Feasibility of increasing the dosage of inpatient movement rehabilitation with additional self-directed independent exercise: “My Therapy”

Dr Tash Brusco1,2, Ms Louise Tilley1, Ms Brianna Walpole1, Ms Helen Kugler1, Mr Ran Li1, Ms Emma Kennedy1, Professor Meg Morris1,2

1Centre for Allied Health Research and Education (CAHRE), Cabrini, Melbourne, Australia, 2La Trobe Centre for Sport and Exercise Medicine Research, School of Allied Health, La Trobe University, Melbourne, Australia

Abstract:

Aim:
To determine the feasibility of implementing My Therapy in addition to rehabilitation inpatient usual care, for musculoskeletal and frail older patients.

Methods:
A two-group quasi-experimental pre-post design examined the feasibility of delivering My Therapy in addition to usual care, compared to usual care. My Therapy comprised independent self-directed exercises prescribed by physiotherapists and occupational therapists. The primary outcome was My Therapy implementation feasibility, to achieve at least 70% adherence. Secondary outcomes were self-reported daily My Therapy participation (minutes), total daily movement rehabilitation participation (minutes), adverse events, length of stay, 10 metre walk speed, FIM scores and discharge home.

Results:
My Therapy participation was achieved by 72% (83/116) of the My Therapy group, averaging 14 minutes (SD 14) of extra practice per day. Total participation was 177 minutes (SD 47) for the My Therapy group (n=116) and 148 minutes (SD 88) for the usual care group (n=89), mean difference of 30 minutes (p=0.00). A minimal clinically important difference in FIM was achieved for significantly more My Therapy participants (22%, n=26) compared to usual care (10%, n=9; p=0.02). There were no safety concerns or group differences for other outcomes.

Significance of the findings to allied health:
My Therapy is a feasible and safe way to increase the amount of allied health therapy in hospitalised older people with musculoskeletal conditions or frailty to achieve an additional 14 minutes of daily practice alongside usual care rehabilitation.

Biography:

As a health economist, Dr Tash Brusco firmly believes that cost and resource implications should always be considered in health care, alongside clinical and health service outcomes. Her career includes 20 years of health service experience in clinical, management and leadership roles across multiple public and private health services. She is a Senior Researcher at Monash University and has extensive experience consulting for complex organisations across the health, education and government sectors. Tash commenced her academic career 15 years ago with a focus on health service research and then through an award winning PhD, this focus shifted to health economics. Tash has been project lead for multi-site and multi-state research projects with robust evaluations, demonstrating the ability to lead and deliver complex projects from conception to completion. She has many peer review journal publications and has delivered numerous conference presentations, signifying high quality and high impact writing and presentation skills. These focus on health economics, stroke care, workplace health and safety, obesity, as well as allied health models of care, workforce development and assistant scope of practice.

Qualifications

PhD: “Economics of weekend rehabilitation” (2015), La Trobe University
Health Economics: 2 x post-graduate units (2012), Monash University
Master of Physiotherapy (2006), La Trobe University
Bachelor of Physiotherapy (1998), La Trobe University