28 Chapter 2 In conclusion, for all patients, the amount of time spent on therapy was related to rehabilitation outcome. However, there tended to be a ceiling effect in the influence of therapy time, while the level of physical activity during inpatient rehabilitation was low. Encouraging patient-regulated exercise and task-specific training during ADL by nurses and family increased therapy time. Group training During rehabilitation, group training is often used by different therapists (eg speech and language therapists, occupational therapists, psychologists and physical therapists), among other things, to enable increased practice time without increasing staffing.34-36 Regarding circuit class therapy, physical therapy is provided in groups and focus on repetitive practice of functional and meaningful tasks. This may comprise either a series of workstations arranged in a circuit, or a series of individualized activities in a group setting.34 Compared to individual therapy sessions, in circuit class therapy sessions patients with stroke spent more time in active task practice and a similar amount of time in walking practice.37 For patients after stroke, circuit class therapy was effective in improving mobility. Patients were able to walk further, faster, less dependently, and were more confident in their balance. Although there seemed to be no greater risk of falls, this item needs further research.34 During inpatient rehabilitation after stroke, group training provided by occupational therapists was feasible for task-specific practice, such as dressing tasks. After receiving group training, a clinically significant improvement in dressing performance was found, although no comparison was made with individual therapy. Nevertheless, this study demonstrated that group therapy is feasible, even for personal ADL.38 Likewise, for persons rehabilitating after a knee or hip replacement, group training proved to be as effective as individual rehabilitation. Patients who received group training had no different clinical/disability evaluation and level of quality of life compared with patients receiving individual therapy.39
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