Stroke is one of Australia’s leading causes of death and disability. It’s estimated that around 65% of people who’ve suffered a stroke will suffer disability that impairs their ability to carry out daily tasks unassisted.

A large amount of practice is required for people with stroke to reduce activity limitations and improve motor skills.

Evidence has shown that programs offering extra practice, in a variety of activities and settings, have greater benefit in improving functional capabilities in people with stroke. There is less evidence, however, around the effect of different doses of the same type of rehabilitation – that is, the extra practice is not varied in content, it is more of the same activities.

As rehabilitation is resource intensive, being expensive for both the patient and the healthcare system, it’s important to only offer the amount that has evidence for a benefit, as more is not always better.

Researchers investigated whether adding more rehabilitation, of the same content as the usual rehabilitation, can improve activity in people with stroke and, if so, what amount is most beneficial.

A systematic review of available evidence was conducted. All studies involved 80% or more adults with stroke and examined the effect of an increased dose of rehabilitation on activity outcomes. The intervention group in the studies received extra rehab of the same content as their usual rehab, in addition to their usual rehab.

The rehab focused on improving lower limb or upper limb activity, or both. The amount of extra time provided in rehab was recorded. Main outcomes assessed were upper or lower limb activity capabilities.

The results of the review showed that extra rehab, of the same content as the usual rehab, improved activity immediately following the intervention period. However, the amount of extra rehab needed to produce a substantial positive outcome was large.

Implications

This review suggests a benefit from undertaking extra rehab, of the same format, in order to improve activity post stroke. The amount of extra rehab required to render a beneficial outcome was substantial.

If you’re recovering from a stroke, talk to your care team about ways that you can safely increase the amount of rehabilitation you are doing, with practice focused on the areas of your functional ability most affected post stroke.

Last Reviewed: 30/11/2019

Norman Swan Medical Communications



References

Schneider, E et al. (2016). Increasing the amount of usual rehabilitation improves activity after stroke: a systematic review. Journal of Physiotherapy http://dx.doi.org/10.1016/j.phys.2016.08.006.