Changing occupational therapy and physiotherapy practice through guidelines and audit in the United Kingdom

Abstract

Background: The National Clinical Guidelines for Stroke (NCGS) were produced and three rounds of the National Sentinel Audit of Stroke conducted to improve the quality of stroke care in the UK.
Objective: To compare the results of the occupational therapy and physiotherapy elements of the most recent national sentinel audit with the occupational therapy-and physiotherapy-specific recommendations of the NCGS.
Methods: Retrospective case-note audit.
Results: Over 95% of hospitals/sites who manage stroke in England, Wales and Northern Ireland took part in the most recent round of the sentinel audit. The clinical audit took place from 1 April to 30 June 2001 and incorporated 235 hospitals/sites. The organizational audit took place in January 2002 and incorporated 240 hospitals/sites. Data are presented from the 235 with both clinical and organizational data, under the headings of: approaches to rehabilitation; carers/families; rehabilitation interventions; and transfer to the community. Low rates of compliance with national standards were observed for all domains.
Conclusion: Our findings suggest that occupational therapists and physiotherapists are not fully complying with the national standards for stroke care.

Full text

Clinical
Rehabilitation
2005;
19:
365-371
Changing
occupational
therapy
and
physiotherapy
practice
through
guidelines
and
audit
in
the
United
Kingdom
R
Hammond
Chartered
Society
of
Physiotherapy,
London,
S
Lennon
University
of
Ulster,
Co
Antrim,
MF
Walker
University
of
Nottingham
and
A
Hoffman,
P
Irwin
and
D
Lowe
Clinical
Effectiveness
and
Evaluation
Unit,
Royal
College
of
Physicians
London
on
behalf
of
the
Intercollegiate
Stroke
Working
Party
Received
5th
October
2003;
returned
for
revisions
6th
January
2004;
revised
manuscript
accepted
3rd
July
2004.
Background:
The
National
Clinical
Guidelines
for
Stroke
(NCGS)
were
produced
and
three
rounds
of
the
National
Sentinel
Audit
of
Stroke
conducted
to
improve
the
quality
of
stroke
care
in
the
UK.
Objective:
To
compare
the
results
of
the
occupational
therapy
and
physiotherapy
elements
of
the
most
recent
national
sentinel
audit
with
the
occupational
therapy-
and
physiotherapy-specific
recommendations
of
the
NCGS.
Methods:
Retrospective
case-note
audit.
Results:
Over
95%
of
hospitals/sites
who
manage
stroke
in
England,
Wales
and
Northern
Ireland
took
part
in
the
most
recent
round
of
the
sentinel
audit.
The
clinical
audit
took
place
from
1
April
to
30
June
2001
and
incorporated
235
hospitals/sites.
The
organizational
audit
took
place
in
January
2002
and
incorporated
240
hospitals/sites.
Data
are
presented
from
the
235
with
both
clinical
and
organizational
data,
under
the
headings
of:
approaches
to
rehabilitation;
carers/families;
rehabilitation
interventions;
and
transfer
to
the
community.
Low
rates
of
compliance
with
national
standards
were
observed
for
all
domains.
Conclusion:
Our
findings
suggest
that
occupational
therapists
and
physiotherapists
are
not
fully
complying
with
the
national
standards
for
stroke
care.
Introduction
Previous
studies
have
shown
that
the
quality
of
stroke
care
in
the
UK
is
poor,
with
unacceptable
variations
in
the
quality
of
care
provided
between
districts
and
regions,
2
yet
there
is
good
evidence
that
well-organized
stroke
care
reduces
mortality
and
morbidity.3
National
Clinical
Guidelines
for
Stroke
(NCGS)
have
been
published,4'5
and
three
Address
for
correspondenice:
Marion
Walker,
Senior
Lecturer
in
Stroke
Rehabilitation,
Division
of
Rehabilitation
and
Ageing,
B
Floor
Medical
School,
Queen's
Medical
Centre,
Nottingham
NG7
2UH,
UK.
e-nmail:
rnarion.walker@nottingham.ac.uk
4
2005
Edward
Arnold
(Publishers)
Ltd
rounds
of
the
National
Sentinel
Audit
of
Stroke
completed.6
8
The
audits
of
stroke
compare
performance
against
evidence-based
standards
for
both
the
organization
of
services
(organizational
audit)
and
processes
of
care
(clinical
audit)
as
agreed
by
the
Intercollegiate
Stroke
Working
Party.
The
Working
Party
consists
of
representatives
from
the
colleges
and
professional
associations
of
all
disciplines
involved
in
the
management
of
stroke,
including
patients'
organizations.
The
NCGS
cover
the
management
of
patients
with
acute
stroke
from
the
onset,
through
rehabi-
litation
to
the
longer
term.4'5
The
aim
is
to
provide
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