Physical Therapists' Guideline Adherence on Early Mobilization and Intensity of Practice at Dutch Acute Stroke Units: A Country-Wide Survey

Clinical practice guidelines for patients with stroke recommend early stroke rehabilitation at acute hospital stroke units. The present study aimed to (1) explore the organization of early stroke rehabilitation; (2) investigate current practice with respect to early mobilization and augmented exercise therapy time; and (3) identify the perceived barriers to and facilitators for guideline adherence as reported by physical therapists (PTs) working on acute hospital stroke units. All 96 Dutch acute hospital stroke units were requested to assign one PT for participation in the survey. Of the 96 contacted PTs, 91 returned the questionnaire. Seventy-one percent of acute hospital stroke units reported that out-of-bed mobilization of patients was performed within 24 hours. PTs provided a mean of 22 minutes of physical therapy per weekday and weekend therapy was not standard practice. PTs reported having sufficient knowledge of and experience with the clinical practice guidelines for patients with stroke and reported that the clinical practice guidelines for patients with stroke left enough room for them to draw their own conclusions and to take patient preferences into account. PTs perceived insufficient time to comply with the clinical practice guidelines for patients with stroke and a need for financial compensation to realize human resources. Our national survey among PTs suggests that the organization of early stroke rehabilitation varies considerably and that early mobilization and intensity of practice in early stroke rehabilitation are not optimal. Addressing this problem requires agreement between hospital management boards and insurance companies about minimum services and resources required and the introduction of novel methods of increasing duration of exercise therapy with minimal use of resources.