Factors influencing the amount of therapy received during inpatient stroke care: an analysis of data from the UK Sentinel Stroke National Audit Programme

You are completely missing the real reason. You just have guidelines NOT PROTOCOLS. With protocols even if it said 10-15 million reps were needed your patients would buckle down and do them to exhaustion knowing they would get these results. Guidelines are fucking worthless.  Tell me where I'm wrong on this, not existing is not a valid excuse. Set them up with music, mirror therapy, action observation and motor imagery and they could do these all day with no therapist involvement.

Factors influencing the amount of therapy received during inpatient stroke care: an analysis of data from the UK Sentinel Stroke National Audit Programme

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Matthew Gittins, Andy Vail, Audrey Bowen, ...

First Published June 7, 2020 Research Article

https://doi.org/10.1177/0269215520927454

Article information

Abstract

Objectives:

To understand why most stroke patients receive little therapy. We investigated the factors associated with the amount of stroke therapy delivered.

Methods:

Data regarding adults admitted to hospital with stroke for at least 72 hours (July 2013–July 2015) were extracted from the UK’s Sentinel Stroke National Audit Programme. Descriptive statistics and multilevel mixed effects regression models explored the factors that influenced the amount of therapy received while adjusting for confounding.

Results:

Of the 94,905 patients in the study cohort (mean age: 76 (SD: 13.2) years, 78% had a mild or moderate severity stroke. In all, 92% required physiotherapy, 87% required occupational therapy, 57% required speech therapy but only 5% were considered to need psychology. The average amount of therapy ranged from 2 minutes (psychology) to 14 minutes (physiotherapy) per day of inpatient stay. Unmodifiable characteristics (such as stroke severity) dominated the variation in the amount of therapy. However important, modifiable organizational factors were the day and time of admission, type of stroke team, timely therapy assessments, therapy and nursing staffing levels (qualified and support staff), and presence of weekend or early supported discharge services.

Conclusion:

The amount of stroke therapy is associated with unmodifiable patient-related characteristics and modifiable organizational factors in that more therapy was associated with higher therapy and nurse staffing levels, specialist stroke rehabilitation services, timely therapy assessments, and the presence of weekend and early discharge services.

Keywords Stroke, physiotherapy, occupational therapy, speech and language therapy, psychology, intensity, dose

Introduction

Within the UK, approximately two-thirds of all stroke survivors are left with some form of long-term disability¹ Stroke therapy, compromising physiotherapy, occupational therapy, speech therapy, and psychology are key to both patient recovery and their long-term quality of life.² There is substantial evidence that stroke therapy is effective when provided intensively, thus the National Clinical Guideline for Stroke recommend that

People with stroke should accumulate at least 45 minutes of each appropriate therapy every day, at a frequency that enables them to meet their rehabilitation goals, and for as long as they are willing and capable of participating and showing measurable benefit from treatment.

This amount of therapy is rarely achieved, however,³ which is a major cause of service users’ dissatisfaction with stroke services.⁴ It has also been attributed to poorer outcomes in the United Kingdom compared to other European countries which provide more therapy even when confounding variables (such as stroke severity) were controlled.⁵ Recent research has indicated that although staffing levels may play a part in the amount of therapy provided, organization is also an important factor.⁶ Our aim was therefore to investigate the variation in the amount of stroke therapy during inpatient stroke care provided using data from Sentinel Stroke National Audit Programme (SSNAP)³ to identify the factors associated with the amount of therapy delivered.