Physiotherapy enables people to relearn lost abilities, regain independence and reduce the risk of further strokes.
Physiotherapy improves recovery of function and mobility after stroke. NICE recommends a minimum of 45 minutes of physiotherapy five days a week as part of a seven day specialist stroke rehabilitation service. High intensity therapy is needed to relearn lost abilities.
Rehabilitation should continue for as long as the person is showing measurable benefit from treatment and has achieved their agreed goals. Access to community rehabilitation services should be flexible to support longer term needs.
Early physiotherapy helps people relearn vital abilities
From 24 hours after a stroke, physiotherapists begin rehabilitation in short frequent spells, focused on getting out of bed, standing and walking. This repetitive task training helps people regain movement and relearn everyday activities.
Physiotherapists use assistive equipment to enhance stroke rehabilitation. Robot-assisted devices support people to walk independently while treadmill training improves walking speed and endurance. Virtual reality training may be beneficial alongside usual care but should not replace conventional therapy approaches.
Early Support Discharge (ESD)
Physiotherapy delivered by seven day services in ESD teams enables people to regain independence and reduces their length of stay in hospital.
ESD for people who are able to transfer independently or with a carer:
- Saves the NHS approximately £1600 over five years per extra patient receiving ESD
- Reduces hospital length of stay by five days
- Reduces long term dependency
- Reduces admission to institutional care
- Improves service satisfaction
- Improves mental health scores of carers
Longer term rehabilitation and reducing the risk of further strokes
- Every year more than 100,000 people have a stroke; or one person has a stroke every five minutes
- The average cost of stroke to the NHS per patient is £13,500 in the first year and £18,000 over 5 years
- By 2035 rate of first time strokes will have increased by 59% and the number of stroke survivors will rise by 123%
- One in four stroke survivors will experience another stroke within five years.
Community physiotherapy teams support stroke survivors to achieve longer term rehabilitation goals including reintegration back into the local community and return to work.
Most people who have a stroke already have other long term conditions. This makes long term management complex.
Flexible pathways which include easy access back into physiotherapy are required to help people manage all aspects of their long term conditions.
Physiotherapy teams help stroke survivors incorporate the physical activity recommendations into their daily routine to reduce the risk of another stroke by up to 35%.
Physiotherapists can provide circuit training, involving intensive repetition of everyday activities, to help people walk further, faster, with more independence and confidence.
Integrating endurance and strength training into rehabilitation reduces disability. Core stability and exercises incorporating balance, weight-shifting and gait improve balance after stroke.
People of working age are two to three times more likely to be unemployed eight years after their stroke. Around one in four strokes occur in people of working age, however people of working age are two to three times more likely to be unemployed after their stroke and commissioning of vocational rehabilitation services is variable.
Patient reported barriers include difficulty accessing rehabilitation services and limited capacity of rehabilitation teams to support people to return to work.
Service Innovation Example
Sherwood Forest Hospitals ESD Team
The Early Supported Discharge Team in Sherwood Forest Hospitals NHS Foundation Trust enables patients to receive early, specialist stroke care within their home environment.
Coordinated rehabilitation is delivered by the multidisciplinary team with access to a consultant and psychology input. The team have knowledgeable rehabilitation support workers trained in all disciplines to ensure that patients receive intensive input.
As well as providing monthly data to the Sentinel Stroke National Audit Programme, the team are the first in the East Midlands to provide additional data fields. This allows the team to promptly analyse changes in patients’ ability to perform everyday activities, the achievement of rehabilitation goals and the completion of mood and cognitive screening.
This data is discussed routinely in multidisciplinary meetings and is also shared at divisional meetings to allow immediate learning and inform service delivery.
After noticing inconsistency in outcome measure scores between leaving inpatient care and starting with ESD, meaning patients appeared to have deteriorated, both teams worked together to improve this.
Teaching sessions and guidance were developed to assist decision making and scoring consistency as well as regular communication between teams.
Outcome measures are routinely compared, allowing real time examples and feedback which staff can learn from. The teams regularly review the data to evaluate the impact of changes made and adapt accordingly.
Together they have:
- Reduced variation in outcome measure scores by 22%
- Improved transition of care and collaboration between inpatient and ESD services.
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