Effects of Recreational Therapy on Functional Independence of People Recovering From Stroke
The purpose of this study was to examine the effects of recreational therapy (RT) on the functional independence of people recovering from stroke. Participants were adolescents and adults (N = 960) receiving recreational therapy and other treatment from an acute care hospital. Dependent variables were change scores (from admission to discharge) on the motor subscale, cognition subscale, and total Functional Independence Measure (FIM). Independent variables were number of treatment units of RT, physical therapy, occupational therapy, speech therapy, and psychological services. Data were analyzed using separate stepwise multiple regressions for each dependent variable. RT was a significant predictor of change scores for all three dependent variables. Results confirm the therapeutic value of RT services in the treatment of stroke.
KEY WORDS: recreational therapy, stroke, functional independence, FIM, efficacy research
Stroke is the leading cause of adult disability and a leading cause of death among Americans (Williams, Weinberger, Harris, Clark, & Biller, 1999). According to the American Stroke Association (n.d.), approximately 700,000 Americans experience a stroke each year, and approximately 157,000 of these people die as a result. Of the more than halfmillion people annually who survive stroke, various therapeutic interventions are recommended to remediate the cognitive and physical effects. Among the professionals treating people who have experienced stroke are Certified Therapeutic Recreation Specialists (CTRS’s).
No data exist confirming the precise number of CTRS’s treating people who have experienced stroke. However, stroke occurs most often in older adults (National Stroke Association, 2006), a population served by more than a quarter of CTRS’s (NCTRC, n.d.). Thus it can be reasonably assumed that stroke represents a significant number of clients of recreational therapy (RT) services.
Calls for efficacy research in RT are longstanding, and these calls typically include a focus on functional independence. In 1991, Shank and Kinney suggested that RT researchers focus on outcomes that could be appreciated by health care professionals both in and outside of RT. Shank, Kinney, and Coyle (1993) suggested a research agenda for the profession that included a focus on functional abilities. These suggested were further elaborated by Shank, Coyle, Boyd, and Kinney (1996) who recommended that RT researchers place their research within the larger context of rehabilitation and focus at least part of their efforts on the effects of recreational therapy on functional limitations. Carruthers (1997) reported results of a survey of RT practitioners and educators. Results confirmed that survey respondents valued efficacy research related to, among other health care priorities, effects of RT services on independent functioning. Wilhite, Keller, Collins, and Jacobson (1996) investigated the research priorities of recreational therapists and reported that effects of RT on functional independence was among the five highest priorities of RT professionals. Recently, the American Therapeutic Recreation Association (ATRA) published a research agenda identifying five target areas for efficacy research (ATRA, 2004). Two of these areas are directly related to stroke: (a) functional mobility and (b) obesity and active lifestyles. Stroke often negatively affects the functional mobility of people (Green, Forster, Bogle, & Young, 2002), and both obesity (Suk et al., 2003) and physically inactive lifestyles (Sacco et al., 1998) are risk factors for stroke.
To determine effects of an intervention on functional abilities, practitioners and researchers in rehabiUtation rely on several different high-quality assessment instruments. One of the more common assessment tools used to evaluate the functional abilities of people who have experienced stroke is the Functional Independence Measure (FIM) (Deutsch, Braun, & Granger, 1997). The FIM is a quantitative assessment instrument that yields cognition, motor and total scores of functional independence of people with a variety of disabilities, illnesses, and conditions. Results of the FIM can be used by practitioners and researchers to demonstrate functional change.
Despite the frequency with which CTRS’s treat people who have experienced stroke and the call to relevant efficacy research issued by numerous RT scholars and professional organizations, relatively Utile research has been done into the effects of RT services on functional skills deficits resulting from stroke. To date, there have been no large-scale studies published describing effects of RT on the functional independence of people who have experienced stroke. However, research in other fields support further investigation of the contribution of RT to the rehabilitation process.
There is a large volume of research into the effects of the rehabilitation following stroke that either directly or indirectly suggests that RT can be an effective contributing intervention. Several researchers have used meta-analyses to summarize known effects. For instance, Ottenbacher and Jannell’s (1993) meta-analysis included 36 clinical trials. The researchers concluded that stroke rehabilitation was effective at improving functional performance, particularly when started soon after a stroke occured. Langhorne and Duncan (2001) conducted a meta-analysis of research into models of care following stroke and concluded that when compared to alternate models (e.g., treatment in a general hospital ward), multidisciplinary stroke rehabilitation reduced the risk of mortality, long-term dependence, and institutionalization. Kwakkel et al.’s metaanalysis (2004) of the effects of therapeutic exercise following stroke demonstrated significant improvement in activities of daily living as a result of the intervention.
