Optimising home-based rehabilitation for survivors of stroke with severe disability
AbstractBackground and Aims: In the UK, over 20% of stroke survivors leave hospital severely disabled. Limited evidence-based clinical guidance is available to support the rehabilitation of these individuals. Our research has focussed on establishing consensus regarding the core components of homebased rehabilitation for this population. This study explores the challenges of providing that rehabilitation and identifies strategies to overcome them.
Method(s): A multiple-case study design examined three multidisciplinary rehabilitation teams providing home-based rehabilitation to this population. Data was collected from focus group transcripts with team representatives (n=20) and publicly available information such as national stroke audit data.
Result(s): High levels of need were reported for these patients across multiple domains such as continence, communication and motor control. There was lack of agreement relating to who was ultimately responsible for providing rehabilitation for this group. Teams have evolved to include this population but are insufficiently commissioned to fully meet their needs. Incomplete and disjointed pathways with resultant healthcare inequalities were commonly reported. Teams have adopted multiple strategies in attempts to overcome these challenges, including upskilling a diverse range of partners. Exploiting available multi-disciplinary expertise, skills and resources across health, social care and voluntary sector boundaries enabled rehabilitation opportunities, focused interventions and optimised outcomes.
Conclusion(s): Collaboration and partnership working are essential for commissioning and delivery of rehabilitation for severely disabled strokesurvivors. Multidisciplinary expertise is required, relying on coordinated multiagency rehabilitation opportunities to be realised to address existing health inequalities.