Quality statement 2: Intensity of stroke rehabilitation

Quality statement

Adults having stroke rehabilitation in hospital or in the community are offered at least 45 minutes of each relevant 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

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 45 minutes of each relevant therapy for a minimum of 5 days a week.

Data source: Local data collection.

Process

a) Proportion of adults having stroke rehabilitation in hospital who receive at least 45 minutes of each relevant therapy for a minimum of 5 days a week.

Numerator – the number in the denominator who receive at least 45 minutes of each relevant therapy for a minimum of 5 days a week.

Denominator – the number of adults having stroke rehabilitation in hospital.

Data source: Local data collection. Data can be collected using the Royal College of Physicians' Sentinel Stroke National Audit Programme (SSNAP) questions 4.5 and 4.6.

b) Proportion of adults having stroke rehabilitation in the community who receive at least 45 minutes of each relevant therapy for a minimum of 5 days a week.

Numerator – the number in the denominator who receive at least 45 minutes of each relevant therapy for a minimum of 5 days a week.

Denominator – the number of adults having stroke rehabilitation in the community.

Data source: Local data collection.

Outcome

Change in Modified Rankin Score at 6 months after a stroke.

Data source: Local data collection. Data can be collected using the Royal College of Physicians' Sentinel Stroke National Audit Programme (SSNAP) question 8.4.

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 45 minutes of each relevant therapy for a minimum of 5 days a week.

Health and social care practitioners offer adults having stroke rehabilitation at least 45 minutes of each relevant therapy for a minimum of 5 days a week.

Commissioners (such as clinical commissioning groups and local authorities) ensure that they commission services in which adults having stroke rehabilitation are offered at least 45 minutes of each relevant therapy for a minimum of 5 days a week.

Adults having rehabilitation therapy after a stroke are offered at least 45 minutes of each type 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, speech therapists and occupational 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 (2013) NICE guideline CG162, recommendation 1.2.16 (key priority for implementation)

Definitions of terms used in this quality statement

Relevant stroke rehabilitation

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 stroke may not have the mental or physical ability to participate in 45 minutes of each rehabilitation therapy. 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.