“Less is more” – is it truly the case?

After surgery or admittance to hospital, rehabilitation programs are commonly required to get people back on track and improve their function and mobility. A lot of the research reports the importance of repetitive practice of exercises and tasks, yet often patients are inactive outside the rehabilitation sessions. So …”Less may not be more”.

Most inactivity whilst in hospital and in a rehabilitation setting occurs in the evenings and on the weekends, as typically physiotherapists are rostered to work Monday to Friday within usual working hours. But does your knee or hip replacement know what day of the week it is? Obviously the answer is no –  so that is why it needs to be exercised and used with frequency in order to give you the best chance of a speedy recovery.

What does the research show?
A group of Sydney-based researchers decided to look at the above concept more closely by conducting a “Systematic Review”. A systematic review is a summary of all the primary research in a particular area in order to answer a desired question. In this instance, the researchers wanted answers to the following:

  1. Does additional out of hours rehabilitation occurring after hours or on weekends improve function?
  2. Does additional out of hours rehabilitation occurring after hours or on weekends increase activity in during hospital stay?
  3. Does additional out of hours rehabilitation occurring after hours or on weekends increase the risk of an adverse event?

After extensive search (including 7 research papers), trials and a review of a variety of conditions ranging from stroke to hip replacements, it was found that added hours of rehabilitation also took many forms ranging from weekend physiotherapy services, nurse-supervised exercise programs and  self-administered exercise with family/carer support. These extra services on average provided over 30 minutes of daily additional therapy to patients during their time in hospital.

So what difference can an EXTRA 30 minutes make?
– Increased walking speed
– Improved balance
– Improved function with day-to-day activities
– Increased physical activity, specifically steps taken and time spent upright during hospital stay

– Improved arm function in stroke patients
– Overall, no increased risk of adverse events with the provision of after hours or weekend rehabilitation

Take home message:
Westmead Private Physiotherapy Services provide 7 days a week  physiotherapy services to ensure our patients receive the best preparation to return home and back to their normal tasks as quickly as possible. Whilst in hospital, the physiotherapy team will endeavour to equip you with the right exercises and programs to get you on track, but (when safe) it is important YOU use these strategies daily – even on weekends! Contrary to common belief, less is NOT always more and good things DON’T necessarily come to those who wait!



  1. Scrivener, Katharine, et al. “After-hours or weekend rehabilitation improves outcomes and increases physical activity but does not affect length of stay: a systematic review.” Journal of physiotherapy2 (2015): 61-67.
  2. Halbert, Julie, et al. “Multi-disciplinary rehabilitation after hip fracture is associated with improved outcome: a systematic review.” Journal of Rehabilitation Medicine7 (2007): 507-512.
  3. Smith, Paul, et al. “Physical activity by elderly patients undergoing inpatient rehabilitation is low: an observational study.” Australian Journal of Physiotherapy3 (2008): 209-213.
  4. Chen, Christine C., et al. “Functional gains and therapy intensity during subacute rehabilitation: a study of 20 facilities.” Archives of physical medicine and rehabilitation11 (2002): 1514-1523.