26 Chapter 2 Results The selection procedure led to the inclusion of 51 articles, mainly from Europe, Australia and the USA. Based on these articles, seven main topics were identified that were considered important for a CRE, ie 1) therapy time, 2) group training, 3) patient-regulated exercise, 4) family participation, 5) task-oriented training, 6) enriched environment, and 7) team dynamics. These topics are discussed separately below. Therapy time Of the 51 articles, 20 reported on how patients spent their day on a rehabilitation ward, describing the amount of therapy given and the effect of increased therapy time on rehabilitation outcomes. Increased therapy time and the level of activity of patients was an important predictor of better rehabilitation outcomes.13-32 Current therapy time The studies showed that patients have a low level of activity during inpatient rehabilitation.13,14,22,25-29 In Western countries, during inpatient rehabilitation for stroke, patients spent up to 80% of their day on non-therapeutic activities (of which 28-38% spent sitting or lying). Patients spent 49-60% of their day alone and 48% inactive. The amount of time spent on therapeutic activities ranged from 9-56%. Patients with higher functional levels spent more time on therapeutic activities.13,14,25-29 Similar results were found for older patients rehabilitating for other conditions within inpatient facilities. For example, patients with orthopaedic problems of the lower extremities who were able to walk independently or with support, walked for an average of only 8 min/day (as measured with an activity monitor). None of them achieved 10 min of moderately intensive physical contiguous activity. Consequently, these patients did not reach the amount of activity that is recommended in guidelines (ie, 30 mins of moderate intensive physical activity, completed in bouts of ≥10 min, on at least 5 days/week).22
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