What would ‘upscaling’ involve? A qualitative study of international variation in stroke rehabilitation

Abstract

Background Demand for stroke rehabilitation is expected to grow dramatically; with the estimated prevalence of stroke survivors rising to 70 million worldwide by 2030. The World Health Organization’s (WHO) report - Rehabilitation 2030: A call for action – has introduced the objective of ‘upscaling’ rehabilitation globally to meet demand. This research explored what upscaling stroke rehabilitation might mean for health professionals from countries at different stages of economic development. Methods Qualitative descriptive study design using semi-structured interviews was employed. Purposively sampled, clinical leaders in stroke rehabilitation were recruited for interviews from low through to high-income countries. Results Twelve rehabilitation professionals (medicine, physical therapy, occupational therapy, and speech and language therapy) from high (United States of America, Germany, United Kingdom, United Arab Emirates, New Zealand), upper-middle (Colombia and Turkey), lower-middle (Vietnam, Pakistan, Ghana), and low-income countries (Nepal and Sierra Leone) were interviewed. Upscaling was seen as a necessity. Successful scaling up will require initiatives addressing: political governance and managerial leadership, increasing knowledge and awareness of the value of rehabilitation, financial support, workforce developments, physical space and infrastructure, and the development of community services and reintegration. Conclusion Although there have been many gains within the development of stroke rehabilitation internationally, further investment is required to ensure that this patient population group continues to receive the best quality services. For the WHO to be successful in implementing their objective to upscale rehabilitation, specific attention will need to be paid to political, professional, economic, and sociocultural issues at global and local levels.

Person-centred care in individuals with stroke: a qualitative study using in-depth interviews

“…Previous studies coincide with our results, where showing concern for the individuals, interest in their experience and showing empathy improve the satisfaction of those cared for [ 3 , 7 , 48 , 52 ]. In addition, it is necessary to encourage continuous communication including everyday issues for the person, generating tranquillity and reinforcing the individual’s dignity [ 50 , 53 , 54 ].…”

The Experience of Limited Access to Care for Community-Based Patients With Spinal Cord Injury and Stroke in Nepal and the Potential of Telerehabilitation: A Qualitative Study

“…Scale-up of rehabilitation services will require simultaneous development of the provision of rehabilitation care nationally which should include paying specific attention to political (eg, political governance and managerial leadership), professional (eg, increasing knowledge and awareness of the value of rehabilitation), economic (ie, financial support), and sociocultural issues (eg, workforce developments, physical space, and infrastructure). 29 …”

“…Scale-up of rehabilitation services will require simultaneous development of the provision of rehabilitation care nationally which should include paying specific attention to political (eg, political governance and managerial leadership), professional (eg, increasing knowledge and awareness of the value of rehabilitation), economic (ie, financial support), and sociocultural issues (eg, workforce developments, physical space, and infrastructure). 29 Our study includes a diverse sample of participants across gender, location, the terrain of residence, nature of their disability, marital status, and employment. This work was completed as part of a larger program of work exploring the design, development, and evaluation of a telerehabilitation system that was deployed in Nepal.…”

Understanding the Professional Care Experience of Patients with Stroke: A Qualitative Study Using In-Depth Interviews

“…Also, according to Parker et al [ 11 ] patients are immersed in mental and emotional concerns (stress, anxiety, fear, uncertainty) that can affect their recovery. Professional support, through close accompaniment (based on the patients’ needs and context), helps stroke patients to understand and validate their concerns, and helps to build a trusting relationship based on empathy, care and understanding [ 38 ]. This improves the bond and the relationship between the professional and the patient and improves the patients’ sense of security by reducing post-stroke stress and anxiety [ 39 ].…”