Factors influencing the amount of therapy received during inpatient stroke care: an analysis of data from the UK Sentinel Stroke National Audit Programme.
Matthew Gittins, Andy Vail, Audrey Bowen and 5 others
PMID 32508132WHAT IT FOUND
Inpatient stroke patients received 14 minutes of physiotherapy per inpatient day on average, below the 45-minute guideline.
More therapy was associated with specialist rehabilitation teams, weekend services, timely assessment, and higher staffing, but this audit did not test whether these factors caused more therapy.
Key findings
01Nearly all patients required physiotherapy and occupational therapy (92% and 87%), while 57% required speech and language therapy and 5% were considered to need psychology.
02Patient-related factors had the strongest influence on therapy/day: premorbid disability was associated with less therapy, very/severe strokes received less physiotherapy and occupational therapy but more speech and language therapy, and cognitive impairment including aphasia was associated with more speech and language therapy.
03Organizational factors were also associated with more therapy/day: specialist rehabilitation teams provided more than combined and acute teams, extended weekend service was associated with more physiotherapy and occupational therapy, timely assessment within 72 hours was associated with more therapy, and higher staffing was associated with more minutes for each therapy.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
This was an observational analysis of routine audit data, so it cannot show that any factor caused more therapy. The amount of therapy depends on what therapists entered, and therapists may overestimate session length. Therapy is counted from the therapist's perspective, so one hour delivered by three therapists could be recorded as three hours. The data do not show the quality or structure of therapy sessions. Stroke team type and stroke severity may have been misclassified, partly because exact admission dates were not available. The large number of statistical tests may produce findings that look meaningful by chance. The proportion of patients from ethnic minorities was small, so ethnic disparities need cautious interpretation.
Declared interests
The work was funded by the National Institute for Health Research. Several authors declared research grant funding from NIHR. Professor Tyson is currently a member of the Intercollegiate Stroke Working Party that produces SSNAP, and Professor Bowen was a member from 2002 to 2016.
The easy way to misread this
Do not conclude that adding therapists or weekend services will improve patient recovery. This is an observational audit; it only reports associations between service features and minutes of therapy recorded, and the authors state no inference of causality can be made.