Understanding the Nature of Home Exercise Programs for Persons With Neurological Injuries

PURPOSE: The purpose of this study was to investigate current occupational therapy (OT) practices in the usage, prescriptions, and clinical reasoning of home exercise programs (HEPs) for clients with neurological injuries (CWNIs).

BACKGROUND: To date, there is insufficient evidence to determine the effectiveness of home-based rehabilitation for improving activity of daily living function and quality of life for CWNIs. Furthermore, clinical guidelines provide limited recommendations for HEPs and fail to include the appropriate dosage, content, and methods for client education. This study is significant because it explores current OT practices of HEPs and provides an initial step that links practice, evidence, guidelines, and practitioner education.

DESIGN: This study was a mixed-methods survey approach.

PARTICIPANTS: Using the American Occupational Therapy Association list rental service, the survey instrument was mailed to 2,000 OTs from the following categories: Special Interest Sections (Gerontology, Physical Disabilities, Home and Community Health, Technology, and Work and Industry); work settings (free-standing outpatient, home health, hospital, private practice, rehabilitation hospital, subacute facility, work/industry/ergonomics, community based, skilled nursing/long-term care); and practice areas (geriatrics, hand therapy, home/community modification, physical disabilities, prevention/health promotion, private practice, visual impairment, work/ergonomics).

METHOD: The survey was developed from semistructured interviews and focus groups with occupational therapists. Questions on the survey included demographics, current practices of HEPs, and attitudes toward using HEPs with CWNIs.

ANALYSIS: Data were entered into a RedCap database and checked for accuracy. The data were exported into Excel, and quantitative questions were analyzed using descriptive statistics. Open-ended questions were coded by two separate researchers, and themes were allowed to emerge from the data.

RESULTS: The largest majority of participants had been practicing occupational therapists for >20 yr, and most participants worked in hospitals or inpatient and outpatient facilities. The most commonly prescribed HEP activities were preparatory in nature (e.g., range of motion, fine motor activities), and prescriptions were for a HEP to be done every day for 16–30 min/day. Participants were in agreement on the benefits of a HEP, which included carryover of skills and more rapid achievement of goals. Participants were also in agreement on their clinical reasoning for a HEP; however, they were less in agreement on the methods used to implement and progress a HEP.

DISCUSSION: The findings from this study highlight the gap between practice and evidence. Although participants were able to clearly articulate the clinical reasoning for a HEP, the dosage prescribed (16–30 min/day) and the content (preparatory activities) are not in alignment with current evidence. The range of implementation strategies used by participants is evidence of client-centered care; however, the efficacy of such strategies are likely limited due in part to the lack of clear, specific clinical guidelines. Based on the findings from this study, practice guidelines for HEPs for CWNIs should include recommendations for dosage, intensity, strategies for educating clients and caregivers, suggestions and tools for using technology effectively, and supports for managers/administrators in standardizing practice.

IMPACT STATEMENT: This research is important to OT practice and policy because it provides clear indications of the gap between current practice and evidence. To improve practice, these findings should be taken into consideration when drafting clear, evidence-based practice guidelines for HEPs for CWNI.