Additional weekend therapy may reduce length of rehabilitation stay after stroke: a meta-analysis of individual patient data.
OBJECTIVE
Among people receiving inpatient rehabilitation after stroke, does additional weekend physiotherapy and/or occupational therapy reduce the length of rehabilitation hospital stay compared to those who receive a weekday-only service, and does this change after controlling for individual factors? Does additional weekend therapy improve the ability to walk and perform activities of daily living, measured at discharge? Does additional weekend therapy improve health-related quality of life, measured 6 months after discharge from rehabilitation? Which individual, clinical and hospital characteristics are associated with shorter length of rehabilitation hospital stay?


METHODS
This study pooled individual data from two randomised, controlled trials (n=350) using an individual patient data meta-analysis and multivariate regression.


METHODS
People with stroke admitted to inpatient rehabilitation facilities.


METHODS
Additional weekend therapy (physiotherapy and/or occupational therapy) compared to usual care (5 days/week therapy).


METHODS
Length of rehabilitation hospital stay, independence in activities of daily living measured with the Functional Independence Measure, walking speed and health-related quality of life.


RESULTS
Participants who received weekend therapy had a shorter length of rehabilitation hospital stay. In the un-adjusted analysis, this was not statistically significant (MD -5.7 days, 95% CI -13.0 to 1.5). Controlling for hospital site, age, walking speed and Functional Independence Measure score on admission, receiving weekend therapy was significantly associated with a shorter length of rehabilitation hospital stay (β=7.5, 95% CI 1.7 to 13.4, p=0.001). There were no significant between-group differences in Functional Independence Measure scores (MD 1.9 points, 95% CI -2.8 to 6.6), walking speed (MD 0.06 m/second, 95% CI -0.15 to 0.04) or health-related quality of life (SMD -0.04, 95% CI -0.26 to 0.19) at discharge.


CONCLUSIONS
Modest evidence indicates that additional weekend therapy might reduce rehabilitation hospital length of stay.


BACKGROUND
ACTRN12610000096055, ACTRN12609000973213. [English C, Shields N, Brusco NK, Taylor NF, Watts JJ, Peiris C, et al. (2016) Additional weekend therapy may reduce length of rehabilitation stay after stroke: a meta-analysis of individual patient data.Journal of Physiotherapy62: 124-129].
School of Health Sciences, University of Newcastle; University of Newcastle Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, Newcastle; International Centre for Allied Health Evidence, Sansom Institute of Health Research, University of South Australia, Adelaide.
Coralie
C
English
School of Allied Health, La Trobe University; Northern Health.
Nora
N
Shields
School of Allied Health, La Trobe University; Physiotherapy Services, Cabrini Health.
Natasha K
NK
Brusco
School of Allied Health, La Trobe University; Allied Health Clinical Research Office, Eastern Health, Box Hill.
Nicholas F
NF
Taylor
Centre for Population Health Research, Deakin Health Economics, Deakin University.
Jennifer J
JJ
Watts
School of Allied Health, La Trobe University.
Casey
C
Peiris
Stroke Division, Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne.
Julie
J
Bernhardt
Department of Rehabilitation and Aged Care, Flinders University, Bedford Park Campus.
Maria
M
Crotty
Division of Health Sciences, University of South Australia, Adelaide; Australian Institute of Health and Tropical Medicine, James Cook University, Cairns.
Adrian
A
Esterman
Health Economics and Social Policy, Health Economics and Social Policy Group, Division of Health Sciences, University of South Australia, Adelaide, Australia.
Leonie
L
Segal
International Centre for Allied Health Evidence, Sansom Institute of Health Research, University of South Australia, Adelaide.
Susan
S
Hillier
D000203:Activities of Daily Living; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D009788:Occupational Therapy; D026741:Physical Therapy Modalities; D011788:Quality of Life; D012047:Rehabilitation Centers; D000071939:Stroke Rehabilitation / Q000379:methods*; D016896:Treatment Outcome
Occupational therapy; Physical therapy; Rehabilitation; Stroke; Weekend therapy