Advancing Rehabilitation Research Through Characterization of Conventional Occupational Therapy for Adult Stroke Survivors with Upper Extremity Hemiparesis
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| Language: | English |
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The Ohio State University / OhioLINK
2019
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| Online Access: | http://rave.ohiolink.edu/etdc/view?acc_num=osu1574743933864793 |
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ndltd-OhioLink-oai-etd.ohiolink.edu-osu1574743933864793 |
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English |
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Occupational Therapy Rehabilitation Neurosciences Health Sciences occupational therapy stroke hemiparesis upper extremity rehabilitation standard care conventional rehabilitation Rehabilitation Treatment Specification System RTSS treatment specification repetitions task-oriented training active ingredients |
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Occupational Therapy Rehabilitation Neurosciences Health Sciences occupational therapy stroke hemiparesis upper extremity rehabilitation standard care conventional rehabilitation Rehabilitation Treatment Specification System RTSS treatment specification repetitions task-oriented training active ingredients Wengerd, Lauren Rachel Advancing Rehabilitation Research Through Characterization of Conventional Occupational Therapy for Adult Stroke Survivors with Upper Extremity Hemiparesis |
| author |
Wengerd, Lauren Rachel |
| author_facet |
Wengerd, Lauren Rachel |
| author_sort |
Wengerd, Lauren Rachel |
| title |
Advancing Rehabilitation Research Through Characterization of Conventional Occupational Therapy for Adult Stroke Survivors with Upper Extremity Hemiparesis |
| title_short |
Advancing Rehabilitation Research Through Characterization of Conventional Occupational Therapy for Adult Stroke Survivors with Upper Extremity Hemiparesis |
| title_full |
Advancing Rehabilitation Research Through Characterization of Conventional Occupational Therapy for Adult Stroke Survivors with Upper Extremity Hemiparesis |
| title_fullStr |
Advancing Rehabilitation Research Through Characterization of Conventional Occupational Therapy for Adult Stroke Survivors with Upper Extremity Hemiparesis |
| title_full_unstemmed |
Advancing Rehabilitation Research Through Characterization of Conventional Occupational Therapy for Adult Stroke Survivors with Upper Extremity Hemiparesis |
| title_sort |
advancing rehabilitation research through characterization of conventional occupational therapy for adult stroke survivors with upper extremity hemiparesis |
| publisher |
The Ohio State University / OhioLINK |
| publishDate |
2019 |
| url |
http://rave.ohiolink.edu/etdc/view?acc_num=osu1574743933864793 |
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AT wengerdlaurenrachel advancingrehabilitationresearchthroughcharacterizationofconventionaloccupationaltherapyforadultstrokesurvivorswithupperextremityhemiparesis |
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ndltd-OhioLink-oai-etd.ohiolink.edu-osu15747439338647932021-08-03T07:13:25Z Advancing Rehabilitation Research Through Characterization of Conventional Occupational Therapy for Adult Stroke Survivors with Upper Extremity Hemiparesis Wengerd, Lauren Rachel Occupational Therapy Rehabilitation Neurosciences Health Sciences occupational therapy stroke hemiparesis upper extremity rehabilitation standard care conventional rehabilitation Rehabilitation Treatment Specification System RTSS treatment specification repetitions task-oriented training active ingredients Stroke remains a leading cause of long-term disability in the United States. While significant medical advances have led to decreased stroke mortality rates, incidence of stroke has remained roughly the same. This has resulted in an increased number of stroke survivors living with upper extremity (UE) hemiparesis requiring occupational therapy (OT). Despite a significant increase in the number of stroke rehabilitation trials over the past decade, a recent systematic review and meta-analysis found insufficient evidence that any experimental interventions were superior to conventional rehabilitation for improving UE motor function post-stroke. While it may be true that novel interventions are no more effective than conventional rehabilitation, an equally probable reason is the large disparities in dosage, frequency, and interventions used across control groups in clinical trials. In the stroke rehabilitation literature, control interventions are often referred to as standard care or conventional rehabilitation. Concerningly, the majority of stroke rehabilitation trials lack an empirically based rationale for how control interventions are comparable to standard care rehabilitation. Inadequate descriptions of, and rationales for, control interventions across stroke rehabilitation trials are significant barriers to the advancement of evidence-based practice. Without a true understanding of `standard care’ in real-world practice, there is no way to know if the control intervention is truly comparable. There is an urgent need to characterize `standard care’ rehabilitation to inform control intervention development and improve interpretability of clinical trial results. The purpose of this study was to investigate current practices of occupational therapy practitioners in outpatient rehabilitation settings to address upper extremity hemiparesis in adult stroke survivors. In Chapter 2, a cross-sectional e-mail survey was sent to OT practitioners across the United States to determine current practice patterns of therapists working in outpatient stroke rehabilitation nationwide. The results of this study (n=269) revealed that stretching, bilateral upper extremity training, strength training, weightbearing, manual therapy and task-oriented training were used by more than 85% of OT practitioners in our sample. Poor patient compliance (84%), medical complexity (64%), and spasticity (63%) were the most commonly reported barriers to patients meeting their OT goals in outpatient rehabilitation. Chapters 3 and 4 present the results of a video-based observational study of outpatient OT sessions at an academic medical center. The Rehabilitation Treatment Specification System (RTSS) was used to analyze 30 OT treatment sessions. The average total session time was 52 ± 4.7 minutes with 36.2 ± 7.4 minutes of active time and 15.8 ± 7.1 minutes of inactive time per session. Interventions in the RTSS categories of `Skills and Habits’ (e.g., task-oriented activities) and `Organ Function’ (e.g., stretching, weightbearing) were used in the majority of OT sessions with `Skills and Habits’ activities accounting for 59% of active time and `Organ Function’ activities accounting for 35% of active time. After removing outliers, an average of 150.2 ± 85.2 UE repetitions occurred per session. Functional electrical stimulation (FES) was commonly used as an adjuvant to task-oriented activities and knowledge of performance was provided often during treatment. Taken together, these results suggest that task-oriented training is commonly used by OT practitioners to address UE hemiparesis and musculoskeletal interventions are often used to mitigate spasticity in preparation for task-oriented activities. Future research will include video observation and analysis of OT practice sessions across multiple practice settings, as well as analyzing our remaining survey data across multiple practice settings (e.g., inpatient rehabilitation, skilled nursing facilities) to describe similarities and differences with the current findings. 2019 English text The Ohio State University / OhioLINK http://rave.ohiolink.edu/etdc/view?acc_num=osu1574743933864793 http://rave.ohiolink.edu/etdc/view?acc_num=osu1574743933864793 unrestricted This thesis or dissertation is protected by copyright: all rights reserved. It may not be copied or redistributed beyond the terms of applicable copyright laws. |