Dose and Content of Training Provided to Stroke Survivors with Severe Upper Limb Disability Undertaking Inpatient Rehabilitation: An Observational Study

Abstract

Background: To retrain upper limb function after stroke, a high dose of activity-related therapy is recommended. However, observational studies indicate that the dose undertaken is minimal. While it is speculated that those with severe disability will perform less therapy, this remains to be explored.Objective: Quantify the dose and content of upper limb therapy performed by stroke survivors with severe upper limb disability during routine inpatient rehabilitation.Methods: Therapy provided by physiotherapists and occupational therapists to 32 stroke survivors receiving inpatient rehabilitation over 20 weekdays was recorded. Dose of individual and group therapy was analysed by discipline and severity of upper and lower limb disability. Dose and content of individual therapy was also analysed by functional domain.Results: On average, 46 minutes of individual and 11 minutes of group upper limb therapy were provided per participant, per day. Occupational therapists provided a higher dose of both individual and group therapy compared to physiotherapists (p < 0.0005). Findings suggest that greater residual upper and lower limb movement can lead to provision of a higher dose of activity-related therapy. Within individual therapy, a higher dose (29 versus 17 minutes, p < 0.002) and greater number (1218 versus 549) of impairment- than activity-related interventions were administered.Conclusions: The dose of activity-related upper limb therapy provided to stroke survivors with severe disability was limited. There is a need to identify interventions and models of service delivery that can increase the intensity and appropriateness of therapy that stroke survivors with severe disability undertake during inpatient rehabilitation.

SMART Arm Training With Outcome-Triggered Electrical Stimulation in Subacute Stroke Survivors With Severe Arm Disability: A Randomized Controlled Trial

“…Usual therapy (received by all participants) was of a high volume in this current study compared to previous studies 35 . No consistent effort was made however, to relate goals of usual therapy to SMART Arm training, limiting potential for carryover for those who received both 46 .…”

Dose of arm activity training during acute and subacute rehabilitation post stroke: a systematic review of the literature

“…The primary author of one study was contacted to clarify the item of investigator concealment. 26 Individual items highlighted several studies with a potentially elevated risk of bias and may have led to an overestimation of dose: three studies failed to use an independent observer to document therapy dose 30,31,35 and five studies had an inadequate sample size to make precise estimates. 26,28,29,32,35 Also, the main aim for only three out of the ten studies 30,32,34 was to document arm training dose.…”

“…27,35 Studies completed during subacute rehabilitation demonstrated a similar pattern, with a mean of four minutes within a physiotherapy session 26,28,30,33 and 11 minutes within an occupational therapy session. [29][30][31] With regards to movement repetitions, 23 to 32 activity-related arm repetitions were performed per session across both Excluded after screening title/abstract, n = 3 115…”

Early upper limb physiotherapy in stroke patients. Questions without answers

“…Natomiast czas aktywnej terapii ruchowej KG chorych średnio 5,6 dnia od udaru wynosił ok. 4 minuty w jednej sesji (17% całej jednostki terapeutycznej) i ok. 11 minut w sesji terapii zajęciowej (49% całej jednostki terapeutycznej) [23]. W fińskim badaniu Peurala et al wykazał, że dawka czasowa aktywności KG chorych (n=19) (średnio osiem dni od udaru) podczas fizjoterapii stanowi ok. 6 minut ćwiczeń na sesję (15% jednostki terapeutycznej) [24,25]. Australijskie doniesienia (n=32) dotyczące chorych (średnio 40 dni od udaru) mówią o braku aktywności KG podczas fizjoterapii [26].…”

“…11 minutes during an occupational therapy session (49% of the whole therapeutic session) [23]. In the Finnish study by Peurala et al, it was noted that on average 8 days post stroke, patients (n=19) received 6 minutes of UL training per session (15% of a therapeutic session) [24,25]. Australian reports (n=32) concerning patients (an average of 40 days post stroke) revealed the lack of UL activity during physiotherapy [26].…”