Development of a consensus approach to upper limb rehabilitation early post stroke amongst a cohort of Western Australian therapists.

Abstract

This study aimed to define commonly reported physiotherapy and occupational therapy terminology regarding rehabilitation interventions for moderate to severe upper limb deficits early post- stroke and to develop a consensus on ‘standard’ post-stroke upper limb rehabilitation across three stroke services. An audit was undertaken of all middle cerebral artery strokes admitted over a nine-month period to an acute tertiary hospital. Data were collected from 48 cases of middle cerebral artery stroke. Twenty four cases had moderate to severe upper limb impairment, and of these 16 were transferred to the two participating rehabilitation sites. A list of upper limb interventions documented in these 16 cases was distributed to therapists from the three participating sites (nine physiotherapists, 13 occupational therapists) who subsequently attended focus groups. Definitions for reported interventions were developed, collated and refined until group agreement was reached using a modified Delphi method. Approaches to upper limb rehabilitation varied according to therapists’ clinical experience and training background; however, definitions did not vary widely between services or disciplines. A consensus on ‘usual care’ for moderate to severe upper limb deficits within participating stroke services was developed from which a structured, individualised, impairment-based treatment template was produced for use in a subsequent interventional study.