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Sorinola I1, Conquest W1, Jupp O1
1King's College London, Department of Public Health Sciences, School of Population Health & Environmental Sciences, London, United Kingdom
Background: The recovery of upper limb function after stroke has been demonstrated to be poor and this is often associated with stroke survivors themselves expressing dissatisfaction with current rehabilitation provided by therapists. Several researchers have consequently called for the development of better rehabilitation approaches to meet the needs and expectations of patients; this requires an understanding of the determinants of the approaches utilised by therapists.
Purpose: This study was specifically aimed at understanding the reasoning behind the decision-making process in the management of individuals with upper-limb problems after stroke, identify the key factors influencing rehabilitation focus and selection of therapeutic strategies and explore healthcare professional perceptions of the effectiveness of current approaches.
Methods: Twenty-one healthcare professionals including 14 physiotherapists, 5 occupational therapists and 2 therapy assistants working in acute stroke units were recruited to participate in four semi-structured focus group interviews exploring the perception and experience of upper-limb rehabilitation early after stroke and the underlying reasoning for commonly utilised approaches. Interviews were audio-recorded, transcribed verbatim and thematic analysis was used to derive meaning from the data.
Results: Three factors emerged from data analysis as influencing therapy decision making for upper stroke rehabilitation; patient, therapist and external factors and these were not necessarily congruent. A prioritisation of mobility recovery, influenced by wider National Health Service contextual factors and patients' preferences, was also expressed as the main rehabilitation goal during early rehabilitation. Therapists also acknowledged the challenge of inadequate clinical guidelines, insufficient therapy time and a predominance of outdated perceptions as challenges to evidence-based approach to post stroke upper limb rehabilitation outcomes.
Conclusion(s): Therapists are also dissatisfied with the current approach to upper-limb rehabilitation. Further education and support for therapists, family and the wider multi-disciplinary team is required to facilitate a 24-hour rehabilitation model to enhance upper-limb rehabilitation.
Implications: There is a need for greater focus on upper-limb rehabilitation early after stroke and this should not be delayed till after discharge. This focus should include provision of accurate information and insight to stroke survivors for joint decision making and effective communication between the multi-disciplinary team.
Keywords: Rehabilitation, Stroke, Upper limb
Funding acknowledgements: No funding was utilised for this study
Purpose: This study was specifically aimed at understanding the reasoning behind the decision-making process in the management of individuals with upper-limb problems after stroke, identify the key factors influencing rehabilitation focus and selection of therapeutic strategies and explore healthcare professional perceptions of the effectiveness of current approaches.
Methods: Twenty-one healthcare professionals including 14 physiotherapists, 5 occupational therapists and 2 therapy assistants working in acute stroke units were recruited to participate in four semi-structured focus group interviews exploring the perception and experience of upper-limb rehabilitation early after stroke and the underlying reasoning for commonly utilised approaches. Interviews were audio-recorded, transcribed verbatim and thematic analysis was used to derive meaning from the data.
Results: Three factors emerged from data analysis as influencing therapy decision making for upper stroke rehabilitation; patient, therapist and external factors and these were not necessarily congruent. A prioritisation of mobility recovery, influenced by wider National Health Service contextual factors and patients' preferences, was also expressed as the main rehabilitation goal during early rehabilitation. Therapists also acknowledged the challenge of inadequate clinical guidelines, insufficient therapy time and a predominance of outdated perceptions as challenges to evidence-based approach to post stroke upper limb rehabilitation outcomes.
Conclusion(s): Therapists are also dissatisfied with the current approach to upper-limb rehabilitation. Further education and support for therapists, family and the wider multi-disciplinary team is required to facilitate a 24-hour rehabilitation model to enhance upper-limb rehabilitation.
Implications: There is a need for greater focus on upper-limb rehabilitation early after stroke and this should not be delayed till after discharge. This focus should include provision of accurate information and insight to stroke survivors for joint decision making and effective communication between the multi-disciplinary team.
Keywords: Rehabilitation, Stroke, Upper limb
Funding acknowledgements: No funding was utilised for this study
Topic: Neurology: stroke; Neurology: stroke
Ethics approval required: Yes
Institution: King''s College London
Ethics committee: College Reseach Ethics Committee
Ethics number: LRU-16/17-4541
All authors, affiliations and abstracts have been published as submitted.
