Use of time by stroke patients: a comparison of four European rehabilitation centers.
OBJECTIVE
Differences exist between European countries in the proportion of patients who die or become dependent after stroke. The aim of the present study was to identify differences in the use of time by stroke patients in 4 rehabilitation centers in 4 European countries.


METHODS
In each of the 4 centers, 60 randomly selected stroke patients were observed at 10-minute intervals using behavioral mapping. Observations took place on 30 weekdays selected at random, on equal numbers of morning, afternoon, and evening sessions. A logistic generalized estimating equation model with correction for differences in case mix and multiple testing was used for the analysis.


RESULTS
Overall time available from different professions was the highest in the United Kingdom, but patients in the United Kingdom spent on average only 1 hour per day in therapy. This was significantly less than patients in Belgium and Germany, who spent approximately 2 hours, and patients in Switzerland who spent approximately 3 hours per day in therapy. In all centers, patients spent less than half their time in interactions and >72% of the time in nontherapeutic activities.


CONCLUSIONS
Important differences in the use of time were established, which appeared dependent on management decisions rather than the number of staff available. Patients in the Swiss and German centers spent more time in therapy, possibly because of the structured organization of rehabilitation. Further studies will verify whether this has an effect on outcome.
De Wit
Liesbet
L
Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Belgium. Liesbet.Dewit@faber.kuleuven.be
Putman
Koen
K
Dejaeger
Eddy
E
Baert
Ilse
I
Berman
Peter
P
Bogaerts
Kris
K
Brinkmann
Nadine
N
Connell
Louise
L
Feys
Hilde
H
Jenni
Walter
W
Kaske
Christiane
C
Lesaffre
Emmanuel
E
Leys
Mark
M
Lincoln
Nadina
N
Louckx
Fred
F
Schuback
Birgit
B
Schupp
Wilfried
W
Smith
Bozena
B
De Weerdt
Willy
W
D000203:Activities of Daily Living; D001519:Behavior; D001530:Belgium; D002561:Cerebrovascular Disorders / Q000628:therapy; D004185:Disability Evaluation; D005060:Europe; D005858:Germany; D006801:Humans; D007902:Length of Stay; D015233:Models, Statistical; D017063:Outcome Assessment, Health Care; D012046:Rehabilitation / Q000379:methods*; D012047:Rehabilitation Centers; D020521:Stroke / Q000628:therapy*; D000071939:Stroke Rehabilitation; D013557:Switzerland; D013995:Time; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom; D000078329:Workforce