Not All Stroke Units Are the Same: A Comparison of Physical Activity Patterns in Melbourne, Australia, and Trondheim, Norway

National Stroke Research Institute, Level 1, Neurosciences Building, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg, 3081 Victoria, Australia.
Stroke (Impact Factor: 5.72). 07/2008; 39(7):2059-65. DOI: 10.1161/STROKEAHA.107.507160
Source: PubMed


Very early mobilization may be one of the most important factors contributing to the favorable outcome observed from a stroke unit in Trondheim, Norway. The aims of this study were to (1) describe and compare the pattern of physical activity of patients with stroke managed in a stroke unit with specified mobilization protocols (Trondheim) and those without in Melbourne, Australia; and (2) identify differences in activity according to stroke severity between the 2 sites.
Melbourne patients were recruited from 5 metropolitan stroke units. Trondheim patients were recruited from the stroke unit at University Hospital, Trondheim. All patients <14 days poststroke were eligible for the study. Patients receiving palliative care were excluded. Consenting participants were observed at 10-minute intervals from 8:00 am to 5:00 pm over a single day. At each observation, patient location, activity, and the people present were recorded. Negative binomial regression analyses were undertaken to assess differences in physical activity patterns between stroke units in the 2 cities.
Patients in Melbourne and Trondheim had similar baseline characteristics. Melbourne patients spent 21% more time in bed and only 12.2% undertook moderate/high activity (versus 23.2% in Trondheim, P<0.001). This difference was even more pronounced among patients with greater stroke severity. The incidence rate ratio for time spent doing standing and walking activities in Melbourne was 0.44 (95% CI: 0.32 to 0.62) when compared with Trondheim.
Higher activity levels were observed in Trondheim patients, particularly among those with more severe strokes. A greater emphasis on mobilization may make an important contribution to improved outcome. Further investigation of this is warranted.

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    • "Studies show that involving nurses in early mobilisation protocols results in more activity.[19,20]Nurses have many opportunities to encourage patients to be active in their daily practise, for instance by encouraging patients to sit upright and get out of bed, walk and move from sitting to standing.[19,21]The physicians in our study reported less encouraging behaviour than most other members of the multidisciplinary team. "
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    ABSTRACT: Purpose: Although physical activity and exercise for stroke patients is highly recommended for fast recovery, patients in hospitals and rehabilitation centres are insufficiently encouraged to be physically active. In this study, we investigated the impact of knowledge brokers (KBs), enterprising nurses and therapists, on health professionals' (HP) performance to encourage stroke inpatients to be physically active. Method: This multicenter intervention study used a pre-post test design. Two or three KBs were trained in each stroke unit of 12 hospitals and 10 rehabilitation centres in The Netherlands. Questionnaires were completed by patients and HPs before and after the KB-intervention. The primary outcome was encouragement given by HPs to their patients to be physically active, as reported by patients and HPs. Results: After the KB-intervention, many more patients (48%; N=217) reported at least some encouragement by HPs to be physically active than before (26%; N=243, p<0.000). HPs (N=288) on an average reported encouraging patients more often after the intervention, but this difference was significant only for occupational therapists and KBs. Conclusions: Based on patient's reports of HP behaviour, the KB-intervention appears effective since more patients felt encouraged to be physically active after the intervention compared to before. Replication of this study in an experimental design is needed to allow causal inferences. Implications for rehabilitation We advise rehabilitation teams to make use of knowledge brokers (KBs), since the KB-intervention was shown to increase the encouragement felt by stroke patients to be physically active. It seems worthwhile to involve physicians, nurses and patients' families more frequently in efforts to encourage stroke patients to be physically active.
    No preview · Article · Jan 2016 · Disability and Rehabilitation
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    • "We found that patients in stroke rehabilitation spent as much as 74% of the “active” day sedentary. Overall patients were more active than stroke survivors in studies from acute stroke units in both Norway (77%) [14, 15] and Australia (88%) [14], but the amount of sedentary time was still high compared to a healthy population (57–57.8%) [11, 30] and for a rehabilitation setting where physical training is supposed to be a central part of the program. "
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    ABSTRACT: Background. Sedentary behaviour is associated with health risks, independent of physical activity. This study aimed to investigate patterns of sedentary behaviour and physical activity among stroke survivors in rehabilitation hospitals. Methods. Stroke survivors admitted to four Swedish hospital-based rehabilitation units were recruited ≥7 days since stroke onset and their activity was measured using behavioural mapping. Sedentary behaviour was defined as lying down or sitting supported. Results. 104 patients were observed (53% men). Participants spent an average of 74% (standard deviation, SD 21%) of the observed day in sedentary activities. Continuous sedentary bouts of ≥1 hour represented 44% (SD 32%) of the observed day. A higher proportion (30%, SD 7%) of participants were physically active between 9:00 AM and 12:30 PM, compared to the rest of the observed day (23%, SD 6%, P < 0.0005 ). Patients had higher odds of being physically active in the hall (odds ratio, OR 1.7, P = 0.001 ) than in the therapy area. Conclusions. The time stroke survivors spend in stroke rehabilitation units may not be used in the most efficient way to promote maximal recovery. Interventions to promote reduced sedentary time could help improve outcome and these should be tested in clinical trials.
    Full-text · Article · Mar 2014 · Stroke Research and Treatment
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    • "Physical activity, location, and people present were recorded across the day for each patient using established standardised behavioural mapping procedures , which have been previously demonstrated to have high interrater reliability [12]. High consistency of patient behaviour across days has been reported in a previous study [13]; therefore, each individual patient was observed for a single working day. Observation days were undertaken approximately every six to eight weeks and up to 10 patients could be recruited for each day of observation. "
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    ABSTRACT: Background. Common models of acute stroke care include the acute stroke unit, focusing on acute management, and the comprehensive stroke unit, incorporating acute care and rehabilitation. We hypothesise that the rehabilitation focus in the comprehensive stroke unit promotes early physical activity and discharge directly home. Methods. We conducted a two-centre prospective observational study of patients admitted to a comprehensive or acute stroke unit within 14 days poststroke. We recruited 73 patients from each site, matched on age, stroke severity, premorbid function, and walking ability. Patient activity was measured using behavioural mapping. Therapy activity was recorded by therapist report. Time to first mobilisation, discharge destination, and length of stay were extracted from the medical record. Results. The comprehensive stroke unit group included more males, fewer partial anterior circulation infarcts, more lacunar infarcts, and more patients ambulant without aids prior to their stroke. Patients in the comprehensive stroke unit spent 14.4% more (95% CI: 8.9%-19.8%; P < 0.001) of the day in moderate or high activity, 18.5% less time physically inactive (95% CI: 5.0%-32.0%; P = 0.008), and were more likely to be discharged directly home (OR 3.7; 95% CI 1.4-9.5; P = 0.007). Conclusions. Comprehensive stroke unit care may foster early physical activity, with likely discharge directly home.
    Full-text · Article · Dec 2013
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