Inpatient rehabilitation following stroke: amount of therapy received and associations with functional recovery

Abstract

Purpose: Canada’s Best Practice Recommendations for Stroke Care state that a minimum of one hour per day of each of the relevant core therapies be provided to patients admitted for inpatient rehabilitation. We examined whether this standard was met on a single, specialized stroke rehabilitation unit and if amount of therapy was an independent contributor to functional improvement. Methods: One-hundred and twenty-three, consecutive patients admitted to a 30-bed stroke rehabilitation program over a 6-month period with the confirmed diagnosis of stroke, were included. Workload measurement data were used to estimate the amount of therapy that patients received from core therapists during their inpatient stay. A multivariable model to predict Functional Independence Measure (FIM) gains achieved was also developed using variables that were significantly correlated with functional gain on univariate analysis. Results: On average, patients received 37 min of active therapy from both physiotherapists (PT) and occupational therapists (OT) and 13 min from speech-language pathologists per day. Admission FIM, length of stay, total OT and PT therapy time (hrs) were significantly correlated with FIM gain. In the final model, which explained 35% of the variance, admission FIM score and total amount of occupational therapy (OT) emerged as significant predictors of FIM gain. Conclusions: Patients admitted to a specialized rehabilitation unit received an average of 37 min a day engaged in therapeutic activities with both occupational and physical therapists. Although this value did not reach the standard of one hour, total amount of OT time contributed significantly to gains in FIM points during hospital stay.

Implications for Rehabilitation

• Patients on an inpatient stroke rehabilitation unit received less than the standard of one hour of physiotherapy and occupational therapy per day.

• Total amount of occupational therapy contributed significantly to gains in Functional Independence Measure points during hospital stay.

Keywords::

• Exercise therapy
• guideline adherence
• stroke
• treatment outcome

Acknowledgements

We thank Eileen Fenerty, Consultant, and Dianne Cambridge, Analyst, in the Department of Quality Management & Clinical Decision Support at St. Joseph’s Health Care London, for compiling the workload measurement data used in this study.

Declaration of Interest: This study was funded by a grant from the Canadian Stroke Network.