Enhanced Medical Rehabilitation: Effectiveness of a clinical training model

Abstract

Background: Patient engagement in medical rehabilitation can be greatly influenced by their provider during therapy sessions. We developed Enhanced Medical Rehabilitation (EMR), a set of provider skills grounded in theories of behavior change. EMR utilizes 18 motivational techniques focused on providing frequent feedback to patients on their effort and progress and linking these to patient goals.

Objective: To examine the effectiveness of a clinical training protocol for clinicians to do EMR, as measured by clinician adherence.

Methods: A physical therapist, physical therapist assistant, occupational therapist, and certified occupational therapist assistant were trained in EMR. Training consisted of five formal training sessions and individual and group coaching. Adherence to EMR techniques was measured during two phases: Pre-Training and Maintenance, with an a priori target of 90% adherence by clinicians to each EMR technique.

Results: With training and coaching, clinician adherence per therapeutic activity significantly improved in 13 out of 18 items (p < 0.05). The target of 90% adherence was not achieved for many items.

Conclusions: Our training and coaching program successfully trained clinicians to promote patient engagement during therapeutic service delivery, although not typically to 90% or greater adherence. Ongoing coaching efforts were necessary to increase adherence.

Keywords: Therapeutic engagement; rehabilitation; skilled nursing facility.

Conflict of interest statement

Declaration of Interest

We certify that no party having a direct interest in the results of the research supporting this article has or will confer a benefit on us or on any organization with which we are associated AND, if applicable, we certify that all financial and material support for this research (eg, NIH or NHS grants) are listed below:

Supported by the partial salary provided by National Institutes of Health (NIH) grant R01 MH099011A1 (MDB, RLB, PB, EML, CEL, EJL). Dr. Lenze receives research support from NIH, FDA, McKnight Brain Research Foundation, Taylor Family Institute for Innovative Psychiatric Research, Barnes Jewish Foundation, Takeda, and Lundbeck.

Figures

Figure 1. Study design of training clinicians in EMR

An outline of the five initial training sessions held with the rehabilitation clinicians.

Figure 2. Mean clinician adherence of two Enhanced Medical Rehabilitation techniques over time, from Pre-Training throughout Maintenance

The mean clinician completion of Enhanced Medical Rehabilitation items from Pre-Training through the 15 months of Maintenance. Two items with different patterns of adherence across the timeframe were selected.