***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose — The optimum model of physiotherapy service delivery for maximizing active task practice during rehabilitation after stroke is unknown . The purpose of the study was to examine the relative effectiveness of 2 alternative models of physiotherapy service delivery against a usual care control with regard to increasing patient activity . Methods — Sub study within a large 3-armed r and omized controlled trial , which compared 3 different models of physiotherapy service delivery , was provided for 4 weeks during subacute , inpatient rehabilitation ( n=283 ) . The duration of all physiotherapy sessions was recorded . In addition , 32 participants were observed at 10-minute intervals for 1 weekday and 1 weekend day between 8:00 AM and 4:30 PM . At each observation , we recorded physical activity , location , and people present . Results — Participants receiving 7-day-week and circuit class therapy received an additional 3 hours and 22 hours of physiotherapy time , respectively , when compared with usual care . Participants were  st and ing or walking  for a median of 8.2 % of observations . On weekdays , circuit class therapy participants spent more time in therapy-related activity ( 10.2 % of observations ) when compared with usual care participants ( 6.1 % of observations ) . On weekends , 7-day therapy participants spent more time in therapy-related activity ( 4.2 % of observations ) when compared with both usual care and circuit class therapy participants ( 0 % of observations for both groups ) . Activity levels outside of therapy sessions did not differ between groups . Conclusions — A greater dosage of physiotherapy time did not translate into meaningful increases in physical activity across the day . Clinical Trial Registration — URL : http://www.anzctr.org.au/. Unique identifier : ACTRN12610000096055 Background Increased therapy has been linked to improvements in functional ability of people with stroke . Aim To determine the effectiveness of two alternative models of increased physiotherapy service delivery ( seven-day week therapy or group circuit class therapy five days a week ) to usual care . Method Three-armed r and omized controlled trial with blinded assessment of outcome . People admitted with a diagnosis of stroke , previously independently ambulant and with a moderate level of disability were recruited .  ‘ Usual care ’ was individual physiotherapy provided five-days a week . Seven-day week therapy was usual care physiotherapy provided seven-days a week . Participants in the circuit class therapy arm of the trial received physiotherapy in group circuit classes in two 90-min sessions , five-days a week . Primary outcome was distance walked on the six-minute walk test at four-weeks post-r and omization . Results Two hundred eighty-three participants were r and omized ; primary outcome data were available for 259 ( 92 % ) . In the seven-day arm participants received an additional three hours of physiotherapy and thosein the circuit class armanadditional 22 h. There were no significant between-group differences at four-weeks in walking distance ( P = 0·72 ) . Length of stay was shorter for seven-day ( mean difference −2·9 days , 95 % confidence interval −17·9 to 12·0 ) and circuit class participants ( mean difference −9·2 days , 95 % confidence interval −24·2 to 5·8 ) compared to usual care , but this was not significant . Conclusions Both seven-day therapy and group circuit class therapy increased physiotherapy time , but walking outcomes were equivalent to usual care Abstract Purpose : This study determined the impact of a pragmatic 6-day physiotherapy service on length of stay , functional independence , gait and balance in people undergoing inpatient rehabilitation  , compared to a 5-day service . Method : A prospect i ve cohort study with historical comparison was undertaken in a mixed inpatient rehabilitation unit . Intervention period participants ( 2011 ) meeting inclusion criteria were eligible for a 6-day physiotherapy service .  All other participants , including the historical cohort ( 2010 ) received usual care ( 5-day physiotherapy ) .  Length of stay , functional independence , gait and balance performance were measured . Results : A total of 536 individuals participated in this study ; 270 in 2011 ( 60 % received 6-day physiotherapy ) and 266 in 2010 . Participants in 2011 showed a trend for reduced length of stay ( 1.7 days , 95%CI −0.53 to 3.92 ) compared to 2010 . Other measures showed no significant differences between cohorts . In 2011 , those receiving 6-day physiotherapy were more dependent , but showed significantly improved functional independence and balance compared to those receiving 5-day physiotherapy ( p < 0.040 ) without impacting length of stay . Conclusion : Implementing a 6-day physiotherapy service in a “ real-world ” rehabilitation setting demonstrated a trend towards reduced length of stay , and improved functional gains . This service could lead to cost-savings for hospitals and improved patient flow . Implication s for Rehabilitation “ Real-world ” implementation of a 6-day physiotherapy service in rehabilitation shows a trend for reducing length of stay . This reduction in length of stay may lead to cost-savings for the hospital system , and improve patient flow into rehabilitation . Patients receiving 6-day physiotherapy made significant gains in balance and functional independence compared to patients receiving 5-day physiotherapy services in the rehabilitation setting Background The cause of adverse weekend clinical outcomes remains unknown . In 2013 , the “ NHS Services , Seven Days a Week ” project was initiated to improve access to services across the seven-day week . Three years on , we sought to analyse the impact of such changes across the English NHS . Methods Aggregated trust-level data on crude mortality rates , Summary Hospital-Level Mortality Indicator ( SHMI ) , mean length of stay ( LOS ) , A&E admission and four-hour breach rates were obtained from national Hospital Episode Statistics and A&E data sets across the English NHS , excluding mental and community health trusts . Trust annual reports were analysed to determine the presence of any seven-day service reorganisation in 2013–2014 . Funnel plots were generated to compare institutional performance and a difference in differences analysis was performed to determine the impact of seven-day changes on clinical outcomes between 2013 and 2014 , 2014–2015 and 2015–2016 . Data was summarised as mean ( SD ) . Results Of 159 NHS trusts , 79 ( 49.7 % ) instituted seven-day changes in 2013–2014 . Crude mortality rates , A&E admission rates and mean LOS remained relatively stable between 2013 and 2016 , whilst A&E four-hour breach rates nearly doubled from 5.3 to 9.7 % . From 2013 to 2014 to 2014–2015 and 2015–2016 , there were no significant differences in the change in crude mortality ( 2014–2015 p = 0.8 , 2015–2016 p = 0.9 ) , SHMI ( 2014–2015 p = 0.5 , 2015–2016 p = 0.5 ) , mean LOS ( 2014–2015 p = 0.5 , 2015–2016 p = 0.4 ) , A&E admission ( 2014–2015 p = 0.6 , 2015–2016 p = 1.0 ) or four-hour breach rates ( 2014–2015 p = 0.06 , 2015–2016 p = 0.6 ) between trusts that had implemented seven-day changes compared to those which had not . Conclusions Adverse weekend clinical outcomes may not be ameliorated by large scale reorganisations aim ed at improving access to health services across the week . Such changes may negatively impact care quality without additional financial investment , as demonstrated by worsening of some outcomes . Detailed prospect i ve research is required to determine whether such reallocation of finite re sources is clinical ly effective Background Providing additional Saturday rehabilitation can improve functional independence and health related quality of life at discharge and it may reduce patient length of stay , yet the economic implication s are not known . The aim of this study was to determine from a health service perspective if the provision of rehabilitation to in patients on a Saturday in addition to Monday to Friday was cost effective compared to Monday to Friday rehabilitation alone . Methods Cost utility and cost effectiveness analyses were undertaken alongside a multi-center , single-blind r and omized controlled trial with a 30-day follow up after discharge . Participants were adults admitted for inpatient rehabilitation in two publicly funded metropolitan rehabilitation facilities . The control group received usual care rehabilitation services from Monday to Friday and the intervention group received usual care plus an additional rehabilitation service on Saturday .  Incremental cost utility ratio was reported as cost per quality adjusted life year ( QALY ) gained and an incremental cost effectiveness ratio ( ICER ) was reported as cost for a minimal clinical ly important difference ( MCID ) in functional independence . Results 996 patients ( mean age 74 ( st and ard deviation 13 ) years ) were r and omly assigned to the intervention ( n = 496 ) or the control group ( n = 500 ) . Mean difference in cost of AUD$1,673 ( 95 % confidence interval ( CI ) -271 to 3,618 ) was a saving in favor of the intervention group . The incremental cost utility ratio found a saving of AUD$41,825 ( 95 % CI -2,817 to 74,620 ) per QALY gained for the intervention group . The ICER found a saving of AUD$16,003 ( 95 % CI -3,074 to 87,361 ) in achieving a MCID in functional independence for the intervention group . If the willingness to pay per QALY gained or for a MCID in functional independence was zero dollars the probability of the intervention being cost effective was 96 % and 95 % , respectively . A sensitivity analysis removing Saturday penalty rates did not significantly alter the outcome . Conclusions From a health service perspective , the provision of rehabilitation to in patients on a Saturday in addition to Monday to Friday , compared to Monday to Friday rehabilitation alone , is likely to be cost saving per QALY gained and for a MCID in functional independence . Trial registration Australian and New Zeal and Clinical Trials Registry November 2009 Background Disinvestment from inefficient or ineffective health services is a growing priority for health care systems . Provision of allied health services over the weekend is now commonplace despite a relative paucity of evidence supporting their provision . The relatively high cost of providing this service combined with the paucity of evidence supporting its provision makes this a potential c and i date for disinvestment so that re sources consumed can be used in other areas .This study aims to determine the effectiveness , cost-effectiveness and safety of the current model of weekend allied health service and a new stakeholder-driven model of weekend allied health service delivery on acute medical and surgical wards compared to having no weekend allied health service . Methods / Design Two stepped wedge , cluster r and omised trials of weekend allied health services will be conducted in six acute medical/surgical wards across two public metropolitan hospitals in Melbourne ( Australia ) . Wards have been chosen to participate by management teams at each hospital . The allied health services to be investigated will include physiotherapy , occupational therapy , speech therapy , dietetics , social work and allied health assistants . At baseline , all wards will be receiving weekend allied health services . Study 1 intervention will be the sequential disinvestment ( roll-in ) of the current weekend allied health service model from each participating ward in monthly intervals and study 2 will be the roll-out of a new stakeholder-driven model of weekend allied health service delivery . The order in which weekend allied health services will be rolled in and out amongst participating wards will be determined r and omly . This trial will be conducted in each of the two participating hospitals at a different time interval . Primary outcomes will be length of stay , rate of unplanned hospital readmission within 28 days and rate of adverse events . Secondary outcomes will be number of complaints and compliments , staff absenteeism , and patient discharge destination , satisfaction , and functional independence at discharge . Discussion This is the world ’s first application of the recently described non-inferiority ( roll-in ) stepped wedge trial design , and the largest investigation of the effectiveness of weekend allied health services on acute medical surgical wards to date .Trial registration Australian New Zeal and Clinical Trials Registry . Registration number : ACTRN12613001231730 ( first study ) and ACTRN12613001361796 ( second study ) .Was this trial prospect ively registered ? : Yes . Date registered : 8 November 2013 ( first study ) , 12 December 2013 ( second study ) .Anticipated completion : June 2015 . Protocol version : 1.Role of trial sponsor : KP and DL are directly employed by one of the trial sponsors , their roles were : KP assisted with overall development of research design and assisted with overall project management ; DL contributed to project management , administration and communications strategy Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVES To identify factors relating to the intensity of rehabilitation services received and to ascertain the relation between injury outcomes , demographics , types of therapy , and the intensity of rehabilitation services provided . DESIGN A multicenter , prospect i ve , nonr and omized study with inpatient rehabilitation data collected between  
    Output:
    
For acute general medical and surgical hospital wards , it was unclear whether the weekend allied health service model provided in the two identified r and omised trials led to significant changes in measured outcomes .
The benefit of providing additional allied health services is clearer in subacute rehabilitation setting s than for acute general medical and surgical wards in hospitals .