Background. Targeted physical activity drives functional recovery after stroke. This review aimed to determine the amount of time stroke survivors spend physically active during physiotherapy sessions. Summary of Review. A systematic search was conducted to identify published studies that investigated the use of time by people with stroke during physiotherapy sessions. Seven studies were included; six observational and one randomised controlled trial. People with stroke were found to be physically active for an average of 60 percent of their physiotherapy session duration. The most common activities practiced in a physiotherapy session were walking, sitting, and standing with a mean (SD) practice time of 8.7 (4.3), 4.5 (4.0), and 8.3 (2.6) minutes, respectively. Conclusion. People with stroke were found to spend less than two-thirds of their physiotherapy sessions duration engaged in physical activity. In light of dosage studies, practice time may be insufficient to drive optimal motor recovery. 1. Introduction People with stroke spend less than a quarter of their day engaged in physical activity in rehabilitation centres [1, 2]. Studies conducted internationally over many years have shown that the time spent by people with stroke in therapy and in contact with therapists during the working day is very little [1–4]. Bernhardt et al. [1] found that people with stroke spent only 5.2 percent of the working day in contact with therapists in an acute stroke unit which equates to 0.5 hours of a nine-hour observation period. Similarly, Thompson and McKinstry [4] found that people with stroke in an inpatient rehabilitation unit spent only 1.2 hours of an 11-hour observation period in therapy. However, an observational study investigating the use of time in physiotherapy sessions specifically, reported that people with stroke spend between 21 percent and 30 percent of therapy sessions inactive [5]. Many studies have identified therapy sessions as being the most active part of the day and therefore provide the greatest opportunity to maximise physical activity levels. Therefore, this review was important to determine exactly how active people with stroke are in their physiotherapy sessions during stroke rehabilitation. Targeted physical activity drives functional recovery after stroke. There is now strong evidence that more time spent in task-specific therapy after stroke improves functional outcomes [6, 7]. Furthermore, high repetitions of a task-specific physical activity have been shown to facilitate positive neuroplasticity in stroke survivors [8–10]. In
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