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 7 am and 7 pm 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.