Use of Time by Stroke Patients A Comparison of Four European Rehabilitation Centers Liesbet De Wit, PT, MSc; Koen Putman, PT, MSc; Eddy Dejaeger, MD, PhD; Ilse Baert, PT, MSc; Peter Berman, MB, BS, FRCP; Kris Bogaerts, MSc; Nadine Brinkmann, PT, BSc; Louise Connell, PT, BSc; Hilde Feys, PT, PhD; Walter Jenni, MD; Christiane Kaske, PT, BSc; Emmanuel Lesaffre, PhD; Mark Leys, PhD; Nadina Lincoln, PhD; Fred Louckx, PhD; Birgit Schuback, PT, MSc; Wilfried Schupp, MD; Bozena Smith, OT, MSc; Willy De Weerdt, PT, PhD Background and Purpose—Differences exist between European countries in the proportion of patients who die or become dependent after stroke. The aim of the present study was to identify differences in the use of time by stroke patients in 4 rehabilitation centers in 4 European countries. Methods—In each of the 4 centers, 60 randomly selected stroke patients were observed at 10-minute intervals using behavioral mapping. Observations took place on 30 weekdays selected at random, on equal numbers of morning, afternoon, and evening sessions. A logistic generalized estimating equation model with correction for differences in case mix and multiple testing was used for the analysis. Results—Overall time available from different professions was the highest in the United Kingdom, but patients in the United Kingdom spent on average only 1 hour per day in therapy. This was significantly less than patients in Belgium and Germany, who spent 2 hours, and patients in Switzerland who spent 3 hours per day in therapy. In all centers, patients spent less than half their time in interactions and 72% of the time in nontherapeutic activities. Conclusions—Important differences in the use of time were established, which appeared dependent on management decisions rather than the number of staff available. Patients in the Swiss and German centers spent more time in therapy, possibly because of the structured organization of rehabilitation. Further studies will verify whether this has an effect on outcome. (Stroke. 2005;36:1977-1983.) Key Words: rehabilitation  stroke units T here is wide variation between European countries in the proportion of patients who die or become dependent within the first 6 months after stroke. 1,2 Outcomes in the United Kingdom appear to be consistently worse than the rest of Europe. 1,2 Beech et al 3 found significant differences in length of stay and percentage of stroke patients receiving brain imaging and neurosurgery on admission. Also, the extent of rehabilitation varied significantly between European countries: the percent- age of patients with an identified need who actually received therapy ranged from 44% to 90% for physiotherapy, 0% to 65% for occupational therapy, and 0% to 60% for speech therapy. 3 Significant differences also existed in the amount of therapy stroke patients received. Two American studies found that patients spent 21% to 31% of the working day in therapeutic activities. 4,5 In the United Kingdom, patients were engaged in therapy for 15% of the working day. 6,7 Another study showed that Swiss stroke patients spent 45% of the working day in therapy, whereas Belgian patients spent 28%. 8 These studies suggest large geographical variation in the amount of therapy stroke patients receive in rehabilitation centers. This is important because evidence suggests that more intensive rehabilitation produces a better functional outcome. 9 Studies comparing the use of time by patients in rehabilitation centers in European countries are lacking. The aim of the present study was to compare the way stroke patients spent their time while in a rehabilitation center in 4 European countries. Received March 31, 2005; final revision received May 23, 2005; accepted June 13, 2005. From the Department of Rehabilitation Sciences (L.D.W., I.B., H.F., W.D.W.), Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Belgium; Department of Health Care Sciences and Medical Sociology (K.P., N.L., F.L.), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Belgium; University Hospital Pellenberg (E.D.), Belgium; Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Belgium; City Hospital NHS Trust (P.B.), Nottingham, UK; Biostatistical Center (K.B., E.L.), Katholieke Universiteit Leuven, Belgium; Fachklinik Herzogenaurach (B.N., W.S.), Germany; Institute of Work, Health, and Organisations (L.C., N.L., B.S.), University of Nottingham, UK; Rehaclinic Zurzach, (W.J., C.K., B.S.), Switzerland. Correspondence to Liesbet De Wit, Katholieke Universiteit Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Tervuursevest 101, 3001 Heverlee (Leuven), Belgium. E-mail Liesbet.Dewit@faber.kuleuven.be © 2005 American Heart Association, Inc. Stroke is available at http://www.strokeaha.org DOI: 10.1161/01.STR.0000177871.59003.e3 1977 by guest on November 9, 2015 http://stroke.ahajournals.org/ Downloaded from