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, David Lugo-Palacios, Lizz Paley, Benjamin Bray, Brenda Gannon, Sarah Tyson*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)981-991
Number of pages11
JournalClinical Rehabilitation
Volume34
Issue number7
DOIs
Publication statusPublished - 1 Jul 2020

Bibliographical note

Funding Information:
We thank the people and organizations participating in the Sentinel Stroke National Audit Programme (SSNAP). The authors acknowledge and thank Dr Martin James, Ms Alex Hoffman, and the Intercollegiate Stroke Working Party of the Sentinel Stroke National Audit Programme for their invaluable discussion and insights regarding interpretation of the results. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was funded by the National Institute for Health Research (NIHR) under its Health Service and Development Research Programme (Grant Reference 14/198/09). The views expressed are those of the authors and not necessarily those of the NHS, NIHR, or the Department of Health and Social Care.

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was funded by the National Institute for Health Research (NIHR) under its Health Service and Development Research Programme (Grant Reference 14/198/09). The views expressed are those of the authors and not necessarily those of the NHS, NIHR, or the Department of Health and Social Care.

Publisher Copyright:
© The Author(s) 2020.

Keywords

  • Stroke
  • dose
  • intensity
  • occupational therapy
  • physiotherapy
  • psychology
  • speech and language therapy

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