Current best practice standards for rehabilitation after stroke call for increasing the dose and intensity of interventions for optimal therapeutic benefit. Despite this, those within inpatient rehabilitation during the acute phase are often sedentary, and they receive a lower dose and intensity of therapy than recommended. This may be due to the lack of therapeutic opportunities outside of therapies, program structure characteristics, or a lack of efficiency in therapeutic encounters, all of which have the potential to reduce therapeutic outcomes. Circuit class therapies and group therapies provide a method of increasing the dose and intensity of therapy provided, and may reduce redundancy and inefficiency within programs, but do not satisfy the 3-hour rule under the current Prospective Payment System in the United States. The Centers for Medicare and Medicaid Services require that individual therapy be the primary mode of intervention provision, which limits programs from providing these evidence-based interventions, at a higher volume in a group or circuit format. Providing an enriched environment outside of structured therapies should be mandated to maximize benefits experienced by patients and reduce sedentary time. Empirical study is required to determine which interventions may be effectively delivered when provided via a nonindividual basis, and to explore the feasibility and fiscal implication of alternative models of care. Reform of regulatory standards may be required to align with best practice standards.
Best Practice Standards for the delivery of NHS Infection Services in the United Kingdom