What if physical and occupational therapists tailored their regimens to the patient’s abilities and desires, instead of using a standard model? Researchers tested out a new approach to occupational and physical therapy for the elderly that makes use of motivational therapy, which takes this exact question into account. The results were definitive in their answer: a resounding yes.  

Why does physical therapy for the elderly need fixing?

The University of Washington School of Medicine, in St. Louis, studied what would happen with an innovative approach toward rehabilitation termed enhanced medical rehabilitation, which gears rehab toward goal-oriented and motivational occupational and physical therapy. This type of rehab fully engages the patient in creating the goals and methods of rehabilitation, making each patient’s program completely customized and totally geared toward that person’s potential success. 

In general, the researchers noted that patients are hard to motivate and are unenthusiastic about therapy. This new model seeks to change that and get the patient excited and motivated about therapy – and the way they intended to do that was by engaging the patient and bringing her into the therapy program.

How the study worked

The researchers followed 229 patients at inpatient facilities just like Hudson View rehab. They were recovering from major illness or surgery, such as a stroke, surgery, or bone fracture. 114 patients received the enhanced medical rehabilitation, and 115 patients received the standard model of rehab therapy.

The actual, practical part of the program involved the patient’s receiving therapy that moved toward her expressed goals, and motivational messages interspersed with care. For example, a patient might describe something he could previously do and now can’t  – such as outdoor gardening. In the standard version of treatment, the therapist wouldn’t know this, but would be working with the patient on improving physical capabilities that would move the patient toward that goal. In the enhanced medical rehabilitation model, the therapist engages the patient in conversation about the therapy and her goals. The patient would tell the therapist that her goal is to get back to her gardening. The therapist would choose exercises that specifically help the patient move toward that goal. She would also give her motivational statements that could help her succeed in her goals.

The sessions in the study were not more or longer than standard, but they included these changes, and the results were very encouraging – they showed 25% higher improvement in function as compared with regular rehab therapy. 

The study’s lead author, Eric J, Lenze, a psychiatry professor, said “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.” He noted that insurers are often turned off by the cost of home therapy, but that in the long run it works out in their benefit, since patients who are recovered are less likely to end up back in rehab. With better results for patients and lower overall costs per patient for insurance companies, this is a model that is likely to be picked up by post acute facilities everywhere.

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