President's Report

Researching the benefits of early physical therapy for patients with a stroke

Patients with a stroke have a better chance of recovery if they keep moving.

That’s what Associate Professor of Physical Therapy Bill Andrews, who found his niche working with patients with a stroke early in his physical therapy career, has discovered. He focused most of his research in the area of stroke rehabilitation.

“Nobody plans on having a stroke,” he says. “It’s a sudden event. It’s an unexpected event most of the time, and it’s a life-altering event. It doesn’t just alter the patient’s life but the family’s life.”

During the past 20 years, the type of physical therapy offered to patients with a stroke in the hospital setting hasn’t changed radically. However, patients do begin receiving rehabilitation services much sooner in their recovery than was previously the norm.

Twenty years ago, a patient might stay in an inpatient setting, such as a hospital or rehabilitation facility, for three to four weeks following a stroke. Often, they didn’t begin rehabilitation immediately. Today people who have strokes have an average inpatient stay of two to three weeks, and they start receiving physical therapy much sooner and often when they are still fairly sick.

“The efficiency is probably better,” Andrews says. “The speed of care demands are higher. The expectations of getting patients rehabilitated quicker are higher.”

While those who sustain a stroke struggle to be mobile because of the impact of their illness, which frequently leaves one side of their bodies weaker than the other, research indicates people who have had strokes shouldn’t be sedentary. Moving is the key to a quicker recovery.

“They need to be active,” Andrews says. “They need to be engaged as much as they can be engaged. There is an emphasis now in starting the rehabilitation process earlier and getting patients as active as possible throughout that process.”

In his most recent research, Andrews looked at data to determine whether receiving physical therapy during a hospital stay impacts the readmission rates in patients who have had a stroke.

After receiving a $10,200 Elon University Faculty Research and Development grant last year, Andrews was able to purchase a database from the Agency for Healthcare Research and Quality of patients who received care in hospitals. The database doesn’t include personal information, such as names and addresses, but it does have details regarding dates of hospital admission and treatments received.

“Different states have different variables that are available,” Andrews says. “Some states have the ability to track a patient from one hospital admission to the next.”

Andrews, who worked on the research with a colleague from another university, narrowed his focus to data on about 66,000 patients in Florida and Arkansas.

“Given that stroke is more common in the South for several different reasons, we focused on southern states in terms of identifying the variables we could look at to see if the provision of physical therapy in the acute or hospital setting has had any impact on patients’ readmission rates,” Andrews says.

Andrews is still analyzing the data for that study and is planning to use the database for other research. While examining the database, he realized there are people who have strokes who never receive any form of physical therapy.

“I knew it intuitively but now I have data to back it up,” he says. “They go to the hospital, get diagnosed that they’ve had a stroke and a significant minority of those people end up not getting any physical therapy services and that was a little bit of a surprise to me. I thought it was a random one or two, but it’s more than that.”

Andrews wants to use the database to compare the outcomes of patients with a stroke who get physical therapy versus those who don’t.

“What are the some of the distinctive characteristics between those two groups?" Andrews asks. “I think I have an educated guess about what some of the differences might be, but we have access to variables that will help us either confirm or deny my suspicions.”

Andrews is also conducting research as part of a service-learning project he does in Romania. He and doctor of physical therapy students spent two weeks in July in the country fitting people who have disabilities with wheelchairs. The team worked with Wheels for the World: Joni and Friends, an organization that refurbishes wheelchairs.

Andrews and students distributed wheelchairs in the same area in 2007 and 2008. This year they collected information about how many people who received wheelchairs in the past, returned. In addition, Andrews along with students have provided physical therapy education to parents and caregivers as well as orphanages that work with children with disabilities.

Andrews has gone to Romania five times, and while the goal is to provide help and physical therapy education to people who would otherwise not receive it, he and the students who take part in the service-learning opportunity always return with lessons of their own.

“You learn a lot when you are over there,” Andrews says. “You learn that your ways are different in a lot of respects, and sometimes they are better. Sometimes your ways are not better, and it’s good to be able to bring that back and try to incorporate some of the things you learned.”

Andrews joined Elon’s faculty in 1997. He received a bachelor’s and master’s degree from the University of North Carolina at Chapel Hill and a doctorate from North Carolina State University. Andrews teaches courses in physical therapy science, neurologic disorders and clinical decision-making.

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