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A description of the outcomes, frequency, duration, and intensity of occupational, physical, and speech therapy in inpatient stroke rehabilitation.

PURPOSE
The purpose of this study was to describe the outcomes, frequency, duration, intensity, and the specific types of therapeutic intervention of inpatient stroke rehabilitation specific to one hospital in the upper midwestern region of the United States following implementation of the IRF PPS.


DESIGN
This was a non-experimental retrospective chart review of individuals who received inpatient stroke rehabilitation from January 2003 to June 2004.


METHODS
A total of 80 medical records met inclusion and exclusion criteria. Data were collected on patient and clinical characteristics, FIM scores, LOS, and discharge location as well as the intensity, frequency, and total number of occupational therapy (OT), physical therapy (PT), and speech therapy (ST) treatment sessions, the type of therapy sessions provided, and the type of therapy service providers.


RESULTS
LOS was 15.19 days +/- 11.69. There was a significant difference (t =-12.163; p = .000) between FIM total admission score (71.90 +/- 21.47) and FIM total discharge score (92.23 +/- 24.43) ). There was a significant difference in FIM discharge scores (F = 26.494; p = 000) based on discharge location with differences found between the discharge locations of home and skilled nursing facilities (p = .000) and skilled nursing facilities and assisted living facilities (p = .019). Mean number of therapy sessions per subject was 21.73 +/- 18.11 for OT, 21.99 +/- 18.10 for PT, and 18.86 +/- 18.71 for ST. Mean number of sessions per day was 1.72 +/- 0.31 sessions for OT, 1.65 +/- 0.36 sessions for PT, and 1.52 +/- 0.48 for ST. Mean number of minutes provided per session was 29.87 +/- 1.77 minutes for OT, 29.70 +/- 1.65 minutes for PT, and 27.23 +/- 6.64 minutes for ST. Mean intensity (days of therapy/length of stay) was 0.82 +/- 0.13 for OT, 0.85 +/- 0.13 for PT and 0.70 +/- 0.24 for ST. Of the total OT sessions, 97.41% were conducted by the OT and 77.68% were intervention only. Of the total PT sessions, 65.66% were conducted by the PT, 15.35% were by the PTA, and 92.67% were for intervention only.


CONCLUSIONS
These findings suggested inpatient stroke rehabilitation has an impact on the rehabilitation process as evidenced by the improved FIM scores at discharge. Individuals who received inpatient rehabilitation for stroke at this facility stayed just over 2 weeks and improved on average by 20 points on the FIM. The patients in this study were seen for skilled OT, PT, and ST for about 30 minutes per session, 1.5 times per day, and received therapy services for 5 to 6 days per week on average. Future prospective research investigating the specific types of therapeutic interventions provided by each rehabilitation discipline is warranted in order to gain a clearer understanding of the effectiveness of inpatient stroke rehabilitation.