Why do stroke survivors not receive recommended amounts of active therapy? Findings from the ReAcT study, a mixed-methods case-study evaluation in eight stroke units.
David J Clarke, Louisa-Jane Burton, Sarah F Tyson and 9 others
PMID 29582712WHAT IT FOUND
Therapists spent between 1.2 and 6.5 hours per week on meetings and paperwork rather than direct patient care.
In units with the highest staffing levels, therapy minutes were higher, but even these units struggled to meet guidelines. Administrative burden was the primary barrier to delivering recommended therapy.
Key findings
01Qualified therapists spent between 1.2 and 6.5 hours per week in information exchange activities, with most spending 3 to 5 hours per week.
02In all but one unit, therapist numbers were lower than recommended, particularly for speech and language therapists.
03The two units with the highest therapist numbers had the highest ratings for SSNAP therapy domains, indicating more therapy minutes were delivered.
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
Most sites were located in the North of England, so findings may not generalize to other regions. The study relied on self-reported data and observations, which may not capture all influences on therapy provision. Patient and carer interview data were not reported in this paper.
Declared interests
One author is the Programme Manager for the SSNAP, which is funded by the Healthcare Quality Improvement Partnership on behalf of NHS England. Three authors are members of the Intercollegiate Stroke Working Party who developed the National Clinical Guideline for Stroke.
The easy way to misread this
Do not assume that simply increasing the number of therapists will automatically result in meeting therapy guidelines. The study shows that even in units with the highest staffing levels, meeting recommendations was challenging due to systemic inefficiencies like excessive handover time and documentation duplication.