Coralie English1, Nora Shields2, Natasha K Brusco3, Nicholas F Taylor4, Jennifer J Watts5, Casey Peiris6, Julie Bernhardt7, Maria Crotty8, Adrian Esterman9, Leonie Segal10, Susan Hillier11. 1. School of Health Sciences, University of Newcastle; University of Newcastle Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, Newcastle; International Centre for Allied Health Evidence, Sansom Institute of Health Research, University of South Australia, Adelaide. 2. School of Allied Health, La Trobe University; Northern Health. 3. School of Allied Health, La Trobe University; Physiotherapy Services, Cabrini Health. 4. School of Allied Health, La Trobe University; Allied Health Clinical Research Office, Eastern Health, Box Hill. 5. Centre for Population Health Research, Deakin Health Economics, Deakin University. 6. School of Allied Health, La Trobe University. 7. Stroke Division, Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne. 8. Department of Rehabilitation and Aged Care, Flinders University, Bedford Park Campus. 9. Division of Health Sciences, University of South Australia, Adelaide; Australian Institute of Health and Tropical Medicine, James Cook University, Cairns. 10. Health Economics and Social Policy, Health Economics and Social Policy Group, Division of Health Sciences, University of South Australia, Adelaide, Australia. 11. International Centre for Allied Health Evidence, Sansom Institute of Health Research, University of South Australia, Adelaide.
Abstract
QUESTIONS: Among people receiving inpatient rehabilitation after stroke, does additional weekend physiotherapy and/or occupational therapy reduce the length of rehabilitation hospital stay compared to those who receive a weekday-only service, and does this change after controlling for individual factors? Does additional weekend therapy improve the ability to walk and perform activities of daily living, measured at discharge? Does additional weekend therapy improve health-related quality of life, measured 6 months after discharge from rehabilitation? Which individual, clinical and hospital characteristics are associated with shorter length of rehabilitation hospital stay? DESIGN: This study pooled individual data from two randomised, controlled trials (n=350) using an individual patient data meta-analysis and multivariate regression. PARTICIPANTS: People with stroke admitted to inpatient rehabilitation facilities. INTERVENTION: Additional weekend therapy (physiotherapy and/or occupational therapy) compared to usual care (5 days/week therapy). OUTCOME MEASURES: Length of rehabilitation hospital stay, independence in activities of daily living measured with the Functional Independence Measure, walking speed and health-related quality of life. RESULTS: Participants who received weekend therapy had a shorter length of rehabilitation hospital stay. In the un-adjusted analysis, this was not statistically significant (MD -5.7 days, 95% CI -13.0 to 1.5). Controlling for hospital site, age, walking speed and Functional Independence Measure score on admission, receiving weekend therapy was significantly associated with a shorter length of rehabilitation hospital stay (β=7.5, 95% CI 1.7 to 13.4, p=0.001). There were no significant between-group differences in Functional Independence Measure scores (MD 1.9 points, 95% CI -2.8 to 6.6), walking speed (MD 0.06 m/second, 95% CI -0.15 to 0.04) or health-related quality of life (SMD -0.04, 95% CI -0.26 to 0.19) at discharge. DISCUSSION: Modest evidence indicates that additional weekend therapy might reduce rehabilitation hospital length of stay. CLINICAL TRIAL REGISTRATION: ACTRN12610000096055, ACTRN12609000973213. [English C, Shields N, Brusco NK, Taylor NF, Watts JJ, Peiris C, et al. (2016) Additional weekend therapy may reduce length of rehabilitation stay after stroke: a meta-analysis of individual patient data.Journal of Physiotherapy62: 124-129].
QUESTIONS: Among people receiving inpatient rehabilitation after stroke, does additional weekend physiotherapy and/or occupational therapy reduce the length of rehabilitation hospital stay compared to those who receive a weekday-only service, and does this change after controlling for individual factors? Does additional weekend therapy improve the ability to walk and perform activities of daily living, measured at discharge? Does additional weekend therapy improve health-related quality of life, measured 6 months after discharge from rehabilitation? Which individual, clinical and hospital characteristics are associated with shorter length of rehabilitation hospital stay? DESIGN: This study pooled individual data from two randomised, controlled trials (n=350) using an individual patient data meta-analysis and multivariate regression. PARTICIPANTS: People with stroke admitted to inpatient rehabilitation facilities. INTERVENTION: Additional weekend therapy (physiotherapy and/or occupational therapy) compared to usual care (5 days/week therapy). OUTCOME MEASURES: Length of rehabilitation hospital stay, independence in activities of daily living measured with the Functional Independence Measure, walking speed and health-related quality of life. RESULTS:Participants who received weekend therapy had a shorter length of rehabilitation hospital stay. In the un-adjusted analysis, this was not statistically significant (MD -5.7 days, 95% CI -13.0 to 1.5). Controlling for hospital site, age, walking speed and Functional Independence Measure score on admission, receiving weekend therapy was significantly associated with a shorter length of rehabilitation hospital stay (β=7.5, 95% CI 1.7 to 13.4, p=0.001). There were no significant between-group differences in Functional Independence Measure scores (MD 1.9 points, 95% CI -2.8 to 6.6), walking speed (MD 0.06 m/second, 95% CI -0.15 to 0.04) or health-related quality of life (SMD -0.04, 95% CI -0.26 to 0.19) at discharge. DISCUSSION: Modest evidence indicates that additional weekend therapy might reduce rehabilitation hospital length of stay. CLINICAL TRIAL REGISTRATION: ACTRN12610000096055, ACTRN12609000973213. [English C, Shields N, Brusco NK, Taylor NF, Watts JJ, Peiris C, et al. (2016) Additional weekend therapy may reduce length of rehabilitation stay after stroke: a meta-analysis of individual patient data.Journal of Physiotherapy62: 124-129].
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