The high level of agreement selleck chemical found by this study suggests that therapists demonstrate good judgement regarding the ability of rehabilitation patients to count exercise repetitions accurately. The observation of a patient counting for a small period (1-2 minutes) to look for obvious errors in counting can be used by therapists to determine if the patient is able to count accurately. It is often perceived by clinicians that rehabilitation patients with neurological diagnoses

have less ability to concentrate and multi-task. The results of this study indicate that patients with neurological diagnoses can be accurate in counting their exercises repetitions. However, a lower percentage of participants with DAPT neurological diagnoses met this study’s inclusion criteria (67% for people admitted to the neurological rehabilitation unit vs 82% of people admitted to the aged care rehabilitation unit were included). Therefore there were more rehabilitation patients with neurological diagnoses excluded from the study because they were obviously unable to count their exercise repetitions accurately. This appears to be the first observational study to analyse the accuracy

of quantification of exercise dosage by patients undertaking rehabilitation. Previous methods of analysing exercise dosage include the use of time in therapy already and behaviour mapping (Kwakkel et al 2004, Mackey et al 1996). Both methods were based on time rather than dosage of exercise. In this study the number of exercise repetitions observed in the 30-minute sessions varied greatly, with a range of 4 to 369

repetitions. Those studies that only consider time will not take into account the rate and therefore the intensity of exercise. A strength of this study is the blinding of both participant and therapist to when the covert observation was occurring. In addition, a variety of therapy contexts were observed, meaning that the results are representative of daily therapy practice. The participants were also observed at various time points in their rehabilitation. Another strength is that the method used to identify patients who are able to count is simple and efficient so it can be replicated clinically. A limitation of this study could be the 30-minute observation period. This represents a small proportion of time the participant would be in therapy each day at Bankstown-Lidcombe Hospital. However, for pragmatic reasons a substantial yet not exhaustive time period was chosen. It is reasonable to believe that if a participant is able to count in this period, that skill would be transferable to other times.