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Cited by 67Stroke Rehabilitation and RecoveryAcute Ischemic Stroke ManagementMedical Practices and Rehabilitation

Rehabilitation Therapy Doses Are Low After Stroke and Predicted by Clinical Factors

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Young, Brittany M., Holman, E. Alison, Cramer, Steven C., Shah, Shreyansh, Griessenauer, Christoph J., Patel, Nirav, Lin, David J., Gee, Joey +26 more·2023·Stroke
DOI 10.1161/strokeaha.122.041098PMC PMC9992003
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Abstract

Background: Stroke is a leading cause of long-term disability. Greater rehabilitation therapy after stroke is known to improve functional outcomes. This study examined therapy doses during the first year of stroke recovery and identified factors that predict rehabilitation therapy dose. Methods: Adults with new radiologically confirmed stroke were enrolled 2 to 10 days after stroke onset at 28 acute care hospitals across the United States. Following an initial assessment during acute hospitalization, the number of physical therapy, occupational therapy, and speech therapy sessions were determined at visits occurring 3, 6, and 12 months following stroke. Negative binomial regression examined whether clinical and demographic factors were associated with therapy counts. False discovery rate was used to correct for multiple comparisons. Results: Of 763 patients enrolled during acute stroke admission, 510 were available for follow-up. Therapy counts were low overall, with most therapy delivered within the first 3 months; 35.0% of patients received no physical therapy; 48.8%, no occupational therapy, and 61.7%, no speech therapy. Discharge destination was significantly related to cumulative therapy; the percentage of patients discharged to an inpatient rehabilitation facility varied across sites, from 0% to 71%. Most demographic factors did not predict therapy dose, although Hispanic patients received a lower cumulative amount of physical therapy and occupational therapy. Acutely, the severity of clinical factors (grip strength and National Institutes of Health Stroke Scale score, as well as National Institutes of Health Stroke Scale subscores for aphasia and neglect) predicted higher subsequent therapy doses. Measures of impairment and function (Fugl-Meyer, modified Rankin Scale, and Stroke Impact Scale Activities of Daily Living) assessed 3 months after stroke also predicted subsequent cumulative therapy doses. Conclusions: Rehabilitative therapy doses during the first year poststroke are low in the United States. This is the first US-wide study to demonstrate that behavioral deficits predict therapy dose, with patients having more severe deficits receiving higher doses. Findings suggest directions for identifying groups at risk of receiving disproportionately low rehabilitation doses.

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  • At least 100 h of cumulative therapy are necessary to achieve significant improvements in functional communication.

    “Studies indicate that at least 100 h of cumulative therapy are necessary to achieve significant improvements in functional communication4.”

    From ORLA combined with telerehabilitation in patients with subacute Poststroke aphasia: a randomized controlled trial (2025) · cites this paper as [4]

    The Discussion section ('Total Therapy Was Low During the Year Following Stroke'; page unavailable) reports that gains in language comprehension were found after at least 20 hours of speech therapy. It does not support the claimed 100-hour threshold or establish that this amount is necessary for significant improvements in functional communication. (LLM, conf=0.86)

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Authors
Young, B. M., Holman, E. A., Cramer, S. C., Shah, S., Griessenauer, C. J., Patel, N., Lin, D. J., Gee, J., Moon, J., Schwertfeger, J., Jayaraman, A., Lee, R., Lansberg, M., Payne, J., Patten, C., Cramer, S. C., Holman, E. A., Agrawal, K., Kissela, B., DeJong, S., Cole, J., Silver, B., Cucchiara, B., Busza, A., Liew, S.-L., Alderman, S., Hayes, H., Majersik, J. J., Worrall, B., Tirschwell, D., Bushnell, C., El Husseini, N., Lee, J.-M., & Falcone, G. J.
Affiliations
University of California, Los Angeles (US)
ORCID
Venue
Stroke
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2023-03
Volume
54
Issue
3
Pages
831-839
ISSN
  • 0039-2499 (ISSN-L)
  • 1524-4628
DOI
10.1161/strokeaha.122.041098
PMC
PMC9992003
OpenAlex
W4319063423
Cited by
67
References
44
Citations by year
2026: 23 · 2025: 30 · 2024: 10 · 2023: 4
FWCI
7.34
Type
journal article
Language
en
Open access
Locations
  • Stroke (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • U.S. Department of Veterans Affairs (IK6 RX003543)
  • National Institute of Nursing Research (R01NR015591)
Topics
  • Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
  • Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
Keywords
stroke rehabilitation, therapeutic dose, physiotherapy, occupational therapy, speech therapy, discharge disposition, inpatient rehabilitation, Hispanic patients, stroke severity, aphasia, hemispatial neglect, activities of daily living, stroke recovery
MeSH terms
Stroke Rehabilitation, Activities of Daily Living, Adult, Aphasia, Humans, Occupational Therapy, United States, Recovery of Function, Stroke

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