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Stroke rehabilitation needs radical overhaul

Support services for people who have had a stroke are lacking and improved access to physiotherapy and psychological therapy is urgently needed, say stroke experts

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22 May 2018, by Siobhan Chan

Patients’ recovery following a stroke is being hindered by a lack of physical and psychological support services after discharge from hospital, leading stroke experts have said.

Stroke survival in England has improved dramatically in the past decade but now ‘radical’ improvements to the support available to patients are needed, according to Professor Anthony Rudd, National Clinical Director for Stroke at NHS England.

“Stroke is a recoverable condition and we need to make sure that people end up back at work instead of in a nursing home,” he told a Westminster Health Forum event, Next Steps for Stroke Care in England, on 10 May 2018.

Deaths related to stroke have declined by 49% in the past 15 years, in part due to better prevention and earlier and more advanced treatment, according to Public Health England1.

However, around 45% of patients say they “feel abandoned when they leave hospital”, according to a large survey by the Stroke Association2. Almost two-thirds of stroke survivors leave hospital with a disability3 and so will need ongoing care after they are discharged.

Cardiovascular conditions such as atrial fibrillation and hypertension raise a person’s risk of stroke. Stroke is one of the areas in which the BHF carries out vital research, such as a glyceryl trinitrate skin patch that can be delivered by paramedics in the crucial minutes after a stroke and is currently being trialled by ambulance services.

Better access to therapy needed

Rehabilitation following a stroke includes occupational therapy, physiotherapy and speech and language therapy.

Although NICE guidelines recommend that patients receive 45 minutes of each type of therapy per day, and the Royal College of Physicians advises 45 minutes every day4, recent research by the Stroke Association found that once they leave hospital patients only receive an average of 16 minutes of physiotherapy, 16 minutes of occupational therapy and 12 minutes of speech and language therapy per day at home5.

Juliet Bouverie, CEO of the Stroke Association, told the event: “When people have a stroke, they can go from being able-bodied to disabled in minutes, so adjusting to that is difficult and requires a lot of support.

“But we have a long way to go, in particular in the community after patients are discharged home and realise they have to live with a lifelong disability,” she said.

Community approach to rehabilitation

Several healthcare leaders at the event suggested that community-based rehabilitation pathways could be the answer.

Natalie Beswetherick, Director of Practice and Development at the Chartered Society of Physiotherapy, said: “We need to move away from disease-specific rehab pathways that don’t maximise what we’ve got in terms of workforce.”

NHS Rightcare, the NHS England-backed programme to improve the quality of care, is looking at developing a combined pathway for community rehabilitation with partners from across the healthcare and voluntary sectors.

“Getting rid of inpatient rehabilitation beds and moving rehab into the community is critical – we need not just a strategy but operational support as well,” said Professor Rudd.

A national stroke plan

NHS England and the Stroke Association, with other partners, are producing a National Stroke Plan due to be published later this year.

Post-stroke rehabilitation will feature alongside stroke prevention, workforce planning and acute stroke care.

Dr Deborah Lowe, Clinical Lead for Stroke at the Getting It Right First Time programme, said: “We need to put recovery and rehabilitation at the heart of planning stroke services, otherwise we are failing our patients.”

Professor Rudd added: “I’m optimistic about what the next few years will bring. The national plan will bring big changes in stroke care, and will enable us to use that huge pot of money we currently spend on stroke – around £26 billion6 – on support and therapy.”

For the latest statistics on patient support following a heart event, read our National Audit of Cardiac Rehabilitation Annual Statistical Report 2017.

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1 Public Health England, News release: New figures show larger proportion of strokes in the middle aged

2 Stroke Association, A New Era for Stroke

3 Adamson J, Beswick A, Ebrahim S (2004). Is stroke the most common cause of disability? Journal of Stroke and Cerebrovascular Diseases 13:171-177.

4 Royal College of Physicians (2016). National Clinical Guideline for Stroke

5 Sentinel Stroke National Audit Programme (SSNAP) portfolio 2017

6 Stroke Association, Current, Future and Avoidable Costs of Stroke in the UK, 2017 [PDF]

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