Goal-oriented, motivational physical and occupational therapy helps older patients recover more fully from broken hips, strokes, and other ailments that land them in skilled nursing facilities for rehabilitation, according to a new study.
Enhanced Medical Rehabilitation—an approach in which physical and occupational therapists work to engage patients more fully during therapy sessions—helped them recover function better than standard physical and occupational therapy that others received in the same skilled nursing facilities, researchers say.
“…if a patient had taken care of grandchildren on Wednesdays before the problems began, then the therapists might focus on the grandchildren to motivate the patient…”
“We found that when you engage and motivate people, they do better,” says first author Eric J. Lenze, a professor of psychiatry at Washington University in St. Louis.
Patients receiving enhanced rehab did not get more or longer therapy sessions. Instead, therapists focused on specific goals important to individual patients, and they delivered, on average, 24 motivational messages about those goals during every therapy session. That approach resulted in a 25% improvement in functional recovery.
Motivation and physical therapy
The research team studied 229 patients—114 of whom randomly were chosen to receive enhanced intervention and 115 of whom received standard therapy. Each was in a skilled nursing facility while recovering from an injury or illness, such as hip fracture, stroke, or major surgery. Study patients received treatment at the Barnes-Jewish Extended Care and Alexian Brothers Sherbrooke Village skilled nursing facilities in the St. Louis area.
The enhanced rehab in this study involved the use of motivation during therapy sessions, and the key was centering therapy on goals that were meaningful to the patient.
“It’s more than just getting people home; everyone wants to go home,” says coauthor and study coordinator Emily Lenard. “In enhanced rehab, therapists focus on concrete goals. For example, if a patient had taken care of grandchildren on Wednesdays before the problems began, then the therapists might focus on the grandchildren to motivate the patient, a goal that patient can visualize in his or her head while doing exercises that might otherwise seem mundane.”
Better care helps everyone
“Now the question is whether those gains will last over the long term. We believe extending enhanced rehab from skilled nursing facilities into the home setting will be the next critical step,” Lenze says.
He says one challenge is that therapy can be expensive, and some insurers balk at the expense. But with an aging population, Lenze argues that enhanced therapy could save money for older patients recovering from injury, particularly if the therapy makes them more likely to get back into their homes and stay there.
“Avoiding rehospitalizations and long-term care in a nursing home has a huge economic benefit,” he says. “We already pay a great deal for what’s called post-acute rehabilitation, and it’s unclear whether the health-care system has the appetite to continue paying for more and more care. I think, however, that we need to get past the idea of providing more care and focus more on providing better, more bang-for-the-buck care. I think Enhanced Medical Rehabilitation does that.”
The findings appear in the journal JAMA Network Open.
Funding for the study came from the National Institute of Mental Health of the National Institutes of Health, the Taylor Family Institute for Innovative Psychiatric Research, and the Center for Brain Research in Mood Disorders at Washington University