Comparison of rehabilitation practice on hospital wards for stroke patients

Background and Purpose: The aim of the study was to observe patients on a stroke unit and to compare their activity with that of patients on conventional hospital wards to identify aspects of rehabilitation practice that might account for differences in outcome. Methods: Stroke patients admitted to the hospital were observed on three 8-hour shifts over 3 consecutive days. An observer recorded, at 10-minute intervals, where patients were, what they were doing, and whether their positioning was as recommended by rehabilitation therapists. Patients on a stroke unit were compared with those on conventional wards. Results: Stroke unit patients spent less time by their beds and more time in other locations on the ward (P<.001). There were significant differences in the frequency of behaviors observed in the two types of ward (P<.001). Stroke unit patients had significantly more interaction with nurses and therapists (P<.001). They were also more often in the recommended position (P<.001). Conclusions: The proportion of time in therapeutic activity was low in all locations, with patients spending many hours sitting and doing nothing. Despite this, stroke unit patients had more therapeutic contact with staff and were more often in the recommended position. These two features may account for some of the differences in outcome.