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| Rebecca Dutton Home After a Stroke |
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.
- 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.
- 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.
- 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."
(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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