Occupational Therapist Treatment of Patients in the Neurological Critical Care Unit: Utilization and Patient Characteristics

Abstract Importance: Occupational therapy use in the neurological critical care unit (NCCU) may relate to patient factors, but data about these relationships remain unpublished. Objective: To examine how patient factors predict NCCU occupational therapy use and intervention types. Design: Retrospective cohort study of electronic health records data from adults admitted to the NCCU between May 2013 and September 2015. Setting: NCCU in a large, urban academic hospital. Participants: Adults (age ≥18 yr; N = 1,134) admitted to the NCCU. Measures: Using length of stay (LOS), number of comorbidities, Glasgow Coma Scale (GCS) score, gender, age, and racial–ethnic minority status as independent variables, separate regression models identified predictors for each dependent variable: receipt of NCCU occupational therapy, occupational therapy onset (days after admission), and receipt of self-care or home management (ADL–Home); functional activities or cognitive training (Func–Cog); and therapeutic exercise (Ther-Ex). Results: Four hundred twenty patients (37.0%) received occupational therapy in the NCCU. Receipt of occupational therapy was positively associated with LOS, number of comorbidities, GCS score, and age. Earlier occupational therapy onset was associated with higher GCS score and shorter LOS. Receipt of ADL–Home or Func–Cog interventions was significantly predicted by number of occupational therapy sessions, but patients with longer LOS were less likely to receive ADL–Home interventions. Receipt of Ther-Ex interventions became less likely as GCS score increased. Conclusions and Relevance: Patients are more likely to receive occupational therapy services if they are older and have a longer NCCU LOS, more comorbidities, and a higher level of consciousness. What This Article Adds: A patient’s level of consciousness is clearly associated with occupational therapy utilization and hospital outcomes, but it should not be the only factor considered when prioritizing patients for NCCU occupational therapy services. Compared with patients who were more awake and alert, patients with a lower level of consciousness had a later onset of occupational therapy, which suggests an opportunity for NCCU occupational therapists to collaborate with physicians in the modification of sedation protocols to enable early rehabilitation.