Designing stroke services for the delivery of cognitive rehabilitation: A qualitative study with stroke rehabilitation professionals

Abstract

This qualitative study explored the potential to deliver cognitive rehabilitation for poststroke cognitive impairment (PSCI), with a specific focus on barriers and facilitators to its delivery from the perspective of Irish stroke rehabilitation professionals. Sixteen semistructured interviews were completed with healthcare professionals in both hospital and community settings. The sample comprised physiotherapists, occupational therapists, nurses, a stroke physician, a psychologist, a neuropsychologist, a speech and language therapist, a dietician and a public health nurse. Interviews were audio-recorded and analysed in NVivo using inductive Thematic Analysis. Barriers and facilitators to the delivery of cognitive rehabilitation were identified and described under four key themes: (i) Cognitive screening; (ii) Cognitive rehabilitation: no one size fits all; (iii) Psychology: the lost dimension of stroke rehabilitation; and (iv) Joining the dots in the community. Staffing required to deliver cognitive rehabilitation for PSCI was highlighted as under-resourced in the Republic of Ireland. Inadequate resourcing of neuropsychology and stroke-related psychological services, in particular, has had negative implications for the delivery of cognitive rehabilitation. Stroke-specific cognitive rehabilitation expertise is virtually inaccessible in the community, highlighting an urgent need for investment in specialist rehabilitation teams to deliver cognitive rehabilitation in this setting.

Capacity building for providers of cognitive rehabilitation in Queensland: a needs analysis survey

“…Impairments in cognitive function often impact more significantly on functional performance, relationships and participation in activities than those in physical function (Khan et al 2003). Cognitive rehabilitation is designed to limit these functional impacts and minimise ongoing challenges in daily life (Cicerone et al 2000;Jeffares et al 2023). Several different professions are involved in the provision of cognitive rehabilitation, including occupational therapists, neuropsychologists and speech pathologists (Wong et al 2014;Pagan et al 2016;Downing et al 2019;Jeffares et al 2023).…”

“…Cognitive rehabilitation is designed to limit these functional impacts and minimise ongoing challenges in daily life (Cicerone et al 2000;Jeffares et al 2023). Several different professions are involved in the provision of cognitive rehabilitation, including occupational therapists, neuropsychologists and speech pathologists (Wong et al 2014;Pagan et al 2016;Downing et al 2019;Jeffares et al 2023). The focus of this study is to examine the characteristics and specific training needs of cognitive rehabilitation providers in Queensland, Australia, with the aim of informing the development of a capacity building program.…”

“…Regardless of approach, cognitive rehabilitation should be focused on improving participation in activities of daily life and relationships (Cicerone et al 2000;Downing et al 2019). Due to the heterogeneous nature of impairment following ABI, a 'one-size fits all' approach is inadequate, with differences in access to resources and funding, and rehabilitation duration, settings and needs across the continuum of recovery further influencing that variability (Jeffares et al 2023). Consequently, cognitive rehabilitation can be a challenging area of practice that requires complex clinical reasoning and specialised skills to plan and deliver best-practice individualised cognitive rehabilitation programs.…”

“…Barriers to the uptake of evidence-based practices include insufficient descriptions of interventions and implementation strategies in the reporting of research, as well as a lack of training and education in understanding and implementing evidence-based recommendations (Bayley et al 2012;Small et al 2022). Instead, practitioners have relied on other sources such as textbooks or colleagues to assist with their clinical decision making (Koh et al 2009;Riedeman and Turkstra 2018;Downing et al 2019;Jeffares et al 2023). Additionally, studies have found that few practitioners reported engaging in training to enhance their skills in cognitive rehabilitation (Riedeman and Turkstra 2018;Downing et al 2019).…”

“…Additionally, studies have found that few practitioners reported engaging in training to enhance their skills in cognitive rehabilitation (Riedeman and Turkstra 2018;Downing et al 2019). Given that practitioners who lack confidence in providing cognitive rehabilitation interventions have been less likely to use them (Wong et al 2014;Pagan et al 2016;Riedeman and Turkstra 2018), it is not surprising that studies have explicitly identified low confidence as a barrier to practising cognitive rehabilitation (Pagan et al 2016;Downing et al 2019;Jeffares et al 2023). For example, a qualitative study of stroke rehabilitation practitioners from a variety of disciplines found that lack of confidence in their cognitive rehabilitation skills, particularly in community settings, was a major barrier to effective service delivery, with potentially negative implications for client outcomes (Jeffares et al 2023).…”