Home-based rehabilitation for survivors of stroke with severe disability (HoRSSe Study)

Abstract

Background and aims: In the UK, over 20% of stroke survivors leave hospital with severe disability. Limited evidence-based clinical guidance is available to support their rehabilitation. Our research focusses on establish ing consensus regarding the core components of home-based rehabilitation for survivors of stroke with severe disability. The barriers to implementing these core components in a real-world setting have been explored. Methods: Stroke rehabilitation experts (n=14) including researchers, cli nicians and those with lived-experience formed two virtual nominal group technique (vNGT) panels. Findings underwent qualitative content analysis to form rich overarching consensus statements.Focus group interviews were conducted with 20 staff participants from three home-based stroke rehabilitation teams. The Context Coding Framework facilitated analysis and synthesis of findings. Results: Findings from the vNGT were distilled into 11 overarching con sensus statements. These outline core components of home-based reha bilitation for this population, including service structure, team composition, knowledge and skills required. Focus groups reported high levels of need across multiple domains with teams being insufficiently resourced to fully meet these. Strategies to overcome these barriers included upskilling a diverse range of partners and employing multi-agency collaboration. Conclusions: These consensus statements highlight the complexity of managing survivors of stroke with severe disability following discharge from hospital. Sufficient resources and collaborative working underpin the implementation of rehabilitation to manage the complex needs of this population.This study supports the provision of services for this patient group, pro viding a benchmark for commissioners and clinicians whilst setting expec tations for stroke-survivors.