Unpacking the black box of therapy - a pilot study to describe occupational therapy and physiotherapy interventions for people with stroke

Objective: To describe the components used in the practice of occupational therapy and physiotherapy for people with stroke and to examine variability between services. Design: A time-sampling strategy in which therapists recorded their face-to -face interventions with stroke patients during 12 weeks over a total of 17 months. Settings and subjects: Six occupational therapists and seven physiotherapis ts from four services (three day hospitals and one domiciliary stroke rehab ilitation service) recorded interventions with 89 stroke patients recruited to a larger randomized controlled trial. Main outcome measures: Frequencies of use of interventions, together with o ther details about delivery of therapy, were recorded using a data collecti on booklet and coding system designed by the participating therapists. Results: The median treatment time for a session was 45 minutes. The most f requently recorded components of physiotherapy intervention were 'walking', 'standing balance' and 'upper limb movement pattern', and of occupational therapy 'physical function', 'social and leisure activities' and 'other'. T here was variability between the services in terms of median treatment time , use of intervention codes, frequency of treatment sessions, amount of tim e spent working with assistance and amount of group work. Conclusions: The findings support the view that occupational therapy and ph ysiotherapy with people with stroke are not homogeneous activities, and var y between therapists and services. Recommendations include further developm ent of the tool, and use of other methodologies to explore the process and nature of stroke rehabilitation.