The rehabilitation of physical function after severely disabling stroke: a survey of UK therapist practice

Abstract

Background/aims Individuals who are severely disabled from stroke (survivors of severely disabling stroke) experience poorer outcomes compared to those who are less disabled from stroke. However, there is a paucity of evidence describing current therapy practice in the management of severely disabling stroke. The aim of the study was to describe intervention and outcome measure use by physiotherapists and occupational therapists in the rehabilitation of physical function of survivors of severely disabling stroke. Methods A mixed-methods survey was conducted, involving an online questionnaire and follow-up interviews. Survey participants were UK-based physiotherapists and occupational therapists with experience treating stroke. Questionnaire data were analysed with descriptive and inferential statistics. Interview data were analysed using content analysis. Results A total of 452 therapists (59% physiotherapists) responded to the questionnaire. Out of the respondents, 18 self-selected therapists participated in follow-up interviews to explain questionnaire data. Whole body positioning, training of upper limb handling and positioning, and sitting balance practice were the most frequently used interventions. Inpatient-based therapists performed more active rehabilitation interventions, whereas community-based therapists performed more training and education. The Barthel Index, Modified Rankin Scale and National Institutes for Health Stroke Scale were the most frequently used outcome measures. Outcome measure use was generally low and was more likely to be completed when it was part of a national audit. Reasons for low outcome measure use were perceived lack of time and insensitivity to detect clinical change. Conclusions A variety of interventions and outcome measures are used in the rehabilitation of survivors of severely disabling stroke. There is a need to evaluate the effectiveness of frequently used interventions and identify outcome measures that are sensitive to the needs of survivors of severely disabling stroke.

Nominal group technique to establish the core components of home-based rehabilitation for survivors of stroke with severe disability

“…The most frequently reported interventions, for both physiotherapists and OT’s, were stroke survivor positioning and training of carers. 37 The authors highlighted the lack of trials researching these areas, arguing that existing research trials do not reflect actual clinical practice. Their findings closely reflects the findings from this study which indicates the need for carer training and education, prevention of secondary complications and posture and seating interventions.…”

“…Outside of the care home environment there is also a dearth of evidence. McGlinchey et al 37 recently reported a survey to describe the current practice of therapists with survivors of stroke with severe disability. The most frequently reported interventions, for both physiotherapists and OT’s, were stroke survivor positioning and training of carers 37.…”

“…McGlinchey et al 37 recently reported a survey to describe the current practice of therapists with survivors of stroke with severe disability. The most frequently reported interventions, for both physiotherapists and OT’s, were stroke survivor positioning and training of carers 37. The authors highlighted the lack of trials researching these areas, arguing that existing research trials do not reflect actual clinical practice.…”

Barriers and facilitators in providing home-based rehabilitation for stroke survivors with severe disability in the UK: an online focus group study with multidisciplinary rehabilitation teams

“…This combination of impairments often requires specialist input from multiple professions within the stroke multidisciplinary team (MDT). Stroke survivors with severe disability commonly require assistance with activities of daily living (ADLs) and may be unable to mobilise as a result of their impairments 3 4. Rehabilitation for these individuals often requires multiple members of the MDT, placing significant burden on services in terms of both the expertise and number of staff required to meet their needs.…”

“…The aim of the current study was to inform recommendations to support the provision of rehabilitation for stroke survivors with severe disability across the UK. Defining severe disability following stroke is complex 4. For the purpose of this study, a score of 4 or 5 on the Modified Rankin Scale (mRS) was used 8…”