How Physically Active Are People with Stroke in Physiotherapy Sessions Aimed at Improving Motor Function? A Systematic Review

Abstract

Background. Targeted physical activity drives functional recovery after stroke. This review aimed to determine the amount of time stroke survivors spend physically active during physiotherapy sessions. Summary of Review. A systematic search was conducted to identify published studies that investigated the use of time by people with stroke during physiotherapy sessions. Seven studies were included; six observational and one randomised controlled trial. People with stroke were found to be physically active for an average of 60 percent of their physiotherapy session duration. The most common activities practiced in a physiotherapy session were walking, sitting, and standing with a mean (SD) practice time of 8.7 (4.3), 4.5 (4.0), and 8.3 (2.6) minutes, respectively. Conclusion. People with stroke were found to spend less than two-thirds of their physiotherapy sessions duration engaged in physical activity. In light of dosage studies, practice time may be insufficient to drive optimal motor recovery.

Investigating Measures of Intensity During a Structured Upper Limb Exercise Program in Stroke Rehabilitation: An Exploratory Study

“…Best evidence for improving functional recovery after stroke suggests rehabilitation should consist of high intensity repetitive task-specific practice [3][4][5][6] . However despite this, the amount of therapy time dedicated to upper limb rehabilitation remains low 7 and upper limb exercises, when prescribed, are often of low intensity 8 .…”

“…Therapists working in stroke rehabilitation are being challenged to find new ways of increasing the intensity of practice that stroke survivors engage in each day 7 with suggested strategies including self-administered exercise 9 , group exercise 10 and family assisted exercise 11 . Despite the strength of evidence supporting intensity, objectively quantifying intensity of therapy in stroke rehabilitation remains problematic.…”

“…Time continues to remain the dominant measure of intensity both in research 7,12 and in clinical guidelines 13,14 . It is the measure used to synthesize data in meta-analyses 3,12,15 and is the standard by which clinicians and services are evaluated 16 .…”

“…It does not give an indication of the actual amount of movement, or the types of movement, that take place during a particular session 18 . It has recently been reported that people with stroke are inactive for an average of 40% of their physical therapy sessions 7 . In addition, therapists' tend to overestimate the time they spend with patients 19 .…”

“…Despite the strength of evidence supporting intensity, objectively quantifying intensity of therapy in stroke rehabilitation remains problematic. It is difficult to determine and increase intensity, without first having robust, feasible methods to be able to measure intensity during rehabilitation.Time continues to remain the dominant measure of intensity both in research 7,12 and in clinical guidelines 13,14 . It is the measure used to synthesize data in meta-analyses 3,12,15 and is the standard by which clinicians and services are evaluated 16 .…”