Application of ‘the PUSH strategy’ to reduce contraversive pushing after stroke during inpatient rehabilitation

Abstract

OBJECTIVE: Given the poor functional outcomes associated with contraversive pushing after stroke and lack of evidence guiding physical therapy interventions, the PUSH (Prioritizing Upright, Standing, and Higher-level stepping activities) Strategy was designed to address unmet needs. The aim of this paper is to describe the clinical application of the PUSH Strategy delivered during the physical therapy plan of care within inpatient rehabilitation. METHODS: The PUSH Strategy was applied during clinical practice in a large, urban inpatient rehabilitation hospital for patients demonstrating contraversive pushing after stroke with the goals to (1) reduce contraversive pushing, (2) contribute to facilitation of a community discharge, and (3) improve functional outcomes. Subsequently, outcomes [Burke Lateropulsion Scale (BLS), discharge disposition, and the Mobility and Walk portions of the Continuity Assessment and Record Evaluation (CARE) Tool] were collected at admission and discharge to assess patient progress. RESULTS: Between 2018 and 2020, 11 patients participated in the PUSH Strategy with 73% of patients achieving all three Strategy goals. On average, patients saw improvement in pushing [admit, 7.73 ± 3.3 (moderate pushing); discharge, 1.55 ± 2.4 (no pushing)] and function (admit mobility, 9.9 ± 4.4; discharge, 21.5 ± 5.3 and admit walking 8.1 ± 0.3, discharge 9.6 ± 2.7) during their inpatient rehabilitation stay. Nine were discharged to the community (82%). CONCLUSIONS: The PUSH Strategy was successfully applied for patients with post-stroke contraversive pushing during inpatient rehabilitation. Overall, patients demonstrated reduced pushing and improved functional outcomes during their rehabilitation and most were discharged to a community setting.