Although it is commonly assumed that the therapies delivered during inpatient rehabilitation are effective, there is generally little direct evidence that demonstrates a clear relationship between typical therapeutic practice and enhanced functional outcomes (Heinemann et al. 1995). Moreover, there is no evidence that establishes a recommended intensity or amount of therapy that should be delivered to produce a desired result. In SCI rehabilitation, there exists a paucity of studies that examine this issue.
Heinemann et al. (1995) employed a case series design to examine the effect of increased therapeutic intensity on functional rehabilitation outcomes as indicated by motor, cognitive and total FIM scores as well as FIM efficiencies. These investigators performed a comprehensive chart review of patients with SCI (N=106) and traumatic brain injury (N=140) to determine the number of 15-minute therapy units delivered in the provision of PT, OT, SLT and Psychology services. They then performed multiple regression analyses to determine if the amount of therapy was associated with positive outcomes. For the most part, there was little evidence that increased therapeutic intensity had any effect on improving outcomes for the SCI sub-sample although the paucity of well-controlled studies in this area limits the strength of the conclusions that can be drawn.
There is level 4 evidence based on a single case series that increased therapeutic intensity may not be associated with any functional benefit as measured by the FIM.