Stroke patients' nonscheduled activity during inpatient rehabilitation and its relationship with the architectural layout: A multicenter shadowing study.

Background: Recovery from stroke aims at regaining mobility through performing activities. However, research studies on time use in rehabilitation environments consistently show low activity levels of stroke patients outside their scheduled therapies. It is not clear whether the architectural layout of clinics is related to patients' activity.Objectives: This study examined the nonscheduled (voluntary) activities of stroke patients during an ordinary day in a rehabilitation clinic to investigate whether and how the built environment contributes to stroke patients' independent activities.Methods: Patient shadowing was used in seven neurological rehabilitation clinics. Ten patients were observed per clinic (n = 70), each patient for 12 consecutive hours (total 840 hours). Their paths, activities, locations and traveled distances were recorded in relation to the clinics' layouts.Results: Patients spent around 50% of the observed time in their rooms. The frequency of nonscheduled activity was low in all participating clinics (Mdn = 21,2%, IQR 6,5%-21%) compared to the scheduled activity. The median length of the nonscheduled paths for all patients was 43,42 m (average 46,97 m), with significantly longer scheduled paths (average 89,11 m, Mdn = 77,06 m, Mann-Whitney U = 536, n1 = 762, n2 = 225, p < .001, two-tailed). Corridors and seating areas in the corridors were the most frequent destinations of patients' nonscheduled paths. The clinic with the most frequent nonscheduled activity had a distinctive spatial distribution of dining and living spaces.Conclusions: There is a need to change the architectural layout of rehabilitation clinics to better support patients' nonscheduled activity.