A self-management program increases the dosage of inpatient rehabilitation by 26 minutes per day: a process evaluation.

Abstract

To evaluate the implementation of a self-management program, My Therapy, designed to increase inpatient rehabilitation therapy dosage via independent practice. A process evaluation of My Therapy for adult patients admitted for rehabilitation for any condition supervised by physiotherapists and occupational therapists across eight rehabilitation wards compared usual care. Outcomes included <i>reach</i>, <i>dosage</i>, <i>fidelity</i> and <i>adaptation.</i> The mean (SD) age of the process evaluation sample (<i>n</i> = 123) was 73 (11) years with a mean (SD) length of stay of 14.0 (6.6) days. The My Therapy program <i>reached</i> 68% of participants (<i>n</i> = 632/928), and resulted in an average increase in therapy <i>dosage</i> of 26 (95% CI 12 to 40) minutes/day of independent practice. All My Therapy audited programs (<i>n</i> = 28) included body function/structure impairment-based exercises, and half (<i>n</i> = 13/28) included activity/participation-based exercises. On average, participants completed programs 1.8 (SD 1.2) times/day, which were prescribed in accordance with the My Therapy criteria, demonstrating <i>fidelity</i>. There were no between-group differences in daily steps or standing time, however, My Therapy participants spent more time sitting (<i>p</i> ≤ 0.05). Implementation <i>adaptations</i> were minimal. A self-management rehabilitation program was implemented with fidelity for two in three rehabilitation patients, resulting in increased therapy dosage with minimal adaptations.