Stroke Services in Scotland and the Challenges Facing Community Rehabilitation

Purpose

The survey was intended to give a snap shot of what was happening in stroke services across Scotland to help inform the CSP ´Rehab Matters´ campaign.

Approach

A simple questionnaire was circulated through Scottish Board members to their staff working in stroke services and via a few stroke physiotherapists known to the CSP.

Outcomes

  • Responses were received from each of the 14 Boards although there was considerable variation in the numbers from each.
  • Considerable variation was seen in the distribution of specialist as compared to generalist physiotherapy staff. Specialists were almost exclusively found in the acute setting.
  • Huge discrepancies were also found between waiting times in acute as compared to community services. Waiting times increased progressively as patients moved along the stroke pathway. 35% of patients had to wait for more than 4 weeks for rehabilitation on leaving hospital and there was a wait of over 6 weeks for specialist community physiotherapy where this service existed.
  • While in hospital patients well over 60% of patients receive daily therapy with the remaining percentage getting therapy 2-3 times per week. The vast majority of community patients, 93%, received physiotherapy once a week or less.
  • A huge number of outcome measures (54) were listed as being used frequently.

Implications

Overall, the findings suggest that when a patient is acutely unwell in hospital with the main focus being on stabilising their medical condition/saving their life, physiotherapy from a specialist physiotherapist is offered daily in the majority of cases. Yet, on discharge from hospital when medically stable and arguably more able to participate with rehabilitation, patients can largely expect weekly physiotherapy delivered by a 'generalist.'

Top three learning points

This survey findings have been a very useful means of improving our advocacy and influencing ability around the rehabilitation agenda. However, the survey is not without its limitations and perhaps raises more questions than it actually answers. Perhaps most importantly it raises many questions of our profession;

  • How can acute and community services better work together to provide seamless quality patient care?
  • Is it right that the majority of our specialist stroke physiotherapists work within acute services or do we need a fluid movement of staff in order to meet patient needs?
  • Should community teams be condition specific or should we be moving towards more 'specialist generalist' roles?
  • What should the profession be doing in order to demonstrate impact and compare service models in terms of cost and outcomes for the patient?

Fund acknowledgements

This work was unfunded.

Additional notes

This work was presented at Physiotherapy UK 2018.