Circuit Class Therapy or Seven-Day Week Therapy for Increasing Rehabilitation Intensity of Therapy after Stroke (CIRCIT): A Randomized Controlled Trial Impact of Intensive Physiotherapy on Cognitive Function after Coronary Artery Bypass Graft Surgery Effects of Conventional Physical Therapy and Functional Strength Training on Upper Limb Motor Recovery After Stroke: A Randomized Phase II Study Are weekend inpatient rehabilitation services value for money? An economic evaluation alongside a randomized controlled trial with a 30 day follow up Is dosage of physiotherapy a critical factor in deciding patterns of recovery from stroke: a pragmatic randomized controlled trial. A Very Early Rehabilitation Trial for Stroke (AVERT): Phase II Safety and Feasibility Additional Saturday rehabilitation improves functional independence and quality of life and reduces length of stay: a randomized controlled trial Randomized, controlled trial to evaluate increased intensity of physiotherapy treatment of arm function after stroke. Is cost effectiveness sustained after weekend inpatient rehabilitation? 12 month follow up from a randomized controlled trial The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Efficiency of immediate postoperative inpatient physical therapy following total knee arthroplasty: an RCT Remedial therapy after stroke: a randomised controlled trial. A Saturday physiotherapy service may decrease length of stay in patients undergoing rehabilitation in hospital: a randomised controlled trial. Effect of high-dosage cholecalciferol and extended physiotherapy on complications after hip fracture: a randomized controlled trial. Efficacy of Functional Strength Training on Restoration of Lower-Limb Motor Function Early After Stroke: Phase I Randomized Controlled Trial A randomised controlled trial to determine the effect of intensity of therapy upon length of stay in a neurological rehabilitation setting. Supervised moderate intensity exercise improves distance walked at hospital discharge following coronary artery bypass graft surgery--a randomised controlled trial. Exercise therapy after coronary artery bypass graft surgery: a randomized comparison of a high and low frequency exercise therapy program. A randomised controlled trial comparing rehabilitation against standard therapy in multiple sclerosis patients receiving intravenous steroid treatment Effect of multiple physiotherapy sessions on functional outcomes in the initial postoperative period after primary total hip replacement: a randomized controlled trial. An intensive physiotherapy program improves mobility for trauma patients Intensive Early Physiotherapy Combined with Dexamphetamine Treatment in Severe Stroke: A Randomized, Controlled Pilot Study HIP4Hips (High Intensity Physiotherapy for Hip fractures in the acute hospital setting): a randomised controlled trial. Physiotherapy services provided outside of business hours in Australian hospitals: a national survey. Task-specific physical therapy for optimization of gait recovery in acute stroke patients. Additional Saturday allied health services increase habitual physical activity among patients receiving inpatient rehabilitation for lower limb orthopedic conditions: a randomized controlled trial. Longer Versus Shorter Duration of Supervised Rehabilitation After Lung Transplantation: A Randomized Trial.
Background Increased therapy has been linked to improvements in functional ability of people with stroke . Aim To determine the effectiveness of two alternative models of increased physiotherapy service delivery ( seven-day week therapy or group circuit class therapy five days a week ) to usual care . Method Three-armed r and omized controlled trial with blinded assessment of outcome . People admitted with a diagnosis of stroke , previously independently ambulant and with a moderate level of disability were recruited .  ‘ Usual care ’ was individual physiotherapy provided five-days a week . Seven-day week therapy was usual care physiotherapy provided seven-days a week . Participants in the circuit class therapy arm of the trial received physiotherapy in group circuit classes in two 90-min sessions , five-days a week . Primary outcome was distance walked on the six-minute walk test at four-weeks post-r and omization . Results Two hundred eighty-three participants were r and omized ; primary outcome data were available for 259 ( 92 % ) . In the seven-day arm participants received an additional three hours of physiotherapy and thosein the circuit class armanadditional 22 h. There were no significant between-group differences at four-weeks in walking distance ( P = 0·72 ) . Length of stay was shorter for seven-day ( mean difference −2·9 days , 95 % confidence interval −17·9 to 12·0 ) and circuit class participants ( mean difference −9·2 days , 95 % confidence interval −24·2 to 5·8 ) compared to usual care , but this was not significant . Conclusions Both seven-day therapy and group circuit class therapy increased physiotherapy time , but walking outcomes were equivalent to usual care Background Coronary artery bypass graft ( CABG ) is a st and ard surgical option for patients with diffuse and significant arterial plaque . This procedure , however , is not free of postoperative complications , especially pulmonary and cognitive disorders . Objective This study aim ed at comparing the impact of two different physiotherapy treatment approaches on pulmonary and cognitive function of patients undergoing CABG .  Methods Neuropsychological and pulmonary function  tests were applied , prior to and following CABG , to 39 patients r and omized into two groups as follows : Group 1 ( control ) – 20 patients underwent one physiotherapy session daily ; and Group 2 ( intensive physiotherapy ) – 19 patients underwent three physiotherapy sessions daily during the recovery phase at the hospital . Non-paired and paired Student t tests were used to compare continuous variables . Variables without normal distribution were compared between groups by using Mann-Whitney test , and , within the same group at different times , by using Wilcoxon test . The chi-square test assessed differences of categorical variables . Statistical tests with a p value ≤ 0.05 were considered significant . Results Changes in pulmonary function were not significantly different between the groups . However , while Group 2 patients showed no decline in their neurocognitive function , Group 1 patients showed a decline in their cognitive functions ( P ≤ 0.01 ) . Conclusion Those results highlight the importance of physiotherapy after CABG and support the implementation of multiple sessions per day , providing patients with better psychosocial conditions and less morbidity Background . Functional training and muscle strength training may improve upper limb motor recovery after stroke . Combining these as functional strength training ( FST ) might enhance the benefit , but it is unclear whether this is better than conventional physical therapy ( CPT ) . Comparing FST with CPT is not straightforward . Objective . This study aim ed at assessing the feasibility of conducting a phase III trial comparing CPT with FST for upper limb recovery . Methods . R and omized , observer-blind , phase II trial . Subjects had upper limb weakness within 3 months of anterior circulation infa rct ion . Subjects were r and omized to CPT ( no extra therapy ) , CPT + CPT , and CPT + FST . Intervention lasted 6 weeks . Primary outcome measure was the Action Research Arm Test ( ARAT ) . Measurements were taken before treatment began , after 6 weeks of intervention , and 12 weeks thereafter . Attrition rate was calculated and differences between groups were interpreted using descriptive statistics . ARAT data were used to inform a power calculation . Results . Thirty subjects were recruited ( 8 % of people screened ) .  Attrition rate was 6.7 % at outcome and 40 % at follow-up . At outcome the CPT + FST group showed the largest increase in ARAT score and this was above the clinical ly important level of 5.7 points . Median ( interquartile range ) increases were 11.5 ( 21.0 ) for CPT ; 8.0 ( 13.3 ) for CPT + CPT ; and 19.5 ( 22.0 ) for CPT + FST . The estimated sample size for an adequately powered subsequent phase III trial was 279 subjects at outcome . Conclusion . Further work toward a phase III clinical trial appears justifiable Background Providing additional Saturday rehabilitation can improve functional independence and health related quality of life at discharge and it may reduce patient length of stay , yet the economic implication s are not known . The aim of this study was to determine from a health service perspective if the provision of rehabilitation to in patients on a Saturday in addition to Monday to Friday was cost effective compared to Monday to Friday rehabilitation alone . Methods Cost utility and cost effectiveness analyses were undertaken alongside a multi-center , single-blind r and omized controlled trial with a 30-day follow up after discharge . Participants were adults admitted for inpatient rehabilitation in two publicly funded metropolitan rehabilitation facilities . The control group received usual care rehabilitation services from Monday to Friday and the intervention group received usual care plus an additional rehabilitation service on Saturday .  Incremental cost utility ratio was reported as cost per quality adjusted life year ( QALY ) gained and an incremental cost effectiveness ratio ( ICER ) was reported as cost for a minimal clinical ly important difference ( MCID ) in functional independence . Results 996 patients ( mean age 74 ( st and ard deviation 13 ) years ) were r and omly assigned to the intervention ( n = 496 ) or the control group ( n = 500 ) . Mean difference in cost of AUD$1,673 ( 95 % confidence interval ( CI ) -271 to 3,618 ) was a saving in favor of the intervention group . The incremental cost utility ratio found a saving of AUD$41,825 ( 95 % CI -2,817 to 74,620 ) per QALY gained for the intervention group . The ICER found a saving of AUD$16,003 ( 95 % CI -3,074 to 87,361 ) in achieving a MCID in functional independence for the intervention group . If the willingness to pay per QALY gained or for a MCID in functional independence was zero dollars the probability of the intervention being cost effective was 96 % and 95 % , respectively . A sensitivity analysis removing Saturday penalty rates did not significantly alter the outcome . Conclusions From a health service perspective , the provision of rehabilitation to in patients on a Saturday in addition to Monday to Friday , compared to Monday to Friday rehabilitation alone , is likely to be cost saving per QALY gained and for a MCID in functional independence . Trial registration Australian and New Zeal and Clinical Trials Registry November 2009 BACKGROUND AND PURPOSE The best treatment and management of stroke patients has been shown to be in stroke units by multidisciplinary rehabilitation teams . Since the composition of stroke units differs it is important to know the extent to which the different components contribute to this results . Physiotherapy is one component of most rehabilitation teams and recent systematic review s have shown that patients with stroke receiving more physiotherapy  achieve more recovery from disability . However , information about the actual amounts of physiotherapy needed to achieve this result is not known . METHOD A pragmatic , r and omized , single-blind , controlled trial comparing recovery from disability in subjects receiving the current st and ard amount of 30 minutes ' physiotherapy with those receiving double that amount ( 60 minutes ) . The study included measures of physical performance and function , psychological aspects of anxiety and depression , and perceived control over recovery . RESULTS Some 114 subjects were recruited to the study ; full six-week data are available for 104 subjects and six-month data for 93 subjects . Comparison of initial to six-week difference scores in the control and intervention groups of the whole sample did not show a significant difference . Scrutiny of the recovery curves of the whole sample showed that , in half the sample , three distinct patterns of recovery were demonstrated . CONCLUSION These results suggest that doubling the physiotherapy time available for patients in a stroke unit will not provide a measurable benefit for all patients . The subgroup analysis of patterns of recovery must be regarded as speculative , but provides the basis for hypotheses about those likely to respond well to more intensive therapy Background and Purpose — Very early rehabilitation , with an emphasis on mobilization , may contribute to improved outcomes after stroke . We hypothesized that a very early rehabilitation protocol would be safe and feasible . Methods — We performed a r and omized , controlled trial with blinded outcome assessment . Patients at < 24 hours after stroke were recruited from 2 Melbourne metropolitan stroke units . Patients were r and omly assigned to receive st and ard care ( SC ) or SC plus very early mobilization ( VEM ) until discharge or 14 days ( whichever was sooner ) . The primary safety outcome was the number of deaths at 3 months . The primary feasibility outcome was a higher “ dose ” of mobilization achieved in VEM . Secondary safety outcomes included adverse events ( including falls and early neurologic deterioration ) , compliance with physiologic monitoring criteria , and patient fatigue after interventions . Secondary feasibility outcomes included “ contamination ” of st and ard care . Results — Overall , 18 % of patients screened were suitable for recruitment . Seventy-one patients were recruited and r and omized , with 2 dropouts by 12 months . The majority experienced ischemic strokes ( 87 % ) . The group mean±SD age was 74.7±12.5 years , and 58 % ( n=41 ) had a National Institutes of Health Stroke Scale score > 7 . There was no significant difference in the number of deaths between groups ( SC , 3 of 33 ; VEM , 8 of 38 ; P=0.20 ) . Almost all deaths occurred in patients with severe stroke . Secondary safety outcomes were similar between groups . The intervention protocol was successfully delivered , achieving VEM dose targets ( double SC , P=0.003 ) and faster time to first mobilization ( P<0.001 ) . Conclusions — VEM of patients within 24 hours of acute stroke appears safe and feasible . Intervention efficacy and cost-effectiveness are currently being tested in a large r and omized , controlled trial Abstract Background Many in patients receive little or no rehabilitation on weekends . Our aim was to determine what effect providing additional Saturday rehabilitation during inpatient rehabilitation had on functional independence , quality of life and length of stay compared to 5 days per week of rehabilitation . Methods This was a multicenter , single-blind ( assessors ) r and omized controlled trial with concealed allocation and 12-month follow-up conducted in two publically funded metropolitan inpatient rehabilitation facilities in Melbourne , Australia . Patients were eligible if they were adults ( aged ≥18 years ) admitted for rehabilitation for any orthopedic , neurological or other disabling conditions excluding those admitted for slow stream rehabilitation/geriatric evaluation and management . Participants were r and omly allocated to usual care Monday to Friday rehabilitation ( control ) or to Monday to Saturday rehabilitation ( intervention ) . The additional Saturday rehabilitation comprised physiotherapy and occupational therapy . The primary outcomes were functional independence ( functional independence measure ( FIM ) ; measured on an 18 to 126 point scale ) , health-related quality of life ( EQ-5D utility index ; measured on a 0 to 1 scale , and EQ-5D visual analog scale ; measured on a 0 to 100 scale ) , and patient length of stay . Outcome measures were assessed on admission , discharge ( primary endpoint ) , and at 6 and 12 months post discharge . Results We r and omly assigned 996 adults ( mean ( SD ) age 74 ( 13 ) years ) to Monday to Saturday rehabilitation ( n = 496 ) or usual care Monday to Friday rehabilitation ( n = 500 ) . Relative to admission scores , intervention group participants had higher functional independence ( mean difference ( MD ) 2.3 , 95 % confidence interval ( CI ) 0.5 to 4.1 , P = 0.01 ) and health-related quality of life ( MD 0.04 , 95 % CI 0.01 to 0.07 , P = 0.009 ) on discharge and may have had a shorter length of stay by 2 days ( 95 % CI 0 to 4 , P = 0.1 ) when compared to control group participants . Intervention group participants were 17 % more likely to have achieved a clinical ly significant change in functional independence of 22 FIM points or more ( risk ratio ( RR ) 1.17 , 95 % CI 1.03 to 1.34 ) and 18 % more likely to have achieved a clinical ly significant change in health-related quality of life ( RR 1.18 , 95 % CI 1.04 to 1.34 ) on discharge compared to the control group . There was some maintenance of effect for functional independence and health-related quality of life at 6-month follow-up but not at 12-month follow-up . There was no difference in the number of adverse events between the groups ( incidence rate ratio = 0.81 , 95 % CI 0.61 to 1.08 ) . Conclusions Providing an additional day of rehabilitation improved functional independence and health-related quality of life at discharge and may have reduced length of stay for patients receiving inpatient rehabilitation . Trial registration Australian and New Zeal and Clinical Trials Registry ACTRN12609000973213 Please see related commentary : http://www.biomed central .com/10.1186/1741 - 7015 - 11 - 199 BACKGROUND AND PURPOSE Many patients have impaired arm function after stroke , for which they receive physiotherapy . The aim of the study was to determine whether increasing the amount of physiotherapy early after stroke improved the recovery of arm function and to compare the effects of this therapy when administered by a qualified therapist or a trained , supervised assistant . The physiotherapy followed a typical British approach , which is Bobath derived . Ten hours of additional therapy were given over a 5-week period . METHODS The study design was a single-blind , r and omized , controlled trial . Stroke patients were recruited from those admitted to the hospital in the 5 weeks after stroke . They were r and omly allocated to routine physiotherapy , additional treatment by a qualified physiotherapist , or additional treatment by a physiotherapy assistant . Outcome was assessed after 5 weeks of treatment and at 3 and 6 months after stroke on measures of arm function and of independence in activities of daily living . RESULTS There were 282 patients recruited to the study . The median initial Barthel score was 6.5 , and the median age of the patients was 73 years . The median initial Rivermead Motor Assessment Arm score was 1 . There were no significant differences between the groups at r and omization or on any of the outcome measures . Only half of the patients allocated to the 2 additional-therapy groups completed the program . CONCLUSIONS This increase in the amount of physiotherapy for arm impairment with a typical British approach given early after stroke did not significantly improve the recovery of arm function in the patients studied . A number of other studies of interventions aim ed at rehabilitation of arm function have reported positive results . Such findings may have been due to the content of these interventions , to the greater intensity of the interventions , or to the selection of patients to whom the treatments were applied Background Our previous work showed that providing additional rehabilitation on a Saturday was cost effective in the short term from the perspective of the health service provider . This study aim ed to evaluate if providing additional rehabilitation on a Saturday was cost effective at 12 months , from a health system perspective inclusive of private costs . Methods Cost effectiveness analyses alongside a single-blinded r and omized controlled trial with 12 months follow up inclusive of informal care . Participants were adults admitted to two publicly funded inpatient rehabilitation facilities . The control group received usual care rehabilitation services from Monday to Friday and the intervention group received usual care plus additional Saturday rehabilitation .  Incremental cost effectiveness ratios were reported as cost per quality adjusted life year ( QALY ) gained and for a minimal clinical important difference ( MCID ) in functional independence . Results A total of 996 patients [ mean age 74 years ( SD 13 ) ] were r and omly assigned to the intervention ( n = 496 ) or control group ( n = 500 ) . The intervention was associated with improvements in QALY and MCID in function , as well as a non-significant reduction in cost from admission to 12 months ( mean difference ( MD ) AUD$6,325 ; 95 % CI −4,081 to 16,730 ; t test p = 0.23 and MWU p = 0.06 ) , and a significant reduction in cost from admission to 6 months ( MD AUD$6,445 ; 95 % CI 3,368 to 9,522 ; t test p = 0.04 and MWU p = 0.01 ) . There is a high degree of certainty that providing additional rehabilitation services on Saturday is cost effective . Sensitivity analyses varying the cost of informal carers and self-reported health service utilization , favored the intervention . Conclusions From a health system perspective inclusive of private costs the provision of additional Saturday rehabilitation for in patients is likely to have sustained cost savings per QALY gained and for a MCID in functional independence , for the inpatient stay and 12 months following discharge , without a cost shift into the community . Trial registration Australian and New Zeal and Clinical Trials Registry November 2009 ACTRN12609000973213 QUESTIONS Does the PEDro scale measure only one construct ie , the method ological quality of clinical trials ? What is the hierarchy of items of the PEDro scale from least to most adhered to ? Is there any effect of year of publication of trials on item adherence ? Are PEDro scale ordinal scores equivalent to interval data ? DESIGN Rasch analysis of two independent sample s of 100 clinical trials from the PEDro data base scored using the PEDro scale . RESULTS Both sample s of PEDro data showed fit to the Rasch model with no item misfit . The  PEDro scale item hierarchy was the same in both sample s , ranging from the most adhered to item r and om allocation , to the least adhered to item therapist blinding . There was no differential item functioning by year of publication . Original PEDro ordinal scores were highly correlated with transformed PEDro interval scores ( r = 0.99 ) . CONCLUSION The PEDro scale is a valid measure of the method ological quality of clinical trials . It is valid to sum PEDro scale item scores to obtain a total score that can be treated as interval level measurement and subjected to parametric statistical analysis Background The main goal of physical therapy treatment ( PT ) in the clinical stage following total knee arthroplasty ( TKA ) is to prepare patients for discharge from the hospital as soon as possible after their operation . Although aggressive rehabilitation is believed to be important , evidence of effects of different exercise programmes following TKA is limited . This led to the question whether the intensity of PT ( once versus twice daily ) following TKA affects short-term recovery , measured as range of motion . Methods A r and omised controlled trial compared an exercise regimen of two sessions per day with a similar programme administered once daily . Primary outcome measure was ROM . Results At the time of hospital discharge , there was no difference between the experimental and control groups in range of motion . Conclusion This study shows that in our setting twice daily PT sessions do not produce different results as daily PT sessions . It may be question ed whether multiple daily therapy sessions are needed as an in-hospital PT regimen in OA total knee patients Of 1094 patients with a confirmed stroke admitted to Northwick Park , a district general hospital , 364 ( 33 % ) died while in hospital , 215 ( 20 % ) were fully recovered when discharged , and 329 ( 30 % ) were too frail or too ill from diseases other than stroke to be considered for active rehabilitation . Only 121 ( 11 % ) were suitable for intensive treatment .  They and 12 patients referred direct to out patients were allocated at r and om to one of three different courses of rehabilitation . Intensive was compared with conventional rehabilitation and with a third regimen which included no routine rehabilitation , but under which patients were encouraged to continue with exercises taught while in hospital and were regularly seen at home by a health visitor .  Progress at three months and 12 months was measured by an index of activities of daily living . Improvement was greatest in those receiving intensive treatment , intermediate in those receiving conventional treatment , and least in those receiving no routine treatment .  Decreasing intensity of treatment was associated with a significant increase in the proportions of patients who deteriorated and in the extent to which they deteriorated . Probably only a few stroke patients , mostly men , are suitable for  intensive outpatient rehabilitation  , but for those patients the treatment is effective and realistic QUESTION Is additional Saturday physiotherapy intervention beneficial for in patients undergoing rehabilitation ? DESIGN R and omised controlled trial with concealed allocation , assessor blinding , and intention-to-treat analysis . PARTICIPANTS Two hundred and sixty-two in patients undergoing rehabilitation in an Australian metropolitan hospital . INTERVENTION The experimental group received physiotherapy intervention from Monday to Saturday and the control group from Monday to Friday . OUTCOME MEASURES Primary outcomes were hospital and physiotherapy length of stay . Secondary measures were collected to reflect patient outcomes ( health state , independence , activity , flexibility and strength ) and burden of care ( discharge destination , adverse events , and follow-up physiotherapy intervention ) . RESULTS There was a 3.2 day reduction for the experimental group ( 95 % CI -0.5 to 6.9 ) in hospital length of stay and a 2.5 day reduction ( 95 % CI -0.9 to 5.9 ) in physiotherapy length of stay . There was no significant between-group difference in change from admission to discharge for most of the secondary patient outcomes ( health state , independence , activity , flexibility ) . The risk of the experimental group being categorised as strong relative to the control group was 1.2 ( 95 % CI 0.99 to 1.50 ) . The risk of not being discharged home , of having an adverse event , or requiring follow-up physiotherapy intervention was no greater for the experimental group than the control group . CONCLUSION The provision of additional Saturday physiotherapy intervention result ed in a trend to shorter hospital and physiotherapy length of stay without affecting patient outcome unfavourably or increasing burden of care , suggesting that a larger multicentre trial is warranted BACKGROUND Care of elderly patients after hip fracture is not well established . METHODS We enrolled 173 patients with acute hip fracture who were 65 years or older ( 79.2 % women ; mean age , 84 years ; 77.4 % living at home ) . Using a factorial design , we r and omly allocated patients to extended physiotherapy ( PT ) ( supervised 60 min/d during acute care plus an unsupervised home program ) vs st and ard PT ( supervised 30 min/d during acute care plus no home program ; single-blinded ) , and to cholecalciferol therapy , 2000 vs 800 IU/d ( double-blinded ) . Primary outcome was rate of falls ; secondary outcome was rate of hospital readmissions during the 12-month follow-up . All analyses included 173 individuals and used multivariate Poisson regression analyses . RESULTS At baseline , 50.9 % of participants had 25-hydroxyvitamin D levels of less than 12 ng/mL and 97.7 % of less than 30 ng/mL. We documented 212 falls and 74 hospital readmissions . Because this was a factorial design trial , all analyses tested the main effect of each treatment while controlling for the other in 173 participants . Extended vs st and ard PT reduced the rate of falls by 25 % ( 95 % confidence interval [ CI ] , -44 % to -1 % ) . Cholecalciferol treatment , 2000 vs 800 IU/d , did not reduce falls ( 28 % ; 95 % CI , -4 % to 68 % ) , but reduced the rate of hospital readmissions by 39 % ( 95 % CI , -62 % to -1 % ) . CONCLUSIONS Extended PT was successful in reducing falls but not hospital readmissions , whereas cholecalciferol treatment , 2000 IU/d , was successful in reducing hospital readmission but not falls . Thus , the 2 strategies may be useful together because they address 2 different and important complications after hip fracture After stroke , physiotherapy can promote brain reorganization and motor recovery . Combining muscle strength and functional training ( functional strength training , FST ) may be beneficial . The aim of the authors was to compare FST with conventional physiotherapy ( CPT ) while controlling for the potential confounder of therapy intensity in a multicenter , r and omized controlled observer-blind trial . The mean age of the participants was 68.3 ( st and ard deviation [ SD ] = 12.03 ) years at a mean of 34 ( SD = 20 ) days after stroke , with mean peak paretic knee extension torque ( torque ) of 22 ( SD = 25 ) Nm . The estimated sample size was 102 to detect a between-group difference of 0.2 m/s in walking speed . After baseline measures , participants were allocated r and omly to CPT or CPT + CPT or CPT + FST for 6 weeks . Additional experimental therapy was provided for up to 1 hour a day , 4 times each week . Outcomes were measured 6 weeks after baseline and at follow-up 12 weeks thereafter . Measures included walking speed , knee extensor torque , and functional mobility ( Rivermead ) . At outcome , both extraintensity groups showed greater increases in walking speed than the CPT group , but this reached significance only for the CPT + CPT group ( P = .031 ) . The CPT + CPT group also had a greater number of participants who walked at 0.8 m/s or above . No significant differences were observed for torque about the knee or for the Rivermead score . At follow-up , no significant differences were observed . These phase I results justify a subsequent trial of CPT + CPT versus CPT + FST A r and omised single-blind controlled trial was design ed to determine whether intensity of therapy ( physiotherapy and occupational therapy ) shortened length of stay for patients in a rehabilitation unit . Patients were under 65 , primarily with stroke , but also with other conditions such as traumatic brain injury , and multiple sclerosis . The experimental group were timetabled to receive 67 % more therapy in any given week , than the control group . After controlling for confounders and case mix ( as expressed by type of therapy required ) patients in the experimental group showed a significant 14-day reduction in length of stay ( < 0.01 ) . Concurrently average length of stay was increased for both groups by 16 days due to delays in discharge BACKGROUND This study aim ed to determine whether a structured , inpatient ( or Phase 1 cardiac rehabilitation ) , physiotherapy-supervised walking program , with or without musculoskeletal and respiratory exercises , might improve walking capacity and other parameters for patients undergoing coronary artery bypass graft surgery ( CABG ) . METHODS Ninety-three patients awaiting first-time CABG over a 12-month period were r and omised to one of three post-operative physiotherapy regimens : ' st and ard intervention ' , consisting of gentle mobilisation ; ' walking exercise ' , consisting of a physiotherapy-supervised , moderate intensity walking program ; and ' walking/breathing exercise ' , consisting of the same moderate intensity walking program , musculoskeletal exercises and respiratory exercises . Primary outcomes ; six-minute walking assessment ( 6MWA ) distance , vital capacity and health-related quality of life , were measured pre-operatively , at discharge from hospital and at four weeks following discharge . RESULTS Walking and walking/breathing exercise groups had significantly higher 6MWA distance ( 444+/-84 m , 431+/-98 m , respectively ) than the st and ard intervention group ( 377+/-90 m ) at discharge from hospital . There was no significant difference between intervention groups for 6MWA distance at four-week follow-up . There was no significant difference between intervention groups in terms of vital capacity and health-related quality of life . CONCLUSIONS A physiotherapy-supervised , moderate intensity walking program in the inpatient phase following CABG improves walking capacity at discharge from hospital . The performance of respiratory and musculoskeletal exercises confers no additional benefit to the measured outcomes BACKGROUND Postoperative exercise therapy aims at recovering , as soon as possible , independence in the basic physical activities ; but the type , intensity , and therefore the costs of the programs , vary widely . The aim of this study was to compare the effectiveness of a low frequency ( once daily , not in the weekend ) program with a high frequency ( twice daily , including the weekend ) one and to assess whether the latter would yield sufficient benefit for the patient to justify higher costs in material and personnel ( physiotherapists ) after uncomplicated coronary artery bypass graft ( CABG ) surgery . METHODS Two-hundred and forty-six patients were r and omly allocated to either a low or high frequency exercise program . Endpoints were the functional level as measured by the achievement of five activity milestones , the patient 's independence ( functional independence measures [ FIM ] ) as assessed by a structured interview , the amount of daily physical activity ( activity monitor ) , and patient satisfaction ( question naire ) . Except for patient satisfaction , all measurements were done in the first week after surgery . RESULTS Patients with the high frequency exercise program achieved functional milestones faster than patients with the low frequency exercise program ( p = 0.007 ) . The frequency of the exercise program had no influence on functional independence as measured with the FIM or quantity of physical activity . The satisfaction degree was greater in the high frequency group ( p = 0.032 ) , although the low frequency group was not dissatisfied . CONCLUSIONS A high frequency exercise program leads to earlier performance of functional milestones and yields more satisfaction after uncomplicated CABG surgery and this should lead to an earlier discharge . On the other h and , if the shortage of physiotherapists remains unchanged or even increases , the low frequency program also yields excellent functional results , albeit at the cost of a somewhat longer hospital stay : but it would allow a sensible redistribution of the physiotherapists activity towards complicated and , therefore , more dem and ing patients Background : There is evidence to support both the use of intravenous methylprednisolone ( IVMP ) in multiple sclerosis ( MS ) relapse and physiotherapy in the management of MS , but no studies have investigated the combination of steroids and rehabilitation together . Objectives : To evaluate the benefits of IVMP with planned , comprehensive multidisciplinary team ( MDT ) care compared to IVMP with st and ard care . Methods : In this r and omised controlled trial , patients confirmed to have had a definite MS relapse severe enough to warrant IVMP ( 1 g daily for three days ) were r and omised to two groups . The control group was managed according to the st and ard ward routine ; the treatment group received planned coordinated multidisciplinary team assessment and treatment . Baseline assessment s , including demographics and Exp and ed Disability Status Scale ( EDSS ) were carried out on both groups . The primary outcome measures were Guy ’s Neurological Disability Scale ( GNDS ) , and Amended Motor Club Assessment ( AMCA ) . The secondary measures were the Barthel Index ( BI ) , Human Activity Profile ( HAP ) , and Short Form Item 36 Health Survey ( SF-36 ) . All measures have published data on reliability and validity . Measures were administered at one and three months . Results : Forty subjects , including 27 females , completed data collection . There were no significant differences between the two groups at baseline . Results showed statistically significant differences in GNDS ( p = 0.03 ) , AMCA ( p = 0.03 ) , HAPM ( p < 0.01 ) , HAPA ( p = 0.02 ) , and BI ( p = 0.02 ) at three months in favour of planned MDT care . Conclusion : This study indicates that combining steroids with planned MDT care is superior to administering them in a st and ard neurology or day ward setting . Further research is necessary in order to confirm this finding UNLABELLED Stockton KA , Mengersen KA . Effect of multiple physiotherapy sessions on functional outcomes in the initial postoperative period after primary total hip replacement : a r and omized controlled trial . OBJECTIVE To determine whether increasing physiotherapy input from once to twice per day will result in earlier achievement of functional milestones ( ie , independence in mobility and transfers ) and decreased length of stay ( LOS ) in patients undergoing a primary total hip replacement . DESIGN R and omized controlled trial . SETTING Metropolitan private hospital . PARTICIPANTS Patients ( N=57 ) with primary total hip replacement were r and omly assigned to the twice daily ( treatment , n=30 ) and once daily ( control , n=27 ) groups . Patients who chose to attend hydrotherapy  were excluded from the r and omization process ; however , they gave consent for outcome measures to be collected for comparison with the r and omized groups . INTERVENTIONS The control group received usual care , and the treatment group received twice-daily physiotherapy from day 1 after surgery to discharge . MAIN OUTCOME MEASURES The Iowa Level of Assistance at postoperative days 3 and 6 and LOS . RESULTS This study demonstrates that patients who received twice-daily l and -based  physiotherapy  after primary total hip replacement attained earlier achievement of functional milestones than patients that received once-daily physiotherapy . A statistically significant ( P=.041 ) but not clinical ly significant difference was evident in the Iowa Level of Assistance score at day 3 . There was no difference between the groups in Iowa Level of Assistance measures on day 6 or on LOS . CONCLUSIONS Patients who received twice-daily physiotherapy showed a trend toward earlier achievement of functional milestones ; however , this finding did not translate to decreased LOS BACKGROUND Physiotherapy is integral to modern trauma care . Early physiotherapy and mobility have been shown to improve outcomes in patients with isolated injuries ; however , the optimal intensity of physiotherapy in the multitrauma patient population has not yet been examined . The primary aim of this study was to determine whether an intensive physiotherapy program result ed in improved inpatient mobility . METHODS We conducted a single-center prospect i ve r and omized controlled study of 90 consecutive patients admitted to the Alfred Hospital ( a Level 1 trauma center ) in Australia between October 2011 and June 2012 who could participate in ward-based physiotherapy .  Participants were allocated to either usual care ( daily physiotherapy treatment , approximately 30 minutes ) or intensive physiotherapy ( usual care plus two additional 30-minute treatments each day ) . The primary outcome measure was the modified Iowa Level of Assistance ( mILOA ) score , collected by a blinded assessor at Days 3 and 5 ( or earlier if discharged ) . Secondary measures included physical readiness for discharge , hospital and rehabilitation length of stay , a patient confidence and satisfaction scale , and quality of life at 6 months . RESULTS Groups were comparable at baseline . Participants in the intensive physiotherapy group achieved significantly improved mILOA scores on Day 3 ( median , 7 points compared with 10 points ; p = 0.02 ) and Day 5 ( median , 7.5 points compared with 16 points ; p = 0.04 ) and were more satisfied with their care ( p = 0.01 ) . There was no difference between groups in time to physical readiness , discharge destination , length of stay , or quality -of-life measures . CONCLUSION Intensive physiotherapy result ed in improved mobility in trauma in patients . Further studies are required to determine if specific groups benefit more from intensive physiotherapy and if this translates to long-term improvements in outcomes . LEVEL OF EVIDENCE Therapeutic study , level 1 Background : The most severely disabled stroke patients are often excluded from studies evaluating effects of physiotherapy . This study intended to investigate the effect of an increased intensity of physiotherapy in combination with dexamphetamine the first week after ischemic stroke in patients with an impaired level of consciousness and severe motor dysfunction . Methods : Thirty patients were enrolled within 96 h after onset of symptoms . Patients were r and omized to 30–45 min of physiotherapy twice daily or to maximally 15 min per day for 5 days . All patients received dexamphetamine to achieve alertness . Functional outcome measures were assessed at baseline , the day after treatment discontinuation , and 3 and 12 months after stroke onset . Residence of living was registered at long-term follow-ups . Results : No statistically significant differences were seen between groups in the outcomes measured at any time point . However , both groups improved over time in all outcomes at 3 and 12 months ( p < 0.05 ) , except for sensory functions at 3 months and motor functions at 12 months . The number of patients needed to treat ( NNT ) to achieve the desired improvement in Lindmark motor score was 8 , with the 95 % CI being NNT(harm ) 10 to NNT(beneficial ) 3 . The fraction of patients who died was the same in both treatment groups , 47 % ( 95 % CI 28–65 % ) . Conclusions : An increased intensity of physiotherapy in combination with dexamphetamine during the first week after stroke onset did not affect short- or long-term outcome in this limited sample of patients with severe stroke OBJECTIVES To investigate the effects of intensive acute hospital physiotherapy for patients with isolated hip fractures . DESIGN , SETTING Single-institution , prospect i ve , r and omised trial at a level 1 trauma centre in Melbourne , March 2014 - January 2015 . PARTICIPANTS 92 patients aged 65 years or more with isolated hip fractures . Patients were excluded if the fracture was subtrochanteric or pathological , or if post-operative orders required the patient to be non-weight-bearing on the operated leg . INTERVENTIONS R and omisation to usual care physiotherapy ( daily ; control group ) or intensive physiotherapy ( three times daily ; intervention group ) . MAIN OUTCOME MEASURES Outcomes were assessed at post-operative Day 5 , at discharge , and at 6 months . The primary outcome was the modified Iowa Level of Assistance ( mILOA ) score , with other outcome measures including Timed Up and Go test performance and hospital length of stay ( LOS ) . RESULTS After controlling for sex , anaesthetic type and home setting , the between-group difference in Day 5 mILOA score favoured the intervention group ( mean difference v control group , -2.7 points ; P = 0.04 ) . Hospital LOS was also shorter for the intervention group ( median , 24.4 days v 35.0 days ; P = 0.01 ) . A Cox proportional hazard model that controlled for potential confounders indicated that the probability of discharge was greater for intervention group patients at all time points following surgery ( P < 0.001 ) . Re-admission and complication rates and 6-month outcomes for the two groups were not significantly different . CONCLUSIONS Intensive acute hospital physiotherapy is safe and reduces hospital LOS after an isolated hip fracture . This has the potential to improve bed flow , given the large numbers of inpatient beds occupied by this patient population . TRIAL REGISTRATION Clinical Trials Registry # NCT02088437 BACKGROUND AND PURPOSE Physiotherapy services provided outside of business hours may improve patient and hospital outcomes , but there is limited underst and ing of what services are provided . This study described current services provided outside of business hours across Australian hospitals . METHODS Design Descriptive , cross-sectional , Web-based survey . Participants A r and om sample of Australian hospitals from the public or private sector located in either metropolitan or rural/regional areas . RESULTS A total of 112 completed surveys were su bmi tted . The most common service outside of business hours was a Saturday service , provided by 61 % of participating hospitals with a median ( interquartile range [ IQR ] ) of 1.0 hour ( 0.0 and 3.4 ) of physiotherapy per 30 beds . Sunday services were provided by 43 % of hospitals , and services provided outside of business hours from Monday to Friday were provided by 14 % of hospitals . More private hospitals provided some form of physiotherapy service  outside of business hours ( 91 % ) than public hospitals ( 48 % ) . More metropolitan hospitals provided some form of physiotherapy service outside of business hours ( 90 % ) than rural/regional hospitals ( 28 % ) . Few of the hospitals providing sub-acute services had  weekend physiotherapy  ( 30 % ) , but the majority of highly acute wards provided weekend physiotherapy  ( 81 % ) . Highly acute wards also provided more hours of service on a Saturday ( median 8.1 hours per 30 beds , IQR 0.6 - 22.5 ) compared with acute wards ( median 0.8 hours per 30 beds , IQR 0.0 - 2.8 ) . CONCLUSION There is limited availability of physiotherapy services in Australian hospitals outside of business hours . There are inequalities in physiotherapy services provided outside of business hours , with public , rural/regional and sub-acute facilities receiving fewer services outside of business hours than private , metropolitan and highly acute facilities A r and omized controlled pilot trial was conducted to estimate the effects of early , intensive , gait-focused physical therapy on ambulatory ability in acute , stroke patients . Twenty-seven patients with middle cerebral artery infa rct of thromboembolic origin confirmed by computed axial tomography scan were stratified and r and omly assigned to the experimental group , to a control group that received early , intensive and conventional therapy , or to a group receiving routine conventional therapy that started later and was not intense . Assessment s at entry , six weeks , and three and six months by independent evaluators permitted comparisons with reference to clinical measures of motor performance , balance , and functional capacity , and laboratory measures of gait movements . Group results at six weeks demonstrated that gait velocity was similar in the two conventional groups thereby eliminating the timing of the interventions as an important factor . At that point , gait velocity was faster in the experimental group . The difference translated into a moderate effect size of 0.58 . The time dedicated to gait training but not to total therapy time was correlated ( rs = 0.63 ) to gait velocity . This effect disappeared at three and six months after stroke . These pilot results justify planning a large trial to test the effectiveness of a therapeutic protocol that focuses on early and intense gait therapy in an effort to facilitate early ambulation following stroke OBJECTIVE To determine whether adults with lower limb orthopedic conditions who received additional weekend physical therapy ( PT ) and occupational therapy ( OT )  demonstrated increased habitual physical activity . DESIGN R and omized controlled trial . SETTING Inpatient rehabilitation center . PARTICIPANTS Adults ( N=105 , 72 women ; mean age ± SD , 74±12y ) admitted with a lower limb orthopedic condition , cognitively alert and able to walk . INTERVENTION The control group received PT and OT Monday to Friday ; in addition , the experimental group also received a full Saturday PT and OT service . Participants wore an activity monitor for 7 days . MAIN OUTCOME MEASURES Daily steps and daily upright time ( hours ) . RESULTS Overall , participants took a mean of 589±640 steps per day and spent a mean of 1.2±0.9 hours upright per day . Experimental group participants took more than twice as many steps ( mean difference , 428 steps ; 95 % confidence interval [ CI ] , 184 - 673 ) and spent 50%±20 % more time upright ( mean difference , 0.5h ; 95 % CI , 0.1 - 0.9 ) than control group participants on Saturdays . In the days after additional therapy , experimental group participants took 63%±28 % more steps ( mean difference , 283 steps ; 95 % CI , 34 - 532 ) and spent 40%±17 % more time upright ( mean difference , 0.4h ; 95 % CI , 0.1 - 0.8 ) per day than participants in the control group . CONCLUSIONS Providing additional rehabilitation services on the weekend increased habitual activity , but patients with lower limb orthopedic conditions admitted to rehabilitation remained relatively inactive even with additional therapy OBJECTIVE To investigate the effects of a supervised longer- ( 14wk ) versus shorter- duration ( 7wk ) rehabilitation program  after lung transplantation ( LTX ) . DESIGN R and omized controlled trial . SETTING Outpatient rehabilitation gym setting . PARTICIPANTS Post-LTX patients aged ≥18 years ( N=66 ; 33 women ; mean age , 51±13y ) who had undergone either single LTX or bilateral LTX . INTERVENTION Outpatient rehabilitation program consisting of thrice-weekly sessions with cardiovascular training on bike ergometer and treadmill plus upper and lower limb strength training . MAIN OUTCOME MEASURES Measures were taken at baseline , 7 weeks , 14 weeks , and 6 months by assessors who were blinded to group allocation . Functional exercise capacity was measured by the 6-minute walk test ( 6MWT ) . Strength of quadriceps and hamstrings was measured on an isokinetic dynamometer and recorded as average peak torque of 6 repetitions for both muscles . Quality of life ( QOL ) was assessed with the Medical Outcomes Study 36-Item Short-Form Health Survey . RESULTS Of the participants , 86 % had bilateral LTX and 41 % had primary diagnosis of chronic obstructive pulmonary disease .  The 6MWT increased in both groups with no significant difference between groups at any time point ( mean 6mo 6MWD : short , 590±85 m vs long , 568±127 m ; P=0.5 ) . Similarly , at 6 months , there was no difference between groups in quadriceps average peak torque ( mean , 115±38Nm vs 114±40Nm , respectively ; P=.59 ) , hamstring average peak torque ( 57±18Nm vs 52±19Nm , respectively ; P=.36 ) , or mental or physical health domains of quality of life . CONCLUSIONS Shorter duration ( 7wk ) of rehabilitation achieves comparable outcomes with 14 weeks of supervised rehabilitation for functional exercise capacity , lower limb strength , and quality of life at 6 months after LTX
OBJECTIVE To up date a previous review on whether additional physical therapy services reduce length of stay , improve health outcomes , and are safe and cost-effective for patients with acute or subacute conditions .