Intensity of usual care physical therapy during inpatient rehabilitation for people with neurologic diagnoses
Jake DiPasquale, Molly Trammell, Kelly Clark, Hayden E. Fowler, Librada Callender, Monica Bennett, Chad Swank
Abstract
BACKGROUND: Early, intense rehabilitation is essential to promote recovery after stroke, spinal cord injury (SCI), and traumatic brain injury (TBI). However, intensity of usual care rehabilitation interventions during inpatient rehabilitation are poorly characterized. OBJECTIVE: To describe the intensity of usual care rehabilitation interventions completed during the subacute phase of recovery from neurologic injury. DESIGN: Observational. SETTING: Inpatient rehabilitation facility. INTERVENTIONS: Twenty-two usual care physical therapy interventions were grouped into six categories: gait (four activities), functional (two), strengthening (four), aerobic (six), balance (four), and wheelchair (two). PATIENTS: Patients admitted to inpatient rehabilitation with a primary diagnosis of stroke, SCI or TBI within 6 months of injury. MAIN OUTCOME MEASURE(S): Cardiovascular intensity (physiological and perceived) was recorded during rehabilitation activity sessions. Physiological intensity was assessed by heart rate reserve (HRR) via a Polar A370 Fitness Watch and characterized as very light (<30%), light (30-39%), moderate (40-59%), vigorous (60-89%), and near maximal (≥90%). Perceived intensity was assessed using the Rating of Perceived Exertion scale. RESULTS: Patients (stroke n = 16 [number of activity sessions = 338/average session duration = 16.4 min]; SCI n = 15 [299/27.4 min]; TBI n = 15 [340/14.2 min]) participated. For patients with stroke, moderate-to-vigorous HRR was attained between 42% (aerobic exercise) to 55% (wheelchair propulsion) of activity sessions. For patients with SCI, moderate-to-vigorous HRR was attained between 29% (strength training) to 46% (gait training) of activity sessions. For patients with TBI, moderate-to-vigorous HRR was attained between 29% (balance activities) to 47% (gait training) of activity sessions. Associations between HRR and rate of perceived exertion were very weak across stroke (r = 0.12), SCI (r = 0.18), and TBI (r = 0.27). CONCLUSIONS: Patients with stroke, SCI, and TBI undergoing inpatient rehabilitation achieve moderate-to-vigorous intensity during some usual care activities such as gait training. Patient perception of intensity was dissimilar to physiological response.