Using activity-based therapy for individuals with spinal cord injury or disease: Interviews with physical and occupational therapists in rehabilitation hospitals

Objective To understand if and how physical therapists (PTs) and occupational therapists (OTs) use activity-based therapy (ABT) and its associated technologies for the rehabilitation of individuals living with spinal cord injury or disease (SCI/D) in Canadian rehabilitation hospital settings. Design Qualitative study. Setting Through rehabilitation hospitals participating in the Rick Hansen Spinal Cord Injury Registry, we recruited licensed OTs and PTs to participate in focus groups. Participants Twelve PTs and ten OTs from nine sites across eight provinces participated. Outcome Measures To inform the development of a semi-structured interview guide, we used the Theoretical Domains Framework. To analyze the data, we used interpretive description. Results We identified three themes that influenced therapists' use of ABT and associated technologies for SCI/D rehabilitation. (1) Therapists' decision-making approach to ABT and technology. Therapist roles, site-specific dynamics and goal setting influenced decision-making. Assuming roles such as mentor, liaison and advocate led to more ABT use. Site-specific dynamics concerned levels of ABT knowledge, teamwork, and staffing. In hospital rehabilitation, there was competition between discharge and neurorecovery goals. (2) Therapist perceived individual factors. Patient factors either increased (i.e. patients' motivation, self-advocacy) or prevented (i.e. mourning period, tolerance) the likelihood that ABT was introduced by therapists. (3) ABT and equipment access. Technology was used for ABT in a variety of ways. Access was affected by visible (e.g. equipment cost) and invisible barriers (e.g. departmental relations). Conclusions The use of ABT and its associated technologies in Canadian rehabilitation hospitals is variable. Ongoing education could be offered, and site-specific implementation strategies could be developed, to promote ABT use.

Automated summary

This study investigated the use of activity-based therapy (ABT) and its associated technologies by physical therapists (PTs) and occupational therapists (OTs) in Canadian rehabilitation hospitals for individuals with spinal cord injury or disease (SCI/D). The results identified three themes that influenced therapists' use of ABT and associated technologies, including decision-making approaches, perceived individual factors, and ABT and equipment access. The findings suggest the need for ongoing education and site-specific strategies to promote ABT use in Canadian rehabilitation hospitals.