Based on: Clarke DJ, Tyson S, Rodgers H, Drummond A, et al, 2015. Why do stroke patients not receive the recommended amount of active therapy?

BMJ Open, 5, e008443. http://bmjopen.bmj.com/content/5/8/e008443.full Submitted by Dr David Clarke, Lecturer in Stroke Care, Bradford Royal Infirmary, d.j.clarke@leeds.ac.uk

SSNAP data identifies units which are performing well across a range of measures including inpatient therapy provision (rated A to E for each therapy). The audit also identifies marked regional and national variation in provision of the recommended amount of inpatient therapy. A study funded by the National Institute for Health Research (NIHR) led by Dr David Clarke, from the University of Leeds, investigated factors to explain this variation using observations of the day-today work of over 200 therapists in eight stroke units across different English regions.

No single factor accounted for why the recommended amount of therapy was not always received. Two of the most important factors identified, which directly impact on therapy provision across all stroke units were, the amount of time therapists spend in non-clinical activity, and the number of therapists routinely available to provide therapy. Table 1 (see ReAcT study below) highlights the large variation in time that individual therapists spent in information exchange events and meetings in the 8 units in the study and which reduced the time available for therapy (range: 1.3 to 8.6 hours per week). Table 2 (ReAcT study below) indicates variation in staffing levels and a probable association between staffing levels and audit ratings for therapy provision.

Consensus meetings held with expert clinicians in regions not involved in the study confirmed these factors are likely to be common across stroke units in England but are amenable to change as part of local service improvement initiatives. An example of where change has occurred in one unit in Yorkshire to increase inpatient therapy provision and which areas of the service were targeted for change is provided in the case studies area of the Annual Report webpage.

ReAcT Study - providing enough rehabilitation to patients 

Case Study