A comparison between reported therapy staffing levels and the department of health therapy staffing guidelines for stroke rehabilitation: a national survey.

BACKGROUND: This study compared reported staffing levels for stroke care within UK in-patient stroke units to stroke strategy staffing guidelines published by the UK Department of Health and the Royal College of Physicians. The purpose was to explore the extent to which stroke teams are meeting recommended staffing levels. METHOD: The data analyzed in this report consisted of the detailed therapist staffing levels reported in the demographic section of our national survey to determine upper limb treatment in stroke units (the ATRAS survey). A contact list of stroke practitioners was therefore compiled primarily in collaboration with the 28 National Stroke Improvement Networks. Geographic representation of the network areas was obtained by applying the straight-forward systematic sampling method and the N(th) name selection technique to each Network list. In total 192 surveys were emailed to stroke care providers around England. This included multiple contacts within stroke teams (e.g. a stroke consultant and a stroke co-coordinator) to increase awareness of the survey. RESULTS: A total of 53 surveys were returned from stroke teams and represented 20 of the 28 network areas providing 71% national coverage. To compare reported staffing levels to suggested DoH guidelines, analysis was conducted on 19 of the 37 inpatient hospital care units that had no missing data for staff numbers, unit bed numbers, number of stroke patients treated per annum, average unit length-of-stay, and average unit occupancy rates. Only 42% of units analyzed reached the DoH guideline for physiotherapy and fewer than 16% of the units reached the guideline for speech & language therapy. By contrast, 84% of units surveyed reached the staffing guideline for occupational therapy. However, a post-hoc analysis highlights this as an irregularity in the DoH guidelines, revealing that all therapies are challenged to provide the recommended therapy time. CONCLUSIONS: Most in-patient stroke units are operating below the DoH guidelines and are therefore challenged in providing the recommended amount of therapy and patient time to facilitate optimal functional recovery for stroke patients.

Treatment components for upper limb rehabilitation after stroke: a survey of UK national practice.

PURPOSE: The aim of this study was to delineate the type of treatment currently provided to rehabilitate the upper limb following stroke in order to inform the treatment protocol for a control arm of a future pragmatic clinical trial of assistive technologies. METHOD: A national survey of stroke teams was conducted. Using open-ended, free script questions, the survey was designed to capture the important components of treatment that are most commonly used to treat patients described as mild, moderate or severely impaired following stroke. Stroke teams were targeted within the 28 geographical areas covered by the Stroke Improvement Networks. RESULT: Treatment descriptions were returned by 53 stroke teams from 20 of the 28 geographical areas. In total, 998 treatment components were provided - 289 for mildly, 403 for moderately and 306 for severely impairment patients following stroke). These captured five substantive treatment categories in terms of most active, moderately active and non-active patient participation in treatment as well as assistive technologies and other. CONCLUSION: From the treatment components described, the highest number of treatment components was listed for the moderately impaired patient. The treatment components used by the units surveyed are quite consistent with the 2012 Clinical Guidelines for Stroke.