Counting repetitions: an observational study of outpatient therapy for people with hemiparesis post-stroke

Given the contemporary clinical belief that more practice is better, it is important to determine how much practice currently occurs during physical therapy (PT) and occupational therapy (OT). The purpose of this study was to examine the number of repetitions of various activities during PT and OT outpatient treatment sessions for people with hemiparesis post-stroke. We observed 36 treatment sessions and recorded the types of activities and the number of repetitions of each activity that were done. Observations were categorized and descriptive statistics were generated for each category and subcategory. Our results showed that treatment time averaged 36 minutes per session. In sessions addressing the upper extremity, the average number of repetitions per session were 39 for active-exercise movements, 34 for passive-exercise movements, and 12 for purposeful movements. In sessions addressing the lower extremity, the average number of repetitions per session were 33 for active-exercise movements, six for passive-exercise movements, and eight for purposeful movements. In sessions addressing gait, the average number of steps taken was 292. In sessions addressing transfers, the average number of repetitions per session was 11. For most categories, there was considerable variability in the number of repetitions observed. We conclude that the numbers of repetitions observed during PT and OT for people with hemiparesis post-stroke are relatively small, except for gait steps. The fact that the number of repetitions of upper extremity purposeful movements was smaller than the number of repetitions of upper extremity active- and passive-exercise movements was surprising. This finding is inconsistent with current teaching that practice of purposeful movements is an integral part of improving functional status.