Background/Aims: Understanding rehabilitation practices will enable identification of targets to enhance quality of rehabilitation and long-term outcomes after stroke. Thus, this study aimed to determine the dose and content of inpatient rehabilitation after stroke.
Methods: Thirty adults with stroke (age: 72.8±12 years; 50% female; 11±9 days post-stroke; admission mRS: 4, IQR:3-4), were observed over 48-hours within the first 14-days of admission to a mixed inpatient rehabilitation unit in Brisbane, Australia. Dose and content of all inpatient rehabilitation was determined through the combination of accelerometers (ActivPAL3), and a behavioural mapping protocol developed using the Stroke Foundation Living Guidelines. Participants were observed for one-minute at 10-minute intervals between 8am to 5pm over two weekdays and simultaneously wore the accelerometer. Measures included: average therapy dose per day (duration, sessions, repetitions and intensity), and therapy content (therapy type, area and activity targeted, feedback type, patient to staff ratio) presented as proportion of total therapy time per day.
Results: Participants completed 89±40 minutes of therapy over 3±1 sessions per day, including 538±527 lower limb repetitions daily. Therapy content varied, but most (93%) participants completed task-specific repetitive practice (36.5%±24 of total therapy time). Therapy typically targeted lower limb standing (23%, IQR:0-23) or upper limb reaching and manipulation activities (22%, IQR:0-51) and included verbal feedback (61%, IQR:29-88). Therapy was led by physiotherapists (41%, IQR:21-50), occupational therapists (22%, IQR:13-59) and speech therapists (10%, IQR:0-22) and delivered mostly one-to-one (57%±27).
Conclusion: Dose of therapy during inpatient rehabilitation is low, with most therapy content delivered one-to-one, and targeting motor outcomes.