27 Challenging Rehabilitation Environment for older persons During inpatient rehabilitation, the professional with whom patients spent the most time was the nurse, ie, up to 13% of the working day (the weekends had even more contact moments than during weekdays). Therefore, the challenge for nurses is to encourage patients to do more task-specific training during their ADL and thereby increase therapy time, especially during times when other professionals are less/not present.13,14,25,27,30 Effect of increased therapy time While patients had low levels of activity and therapy time during inpatient rehabilitation, the therapy time appeared to be related to the outcome of rehabilitation.13,15-24,31-33 An increase in therapy time was associated with positive outcomes such as return home, functional recovery, and a shorter length of stay. A decrease of therapy time was associated with return to hospital or death.18,19,22,23,33 For example, for older patients rehabilitating after hip fracture, 1 h extra therapy led to a 3.1% increased chance of returning home.24 For stroke patients, the amount of therapy time proved to be a predictor of rehabilitation outcomes. Among others, effects were reported in mobility, self-care and functional recovery.15,16,31,32 An increase of time spent on therapy led to better results concerning functional recovery, independence in ADL, instrumental ADL, and walking speed, as well as a shorter length of stay in the inpatient facility and an increased chance of returning home.17-20 For recovery after stroke, at least 16 h/week of high-quality therapy is required for older patients.21 For patients aged ≥65 years, an increase from <3 h to >3-3.5 h of therapy/day led to an improved functional recovery (as visualized with a threepoint gain on the functional independence measure) whereas an increase to >3.5 h yielded no significant difference.15 An increase of (independent) practice can be achieved if nurses incorporate the rehabilitation goals in daily care. Task-oriented activities must be an important part of daily reality. Through encouragement by nurses and family, the time spent on therapeutic activities can be increased by 50 min/day.13,21 2
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