title: The effects of increased therapy time on cognition and mood in frail patients with a stroke who rehabilitate on rehabilitation units of nursing homes in the Netherlands: a protocol of a comparative study.
abstract: BACKGROUND
  Recovery after stroke is dependent on how much time can be spent on rehabilitation. Recently, we found that therapy time for older stroke patients on a rehabilitation unit of a nursing home could be increased significantly from 8.6 to at least 13 hours a week. This increase was attained by the implementation of interventions, focused on strength, mobility and balance. Nurses carried out these exercises with the patients during their daily activities. The aim of the present study is to investigate if increased therapy time has a positive effect on cognition, mood (depression and anxiety), and ADL in stroke patients.
  
  
  METHODS
  A comparative single blind controlled study will be applied. Patients suffering from a stroke and staying on one of the rehabilitation units of the nursing homes are eligible for participation. Participants belong to the intervention group if they stay in two nursing homes where four interventions of the Clinical Nursing Rehabilitation Stroke Guideline were implemented. Participants who stay in two nursing homes where therapy is given according to the Dutch stroke Guideline, are included in the control group. Clinical neuropsychologists will assess patients' cognitive functioning, level of depression (mood) and anxiety. Nurses will assess a Barthel Index score on a weekly basis (ADL). These variables are measured at baseline, after 8 weeks and at the moment when participants are discharged from the nursing home.
  
  
  CONCLUSIONS
  The present study evaluates the effect of increased therapy time on cognition, mood (level of depression and anxiety), and ADL in stroke patients. When positive effects will be found this study can guide policy makers and practitioners on how to implement more therapy time on rehabilitation wards of nursing homes.
  
  
  BACKGROUND
  TNR Our study has been documented in the Dutch Trial Registration, TC = 3871.
authors.affiliation: Department of Clinical Neuropsychology, Free University of Amsterdam, Van der Boechorststraat 1, Amsterdam 1081 BT, The Netherlands. marleenhuijben@gmail.com.
authors.forename: Marleen
authors.initials: M
authors.lastname: Huijben-Schoenmakers
authors.forename: Arno
authors.initials: A
authors.lastname: Rademaker
authors.forename: Peter
authors.initials: P
authors.lastname: van Rooden
authors.forename: Erik
authors.initials: E
authors.lastname: Scherder
mesh_terms: D000339:Affect / Q000502:physiology; D000368:Aged; D003071:Cognition / Q000502:physiology; D005260:Female; D016330:Frail Elderly / Q000523:psychology; D006801:Humans; D009426:Netherlands / Q000453:epidemiology; D009735:Nursing Homes / Q000639:trends*; D012047:Rehabilitation Centers / Q000639:trends*; D016037:Single-Blind Method; D020521:Stroke / Q000453:epidemiology / Q000523:psychology; D000071939:Stroke Rehabilitation; D013997:Time Factors; D016896:Treatment Outcome