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Stroke rehabilitation: are highly structured units more conducive to physical activity than less structured units?
1Physiotherapy Department, Illawarra Regional Hospital, Wollongong, Australia.
Objective:
To determine if the physical design and organizational structure of rehabilitation units is related to the amount of patients' motor activity.
Design:
An observational study was conducted; time samples of the motor activity of patients following stroke were taken between 7AM and 7PM both on weekdays and weekends.
Setting:
Two rehabilitation units associated with general hospitals with different physical design and organizational structure. One unit was spread over a large area and had a highly organized daily structure; the other was small and informally organized.
Subjects:
Inpatients with hemiplegia as a result of stroke who gave consent to participate.
Main Outcome Measure:
The nature and frequency of 14 motor activities were compared between units.
Results:
No significant difference was found in any of the observed motor activities between the units when using independent groups t tests (p = 0.1-0.8). Subjects in both units spent more than 70% of their day in activities largely unrelated to physical outcome (eg, conversing with visitors or doing nothing observable) and less than 20% of the day in activities that could potentially contribute to their recovery (eg, in therapy or exercising independently).
Conclusions:
Rehabilitation units are not functioning as learning environments. The challenge is to identify and implement measures that will change this finding.