Semi-supervised practice in inpatient rehabilitation
Following orthopaedic injury or stroke, there is clear evidence that people who do more practice in rehabilitation achieve better outcomes.
Despite the evidence that increased amounts of practice result in better outcomes, patients in rehabilitation do not generally engage in large amounts of physical practice.
The time spent in physiotherapy for stroke survivors in inpatient rehabilitation ranges from 24 minutes to 87 minutes per day. Similarly, the time spent in physiotherapy for patients with orthopaedic conditions is only 45 minutes per day.
A recent large observational study, examined the amount of exercise practice that occurred when an inpatient rehabilitation gym was set up to facilitate semi-supervised practice.
Semi-supervised practice means that patients practise in the therapy area without the direct supervision of a therapist, thereby allowing patients to spend much longer periods of the day in the gym area with the potential for achieving more time in active practice.
The following strategies were be used to facilitate the provision of semi-supervised practice:
- the environment of the therapy area was structured to provide permanent practice areas, e.g., all the required equipment for different exercises were placed at workstations, allowing efficient set up for practice;
- the environment at these workstations was modified to provide safety when patients are practising without a therapist, ie, the use of adjacent walls, benches and plinths;
- therapists or therapy assistants supervised many patients at the same time in class or group settings; and
- members of the patient’s family can provide assistance to practise.
The rehabilitation gym was observed on over 100 occasions, resulting in over 1000 individual-patient observations. An average of 12 patients were in the gym during the observations. Practice was being done with family supervision in 15% of observations and with no direct supervision in 26% of observations, resulting in semi-supervised practice accounting for 41% of all observations of practice.
The percentage of observations that were of patients doing active practice was 78%. There were no adverse safety events in the gym. The authors concluded that, in an inpatient setting, a large percentage of practice can be done as semi-supervised practice. This does not appear to compromise the time spent in active practice or patient safety.
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> From: Dorsch et al., J Physiother 65 (2019) 23-27 (Epub ahead of print). All rights reserved to the Australian Physiotherapy Association. Click here for the online summary.