Why do some people with stroke not receive the recommended 45 minutes of Occupational Therapy and Physiotherapy? A Delphi Study

Abstract

Objectives: to gain consensus amongst therapists for reasons why a person with stroke may not receive the Royal College of Physicians’ recommended minimum of 45 minutes of daily therapy

Design: three-round remote e-Delphi study.

Setting: national study, based in the UK

Participants: Occupational Therapists and Physiotherapists with experience of delivering therapy after Stroke and awareness of the 45-minute guideline.

Results: forty-five therapists consented to participate in the study. Thirty-five (78%) completed round one, 29/35 (83%) completed round 2 and 26/29 (90%) completed round three. Consensus (75%) was reached for 32 statements. Reasons why a person may not receive 45 minutes were related to the suitability of the guideline for the individual (based on factors like therapy tolerance or medical status) or the capability of the service to provide the intervention. In addition to the statements for which there was consensus, 32 concepts did not reach consensus. Specifically, there was a lack of consensus concerning the suitability of the guideline for people receiving Early Supported Discharge (ESD) services and a lack of agreement about whether people who need more than 45 minutes of therapy actually receive it.

Conclusion: some people do not receive 45 minutes of therapy as they are considered unsuitable for it and some do not receive it due to services’ inability to provide it. It is unclear which reasons for guideline non-achievement are most common. Future research should focus on why the guideline is not achieved in ESD, and why people who require more than 45 minutes may not receive it. This could contribute to practical guidance for therapists to optimise therapy delivery for people after stroke.

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Identifiers

ORCID for Beth Clark: orcid.org/0000-0003-4493-166X

ORCID for Ann-Marie Hughes: orcid.org/0000-0002-3958-8206

ORCID for Ruth Turk: orcid.org/0000-0001-6332-5353

ORCID for Jane Burridge: orcid.org/0000-0003-3497-6725

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