Patient Active Time During Therapy Sessions in Postacute Rehabilitation: Development and Validation of a New Measure.
Patient Active Time During Therapy Sessions in Postacute Rehabilitation: Development and Validation of a New Measure.
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DOI：
10.3109/02703181.2014.915282
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发表时间：
2014-06
影响因子：
0.9
通讯作者：
Lenze EJ
中科院分区：
文献类型：
--
作者：
Host HH;Lang CE;Hildebrand MW;Zou D;Binder EF;Baum CM;Freedland KE;Morrow-Howell N;Lenze EJ
对急性后康复治疗强度的准确测量对于改善这一环境下的结果的研究是重要的。我们开发并验证了一种测量患者在物理(PT)和职业治疗(OT)期间的活动时间的方法，作为治疗强度的替代。这项测量效度研究是对26名住进熟练护理机构(SNF)接受急性后康复治疗的老年人进行的，他们有各种主要的潜在诊断，包括髋部骨折、心血管疾病、中风和其他。他们是一项随机对照试验的参与者，该试验将实验性高强度疗法与标准护理疗法进行比较。研究评分者观察患者活动时间，即患者在PT和OT治疗期间积极参与治疗活动的总分钟数。这与在相同的PT/OT过程中使用患者四肢佩戴的三维加速度计的数据来量化患者的运动(肌动图)进行了比较。收集了136次治疗过程中的活动测量。患者活动时间在PT(r=0.995，p<；0.001)和OT(r=0.95p=0.012)中均具有较高的评价者间信度。在高强度实验条件和护理康复标准之间，PT组和OT组的活动时间显著相关(r=0.73，p<；0.001；r=0.6，p<；0.001)，并且区分高强度实验条件和护理康复标准：PT组，47.00±13.5min，16.7±10.1min(p<；0.001)，OT组，46.2±15.2min，27.7±6.6min(p<；0.001)。对患者活动时间的系统观察提供了在PT和OT治疗过程中客观、可靠和有效的体力活动指标，作为衡量治疗强度的真实替代方法。这一衡量标准可用于区分较高和较低的治疗强度，并帮助确定急性后和其他环境中患者的最佳积极治疗时间水平。
The accurate measurement of therapy intensity in postacute rehabilitation is important for research to improve outcomes in this setting. We developed and validated a measure of Patient Active Time during physical (PT) and occupational therapy (OT) sessions, as a proxy for therapy intensity. This measurement validity study was carried out with 26 older adults admitted to a skilled nursing facility (SNF) for postacute rehabilitation with a variety of main underlying diagnoses, including hip fracture, cardiovascular diseases, stroke, and others. They were participants in a randomized controlled trial that compared an experimental high-intensity therapy to standard-of-care therapy. Patient Active Time was observed by research raters as the total number of minutes that a patient was actively engaging in therapeutic activities during PT and OT sessions. This was compared to patient movement (actigraphy) quantified during some of the same PT/OT sessions using data from three-dimensional accelerometers worn on the patient’s extremities. Activity measures were collected for 136 therapy sessions. Patient Active Time had high interrater reliability in both PT (r = 0.995, p < 0.001) and OT (r = 0.95, p = 0.012). Active time was significantly correlated with actigraphy in both PT (r = 0.73, p < 0.001) and OT (r = 0.60, p < 0.001) and discriminated between a high-intensity experimental condition and standard of care rehabilitation: in PT, 47.0 ± 13.5 min versus 16.7 ± 10.1 min (p < 0.001) and in OT, 46.2 ± 15.2 versus 27.7 ± 6.6 min (p < 0.001). Systematic observation of Patient Active Time provides an objective, reliable, and valid index of physical activity during PT and OT treatment sessions that has utility as a real-world alternative to the measurement of treatment intensity. This measure could be used to differentiate higher from lower therapy treatment intensity and to help determine the optimal level of active therapy time for patients in postacute and other settings.