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Stroke audit reveals rehab woes

Only two-thirds of stroke patients are seen by a physiotherapist within recommended timescales, according to a report.

The CSP says the findings in the national sentinel audit for stroke 2004 are a cause for concern and proof that more investment in rehabilitation is needed.

The audit, the fourth since 1998, was funded by the Healthcare Commission and carried out by the Royal College of Physicians.

It looks at progress made by around 250 trusts in meeting 'stroke milestones' set out in the national service framework for older people and compliance with national clinical guidelines for stroke.

The findings reveal that only 63 per cent of stroke patients are seen within the recommended first 72 hours of admission. This is up only four per cent since 2000.

The audit also shows that many stroke units do not have the capacity to cope with demand. This means many patients are still being denied potentially life-saving checks and treatments soon after admission, adding to the risk of complications and long-term disability.

The audit highlights the 'critical' importance of effective longer-term management of stroke patients but says specialist community rehabilitation teams are in short supply.

Debbie Neal, a physiotherapist who coordinates stroke services across Leeds, told Frontline: 'I've seen the Leeds comparative results. Generally, access to rehab does not seem to be much better than it was, particularly after discharge from the acute phase, which  is where the sentinel audit focuses.'

She added: 'This may be due to few therapists being in a position to influence primary care trust commissioning decisions - resulting in a very limited number of clinical specialist and consultant therapist posts in stroke.'

Ms Neal, who is involved in developing a community stroke team in Leeds, said such changes would bring improvements.

In addition, as management of long-term conditions came to the fore, health organisations would realise the importance of rehabilitation in keeping patients out of hospital, she said.

CSP chief executive Phil Gray expressed concern at the audit findings, saying evidence showed that early access to physiotherapy was 'essential' to recovery.

He said extra investment in rehabilitation services would help stroke patients to live independently and could reduce health costs elsewhere. 'For these individuals, failure to provide sufficient rehabilitation could seriously compromise their quality of life,' he said.

On the plus side, more hospitals now have specialist stroke units and the quality of care within them 'seems to be improving'. In England, 82 per cent of hospitals now have a stroke unit, compared with 74 per cent in 2001.

The stroke unit at the Royal Free Hampstead trust has been named the best in England, Wales and Northern Ireland following the audit. Look out for more details in a future issue of Frontline

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