Little therapy, little physical activity: Rehabilitation within the first 14 days of organized stroke unit care

Objective: To examine rehabilitation interventions and resulting physical activity patterns of patients managed in acute stroke units to help inform development of a randomized controlled trial of very early rehabilitation. Design: An open observational study of patient activity and therapist report of patient interventions. A survey of stroke unit resources. Methods: Patients less than 14 days post-stroke from 5 metropolitan stroke units were observed over 2 consecutive weekdays at 10-minute intervals between 08.00 h and 17.00 h. Physical activity, location and person(s) present were ascertained at each observation. Therapists completed treatment records. Senior staff completed stroke unit surveys. Results: Patients after stroke (n = 58) were with therapists 5.2% of the observed day. Few patients (17.1%) received daily therapy by more than one therapist. When patients received therapy, average session times were 24 minutes of physio therapy, 23 minutes of occupational therapy and 33 minutes of speech pathology. The more time that family members were present, the longer the treatment time. Four to 11min of upper-limb therapy was provided. Muscle weakness and left hemiparesis were associated with less upper-limb activity. Conclusion: These acute stroke care units were resourced according to recommended staff-patient ratios. Patients received little therapy and had low levels of physical activity.