The MoCA is the most valid and clinically feasible screening tool to identify stroke survivors with a wide range of cognitive impairments who warrant further assessment.
Objective:To identify why the National Clinical Guideline recommendation of 45 minutes
of each appropriate therapy daily is not met in many English stroke
units.Design:Mixed-methods case-study evaluation, including modified process mapping,
non-participant observations of service organisation and therapy delivery,
documentary analysis and semi-structured interviews.Setting:Eight stroke units in four English regions.Subjects:Seventy-seven patients with stroke, 53 carers and 197 stroke unit staff were
observed; 49 patients, 50 carers and 131 staff participants were
interviewed.Results:Over 1000 hours of non-participant observations and 433 patient-specific
therapy observations were undertaken. The most significant factor
influencing amount and frequency of therapy provided was the time therapists
routinely spent, individually and collectively, in information exchange.
Patient factors, including fatigue and tolerance influenced therapists’
decisions about frequency and intensity, typically resulting in adaptation
of therapy rather than no provision. Limited use of individual patient
therapy timetables was evident. Therapist staffing levels were associated
with differences in therapy provision but were not the main determinant of
intensity and frequency. Few therapists demonstrated understanding of the
evidence underpinning recommendations for increased therapy frequency and
intensity. Units delivering more therapy had undertaken patient-focused
reorganisation of therapists’ working practices, enabling them to provide
therapy consistent with guideline recommendations.Conclusion:Time spent in information exchange impacted on therapy provision in stroke
units. Reorganisation of therapists’ work improved alignment with
guidelines.
Valid and clinically feasible mood screening tools for stroke have been identified but methodological inconsistency prevented recommendations about the optimal cut-off scores.
The main features of operation of multi-disciplinary team meetings have been identified which will enable assessment tools and interventions to improve effectiveness to be developed.
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