An evaluation of stroke rehabilitation within Greater Manchester

• Main Author: McGovern, Alison
• Published: University of Salford 2014
• Subjects: 362.1968; Health and Wellbeing
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.605118

This study aimed to evaluate stroke rehabilitation services including the quality of services and the opinions of multiple stakeholders involved in stroke rehabilitation. Several methodologies were employed including a literature review, content analysis of national documents, case note audit and questionnaires of patients, staff and commissioners. The content analysis identified 214 separate recommendations from 15 documents. Of these 21 were relevant to every patient receiving stroke rehabilitation; 13 related to the overall service provision and 8 related to specific aspects of patient care. These recommendations were converted to standards and used to audit the 10 stroke rehabilitation services in Greater Manchester using 100 individual patient records. 146 patients completed a satisfaction questionnaire, 46 staff and 6 commissioners completed questionnaires. Results demonstrated variable compliance to national recommendations with primary stroke centres showing greater adherence than district stroke centres, indicating a two-tier service. All services offered a weekly multidisciplinary team meeting, 93% of patients spent most of their time in hospital on a specialist stroke ward and 96% commenced rehabilitation as soon as they were medically stable. However, only 22% of patients received 45 minutes of therapy per day and 4% received a discharge plan when leaving hospital. Staffing levels did not impact on adherence to national recommendations, however the most long-standing and prominent recommendations achieved greatest compliance. Patients felt that they were treated with dignity, with older patients being more satisfied with stroke rehabilitation services than younger patients. However, patients did not feel that they received enough therapy or information relating to their goals within rehabilitation. Staff felt patients should receive more therapy than they currently do; patients should receive more than 3 hours a day despite currently receiving less than 60 minutes a day. The amount of therapy offered varied across disciplines with speech and language therapists providing less therapy than occupational therapists, physiotherapists and nursing staff. Staff felt the primary factor limiting the amount of therapy was staffing levels. Commissioners' primary priority was to improve the outcomes for stroke patients, however different monitoring mechanisms between localities leads to the potential for different priorities and accountability. This study is the first to systematically compile and evaluate national recommendations within stroke rehabilitation services and to include commissioners in the evaluation of stakeholders’ opinions.