The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Share

¹ 1 Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, Bradford Royal Infirmary, Bradford, UK.

² 2 School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.

³ 3 Stroke Research Group, Institute of Neuroscience, Newcastle University, Newcastle, UK.

⁴ 4 Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.

⁵ 5 Health Services Research, School of Health and Related Research, The University of Sheffield, Sheffield, UK.

⁶ 6 Sentinel Stroke National Audit Programme, Royal College of Physicians, London, UK.

⁷ 7 Physiotherapy Department, Bradford Teaching Hospitals NHS Trust, Bradford, UK.

⁸ 8 Salford Royal NHS Foundation Trust and Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.

¹ 1 Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, Bradford Royal Infirmary, Bradford, UK.

² 2 School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.

³ 3 Stroke Research Group, Institute of Neuroscience, Newcastle University, Newcastle, UK.

⁴ 4 Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.

⁵ 5 Health Services Research, School of Health and Related Research, The University of Sheffield, Sheffield, UK.

⁶ 6 Sentinel Stroke National Audit Programme, Royal College of Physicians, London, UK.

⁷ 7 Physiotherapy Department, Bradford Teaching Hospitals NHS Trust, Bradford, UK.

⁸ 8 Salford Royal NHS Foundation Trust and Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.

Over 1000 hours of non-participant observations and 433 patient-specific therapy observations were undertaken. The most significant factor influencing amount and frequency of therapy provided was the time therapists routinely spent, individually and collectively, in information exchange. Patient factors, including fatigue and tolerance influenced therapists' decisions about frequency and intensity, typically resulting in adaptation of therapy rather than no provision. Limited use of individual patient therapy timetables was evident. Therapist staffing levels were associated with differences in therapy provision but were not the main determinant of intensity and frequency. Few therapists demonstrated understanding of the evidence underpinning recommendations for increased therapy frequency and intensity. Units delivering more therapy had undertaken patient-focused reorganisation of therapists' working practices, enabling them to provide therapy consistent with guideline recommendations.

Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: A.H. is Programme Manager for the SSNAP and provided technical information on SSNAP data collection and analysis. SSNAP is funded by the Healthcare Quality Improvement Partnership on behalf of NHS England. A.D., H.R. and P.T. are members of the Intercollegiate Stroke Working Party who developed the National Clinical Guideline for Stroke, Fifth Edition 2016. The authors declare no other financial relationships with any organisations that might have an interest in the submitted work in the previous three years.

Clarke DJ, et al. BMJ Open. 2015 Aug 25;5(8):e008443. doi: 10.1136/bmjopen-2015-008443. BMJ Open. 2015. PMID: 26307617 Free PMC article. Otterman NM, et al. Stroke. 2012 Sep;43(9):2395-401. doi: 10.1161/STROKEAHA.112.660092. Epub 2012 Jul 5. Stroke. 2012. PMID: 22773556 Clarke DJ, et al. BMJ Open. 2014 Apr 15;4(4):e004473. doi: 10.1136/bmjopen-2013-004473. BMJ Open. 2014. PMID: 24736035 Free PMC article. Clinical Trial. Simister R, et al. Southampton (UK): NIHR Journals Library; 2020 Aug. Southampton (UK): NIHR Journals Library; 2020 Aug. PMID: 32894668 Free Books & Documents. Review. Jones F, et al. Southampton (UK): NIHR Journals Library; 2020 Aug. Southampton (UK): NIHR Journals Library; 2020 Aug. PMID: 32894667 Free Books & Documents. Review. Cormican A, et al. Clin Rehabil. 2023 May;37(5):701-712. doi: 10.1177/02692155221141036. Epub 2022 Dec 7. Clin Rehabil. 2023. PMID: 36475911 Free PMC article. Moore SA, et al. Stroke. 2022 Nov;53(11):3494-3505. doi: 10.1161/STROKEAHA.122.038956. Epub 2022 Sep 7. Stroke. 2022. PMID: 36069185 Review. Moore SA, et al. Pilot Feasibility Stud. 2022 Sep 3;8(1):197. doi: 10.1186/s40814-022-01139-4. Pilot Feasibility Stud. 2022. PMID: 36057723 Free PMC article. Baker A, et al. BMC Health Serv Res. 2022 Jun 22;22(1):811. doi: 10.1186/s12913-022-08047-6. BMC Health Serv Res. 2022. PMID: 35733190 Free PMC article. Thompson N, et al. Brain Sci. 2022 Apr 13;12(4):497. doi: 10.3390/brainsci12040497. Brain Sci. 2022. PMID: 35448028 Free PMC article.