Function in Sitting: Outcomes for Occupational Therapy in the Acute Phase of Stroke Recovery

PURPOSE: The aim of this study was to assess the impact of activity of daily living (ADL) interventions on functional sitting balance as measured by the Function in Sitting Test (FIST; Gorman et al., 2010) for participants diagnosed with acute subarachnoid hemorrhage (SAH). Currently, there is a gap in the evidence regarding the effect of bedside acute care occupational therapy ADL interventions on the sitting balance of patients with an acute SAH as measured by a standardized, valid, and reliable assessment tool.

METHOD: In this quasi–experimental, single–group, within–subjects design study, the independent variable was ADL intervention and the dependent variable was numerical score on the FIST. Eight participants were recruited through convenience sampling from among patients admitted to an acute care setting with the following inclusion criteria: diagnosis of acute SAH, ability to follow one–step commands, orientation to self, age 18 and older, and English as their primary language.

Participants were initially measured using the FIST, a standardized sitting balance assessment consisting of 14 tasks that take an average of 15 min to complete (Gorman et al., 2010). This assessment has strong concurrent validity (.85; Samuel Merritt University, 2016) and excellent inter– and intrarater reliability (Gorman et al., 2014). After initial assessment, participants received a cycle of three ADL interventions and a FIST reassessment until discharge.

Participants’ total FIST scores were categorized on a ratio scale (Jackson, 2016). We analyzed the data using multiple paired sample t tests (Jackson, 2016) with the alpha level preset to .01. IBM SPSS Statistics (IBM Corp., Armonk, NY) was used to analyze the data.

RESULTS: No significant difference was found between any pairs. Graphic depictions showed improvements in FIST scores with continued reassessments based on continued ADL treatment sessions.

CONCLUSION: Although the results were not statistically significant, participants demonstrated clinically improved sitting balance over time associated with the ADL intervention. Therefore, the findings of this study tend to support the use of an occupation–based ADL intervention as an effective approach to improving patients’ sitting balance after stroke in acute care settings and represent the only evidence available to date. Future research is needed, but until then occupational therapy practitioners can use these findings to improve the quality of patient care when carrying out ADL treatments and measuring the outcomes of sitting balance with a reliable and standardized assessment tool such as the FIST.

IMPACT STATEMENT: The results of this study represent the only evidence available to date regarding the completion of self–care tasks and sitting balance in the acute care setting for patients with acute stroke. This study highlights the importance of completing edge–of–bed self–care tasks, and acute care occupational therapy practitioners can use these findings to inform the standard of care for patients when executing ADL interventions and measuring sitting balance with a sensitive standardized assessment tool such as the FIST.

References

Gorman, S. L., Harro, C. C., Platko, C., & Greenwald, C. (2014). Examining the Function in Sitting Test for validity, responsiveness, and minimal clinically important difference in inpatient rehabilitation. American Congress of Rehabilitation Medicine, 95, 2304–2311. https://doi.org/10.1016/j.apmr.2014.07.415

Gorman, S. L., Radtka, S., Melnick, M. E., Abrams, G. M., & Byl, N. N. (2010). Development and validation of the Function in Sitting Test in adults with acute stroke. Journal of Neurologic Physical Therapy, 34, 150–160. https://doi.org/10.1097/NPT.0b013e3181f0065f

Jackson, S. L. (2016). Research methods and statistics: A critical thinking approach (5th ed.). Boston: Cengage Learning.

Samuel Merritt University. (2016). Function in Sitting Test. Available from http://www.samuelmerritt.edu/fist