The feasibility of increasing inpatient rehabilitation therapy duration by implementing an additional self-directed independent exercise program: My Therapy.

The My Therapy program includes Occupational Therapy and Physiotherapy directed self-directed management elements. These are prescribed on an individual basis, dependent on therapist discretion and may include any of the following: -cognitive rehabilitation - relaxation and mindfulness -upper limb management -lower body dressing - surgical precautions -bed transfers - strength, balance and range of movement exercises for both the upper limb and lower limb Eligible patients will begin the My Therapy program on Day 2 of their admission, when admitted Monday to Friday. Those patients admitted over a weekend or public holiday however, will commence their My Therapy on Day 3 or 4 of admission. Patients will then be described 1, 2, or 3, sessions to complete daily during their admission from time of consent to discharge. The independent My Therapy sessions shall be undertaken outside of formal therapy areas, most likely in the patient's hospital room. The exercises that a patient completes as part of their My Therapy program, shall be provided in writing in the 'My Therapy' booklet that is kept by the patient, with an additional copy kept by the therapist to file in the medical record. Exercises will be prescribed by the patient's treating Physiotherapist and Occupational Therapist. Patients will be prescribed a therapy set of exercises to perform between one and three times per day during their admission, dependent upon their rehabilitation goals. The amount of time that it takes a patient to complete their exercises will be recorded in their diary. Patients will not be supervised during their My Therapy additional exercises, as those patients prescribed independent exercises are assessed by their therapist(s) as being safe for the patient to complete independently. Exercises that may be prescribed may include, but are not limited to: 1) Upper Limb Exercises - shoulder shrug, scapula setting, elbow bends, arm raising, arm pulls 2) Seated Lower Limb Exercises - ankle pumps, seated marching, knee straightening, 3) Lower Limb Exercises - walking, sit to stand, squats, heel raises, straight leg behind, straight leg to the side, high knees, knee bends. Cognitive Rehabilitation help stimulate the brain and keep the mind active. Exercises are prescribed by your Occupational Therapist and include memory skills, executive functioning and thinking skills. Mindfulness is a simple exercise, that when performed regularly, assists with muscle tension release and improves sleep. Your Occupational Therapist will guide you through the script contained in your My Therapy Booklet to encourage deep breathing and restfulness. Lower body dressing focuses upon the education and self practice in use of assistive aides including pick up sticks, long shoe horns and sock aides, to enable patients to achieve independence with daily lower body Dressing tasks. Upper limb management includes education and practice of tasks such as dressing and fine motor tasks such as button and zips that therapists prescribe to patients in order for them to reach their rehab goals. Education is provided verbally at the time of practice, but also via content in the My Therapy booklet, that all participants are directed to read upon commencement. Surgical precautions and restrictions are listed and explained in the My Therapy booklet for all patients following Orthopeadic surgery, as stated on post operative orders. This may include bed transfers for patients following hip surgery. Therapists can use their own discretion to prescribe any further additional exercise(s) that are clinically indicated to assist a patient to reach their goals. Adherence to the My Therapy program shall be evaluated via an audit of the My Therapy booklets. The percentage of rehabilitation days in which patients participated in their exercises will be recorded upon discharge. For the purpose of this study, there is no set number, frequency or duration of physiotherapist and/or occupational therapist sessions with each participant during the My Therapy Project. These are all prescribed on an individual and case by case basis.