Quality standard
Quality statement 2: Intensity of stroke rehabilitation
Quality statement 2: Intensity of stroke rehabilitation
Quality statement
Adults having stroke rehabilitation in hospital or in the community are offered at least 3 hours of rehabilitation covering a range of multidisciplinary therapy for a minimum of 5 days a week. [2010, updated 2016]
Rationale
Higher-intensity stroke rehabilitation therapies can improve the quality of life for adults who have had a stroke. The improvements that an adult with stroke should expect to achieve will depend on their health and abilities before and after the stroke, the severity of the stroke and the intensity of the rehabilitation therapy. The intensity of stroke rehabilitation should be suitable for the person, so that they are able to participate and make progress towards their functional goals.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements and written clinical protocols to ensure that adults having stroke rehabilitation in hospital or in the community are offered at least 3 hours of rehabilitation covering a range of multidisciplinary therapy for a minimum of 5 days a week.
Data source: Data can be collected from information recorded locally by healthcare provider organisations, for example, from service or clinical protocols.
Process
a) Proportion of adults having stroke rehabilitation in hospital who receive at least 3 hours of rehabilitation covering a range of multidisciplinary therapy for a minimum of 5 days a week.
Numerator – the number in the denominator who receive at least 3 hours of rehabilitation covering a range of multidisciplinary therapy for a minimum of 5 days a week.
Denominator – the number of adults having stroke rehabilitation in hospital.
Data source: The Sentinel Stroke National Audit Programme (SSNAP) clinical audit collects information on how many minutes and how many days patients receive different types of therapy in hospital.
b) Proportion of adults having stroke rehabilitation in the community who receive at least 3 hours of rehabilitation covering a range of multidisciplinary therapy for a minimum of 5 days a week.
Numerator – the number in the denominator who receive at least 3 hours of rehabilitation covering a range of multidisciplinary therapy for a minimum of 5 days a week.
Denominator – the number of adults having stroke rehabilitation in the community.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.
Outcome
Change in Modified Rankin Score at 6 months after a stroke.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records. The SSNAP clinical audit includes the Modified Rankin Score at 6 months after a stroke.
What the quality statement means for different audiences
Service providers (such as secondary care providers and community care providers) ensure that adults having stroke rehabilitation are offered at least 3 hours of rehabilitation covering a range of multidisciplinary therapy for a minimum of 5 days a week.
Health and social care practitioners offer adults having stroke rehabilitation at least 3 hours of rehabilitation covering a range of multidisciplinary therapy for a minimum of 5 days a week.
Commissioners ensure that they commission services in which adults having stroke rehabilitation are offered at least 3 hours of rehabilitation covering a range of multidisciplinary therapy for a minimum of 5 days a week.
Adults having rehabilitation therapy after a stroke are offered at least 3 hours of rehabilitation therapy that they need on at least 5 days a week. Rehabilitation therapy is long-term support to help people regain their independence and cope with any remaining disabilities after a stroke. It may involve many different specialists, such as physiotherapists, occupational therapists and speech and language therapists. They can help people who have problems with their memory and concentration; speaking, reading and writing; emotions and feelings; sight; swallowing and eating; strength, balance and movement; and shoulder pain. They also include help to encourage physical activity and independent living.
Source guidance
Stroke rehabilitation in adults. NICE guideline NG236 (2023), recommendation 1.2.16
Definitions of terms used in this quality statement
Rehabilitation covering a range of multidisciplinary therapy
A range of multidisciplinary therapy includes physiotherapy, occupational therapy, and speech and language therapy. Adults who have had a stroke should be offered all rehabilitation therapies that are suitable for their needs, as long as they have the ability to participate and make progress towards their functional goals. Adults with stroke should be able to access rehabilitation at any stage of the stroke care pathway when needed. [Adapted from NICE's guideline on stroke rehabilitation in adults, recommendation 1.2.16, and expert opinion]
Equality and diversity considerations
Some adults who have had a stroke may not have the mental or physical ability to participate in at least 3 hours of rehabilitation covering a range of multidisciplinary therapy each day. Where it is agreed with the person that they are unable, or do not wish, to participate in rehabilitation therapy for at least 3 hours a day, service providers should ensure that therapy is still offered 5 days a week but for a shorter amount of time. It should be given at an intensity that allows the person to actively participate and at a level that enables them to make progress.