Dosage and predictors of arm practice during inpatient stroke rehabilitation: an inception cohort study

Abstract

Purpose

To describe the amount/type of arm practice completed by stroke survivors during inpatient rehabilitation; and establish predictors of arm practice dose achieved.

Materials and methods

Inception cohort study including 99 consecutively admitted stroke survivors. Amount (repetitions) and type of arm practice completed during inpatient rehabilitation and possible predictors of dose were recorded.

Results

Average length-of-stay was 36.9 days (standard deviation (SD) = 30.0, median = 28.0, interquartile range = 39.5) and days of therapy provided was 11.1 days (SD = 13.3, median = 6.0, IQR = 12.0). Mean number of arm practice sessions completed overall was 12.8 (SD = 15.3, median = 7.0, interquartile range = 15.0), or 2.0 sessions per week (SD = 1.5, median = 1.5, interquartile range = 1.7). Mean repetitions of practice completed per therapy day was 86.1 (SD = 76.5, median = 68.5, interquartile range = 88.2). Variation in practice dose was best explained by age (−1.3 repetitions per year of age, p = 0.04) and cognitive impairment (−34.9 repetitions, p = 0.03). In participants without cognitive impairment (n = 73) variation in dose was best explained by stroke severity (modified Rankin Sale = 5, –48.4 repetitions, p = 0.01), and the inability to grasp/release (Box and Block Test = 0, +48.3 repetitions, p = 0.03).

Conclusions

The amount of arm practice completed was low. Daily sessions were often not provided as recommended in clinical guidelines. Clinicians should focus on strategies to increase intensity and opportunities for arm practice.

Implications for Rehabilitation

• Dose (repetitions) of arm practice varied greatly during inpatient rehabilitation.

• Number of arm rehabilitation sessions provided was lower than levels recommended in clinical guidelines.

• Therapists and researchers should focus on strategies to increase amount of therapy and opportunities for arm practice.

Keywords:

• Stroke
• stroke rehabilitation
• rehabilitation
• arm
• prognosis
• upper extremity

Acknowledgement

The authors thank the study participants, the occupational therapy and physiotherapy stroke unit staff and Despina Henriques for assisting with participant screening and measurement.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was supported by grants from the National Stroke Foundation and Ingham Institute for Applied Medical Research. CS is supported by a fellowship from the National Health and Research Medical Council.