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All physios involved in stroke care should participate in national audit, urges CSP

10 January 2015 - 10:10am

The CSP wants physiotherapy teams in stroke care to collect data on their services as the first annual audit of stroke care in England and Wales reveals wide variations in provision.

File 141361 The CSP calls on all physiotherapists involved in stroke care to participate in SSNAP audits

How good is stroke care was published last month by the Stroke Sentinel National Audit Programme (SSNAP). It says patients who need physiotherapy receive a daily average of 32 minutes of treatment on over half of their days in hospital.

This means many acute physiotherapy services fall short of the National Institute for Health and Care Excellence benchmark that patients should receive the equivalent of 45 minutes of physiotherapy a day for five days or 32 minutes over seven days.

Based on data from 74,000 patients, the report gives an overview of patient care from April 2013 to March 2014. It measures services against national clinical standards and questions whether patients are receiving enough therapy.

It found that while patients really value therapy, they do not feel they receive enough on stroke units.

Cherry Kilbride, CSP representative on the SSNAP and a senior lecturer in physiotherapy at Brunel University London, said: ‘Specialist stroke physiotherapy is continuing to make great strides in delivering treatments, but there is still a considerable way to go.

‘If the median is 32 minutes a day, we know that the level across seven day working is still very low so that the majority of patients will not be receiving the benchmark.’

Improvements needed

Jakko Brouwers, chair of the Association of Chartered Physiotherapists in Neurology, said: ‘Those patients who have been identified to have physiotherapy needs receive less than 60 per cent of the amount of required.

‘This shocking statistic needs to be improved, possibly with improved staffing ratios and the adoption of novel treatment methods using new technology.’ There should also be protected time for training, research and service improvement activities in stroke physiotherapy teams, Mr Brouwers said.

The SSNAP report says that access to specialist stroke support in the community is ‘variable and inconsistent at best’ and calls for improvements.

It found that one in patient in four was discharged with the support of an early supported discharge (ESD) team. Such specialist multidisciplinary teams – which include physiotherapists – enable patients to leave hospital after a stroke, by providing stroke unit expertise at home.

Access to ESD teams increased from 31 per cent of patients in 2008 to 74 per cent in 2014, but the goal is for all patients to have this support, the report says.

Early supported discharge

‘Early supported discharge needs to be a higher priority. It is down to local trusts to look at how this can be achieved and if there is a better way to organise services more efficiently, such as through more integrated working,’ said Dr Kilbride.

However, the report suggests that the rehabilitative work of these teams may be significantly under-reported. The SSNAP data show that fewer than 5,000 patient records from ESD or community rehabilitation teams had been completed out of a possible 23,000.

It also found that only 17 per cent of stroke survivors has an assessment six months after admission, but says that this low figure may be due to poor record keeping.

The CSP called on all physiotherapists involved in stroke care to participate in SSNAP audits. This applies in particular to community physios who treat other types of patients and may not have considered their work relevant to the project.

Ralph Hammond, a CSP professional adviser and neurology physiotherapist, said: ‘It’s vital that all teams treating at least 10 stroke patients a year are part of the audit, as it’s only when we have full participation across the care pathway that we can get a complete picture of the care stroke patients receive.’

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