Extra rehabilitation improves activity after stroke
People who have had a stroke commonly have difficulty walking and using the arm to complete self-care tasks. Repetitive practice of these tasks (or components of the tasks) with progressive increases in difficulty to challenge the patient is required to bring about improvement in function. Guidelines for stroke management recommend a large amount of practice in order to maximise outcome after stroke.
Rehabilitation is resource intensive, both for the patient and the healthcare system. It is therefore important to determine the effect increasing the amount of usual rehabilitation. Specifically, how much extra rehabilitation time is required to bring about measureable improvements in activity after stroke?
A group of researchers in Sydney and Melbourne have sought to answer this by rigorously searching for evidence on the topic and statistically pooling all of the evidence they could identify to generate one overall answer - and the results are somewhat surprising!
As expected, increasing the amount of usual rehabilitation aimed at reducing activity limitations improved activity in people after stroke. However, the amount of extra rehabilitation that needs to be provided to achieve a beneficial effect is large - an increase of about 240%. To provide an example as a measure of time: if a therapy service usually provides 30 minutes of reaching and grasping practice for the arm per day, in order to ensure a better outcome, approximately 100 minutes of reach and grasp practice per day would be required.
The challenge now is to determine how to increase the amount of rehabilitation. Implementation will demand a change in clinical practice that is far-reaching; models of delivery, patient expectations, and therapist beliefs should be guided by the findings of this review.
Want to read deeper into this topic? Have a look at the free full text version of this article published in Journal of Physiotherapy!
> From: Schneider et al., J Physiother 62 (2017) 182-187. All rights reserved to the Australian Physiotherapy Association. Click here for the online summary.