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Systematic Documentation of Physiotherapy Practice During Usual Care and High-Intensity Gait Training in Inpatient
Ylva Hivand Hiorth1,2, Jennifer L Moore3,4,
1Department of Physical Medicine and Rehabilitation, Stavanger University Hospital, Stavanger, Norway.
Background:
Usual care (UC) in stroke rehabilitation is often insufficiently documented, limiting evaluation of interventions such as high-intensity gait training (HIGT).
Objective:
To describe physiotherapy delivery in UC and HIGT in inpatient stroke rehabilitation, focusing on session frequency, intensity, time, type and overall daily activity volume (FITT-V), and to evaluate the correspondence between heart rate-based and perceived exertion-based intensity monitoring.
Methods:
This prospective quasi-experimental longitudinal study included 147 inpatients with stroke and impaired gait (median age 67 years, 67% male, median time since stroke 19 days). Median hospital stay was 33 days (IQR 25-42). Seventy-three received UC and 74 HIGT. Physiotherapy delivery and patient characteristics were collected prospectively. Exercise intensity was measured using heart rate zones (Polar H10) and Borg RPE. Daily steps and active time were recorded with the Polar Vantage V2.
Results:
Across 1443 physiotherapy sessions lasting more than 10 min, weekly frequency was similar between groups (median 3.5 sessions), but HIGT sessions were longer (45 min vs. 38 min, p < 0.001) and delivered at higher cardiovascular intensity (all HR zones p < 0.001). HIGT sessions involved more gait-focused activities, whereas UC showed a broader mix of training types. Correspondence between perceived exertion (RPE) and heart rate was low for mean intensity (19.5%) but higher for peak intensity (47.8%), reflecting variability in perceived exertion in this heterogeneous inpatient stroke population. For overall daily activity volume, active time was comparable, yet HIGT patients took more daily steps (3446 vs. 3176 steps/day, p < 0.001). Clinician adherence was ≥ 80% for most measures.
Conclusion:
FITT-V provides a structured approach to document physiotherapy delivery, revealing key differences in intensity, duration, and activity type that support targeted improvements in post-stroke rehabilitation. Challenges remain in accurately capturing perceived exertion, underscoring the need for complementary objective measures.
