title: Are recommendations regarding inpatient therapy intensity following acute stroke really evidence-based?
abstract: BACKGROUND
  Recommendations regarding the daily minimum dose of therapy that patients should receive following stroke are included in many clinical practice guidelines. We examined the related literature to determine whether a specific evidence-based recommendation could be supported.
  
  
  METHODS
  Six clinical practice guidelines were retrieved and examined to determine what recommendation, if any, had been made regarding the daily provision of therapy during inpatient rehabilitation. All studies cited by the guideline authors to support their recommendations were identified and retrieved. Studies in which treatment was (a) focused on motor recovery, (b) initiated during inpatient rehabilitation, and (c) provided within 3 months of stroke onset were reviewed in greater detail.
  
  
  RESULTS
  Three of the 6 identified guidelines recommended daily minimum amounts of therapy, ranging from 45 to 60 minutes each day of occupational (OT) and physiotherapy (PT), and 3 made general statements indicating that increased intensity of therapy was either recommended or was not recommended. Among the 6 guidelines, 37 studies had been cited to support the recommendations. Of these, 15 were reviewed in detail. On average, patients in the control condition received 48 minutes of therapy per day while those in the experimental group received 63% more, or 78 minutes per day. Patients in the experimental group performed significantly better on the primary outcome in only 5 (33%) studies.
  
  
  CONCLUSIONS
  We believe the evidence base cannot support a specific recommendation related to therapy intensity during inpatient rehabilitation following stroke.
authors.affiliation: Lawson Health Research Institute, London, Ontario, Canada.
authors.forename: Norine
authors.initials: N
authors.lastname: Foley
authors.forename: Shelialah
authors.initials: S
authors.lastname: Pereira
authors.forename: Katherine
authors.initials: K
authors.lastname: Salter
authors.forename: Matthew
authors.initials: M
authors.lastname: Meyer
authors.forename: J Andrew
authors.initials: JA
authors.lastname: McClure
authors.forename: Robert
authors.initials: R
authors.lastname: Teasell
mesh_terms: D000203:Activities of Daily Living; D000208:Acute Disease; D019317:Evidence-Based Medicine / Q000592:standards*; D006801:Humans; D007297:Inpatients; D026741:Physical Therapy Modalities / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D000071939:Stroke Rehabilitation