A descriptive analysis of physical therapy group intervention in five midwestern inpatient rehabilitation facilities

Journal of Physical Therapy Education, Spring 2000 by Gelsomino, Kristi L, Kirkpatrick, Lisa A, Hess, Rebecca R, Gahimer, Julie E

ABSTRACT. Throughout the nation, the rapidly changing health care system has led to the use of more cost-effective and time-efficient means of intervention in rehabilitation. Group therapy has been utilized as a solution to these challenges. The purpose of this study was to describe the characteristics, utilization, frequency, and implementation of therapeutic groups in five midwestern inpatient rehabilitation facilities. Staff and group participants were observed within these facilities in order to describe each facilities 'group intervention. Clinic visitations were arranged, and data were collected by means of a data collection tool, researcher observations, and staff interviews. Information was gleaned regarding number of patients seen per day; predominance of group therapy versus individual therapy, number and types of groups offered, number of patients per group, number of offerings per week, length of group sessions, staff involvement, billing issues, and subjective reactions from group leaders and patients. Responses given during data collection were used to describe characteristics, utilization, frequency, and implementation of groups. All facilities were treating more than 60 patients per day. All facilities were using a combination of individual therapy and group therapy The number of groups per facility varied from 2 to 9. The most commonly offered groups included: spinal cord injury, mat, upper ex

tremity, stroke, gait/ambulation, and wheelchair. The number of patients per group varied from 3 to 12. Group treatments were conducted 1 to 6 times per week. Group meeting times varied from 30 to 120 minutes. Group leaders were either physical therapists or physical therapist assistants in all facilities. Facilities 'group charges ranged from 33% to 100% of their individual treatment charges. Group leaders described group physical therapy as a good adjunct to individual therapy. Many of the participants appeared to enjoy the groups and were motivated by each other Group intervention is a viable option to the demands placed on therapists with shortened length of stays and decreased reimbursement.

INTRODUCTION

Throughout the nation, the rapidly changing health care system has led to the use of more cost-effective means of intervention for patients undergoing rehabilitation. Health care costs have increased five times the general inflation rate.1 Current trends in health care have allowed less time for patients to be seen in rehabilitation.2 Organizing therapeutic groups has been beneficial to the health care system by decreasing the cost and time spent for rehabilitation.3-6 According to Gauthier and colleagues, "The group approach is ... very cost-effective, only one or two therapists are needed for 8-10 patients for a period of 20 hours.."4(P363> The placement of patients into groups for therapy not only has been proposed to increase the speed of recovery7,8 but also has been shown to decrease costs of physical therapytreatments.1,3,6

PHYSICAL THERAPY LITERATURE

In the physical therapy literature, a lack of referred publications exists regarding therapeutic group intervention; however, several published abstracts address the use of physical therapy groups in the outpatient setting.9-15 More relevant to this research are those containing information on inpatient groups that describe dividing group treatment classes into the type of activity the group performs. For example, transfer and ambulation groups,16 bronchopulmonary fitness groups,17 balance groups,18 functional exercise,19 and interdisciplinary community reentry groups20 have been proposed.

The New American Webster Handy College Dictionary defines a group as "a number of persons or things gathered or classified together, usually because of likeness or common purpose."21(p242> Duncombe and Howe define a group as "an aggregate of people who share a common purpose which can be attained only by group members interacting and working together."3(p202) In relation to these definitions, inpatient and outpatient groups are generally categorized according to patient diagnosis or group activity.

In 1987, Nishimoto and Schunk6 presented a case in which physical therapy treatment groups were initiated due to an inadequate number of therapists to handle the large number of patient referrals. All patients were initially evaluated with individual functional goals established. The patient's functional status primarily determined appropriateness for group therapy versus individual therapy, although diagnosis was also a consideration. The group treatments focused on exercises followed by functional activities in follow-theleader, buddy system, or circuit training formats. Treatment outcomes for patients in these groups included increased socialization, camaraderie, attention span, memory skills, and progress toward individual goals.

Szekely and colleagues7 provided comprehensive group therapy to patients with Parkinson disease and their families. Seven volunteers participated in a 13-week course of 2-hour sessions, with the first hour consisting of exercises for flexibility, walking, and marching. Families were included in this session, and cassettes and exercise logs were given to each patient to reinforce exercising at home. In the second hour, family members met in a group with a nurse coordinator and a nurse psychologist and discussed home and family issues. Meanwhile, patients met with the physical therapist, a nurse coordinator, and a nurse psychologist for further discussion, support, and education. Improvements in objective gait measures and reports of psychological gains were noted.

Kurasik8 studied 15 patients with cerebrovascular accidents, of which 10 patients were treated with group therapy and 5 patients were treated individually for rehabilitation. All patients receive therapy two times each day for 5 days. At the end of 2 weeks, the group therapy patients showed greater gains in function and mental attitude compared with the individually treated patients.