National stroke guidelines are not being met, despite the evident need for consistent provision of rehabilitative therapies within stroke care. This article presents a picture of the current guidelines and explores the role of goal setting in improving current rehabilitation provision for stroke.
A current picture of rehabilitation
Rehabilitation is a crucial aspect of healthcare worldwide, with an estimated 2.41 billion people potentially benefiting from rehabilitation services (Cieza et al., 2020).
Stroke, in particular, is a major focus within this field, as it represents the second leading cause of death globally and is a primary cause of disability (Katan & Luft, 2018).
In the UK alone, approximately 100,000 people are admitted to hospitals for stroke each year, and around 1.3 million stroke survivors live with long-term disability (SSNAP, 2024).
These statistics highlight the significant demand for effective stroke care.
To meet this need, it is essential to understand what constitutes ‘effective stroke care’- specifically, how much stroke rehabilitation is required to achieve the best possible outcomes?
Current guidelines
National stroke guidelines state: “stroke patients in rehabilitation should receive at least 45 minutes of each relevant therapy (e.g., physiotherapy, occupational therapy, speech and language therapy) for a minimum of five days a week, as long as they are capable of tolerating it and it remains beneficial” (NICE Stroke Guidelines, 2023; Royal College of Physicians, 2019).
These guidelines emerged from an examination of therapists’ role in stroke rehabilitation within a Collaborative Evaluation of Rehabilitation in Stroke across Europe (CERISE) study (De Wit et al,. 2006).
Expanding on this, a range of studies have demonstrated the benefits of ‘extra rehabilitation’, detailing that groups receiving more intervention time had improved outcomes (Lohse, Lang & Boyd, 2014), therefore supporting the need for time in each relevant therapy.
A positive relationship was also found between ‘extra rehabilitation’ and improved activity (Schneider et al., 2016), particularly if intervention encompasses 16 hours within the first 6 months following stroke (Kwakkel et al., 2004).
However, despite the obvious need and benefit to meet these guidelines within stroke care, since the introduction of the Sentinel Stroke National Audit Programme (SSNAP) in January 2013 (NHS England Digital, 2024), data has shown that patients are receiving significantly less inpatient therapy than recommended by national stroke guidelines (Royal College of Physicians, 2015).
The aptly titled paper: “Why do stroke survivors not receive recommended amounts of active therapy?” (Clarke et al., 2018), analysed why this could be the case.
Why are guidelines not being met?
SSNAP monitors therapist self-reported outcomes against guideline targets to monitor if recommended amounts of care are being provided.
As Clarke et al. (2018) detailed, they are often unmet, identifying key barriers to care that hinder compliance with these guidelines.
Their paper presents that time lost in information exchange and administrative tasks reduces time availability for therapy provision.
Furthermore, clinicians face barriers in goal setting for these patients, such as lack of guidelines, insufficient time and clinical demands (Crawford et al., 2022).
We are aware of the positive effects of goal setting as a rehabilitative device, improving recovery, goal achievement and positively influencing patients’ experience of rehabilitation (Sugavanam et al., 2013), and so for stroke patients to be receiving less targeted goals, is an issue.
Overall, research demonstrates stroke patients are receiving less goal-orientated and insufficient therapy.
The role of Kompass in bridging the gap
Technology solutions and goal-setting templates can be extremely useful in reducing administrative time and time lost in information exchange, as well as providing gold standard goal setting apparatus for use.
Kompass, a cloud-based rehabilitation application (formally Goal Manager®) streamlines goal setting through its incorporation of best practice templates and allows for MDT collaboration within goals and objectives, across patients.
Kompass helps solve the issues presented of stroke patients are receiving less goal-orientated and insufficient therapy by enabling clinicians to spend more time with patients and less on administrative tasks, improving rehabilitation outcomes in line with national guidelines (Clarke et al., 2018; Gittins et al., 2020).
It enhances goal-setting quality and effectiveness (Latamore, 1999) while replacing outdated software (Department of Health & Social Care, 2020), supporting the government’s goal for digital maturity by 2025 (UK Parliament, 2023).
The need for digital transformation, highlighted by COVID-19 (Hammers et al., 2020), makes Kompass essential for addressing healthcare challenges (Tulchinsky & Varavikova, 2014).
This not only benefits the NHS, but also enhances patient outcomes and supports the wider community by improving the overall quality of rehabilitation services (Anderson et al., 2019; Schreyögg et al., 2006).
The adoption of such technologies contributes to policy initiatives aimed at reducing healthcare inequalities (Chishtie et al., 2022; Joynt et al., 2017), a critical issue for everyone.
Conclusion
Being aware that recommendations are not being met was the crucial first step, and with the analysis of reasons to why, stroke rehabilitation has key building blocks and improvement points to action.
Employing technology solutions to reduce administrative burdens and prevent time-loss in information exchange is one way to action these improvements.
Gold standard goal setting templates, that can also be provided through technology solutions like Kompass, will also improve stroke care by facilitating the setting of more meaningful goals.
Article Credit:
Sarah Lake, Research Assistant- sarahlake@kompass.health
References
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