Community physio is two 45 minute sessions a week. How many hours actually moves the needle?

#1Moira G.(Joined Mar 2026 · 5 posts)June 7, 2026, 10:22 am

Me again, the tired wife from the carers board, but this question belongs here I think.

My husband is now 13 months post stroke. On the ward he had physio and occupational therapy most days, and you could watch the progress week to week. Since coming home he gets two 45 minute community physio sessions a week, and last night I read an article saying the guidelines recommend THREE HOURS A DAY. Three hours a day is over fifteen hours a week. He is getting ninety minutes.

We do his morning exercises together, maybe 30 or 40 minutes, but I have no idea if that even counts or if it's the therapy equivalent of a nice walk. So what's the real number? Is ninety minutes of professional time doing anything at all, or are the other thirteen and a half hours supposed to be coming from somewhere, and if so, where? Because I suspect the answer is "from us" and I'd rather know.

#2keithb57(Joined Oct 2024 · 51 posts)June 7, 2026, 5:58 pm

You've spotted the trick of it, Moira, and it took me a year to spot: the sessions aren't the dose. The sessions are where you find out WHAT to practise and whether you're doing it right. The dose is what happens in your kitchen the other six days.

When my arm finally started coming back it wasn't because I got more appointments, it was because I stopped counting minutes and started counting repetitions. Sixty cup-reaches while the kettle boiled, every kettle, every day. Buttons on an old shirt draped on a chair, twenty a go. My physio set the exercises, checked them fortnightly, and the numbers happened at home. Ninety minutes of steering plus a week of actual miles, that's the shape of it.

#3davew1966(Joined Oct 2025 · 9 posts)June 8, 2026, 9:14 am

Can back that up with recent numbers. My new programme, the one from my update thread, is also twice a week. Arm's gone from maybe 30% to 50% on it. But the twice a week only works because they send me home with rep targets and my wife's tally chart enforces them.

One honest caveat. Some weeks the fatigue flattens me and I tried powering through anyway, because more is better, right? Made everything worse, form went sloppy, then I lost two more days recovering. My physio said a short session done properly beats a long one done grey-faced. Took me a while to believe her.

#4mattw_tbi(Joined Jun 2025 · 17 posts)June 9, 2026, 7:31 pm

Seconding Dave on the fatigue maths. TBI here rather than stroke, but same lesson: when I doubled my practice hours my scores went DOWN, because I was doing repetitions with a brain that had already clocked off. Sorted my sleep, cut the sessions shorter, spread them across the day, started improving again. Hours only count when your head's actually in them.

#5Dr Paul HutchinsClinical moderator(Joined Nov 2024 · 64 posts)June 10, 2026, 8:47 am

Moira, your reading is accurate and your suspicion is too, so let me put numbers on both. Stroke guidelines in several countries converge on at least 3 hours of therapy a day, at least 5 days out of 7, around 15 hours a week, for people with rehabilitation goals who can tolerate it, and one national guideline goes further: support to be active for up to 6 hours a day. The crucial detail is what those hours contain. The larger figure is total active practice, not therapist contact, so yes, your morning half hour counts fully, and Keith's kettle repetitions are precisely the sort of thing the guidance means. Two 45 minute community sessions is a common contact dose, and it works the way Keith describes: the therapist sets and progresses the programme, and the repetitions between sessions are where the change is driven, because recovery runs on intensive, repetitive, task-specific practice.

Two honest caveats so the number doesn't become a stick to beat yourselves with. More is not automatically better: the measured benefit of extra intensity is real but modest, the dose-response is not a straight line, and Dave and Matt have both described the fatigue ceiling accurately; someone who cannot manage 3 hours should get an adjusted amount, shaped to what they can absorb, not a guilty silence. And quality gates everything, so grey-faced repetitions are spent, not invested. I'd take this thread to his community team and ask them directly for a home programme with repetition targets and a fatigue plan, because what your husband can tolerate at 13 months is something they can assess and a forum cannot. The site's guide to how much therapy you need sets out the full evidence, including where the 3 hour figure comes from and who it does and doesn't fit.

#6Moira G.(Joined Mar 2026 · 5 posts)June 30, 2026, 9:05 pm

Update: took the thread to his physio, more or less verbatim. She was lovely about it, said she wished more families asked, and my husband now has written rep targets for every exercise and a rule about stopping when his form goes. There is a tally chart on the kitchen counter (Dave's wife and I are apparently the same person) and he grumbles at it daily and does them anyway.

Ninety minutes of steering, a week of miles. It helps enormously to know the other hours were always meant to be ours, rather than a service we were failing to receive.