Enhanced Medical Rehabilitation: Effectiveness of a clinical training model.
Marghuretta D Bland, Rebecca L Birkenmeier, Peggy Barco and 3 others
PMID 27689608WHAT IT FOUND
Training four therapists in Enhanced Medical Rehabilitation improved or maintained use of 18 engagement techniques, and 13 of 18 items increased.
Adherence was variable and below the 90% goal for many techniques. This tested therapist behavior, not patient recovery.
Key findings
01After training and coaching, therapist adherence to EMR techniques improved or stayed the same, and 13 of 18 items increased significantly.
02Many techniques still did not meet the 90% adherence goal during maintenance.
03Adherence to asking what goal to work on rose from less than 5% before training to 70% at the start of maintenance, then dropped.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Only four clinicians were trained, and they were chosen for logistical reasons rather than random selection. Training was voluntary, and one clinician opted out, so the trained clinicians may be more motivated than typical staff. The study measured therapist adherence, not patient outcomes, and the larger trial had not yet shown that EMR improves recovery. Adherence was variable, often below the 90% goal, and some techniques faded during maintenance. Patients were non-demented and had been walking prior, so results may not apply to more impaired nursing-facility patients. Observations were not independent because the same clinicians treated the same patients over multiple sessions. Only one team used EMR, and only in trial-eligible patients randomized to the EMR condition, limiting generalizability. Five items were observed infrequently, reducing the ability to detect small changes.
Declared interests
No competing interests were declared. The work was supported by partial salary from NIH grant R01 MH09901.
The easy way to misread this
Do not read the improved use of engagement techniques as proof that EMR helps patients recover. This paper measured therapist behavior only, and the larger trial has not yet shown patient outcomes.