Can therapists estimate therapy dose dimensions? A comparison between patient, therapist, and objective outcomes in (sub)acute rehabilitation

Abstract

Introduction Arm-hand training at an intensive and individualized dosage potentially provides a powerful stimulus for neurological recovery. The current dosage is based on therapists' experience and subjective feelings, which might differ from patients' perceived dosage.

Main objective To assess differences in therapy dose dimensions (TDD) between patients' and therapists' perceptions and between therapists' perceptions and objective measured TDD in (sub)acute arm-hand therapy in PwC-SCI. Methods In this longitudinal observational study in 3 rehabilitation centers, PwC-SCI and their therapists estimated TDD difficulty and intensity of arm-hand therapy using a VAS. Active minutes within a session were estimated by the therapist and objectively measured using video recordings of the therapy. Measurements were taken during 3 weeks between 4-24 weeks post-injury, with an interval of 8 weeks, during 3 days per week. Paired sample T-test was used to assess differences. Result and discussion The ongoing study measured 73 arm-hand sessions, including 8 patients (lesion C1-C5, mean age of 56.13 years SD(12.11) and mean post-injury weeks 7.5 SD(1.6) at inclusion) and 16 therapists (mean experience of 11.7 years SD(9.22)). Therapists estimated the difficulty (M(4.89);SD(2.08)) and intensity (M(4.97); SD(2.19)) significantly higher (p<0.005) than perceived difficulty (M(4.03); SD(2.43)) and intensity (M(3.66); SD(2.26)) by the patients. Fifty sessions (mean session length 40’03’’; SD(25’12’’)) were included for estimating active time. Therapists estimated the active time (M(29’44’’); SD(20’30’’)) significantly higher (p=0.003) than objectively measured (M(23’22’’);SD(12’21’’)). Conclusion These preliminary results indicate that therapists overestimate all TDD compared to patient perception and objective measurement.