Guideline recommendations for active therapy dose following acute stroke are not being met in any setting

Background: National guidelines recommend a minimum of three hours scheduled active therapy (occupational therapy and physiotherapy) per weekday after acute stroke. Little is known about dose of rehabilitation received. Aims: To describe current dose of active rehabilitation therapy following acute stroke across different rehabilitation settings. Methods: Prospective observational cohort study of consecutive patients who received rehabilitation after acute stroke in seven sites. We collected data on therapy delivered by allied health professionals (duration, professional group, setting) through all types of rehabilitation episodes up to 6-months post stroke. Active therapy time was defined as face-to-face physiotherapy or occupational therapy in minutes/weekday. Descriptive analyses are presented. Results: 368 patients received rehabilitation (40% female, mean age 71). Median (IQR) active therapy dose was 42 minutes/weekday (IQR 15, 87). Active therapy dose in minutes/weekday (IQR) within different rehabilitation settings was: statistical rehabilitation episodes in acute stroke unit (ASU) 104 (48,168); inpatient rehabilitation units (IRU) 95 (63,135); centre and home-based community rehabilitation (CR)10 (4,22); and transition care (TC) 19 (9,31). Median total active therapy per patient across all episodes (mean 1.2 episodes / patient) was 22 hours (IQR 5.7, 54): ASU 9hours (3,26), IRU 30hours (12,60), CR 3hours (1, 7), and TC 11hours (5,19). Daily dose of active therapy exceeded 3 hours in 11% of all episodes: 24% in ASU, 10% in IRU, 3% in CR, and 5% in TC. Conclusion: Active therapy guideline recommendations are not being met for most stroke survivors across all settings.