Stroke rehabilitation in country: Are we getting it right?

Alanna Grover1

1Whyalla Hospital & Health Service, PO box 267 Whyalla, SA 5600, alanna.grover@sa.gov.au

Background

Stroke is a major health care concern in Australia. Therefore there are best practice standards, informed by current best research evidence, on the management of stroke. Despite these standards, translating these into practice face numerous challenges, especially in rural and remote areas where access to health care is already compromised, resulting in poor health outcomes. A clinical audit project was undertaken to determine if the current physiotherapy practice adhered to current best practice for stroke patients in Country Health SA Local Health Network (CHSALHN) inpatient rehabilitation services.

Methods

Medical records documentation and client contact data from the three CHSALHN inpatient rehabilitation services for all patients admitted for inpatient stroke rehabilitation in the financial year 14/15 was audited. Compliance was measured against national clinical practice guidelines using a customised clinical audit tool.

Results

Findings from the data indicate that physiotherapy services are compliant for task specific training, retraining of sitting balance, transfers/gait, standing balance, progressive resisted strengthening and cardiovascular training. However, areas for improvement were identified including initial assessment, client/family-centred goals setting and decision making, intensity of therapy, prevention of shoulder subluxation, and intervention for somatosensory impairments.

Discussion

These findings highlight the ongoing challenges confronting rural and remote allied health clinicians in providing best practice care for stroke. While the challenges are evident, the solution to these issues remains difficult. This is because of the complexity of the health system, competing clinical priorities etc. If these issues are to be addressed, a system wide approach to change is required.

Biography

Alanna is the Clinical Senior Physiotherapist for Rehabilitation services in Country Health SA Local Health Network, and is based at the Whyalla Hospital.  She has worked in country South Australia since 2006 and is passionate about ensuring people from country South Australia have access to specialist rehabilitation services closer to home.