Terminology billing codes) and intensity of these interventions (measured in minutes) as they are administered to skilled nursing facility residents admitted with a diagnosis of stroke, at two time points (5-day and 30-day reporting periods). In addition, this study examined what types of rehabilitation interventions at what level of intensity contributed most to a change in the level of activities of daily living disability (ADL end-split) between these two time points.At the 5-day and 30-day time points, the proportion of impairment-based and function-based interventions differed significantly, with the greatest proportion of time focused on function-based interventions at both time points.Function-based interventions decreased in proportion from 5 to 30 days and the impairment-based interventions increasing in proportion from 5 to 30 days. Function-based occupational therapy interventions were significant predictors of positive changes in functional outcomes (ADL end-split), however, in subsequent models, when other significant predictors of a change in functional outcomes entered (bed mobility and the presence of fecal incontinence), the unique contribution of occupational therapy was no longer significant.Results of this study also indicated strong and significant associations between both impairment-based and function-based interventions and the presence of urinary incontinence and fecal incontinence, dependence in toilet use, and the presence of an active discharge plan to return to the community.

[发布机构] the University of Pittsburgh