My Therapy: Effect of Self-Managed Occupational Therapy and Physiotherapy on Rehabilitation Outcomes

When wards transition to experimental conditions (i.e. My Therapy), all patients will continue with their usual rehabilitation plan. In addition, the patient's usual Occupational Therapist (OT) and Physiotherapist (PT) will provide patients with a sub-set of usual care exercises and activities to be practiced independently (where it is deemed safe and appropriate), outside of supervised sessions. These exercises and activities may be performed in the patients’ rooms on the ward or other designated independent practice areas. The intervention will be progressed as required throughout the rehabilitation admission and can be updated by the occupational therapist and physiotherapist as often as required, based on the clinical judgement of the therapist as to when they are ready to progress or require modifications to their progress. The number of repetitions and sets will be specified, and can be updated by the OT and PT as often as required. While a goal will be set for the amount of independent practice, it is the patient who decides the number of sessions, the durations of the sessions and the number of repetitions. The total duration of the intervention will vary depending upon the length of the patient’s rehabilitation admission, up to a maximum of 48 weeks. The intervention will commence on admission to rehabilitation or shortly following admission, and conclude on discharge from rehabilitation. The exercises and activities will be delivered to patients via a program called ‘Physiotherapy Exercises (PTX)®’. The treating clinician will log into PTX, select the My Therapy exercises and activities for the individual patient, and then send the My Therapy program to the patient via SMS or email (or they can print out the My Therapy program as a booklet). Patients will use their own device to access the exercises. Examples of exercises and activities may include: Calf raises in standing, knee extension while seated, lower body dressing practice. Additional materials include adjuncts to the prescribed tasks and exercises such as written cognitive tasks, hand weights and TheraBand. To measure adoption of My Therapy, each of the eight wards will be audited in week three of each six-week block by the site coordinator. The audit will capture information regarding the number of patients on the ward and the number of patients engaged in the My Therapy program for experimental wards. For a subset of 120 participants, a self-reported activity log will be used to assess or monitor adherence to the intervention. Adherence will also be monitored via an audit of the patient’s PTX account, where they can record task completion. To ensure there is no cross-contamination between the control condition and the experimental condition, any patients who experience both the control and experimental condition at the point of transition to the experimental condition, will be excluded. This “wash out” period is expected to last up to 18 days, which is the state average length of stay for rehabilitation in-patients in public health.