Intensity in rehabilitation (COURSE-10)

Course
Time:
10 May 2019 08:30-16:30
Duration
One day
Location:
HedS Champel
Level of learning:
Multiple
Fee:
€250, fee includes all course materials, breaks and lunches
Chair/speaker
Speakers
1000 REPS A DAY: STRATEGIES TO INCREASE INTENSITY IN REHABILITATION

One day course

Language: English

Dorsch S1Scrivener K2
1Australian Catholic University, Faculty of Health Sciences, Sydney, Australia, 2Macquarie University, Sydney, Australia
 

Learning objective 1: At the completion of this course you should be able to outline the evidence for a dose-response relationship between amount of practice and outcomes in rehabilitation.
Learning objective 2: At the completion of this course you should be able to describe strategies to increase patient motivation and empowerment.
Learning objective 3: At the completion of this course you should be able to describe strategies to increase semi-supervised and independent practice in inpatient, outpatient and community rehabilitation.

Description:

This workshop explores the evidence for a dose-response relationship between amount of practice and outcomes in rehabilitation, strategies to increase patient motivation and strategies to maximise opportunities for patients to practice. To facilitate the presentation of strategies that can be used in all rehabilitation settings service delivery has been divided into three categories. The first is one to one practice, in this mode the therapist is working with the patient, strategies to increase intensity of practice include examining the coaching skills of the therapist, their ability to communicate effectively and to set up the environment effectively. The second mode of service delivery is semi-supervised practice, in this mode the patient is in a therapy environment but is not under direct supervision of a therapist. This mode can include groups and classes and patients working with family in a therapy area. The barriers to this mode of service delivery are patient safety and quality of practice. Strategies to overcoming these barriers are discussed in detail and case study examples are used to aid in the application of these strategies. The third mode of service delivery is independent practice, in this mode the patient is not under any therapist supervision while they practice. This mode includes home exercise programmes for outpatient and community settings and evening and weekend practice for inpatient settings. The evidence for increasing adherence to exercise in a variety of patient populations is explored and strategies are drawn from this evidence. A summary of the content under each of the main topic areas is provided below. Following the delivery of lecture content, there is a practical session on each of these topic areas. Participants will complete these practical sessions in small groups allowing the sharing of knowledge and ideas amongst therapists from diverse backgrounds.

How much is enough practice?
· The evidence for a dose-response relationship between amount of practice and outcomes 

Changing motivation:
· Meaningful assessments
· How to increase patient motivation and involvement in practice
· Changing environments
· Changing therapists' behaviour

One to one practice:
· Optimal amount and frequency of instructions
· Internal and external focus of instructions
· Optimal type, amount and frequency of feedback
· Structuring the environment to drive practice

Semi-supervised practice:
· Structuring the environment for safe semi-supervised practice
· Structuring the environment for effective semi-supervised practice
· Designing classes
· Increasing participation and attendance in classes
· Using workstations to increase practice
· Using devices to increase practice
· Evidence for involving carers in patient practice
· Strategies for involving carers in patient practice

Independent practice:
· Evidence for improving adherence to home exercise/ independent exercise programmes
· Practical strategies for increasing adherence to home exercise/ independent exercise programmes


Implications / Conclusions: 

There is indisputable evidence that increasing the intensity of practice patients complete in rehabilitation results in better outcomes. However, research shows that rehabilitation patients do very low amounts of practice and spend the majority of the day inactive. Consequently, strategies that are both resource and time efficient are urgently required in clinical settings to help deliver larger doses of therapy to maximise recovery after neurological and orthopaedic events. The focus of this workshop is on identifying strategies that increase intensity of practice in rehabilitation without increasing staff or equipment resources.  

 

Target Audience: Physiotherapists that are working in a rehabilitation setting, including inpatient, outpatient and community settings and neurological and orthopaedic and aged care rehabilitation. 
Key-Words: Rehabilitation; physical activity; outcomes