Saturday, September 19, 2015

OT Fails with Stroke Survivors in Care-Homes

Rebecca Dutton
Home After a Stroke
September 4, 2015

Professor Sackley who teaches PT at the University of East Anglia in England conducted a study that provided 2500 hours of OT to 1042 stroke survivors in nursing homes (1). The treatment did not produce a significant change. This study is disappointing for the following reasons.
  1. The study used a 50 year old outcome measure called the Barthel Index of ADLs. The Barthel has 3 levels: zero = dependent, one = needs help, and two = independent. People who are frail enough to be in a nursing home are unlikely to become totally independent. Other researchers have used ADL tests that are sensitive to small changes, like the Functional Independence Measure which has seven levels of assistance.  
  2. Another outcome measure was the Rivermead Mobility Index. Having worked in a nursing home I know that the nursing staff do not have a stake in encouraging residents to get out of bed independently or walk unassisted. Decreased mobility makes it easier to keep residents safe with fewer staff. No increase in mobility in a nursing home is not surprising.
  3. The average treatment was only 5.1 sessions and only 15% of the time was spend on ADL and mobility training which the outcome measures evaluated. The majority of time was spent on evaluation and "communication."  
Bottom Line: Professor Sackley said "we need to rethink what is needed for these patients.” I agree. Dressing and walking 10 meters are "shoulds" that people do to get the life they want. People with chronic conditions need the incentive of participating in activities they enjoy to sustain their commitment to action. Asking nursing home residents "What activity makes you happy or lifts your spirits?" has to come before teaching them the skills they need to participate in an activity.
(1) OT Fails in Care-Home Stroke Patients presented at the XXIII European
     Stroke Conference on May 6-9, 2014, Nice, France.

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