Article

OBJECTIVE: To identify why the National Clinical Guideline recommendation of 45
minutes of each appropriate therapy daily is not met in many English stroke
units. DESIGN: Mixed-methods case-study evaluation, including modified process
mapping, non-participant observations of service organisation and therapy
delivery, documentary analysis and semi-structured interviews. SETTING: Eight
stroke units in four English regions. SUBJECTS: Seventy-seven patients with
stroke, 53 carers and 197 stroke unit staff were observed; 49 patients, 50 carers
and 131 staff participants were interviewed. RESULTS: Over 1000 hours of
non-participant observations and 433 patient-specific therapy observations were
undertaken. The most significant factor influencing amount and frequency of
therapy provided was the time therapists routinely spent, individually and
collectively, in information exchange. Patient factors, including fatigue and
tolerance influenced therapists' decisions about frequency and intensity,
typically resulting in adaptation of therapy rather than no provision. Limited
use of individual patient therapy timetables was evident. Therapist staffing
levels were associated with differences in therapy provision but were not the
main determinant of intensity and frequency. Few therapists demonstrated
understanding of the evidence underpinning recommendations for increased therapy
frequency and intensity. Units delivering more therapy had undertaken
patient-focused reorganisation of therapists' working practices, enabling them to
provide therapy consistent with guideline recommendations. CONCLUSION: Time spent
in information exchange impacted on therapy provision in stroke units.
Reorganisation of therapists' work improved alignment with guidelines.

Langue : ANGLAIS