Rehabilitation Therapy Services Research Articles

Exploring home rehabilitation therapists' experiences of supporting older persons to physical exercise after acute hospitalization: a qualitative interview study.

After hospitalization, older persons may face a decline in physical function and daily independence. In-hospital exercise interventions can mitigate this decline, and continued support from primary healthcare post-discharge may enhance sustainability. This study aimed to explore home rehabilitation therapists' experiences of supporting physical exercise after acute hospitalization, including exercise programs initiated during hospital stay. This qualitative study was conducted alongside a randomized-controlled trial to investigate prerequisites for a transitional care intervention. Twelve interviews were conducted with physiotherapists, occupational therapists, and managers across seven rehabilitation therapy services in Stockholm, Sweden. Data were analyzed using reflexive thematic analysis. The analysis generated the theme Striving for individualized support for physical exercise, although limited resources and a fragmented home care risk to direct support away from those who need it the most. It was based on four subthemes: The starting point is always the patient's current needs, goals, and prerequisites, Continuing the exercise initiated during hospitalization by adapting it to the patient's situation at home, Work premises not tailored to patients with complex care needs, and A home care organization that lacks coordination and unified purpose. Interventions supporting older persons to physical exercise after acute hospitalization need to be tailored to the individual, support motivation, and be adapted to the patient's home situation. Challenges may arise when care recourses lack alignment with the patients' needs, and when the collaboration among care providers is limited. The findings contribute valuable insights for future studies incorporating transitional care interventions in similar context.

Factors Related to Favorable Outcomes in Older Adults Undergoing Home-Visit Rehabilitation Therapy.

Increasing elderly population is a major health concern worldwide, requiring various at-home care services. The aim of home-visit rehabilitation therapy is to support at-home living of the elderly and to promote their participation in social activities. There is a paucity of data about the clinical conditions of this population that can contribute to the achievement of goals in-home visit rehabilitation therapy. This study aimed to clarify clinical variables that could be related to the achievement of goals in-home visit rehabilitation therapy. We collected retrospective clinical data of the older adults who underwent home-visit rehabilitation therapy between July 2006 and June 2021. We searched the clinical variables of home-visit rehabilitation therapy users and their frequency of utilization of home-visit rehabilitation therapy services from the clinical record. The initial and final clinical variables evaluated in this study included the abilities of daily living, degree of being bedridden, dementia rating, and levels of support or long-term care. Those variables were evaluated by rehabilitation therapists and doctors. The users were divided into three groups according to the reason for terminating rehabilitation therapy: goal achievement (achieved group), aggravation of underlying disease (aggravated group),and treatment suspension because of their own/others' wish (suspended group). The clinical parameters concerning the rehabilitation program, care level, and activities of daily living were evaluated among the groups. The clinical parameters concerning the rehabilitation program, care level, and activities of daily living were statistically evaluated among those three groups, using the chi-square test and Kruskal-Wallis test. In the achieved, aggravated, and suspended groups, 45, 190, and 38 users were respectively enrolled. The aggravated group showed significantly higher finalcare level (p = 0.002), degree of being bedridden (p=0.001), and dementia rating (p = 0.017) and significantly lower Barthel index scores (p < 0.001) and Frenchay Activities Index scores (p = 0.001) than the achieved group. Persons requesting the therapy were significantly older adults themselves in the achieved group (p = 0.018). The therapy was significantly performed more than once per week in the achieved group (p = 0.018). Older adults undergoing self-motivated home-visit rehabilitation therapy more than once per week may contribute to the achievement of the goal.

The association between receipt of home care rehabilitation services and acute care hospital utilization in clients with multimorbidity following an acute care unit discharge: a retrospective cohort study

BackgroundIndividuals experiencing multimorbidity have more complex healthcare needs, use more healthcare services, and access multiple service providers across the healthcare continuum. They also experience higher rates of functional decline. Rehabilitation therapists are well positioned to address these functional needs; however, little is known about the influence of rehabilitation therapy on patient outcomes, and subsequent unplanned healthcare utilization for people with multimorbidity. The aims of this study were to: 1) describe and compare the characteristics of people with multimorbidity receiving: home care rehabilitation therapy alone, other home care services without rehabilitation therapy, and the combination of home care rehabilitation therapy and other home care services, and 2) determine the association between home care rehabilitation therapy and subsequent healthcare utilization among those recently discharged from an acute care unit.MethodsThis retrospective cohort study used linked health administrative data housed within ICES, Ontario, Canada. The cohort included long-stay home care clients experiencing multimorbidity who were discharged from acute care settings between 2007–2015 (N = 43,145). Descriptive statistics, ANOVA’s, t-tests, and chi-square analyses were used to describe and compare cohort characteristics. Multivariable logistic regression was used to understand the association between receipt of rehabilitation therapy and healthcare utilization.ResultsOf those with multimorbidity receiving long-stay home care services, 45.5% had five or more chronic conditions and 46.3% required some assistance with ADLs. Compared to people receiving other home care services, those receiving home care rehabilitation therapy only were less likely to be readmitted to the hospital (OR = 0.78; 95% CI: 0.73–0.83) and use emergency department services (OR = 0.73; 95% CI: 0.69–0.78) within the first 3-months following hospital discharge.ConclusionsReceipt of rehabilitation therapy was associated with less unplanned healthcare service use when transitioning from hospital to home among persons with multimorbidity. These findings suggest rehabilitation therapy may help to reduce the healthcare burden for individuals and health systems. Future research should evaluate the potential cost savings and health outcomes associated with providing rehabilitation therapy services for people with multimorbidity.

Indigenous Community-Directed Needs Assessment for Rehabilitation Therapy Services

ABSTRACT The eleven Indigenous communities served by the File Hills Qu’Appelle Tribal Council (FHQTC) in Saskatchewan, Canada have experienced a progressive reduction in access to physical and occupational therapy services. A community-directed needs assessment facilitated by FHQTC Health Services was undertaken in the summer of 2021 to identify experiences and barriers of community members in accessing rehabilitation services. Sharing circles were conducted according to FHQTC COVID-19 policies; researchers connected to community members via Webex virtual conferencing software. Community stories and experiences were collected via sharing circles and semi-structured interviews. Data was analysed using an iterative thematic analysis approach with NVIVO qualitative analysis software. An overarching theme of culture contextualised five primary themes: 1) Barriers to Rehabilitation Care, 2) Impacts on Family and Quality of Life, 3) Calls for Services, 4) Strength Based Supports, and 5) What Care Should Look Like. Each theme is comprised of numerous subthemes amassed by stories from community members. Five recommendations were developed to enhance culturally responsive access to local services in FHQTC communities: 1) Rehabilitation Staffing Requirements, 2) Integration with Cultural Care, 3) Practitioner Education and Awareness, 4) Patient and Community-Centered Care, and 5) Feedback and Ongoing Evaluation.

Older Adults' Demand for Community-Based Adult Services (CBAS) Integrated with Medical Care and Its Influencing Factors: A Pilot Qualitative Study in China.

The number of older people in China who require formal care is increasing. In response, China is creating a service delivery mode of health and social care combination for older people-community-based adult services (CBAS) integrated with medical care-in some provincial capital cities, such as Changsha. However, the needs of most older people for this service delivery mode are not well understood. To assess older people's awareness of and demand for CBAS integrated with medical care and to determine influencing factors. Semi-structured guideline interviews were conducted with 20 older people (aged 65+ years) from two communities at different economic development levels and from a nursing home in Changsha, China. Interviews were analyzed using qualitative content analysis. The specific needs that older adults expect from CBAS integrated with medical care involve daily care, primary care, self-management guidance, rehabilitation therapy services, and mental health services. Contrary to expectations, most interviewees showed low awareness of and demand for CBAS integrated with medical care. Individual, family, and community factors influence older people's demand, as do exogenous variables such as gender and number of children. The influencing mechanism of older people's demand for CBAS integrated with medical care is complex and multifaceted. To implement and promote CBAS integrated with medical care, attention should be given to older people's individual needs, family backgrounds and community environment improvement. Furthermore, improving awareness of integrated care and increasing ageing-in-place opportunities for more older adults is essential and urgent.

A Lesson / An Eye Opener

The pandemic of Coronavirus disease 2019 (COVID-19) has led to serious implications throughout the globe ranging from finance, education, social support to health. There is hardly any aspect left untouched by this fatality. It has also opened our eyes about unequal and unjust distribution of resources among the world where the deprived have seen the worse scenarios. The developed nations tried to cope this situation with their assets while the rest have either suffered or have emerged even stronger. The major burden was definitely on the health services delivery and provision, where the scares means from equipment to space and man power have all played their role. The pandemic has opened the eyes of health policy makers and service providers who were living in deception and have never been ready for certain contagion. We have come to know that the medical services are never enough to deal with similar situation. COVID-19 has taught us the skill of how to be prepared and fight in a worse situation but unfortunately, we have learned this after losing many precious lives. The changes in healthcare practices have also been modified. The infection control (IC) system which should have been a focus prior became a highlight after pandemic. The IC practices in hospitals (public and private sector) were not sufficient and adherence to them wasn’t observed either. Even the majority of services providers and heath care professionals weren’t aware of use of personal protective equipment (PPE); their use and sequences of donning and doffing, except for those working in intensive care units and isolation areas. Thanks to COVID-19 who taught us to be familiar with these things whether their use is un-common. COVID-19 has also been a guide for people in rehabilitation who are prime part of recovery from all illnesses including this pandemic. COVID-19 was found to be a cause of multiple complications i.e. pulmonary, cardiac, neurological, musculoskeletal, psychological and social. Attention was also diverted to recovery in all the mentioned aspects which led to provision and improvements in tertiary care setups with focus on rehabilitation as a mode of full recovery. The stakeholders have started to be more focused on improving the mental and physical aspects of disease along with the physiological. The rehabilitation and physical therapy services have not been spared from the pandemic. Where the physical therapy professionals were not ready and well trained to deal with contagious diseases and safety measures it put us in a bigger challenge. Many clinics and hospitals had scares availability of personnel protective equipment (PPE) which also lead to seriousness of situation. As for provision of physical therapy care direct contact with patients cannot be limited, and lack of knowledge on unavailability of PPE could put therapist’s or the patient’s life in danger. Covid-19 opened the eyes and importance of teaching safety measures and donning and doffing of PPEs was learned with appropriate sequence. Although the well-organized hospitals were also working as per global standard protocols had least difficulty dealing with such issues. The physical therapists are trained to deal with such emergencies and critical situations but not being exposed to a pandemic and emergency like this has made the suppression of such reflexes in practice. The therapist learned to manage patients with optimum precautions making sure that the quality of care is not compromised. Several tele-rehabilitation models have also been develop and practiced to encounter the issue.1, 2 Hence we would take COVID-19 as an eye opener and as taught to be fair in the division of global resources and be prepared for a disaster that doesn’t discriminate among developed and undeveloped nations. The efficient use of services and being aware of emergency and safe healthcare practices can save us from unpredictable disasters like COVID-19.

A comparative approach to quantifying provision of acute therapy services.

This study aims to compare delivery of acute rehabilitation therapy using metrics reflecting distinct aspects of rehabilitation therapy services. Seven general medical-surgical hospitals in Illinois and Indiana prospectively collected rehabilitation therapy data. De-identified data on all patients who received any type of acute rehabilitation therapy (n = 35,449) were extracted and reported as aggregate of minutes of therapy services per discipline. Metrics included therapy types, total minutes, and minutes per day (intensity), as charted by therapists. Extended hospital stay was defined as a length of stay (LOS) longer than Medicare's geometric mean LOS. Discharge destination was coded as postacute care or home discharge. Substantial variability was observed in types, number of minutes, and intensity of therapy services by condition and hospital. The odds of an extended hospital stay increased with increased number of minutes, increased number of therapy types, and decreased with increased rehabilitation intensity. This comparative approach to assessing provision of acute therapy services reflect differential effects of service provision on LOS and discharge destination. Investigators, policymakers, and hospital administrators should examine multiple metrics of rehabilitation therapy provision when evaluating the impact of health care processes on patient outcomes.

Leaders’ Visions of Rehabilitation Services for Children in Ontario’s Schools: Effective Collaboration between Education and Health Sectors

Leaders in Ontario’s district school boards (DSBs) and children’s treatment centers (CTC’s) share responsibility for rehabilitation therapy services in inclusive schools. Children with or at risk of disability rely on these services to enable their participation in learning and social environments. The aim of this study was to explore how leaders in DSBs, CTCs and the community envision effective collaboration in rehabilitation therapy services to advance collaboration in service of children with or at risk of disability and their families. Seven 90-minute online semi-structured focus groups were conducted involving a total of 36 education, community and health leaders and data were analyzed thematically. An eighth focus group comprised of representatives from the seven previous groups was conducted to validate the findings and develop recommendations. Three themes were established: collaboration is a relational and intentional process, forging a path forward to serve children with rehabilitation therapy needs, and leaders’ attributes needed to effect change. The participants recommended the following next steps: clarifying provincial standards for services including roles of all partners, knowledge building within schools, and utilizing existing evidence-based tools. A shared vision of rehabilitation therapy services is needed for effective collaboration between health and education sectors. Future research should involve leaders from health and education sectors, with parents, children and other partners in co-designing, implementing, and evaluating rehabilitation services in schools.

Job-Task Analysis of Vision Rehabilitation Therapists

Introduction: One way to understand a profession is to examine the job tasks undertaken by professionals within the field. The profession of vision rehabilitation therapy is examined by finding the frequency at which 100 specific job tasks are performed on average by current vision rehabilitation therapists (VRTs). Fifty-one of the job task frequencies are compared to 1989 frequencies for changes across the last 28 years. Methods: An anonymous online survey was carried out with current and recently retired VRTs. Participants were asked to rate the frequency at which they perform 100 specific job tasks and 13 demographic questions. Results: One hundred eighty-nine practitioners completed the survey. Mean frequencies for the 100 job tasks fell between a low of 1.08 (slightly above “do not perform the task”) for “writes grants for funding of agency services” and a high of 5.51 (above “perform 4 or 5 times a week”) for “writes case notes and reports for documentation.” Half of the 51 comparable job tasks indicated statistically significant changes in frequency across the 28-year period. Discussion: Statistically significant changes in job task frequencies occurred across job roles of teaching, case management, and professional or administrative activities, indicating that many aspects of the therapist’s job have changed. Individualized teaching remains a common aspect of the job, personalizing the skills taught and the teaching methods, for the individual client. VRTs are less frequently providing consultation to medical and community organizations. Implications for practitioners: The results presented provide an understanding of current job tasks of a practicing VRT. Understanding the changing trends of job tasks may inform university personnel preparation programs to better prepare students for employment demands. Decreasing community outreach may negatively affect the visibility of blind rehabilitation services and inadvertently affect referrals for vision rehabilitation therapy services.

Factors Associated With Medication Use Among Individuals Living With Multiple Sclerosis.

Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system causing neurological deterioration over time. The objective of this study was to examine the predictors associated with MS medication use. The categories that were investigated were various alternative treatments such as complementary/alternative medications (CAMs), rehabilitation therapy and psychotherapy services as well as comorbid health conditions. The Survey on Living with Neurological Conditions in Canada (SLNCC) 2011-2012 was used (N = 73 347) to carry out a logistic regression model. Individuals who did not take CAMs were more (OR = 5.44, 95% CI 1.37-9.29) likely to use medications for MS. Having a mood disorder was associated with greater use of MS medications (OR = 5.39, 95% CI 1.60-18.17) while back problems were associated with lower odds of medication use (OR = 0.38, 95% CI 0.15-0.98). These factors need to be taken into consideration when creating effective medication adherence interventions.

Home care rehabilitation therapy services for individuals with multimorbidity: A rapid review.

Multimorbidity refers to the co-occurrence of two or more chronic conditions, where no one disease is considered the central disease. Individuals with multimorbidity experience increased patient health complexity, increased disability and functional decline, and increased health care utilization. Rehabilitation therapists are well positioned to address the complex functional needs that can contribute to disability for people living with multimorbidity; however, it is not well understood how they address these needs within the home care setting. A rapid review was conducted to identify and synthesize the existing literature on home care rehabilitation services for clients with multimorbidity and the effect of those services. Two electronic databases (Medline and CINAHL) were searched. The Journal of Comorbidity was hand-searched for thoroughness because this journal focuses on populations with multiple chronic conditions. This rapid review included observational and experimental studies that focused on rehabilitation therapy interventions embedded within existing home care systems for adults with multimorbidity. Four studies were included in the final review. The results revealed that therapists delivered interventions aimed towards improving functional outcomes related to activities of daily living and instrumental activities of daily living. Physical therapy interventions were the only therapy delivered in three of the four studies included. Furthermore, 50% of these studies explicitly included people with chronic conditions impacting the musculoskeletal system only. This review offers an important perspective on how home care rehabilitation therapy interventions and outcomes are operationalized for individuals with multimorbidity. Despite the varying definitions of multimorbidity, therapeutic intervention supported functional improvements.

The role of occupational therapy in the Solomon Islands: experiences and perceptions of occupational therapists and rehabilitation health workers.

In most Western countries occupational therapy is well established as a crucial aspect of overall health care; however, in low-middle-income countries it is still an emerging profession. This article investigates the role of occupational therapy in the Solomon Islands by examining the experiences and perceptions of occupational therapists (OTs) and other rehabilitation health workers who have worked there. Using a qualitative research design, participants were recruited using purposive sampling, and data were gathered through in-depth interviews, diary entries and observations of an occupational therapy setting in the Solomon Islands. Ten participants were interviewed. A significant role in health-promoting practices was revealed through the various tasks undertaken by OTs in the Solomon Islands, including influencing health policy and practice broadly through advocacy and education. Challenges relating to geography, cultural, language and resource barriers, and professional practice issues were identified. Implications for practice were drawn from the data including the need for culturally safe practice, pragmatism, creativity and practising across disciplinary boundaries. Results illustrate a clear role for occupational therapy in promoting health and sustainability of rehabilitation therapy services in the Solomon Islands, which also have relevance throughout Pacific island nations.

The congressional mandate: standardised post-acute care quality measures

Background/Aims This study describes the relationships between rehabilitation services intensity, post-acute care measures of Functional Performance Change, and length of stay for episodes of care provided in 93 skilled nursing facilities in the US. Methods The study used a secondary analysis of existing data on Medicare beneficiaries admitted to skilled nursing facilities from acute hospitals (n=518) who subsequently returned to the community. Data were selected from Minimum Data Set Section GG items reported by therapists. Results Statistically significant correlations were identified between rehabilitation services intensity and functional outcomes (P&lt;0.001); and between rehabilitation intensity, medical condition, and length of stay (P&lt;0.001) for rehabilitation patients in skilled nursing facilities. Conclusions The intensity of occupational and physical rehabilitation therapy services correlate with patients achieving higher functional outcomes, specifically improvement in self-care and mobility.

Experience of Robotic Exoskeleton Use at Four Spinal Cord Injury Model Systems Centers.

Refinement of robotic exoskeletons for overground walking is progressing rapidly. We describe clinicians' experiences, evaluations, and training strategies using robotic exoskeletons in spinal cord injury rehabilitation and wellness settings and describe clinicians' perceptions of exoskeleton benefits and risks and developments that would enhance utility. We convened focus groups at 4 spinal cord injury model system centers. A court reporter took verbatim notes and provided a transcript. Research staff used a thematic coding approach to summarize discussions. Thirty clinicians participated in focus groups. They reported using exoskeletons primarily in outpatient and wellness settings; 1 center used exoskeletons during inpatient rehabilitation. A typical episode of outpatient exoskeleton therapy comprises 20 to 30 sessions and at least 2 staff members are involved in each session. Treatment focuses on standing, stepping, and gait training; therapists measure progress with standardized assessments. Beyond improved gait, participants attributed physiological, psychological, and social benefits to exoskeleton use. Potential risks included falls, skin irritation, and disappointed expectations. Participants identified enhancements that would be of value including greater durability and adjustability, lighter weight, 1-hand controls, ability to navigate stairs and uneven surfaces, and ability to balance without upper extremity support. Each spinal cord injury model system center had shared and distinct practices in terms of how it integrates robotic exoskeletons into physical therapy services. There is currently little evidence to guide integration of exoskeletons into rehabilitation therapy services and a pressing need to generate evidence to guide practice and to inform patients' expectations as more devices enter the market.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A231).

Editors' note: Utilization of rehabilitation therapy services in Parkinson disease in the United States

In “Utilization of rehabilitation therapy services in Parkinson disease in the United States,” Fullard et al. analyzed 174,643 Medicare beneficiaries with a diagnosis of Parkinson disease (PD) in 2007 and followed them through 2009. They found based on claims data that only a minority of individuals with PD had obtained physical therapy, occupational therapy, or speech therapy. They concluded that rehabilitation therapy utilization among older patients with PD in the United States is lower than reported for countries with comparable health care infrastructure. They also found that neurologist care is associated with rehabilitation therapy use; provider supply is not. Commenting on the article, Drs. Bryant and Protas share the results of their own retrospective study using data from electronic medical records at the Veterans Administration, a non-fee-for-service system, which yielded similar results. In “Utilization of rehabilitation therapy services in Parkinson disease in the United States,” Fullard et al. analyzed 174,643 Medicare beneficiaries with a diagnosis of Parkinson disease (PD) in 2007 and followed them through 2009. They found based on claims data that only a minority of individuals with PD had obtained physical therapy, occupational therapy, or speech therapy.

Author response: Utilization of rehabilitation therapy services in Parkinson disease in the United States.

We thank Drs. Bryant and Protas for the comment on our article,1 and for pointing out their supportive study.2 Together, our data suggest that underutilization of rehabilitation therapies in Parkinson disease (PD) is persistent and pervasive. During the time period of these 2 studies, several randomized controlled trials were published that supported the use of rehabilitation therapies in PD.3,4 Improvements in mobility, activities of daily living, speech volume, and quality of life were demonstrated in these and other studies. This is another example of the gap between PD research and implementation. The barriers to dissemination of proven treatments need to be addressed for PD outcomes to improve.

Reader response: Utilization of rehabilitation therapy services in Parkinson disease in the United States.

We read with interest the article by Fullard et al.1 regarding the utilization of rehabilitation in Parkinson disease (PD). This article presents the most robust data reflecting utilization of rehabilitation by people with PD in the United States, because the authors used Medicare claim records. Rehabilitative therapies are a necessary adjunct to the management of PD. In addition, they are recommended to be prescribed early in the disease process.2 Fullard et al. revealed that rehabilitation is underutilized in the United States compared to other countries.3,4 They also found that Medicare beneficiaries who visited a neurologist often used rehabilitation services more than those with less frequent visits.

Parent/carer views on personal health budgets for disabled children who use rehabilitation therapy services

Personalised budgets are promoted as the person-centred alternative to generically provided services. Nine parents/carers of disabled children (aged 18 years or younger) who accessed at least two rehabilitation therapy services (physiotherapy, occupational therapy, and speech and language therapy) were recruited from one region in England. Focus group/interviews explored their views on the proposed introduction of personalised budgets. Parents and carers viewed a personal health budget with caution and perceived benefits were tempered by their experiences of current provision. Concerns were raised about entitlement and how a personal budget would work in practice.

Utilization of rehabilitation therapy services in Parkinson disease in the United States.

To examine rehabilitation therapy utilization for Parkinson disease (PD). We identified 174,643 Medicare beneficiaries with a diagnosis of PD in 2007 and followed them through 2009. The main outcome measures were annual receipt of physical therapy (PT), occupational therapy (OT), or speech therapy (ST). Outpatient rehabilitation fee-for-service use was low. In 2007, only 14.2% of individuals with PD had claims for PT or OT, and 14.6% for ST. Asian Americans were the highest users of PT/OT (18.4%) and ST (18.4%), followed by Caucasians (PT/OT 14.4%, ST 14.8%). African Americans had the lowest utilization (PT/OT 7.8%, ST 8.2%). Using logistic regression models that accounted for repeated measures, we found that African American patients (adjusted odds ratio [AOR] 0.63 for PT/OT, AOR 0.63 for ST) and Hispanic patients (AOR 0.97 for PT/OT, AOR 0.91 for ST) were less likely to have received therapies compared to Caucasian patients. Patients with PD with at least one neurologist visit per year were 43% more likely to have a claim for PT evaluation as compared to patients without neurologist care (AOR 1.43, 1.30-1.48), and this relationship was similar for OT evaluation, PT/OT treatment, and ST. Geographically, Western states had the greatest use of rehabilitation therapies, but provider supply did not correlate with utilization. This claims-based analysis suggests that rehabilitation therapy utilization among older patients with PD in the United States is lower than reported for countries with comparable health care infrastructure. Neurologist care is associated with rehabilitation therapy use; provider supply is not.

Allocation of Rehabilitation Services for Older Adults in the Ontario Home Care System.

Background: Physiotherapy and occupational therapy services can play a critical role in maintaining or improving the physical functioning, quality of life, and overall independence of older home care clients. Despite their importance, however, there is limited understanding of the factors that influence how rehabilitation services are allocated to older home care clients. The aim of this pilot study was to develop a preliminary understanding of the factors that influence decisions to allocate rehabilitation therapy services to older clients in the Ontario home care system, as perceived by three stakeholder groups. Methods: Semi-structured interviews were conducted with 10 key informants from three stakeholder groups: case managers, service providers, and health system policymakers. Results: Drivers of the allocation of occupational therapy and physiotherapy for older adults included functional needs and postoperative care. Participants identified challenges in providing home care rehabilitation to older adults, including impaired cognition and limited capacity in the home care system. Conclusions: Considering the changing demands for home care services, knowledge of current practices across the home care system can inform efforts to optimize rehabilitation services for the growing number of older adults. Further research is needed to advance the understanding of, and optimize rehabilitation service allocation to, older frail clients with multiple morbidities. Developing novel decision-support mechanisms and standardized clinical care pathways for older client populations may be beneficial.