BACKGROUND AND PURPOSE: The accurate measurement of therapy intensity in postacute rehabilitation is important for research to improve outcomes in this setting. We developed and validated a measure of Patient Active Time during physical (PT) and occupational therapy (OT) sessions, as a proxy for therapy intensity. METHODS: This measurement validity study was carried out with 26 older adults admitted to a skilled nursing facility (SNF) for postacute rehabilitation with a variety of main underlying diagnoses, including hip fracture, cardiovascular diseases, stroke, and others. They were participants in a randomized controlled trial that compared an experimental high-intensity therapy to standard-of-care therapy. Patient Active Time was observed by research raters as the total number of minutes that a patient was actively engaging in therapeutic activities during PT and OT sessions. This was compared to patient movement (actigraphy) quantified during some of the same PT/OT sessions using data from three-dimensional accelerometers worn on the patient's extremities. RESULTS:Activity measures were collected for 136 therapy sessions. Patient Active Time had high interrater reliability in both PT (r = 0.995, p < 0.001) and OT (r = 0.95, p = 0.012). Active time was significantly correlated with actigraphy in both PT (r = 0.73, p < 0.001) and OT (r = 0.60, p < 0.001) and discriminated between a high-intensity experimental condition and standard of care rehabilitation: in PT, 47.0 ± 13.5 min versus 16.7 ± 10.1 min (p < 0.001) and in OT, 46.2 ± 15.2 versus 27.7 ± 6.6 min (p < 0.001). CONCLUSIONS: Systematic observation of Patient Active Time provides an objective, reliable, and valid index of physical activity during PT and OT treatment sessions that has utility as a real-world alternative to the measurement of treatment intensity. This measure could be used to differentiate higher from lower therapy treatment intensity and to help determine the optimal level of active therapy time for patients in postacute and other settings.
RCT Entities:
BACKGROUND AND PURPOSE: The accurate measurement of therapy intensity in postacute rehabilitation is important for research to improve outcomes in this setting. We developed and validated a measure of Patient Active Time during physical (PT) and occupational therapy (OT) sessions, as a proxy for therapy intensity. METHODS: This measurement validity study was carried out with 26 older adults admitted to a skilled nursing facility (SNF) for postacute rehabilitation with a variety of main underlying diagnoses, including hip fracture, cardiovascular diseases, stroke, and others. They were participants in a randomized controlled trial that compared an experimental high-intensity therapy to standard-of-care therapy. Patient Active Time was observed by research raters as the total number of minutes that a patient was actively engaging in therapeutic activities during PT and OT sessions. This was compared to patient movement (actigraphy) quantified during some of the same PT/OT sessions using data from three-dimensional accelerometers worn on the patient's extremities. RESULTS: Activity measures were collected for 136 therapy sessions. Patient Active Time had high interrater reliability in both PT (r = 0.995, p < 0.001) and OT (r = 0.95, p = 0.012). Active time was significantly correlated with actigraphy in both PT (r = 0.73, p < 0.001) and OT (r = 0.60, p < 0.001) and discriminated between a high-intensity experimental condition and standard of care rehabilitation: in PT, 47.0 ± 13.5 min versus 16.7 ± 10.1 min (p < 0.001) and in OT, 46.2 ± 15.2 versus 27.7 ± 6.6 min (p < 0.001). CONCLUSIONS: Systematic observation of Patient Active Time provides an objective, reliable, and valid index of physical activity during PT and OT treatment sessions that has utility as a real-world alternative to the measurement of treatment intensity. This measure could be used to differentiate higher from lower therapy treatment intensity and to help determine the optimal level of active therapy time for patients in postacute and other settings.
Authors: M D Miller; C F Paradis; P R Houck; S Mazumdar; J A Stack; A H Rifai; B Mulsant; C F Reynolds Journal: Psychiatry Res Date: 1992-03 Impact factor: 3.222
Authors: Eric J Lenze; Helen H Host; Mary Hildebrand; Nancy Morrow-Howell; Brian Carpenter; Kenneth E Freedland; Carolyn M Baum; Ellen F Binder Journal: Am J Geriatr Psychiatry Date: 2013-01-11 Impact factor: 4.105
Authors: Nalin A Singh; Susan Quine; Lindy M Clemson; Elodie J Williams; Dominique A Williamson; Theodora M Stavrinos; Jodie N Grady; Tania J Perry; Bradley D Lloyd; Emma U R Smith; Maria A Fiatarone Singh Journal: J Am Med Dir Assoc Date: 2011-09-22 Impact factor: 4.669
Authors: Michael C Munin; Karen Seligman; Mary Amanda Dew; Tanya Quear; Elizabeth R Skidmore; Gary Gruen; Charles F Reynolds; Eric J Lenze Journal: Arch Phys Med Rehabil Date: 2005-03 Impact factor: 3.966
Authors: Neil F Gordon; Meg Gulanick; Fernando Costa; Gerald Fletcher; Barry A Franklin; Elliot J Roth; Tim Shephard Journal: Circulation Date: 2004-04-27 Impact factor: 29.690
Authors: Eric J Lenze; Helen H Host; Mary W Hildebrand; Nancy Morrow-Howell; Brian Carpenter; Kenneth E Freedland; Carolyn A Baum; David Dixon; Peter Doré; Leah Wendleton; Ellen F Binder Journal: J Am Med Dir Assoc Date: 2012-08-03 Impact factor: 4.669
Authors: Kimberly J Waddell; Michael J Strube; Ryan R Bailey; Joseph W Klaesner; Rebecca L Birkenmeier; Alexander W Dromerick; Catherine E Lang Journal: Neurorehabil Neural Repair Date: 2016-12-13 Impact factor: 4.895
Authors: Eric J Lenze; Emily Lenard; Marghuretta Bland; Peggy Barco; J Philip Miller; Michael Yingling; Catherine E Lang; Nancy Morrow-Howell; Carolyn M Baum; Ellen F Binder; Thomas L Rodebaugh Journal: JAMA Netw Open Date: 2019-07-03
Authors: Catherine E Lang; Michael J Strube; Marghuretta D Bland; Kimberly J Waddell; Kendra M Cherry-Allen; Randolph J Nudo; Alexander W Dromerick; Rebecca L Birkenmeier Journal: Ann Neurol Date: 2016-08-16 Impact factor: 11.274
Authors: Baris Ercal; Thomas L Rodebaugh; Marghuretta D Bland; Peggy Barco; Emily Lenard; Catherine E Lang; J Philip Miller; Michael Yingling; Eric J Lenze Journal: Am J Phys Med Rehabil Date: 2021-07-01 Impact factor: 3.412