PHYSICAL THERAPY DURING STROKE REHABILITATION FOR PERSONS WITH DIFFERENT WALKING ABILITIES. Nancy Latham1; Diane Jette*2; Randy Smout5; Mary Slavin1; Lorie Richards4,5; Brendan Conroy6; Julie Gassaway3; Gerben Dejong7,8; Susan Horn3 1. Health and Disability Research Institute, Boston University, Boston, MA; 2. Physical Therapy Department, Simmons College, Boston, MA; 3. Institute for Clinical Outcomes Research, Salt Lake City, UT; 4. Department of Veterans Affairs Medical Center, Gainesville, FL; 5. Occupational Therapy Department, University of Florida, Gainesville, FL; 6. National Rehabilitation Hospital, Washington, DC; 7. VA Rehabilitation Outcomes Research Center, Gainesville, FL; 8. Brooks Center for Rehabilitation Studies, University of Florida, Gainesville, FL PURPOSE: To describe physical therapy (PT) activities during post-stroke rehabilitation, and how these activities differ by admission walking ability and over time. BACKGROUNDS/SIGNIFICANCE: There are few studies that describe the precise activities that physical therapists (PTs) use to manage patients with stroke. With reliable descriptions of post-stroke rehabilitation activities, we can begin to assess whether practice reflects current evidence. SUBJECTS: Subjects included 715 people with stroke who received PT at 6 U.S. inpatient rehabilitation hospitals and whose major mode of locomotion at admission was walking. Patients received 5 to 27 hours of PT. Subjects had a mean age of 66.5 years (standard deviation 14) and 51% were male. 45% had a right-hemisphere stroke, 42% had left-hemisphere and the remainder had bilateral or unknown. Average length of stay was 18.3 days, and 85% of patients were discharged to the community. METHODS AND MATERIALS: At the time of admission patients' function was determined using the Functional Independence Measure (FIM). During the rehabilitation stay, total time patients spent in PT sessions as well as the time spent in 11 activities were documented for each session. Additional data were collected from patients' records following discharge. For the purposes of this study, patients were categorized according to the amount of PT they received (i.e. 1, 2, 3 or 4 six-hour blocks) and their admission FIM locomotion score (i.e. less than or equal to 2, or 3 and above). ANALYSES: Descriptive statistics were derived to examine characteristics of patients within each category as well as characteristics of their episode of care. For each category of patients, the content of treatment sessions was described by determining the percentage of all PT time within each six-hour block spent on the 11 activities. RESULTS: The majority of PT time was spent in gait activities. Even people who had the most limited mobility spent 25-38% of PT time in gait activities during the first treatment block. Treatment progression was evident, as a shift from less to more advanced activities occurred over time with less bed mobility (from a high of 6% during the first block to a high of 3.5% during the final block) and more advanced gait (from a high of 5.9% to 10.7%). However, even in the final block a small proportion of time was spent on community mobility activities (1.2-5.2%) and the majority of people received no community mobility training. CONCLUSIONS: For patients whose major locomotion mode was walking, PTs spend the majority of their stroke rehabilitation treatment time on the specific task of walking. PTs tend to design plans of care for their patients that are aimed at the level of ability of the individual patient and provide higher level activities as patients improve their function. Although you would expect PT management to be consistent with the environmental context, very little time was spent in community mobility activities. FUNDING SOURCE: National Institute on Disability & Rehabilitation Research (NIDRR) Grant # H133B990005 KEYWORDS: gait, stroke, cohort study, activities, community integration Copyright 2009 by the American Physical Therapy Association. Requests for reprints should be directed to the corresponding author of the article. Educators, students, and other academic customers may receive permission to reprint copyrighted material from Physical Therapy (ISSN 1538-6724) by contacting the Copyright Clearance Center Inc, 222 Rosewood Dr, Danvers, MA 01923. Other types of customers who want permission to reprint should contact the APTA Editorial Office, Attn: Physical Therapy.