We thank our colleagues for their interest in our work. Our respective studies point
to different results on the association between therapy time and cognitive outcomes
in post-acute care patients with stroke. Specifically, Hori and colleagues identified
7 differences; we respond to each point below.
- 1.Of the 95 participants included in our analysis, 83 received speech-language therapy. We found no difference in our results when excluding those who had not received speech-language therapy.
- 2.We noted our small sample as a limitation of our study.1We have noted elsewhere that the sample from the parent study overrepresents patients from large, freestanding inpatient rehabilitation facilities and may not reflect all patients receiving rehabilitation in the United States.2
- 3.Our study used CogMeas, which combines items from 3 US federally mandated post-acute care measures (2 from FIM, 3 from the Minimum Data Set, and 1 from the Outcome and Assessment Information Set). Our research indicates that CogMeas has good measurement precision and is sufficiently precise to detect changes in cognition in this population.3We would argue that, rather than inaccurately detecting the effects of speech-language therapy, we measured a different outcome than Sakai and Momosaki.4
- 4.We also noted the ceiling effect of CogMeas in our sample as a limitation.1CogMeas does not measure executive dysfunction and, therefore, would not have captured the impact of any therapy on such higher-level cognitive skills.3
- 5.As we noted in our limitations, we did not evaluate therapy content in our study.1
- 6.All participants in our study were receiving post-acute care services and had prior acute care stays. Mean days from stroke onset to post-acute care admission was 14 days (SD 13.3) for skilled nursing facilities and 8 days (SD 10.8) for inpatient rehabilitation facilities. It is likely that participants received rehabilitation services during their acute care hospital stay; however, those data are unavailable, as the parent study only collected data in post-acute care settings.
- 7.The parent study's research team was multidisciplinary.2,5We respectfully suggest that, within the limitations of the study design, the data speak for themselves.
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References
- Association of therapy time and cognitive recovery in stroke patients in post-acute rehabilitation.J Am Med Dir Assoc. 2021; 22: 453-458.e3
- A comparison of discharge functional status after rehabilitation in skilled nursing, home health, and medical rehabilitation settings for patients after lower-extremity joint replacement surgery.Arch Phys Med Rehabil. 2011; 92: 712-720
- Combining items from three federally-mandated assessments using Rasch measurement to reliably measure cognition across post-acute care settings.Arch Phys Med Rehabil. 2020; 102: 106-114
- Real-world effectiveness of speech therapy time on cognitive recovery in older patients with acute stroke.Prog Rehabil Med. 2016; 1: 20160004
- Comparison of discharge functional status after rehabilitation in skilled nursing, home health, and medical rehabilitation settings for patients after hip fracture repair.Arch Phys Med Rehabil. 2014; 95: 209-217
Article info
Publication history
Published online: March 27, 2021
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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- Association of Speech Therapy Time and Cognitive Recovery in Stroke Patients: A Comparison of StudiesJournal of the American Medical Directors AssociationVol. 22Issue 6
- PreviewWe read the article by Cogan et al with great interest and appreciate the authors’ efforts to investigate the association between therapy time and cognitive recovery of stroke patients in inpatient post-acute care facilities.1 The study showed that higher-intensity occupational therapy services were associated with better cognitive outcomes at discharge. However, no association was found between speech-language therapy time and cognitive outcomes.
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