Circuit Class Therapy and 7-Day-Week Therapy Increase Physiotherapy Time, but Not Patient Activity: Early Results From the CIRCIT Trial

Study Questions:

Compared to usual care physiotherapy, what is the impact of providing physiotherapy services in group circuit classes for 7 days/week?


This was a substudy of CIRCIT, a randomized, controlled trial of patients in subacute, inpatient rehabilitation centers at Australia; eligible patients were enrolled as soon as possible after stroke. Patients were randomized to one of three arms: usual care therapy (5 days weekly predominantly in individual therapy sessions), 7-day-week therapy (usual care plus additional one-to-one therapy on Saturdays and Sundays), and circuit class therapy (≤90-minute sessions of physiotherapy per day, in groups >3 participants). Data on therapy session duration were recorded. Behavioral mapping was used to examine time spent active across the day and time spent alone.


Participants in the 7-day-week and circuit class therapies received an additional 3 hours and 22 hours of physiotherapy time, respectively, when compared with usual care. However, regardless of the model of physiotherapy used, patients were alone almost half of the working day.


For patients receiving inpatient rehabilitation following acute stroke, both circuit class and 7-day-week therapies led to increase in physiotherapy time.


This is an important study that examines two different modes of delivery for physiotherapy, compared to usual care. Although the intervention groups received more physiotherapy, this did not translate to meaningful differences in activity levels outside of the intervention. As meaningful activity is a key determinant of recovery and cortical reorganization following stroke, future studies should define modes of delivery that both increase physiotherapy time and provide sustained clinical benefit with an increase in physical activity throughout the day.

Keywords: Stroke, Rehabilitation Centers, Australia, Motor Activity, Physical Therapy Modalities, Inpatients

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