Patients with cognitive impairment are less commonly prescribed self-management programs in inpatient rehabilitation: a cross-sectional study.

Abstract

To determine factors (patient, ward and hospital characteristics) associated with the prescription of self-management programs by occupational therapists and physiotherapists within rehabilitation settings. This cross-sectional study used data from a larger randomised controlled trial of a self-management program ('My Therapy') across eight rehabilitation wards in four metropolitan hospitals in Victoria, Australia. Univariable and multivariable logistic regression models were used to determine factors associated with self-management prescription. Of 743 participants included, 68% (<i>n</i> = 505/743) were prescribed a self-management program. Participants with a higher total admission FIM^TM score had a 2% higher odds (adjusted odds ratio 1.02, 95% CI 1.01, 1.02) of being prescribed a self-management program. Post-hoc univariable analysis of the FIM^TM subscales showed participants with a higher admission cognitive FIM^TM score had an 8% higher odds of being prescribed a self-management program (odds ratio 1.08, 95% CI 1.06, 1.10). Patients with higher function, specifically higher cognitive function, on admission to rehabilitation were more commonly prescribed a self-management program by an occupational therapist or physiotherapist. For patients with functional deficits or cognitive impairment, supporting strategies may be needed to increase self-management program prescription, including memory and comprehension supports, strategies to increase intrinsic motivation, and informal caregiver engagement.