10 and 11 In this study we were not able to determine the appropriateness of the specific activities in sitting for each participant. Notwithstanding the fact that some time spent practising tasks in sitting may be appropriate,

the challenge for therapists is to find ways to convert at least some of the time that people with stroke spend engaged in activities in lying and sitting to more walking practice. Similarly, while some rest time is needed during physiotherapy Cobimetinib sessions, therapists should aim to maximise the time that people with stroke are active within each therapy session – bearing in mind that therapists are known to underestimate the amount of time that their patients rest in therapy sessions.12 This study has several strengths; it involved multiple rehabilitation centres, examined selleck both individual and circuit class therapy sessions, and involved clinicians with

a range of experience. A limitation of the study is that a simple measure of time spent in particular activities does not allow for an assessment of the appropriateness of the activities for the participants, and whether tasks were optimally tailored to drive recovery. This study was embedded within an ongoing randomised trial. Some, but not all, of the circuit class therapy sessions within this trial were mandated in terms of duration. However, the specific content of therapy sessions (ie, what exercises and activities were performed within therapy sessions) was not mandated. While we know that increasing therapy time is beneficial for our patients and that we should be aiming for our patients to be as physically active as possible, we have very little evidence from research to guide the specific tasks and activities that

we ask our patients to do in therapy sessions – or how to best structure our sessions to achieve the optimal balance between part and whole practice. Further research is also needed to clarify the nature of active practice, the quality of the practice, and its ADP ribosylation factor relationship to therapy components that do not involve physical activity, such as mental imagery, relaxation, and education. The challenge for therapists is to reflect upon and objectively measure their own practice and to look for ways to increase active practice time in rehabilitation centres. Overall, the results of this study suggest that providing therapy in group circuit class sessions allows for people with stroke to spend more time engaged in active task practice. What is already known on this topic: More time spent undertaking physiotherapy rehabilitation provides greater benefits for people after stroke. Circuit class therapy allows greater time in physiotherapy sessions and improves some outcomes such as walking ability.