Circuit Class Therapy and 7-Day-Week Therapy Increase Physiotherapy Time, But Not Patient Activity

Active task practice drives recovery of motor function after stroke. Lasting neuroplastic changes occur in the cortex with repetitive practice of active, meaningful movements. Opportunities to engage in active task practice in rehabilitation hospitals after stroke may be limited. Australia’s National Stroke Foundation Clinical Guidelines recommend that people with stroke engage in ≥1 hour/d of active task practice while in rehabilitation hospitals. However, estimates of the amount of physiotherapy time routinely provided to people after stroke are well below this, at 30 to 40 minutes/d. For the past 15 years research has consistently shown that during rehabilitation people with stroke spend as little as 113 minutes a day walking, standing or in activities likely to produce benefit, and that the majority of physical activity occurs in the presence of a therapist and in therapy areas. It is therefore important to investigate alternative models of rehabilitation care with a view to increasing the amount of time people with stroke spend in active task practice each day. Several meta-analyses have demonstrated the superiority of circuit class therapy to usual care physiotherapy in improving walking ability for people after stroke. The purpose of the 3-arm Circuit class therapy and 7-dayweek therapy for Increasing Rehabilitation Intensity of Therapy after stroke trial (CIRCIT) was to examine the relative effectiveness and cost-effectiveness of 2 alternative models of physiotherapy service delivery against a usual care control. In this substudy, we hypothesized that compared with usual care physiotherapy, providing physiotherapy services in group circuit classes or for 7 days/wk would result in