Stroke rehabilitation: are highly structured units more conducive to physical activity than less structured units?

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.