Determine Current Treatment Methods and
Outcome Measures Used in England for Upper
Limb Rehabilitation Following Stroke
Refresher
Objective for WP1
 Gather information on current



Treatment methods
Outcome measures
Indicative costs
 Over the course of the first year following stroke
Refresher
Method
 Phase
1 – advisory group
2 – workshop
 Phase 3 – pilot
 Phase 4 – national distribution
 Phase
Where we are at today
Phase 1 – Advisory group
 Created a multidisciplinary advisory group
 Inaugural meeting held May 21, 2009
 Summary of outcome
 Structure of workshop outlined
 Need to include patient perspective underscored
Where we are at today
Phase 2 - workshop
 Held July 9th, 2009 at Bournemouth University
 Participants
 30 multidisciplinary specialists from across the
Southwest representing



Physiotherapists – 40%
Occupational therapists – 40%
Speech & Language therapist, stroke co-ordinators,
educators – 20%
GP
Social
services
Charities
Not admitted
Community
Hospital
Nursing Home
ASU
SRU
Home
Non ASU
Neurorehab
ward
Spasticity
Clinic
Orthotics
Community Rehab
Team
OPD
Private
provider
Liaison
Nurse
Phase 2 – Workshop Structure
 3 Break-out Sessions, 20 minute feed-back sessions
 Break-out session
 What are you doing and why?






No clear pathway
Amount of treatment dependent on setting
No standard guidelines for type/duration of treatment
limited focus on upper limb rehabilitation – 30% physio time,
50% OT time.
Treatment mainly function-based but dependent on patient
status
Funding from general budget – minimal for specialist kit
Phase 2 – Workshop Structure
 3 Break-out Sessions, 20 minute feed-back sessions
 Break-out session
 How do you measure change?
Feed-back Highlight: no standard protocol for
assessing ongoing rehab nor routine measures used.
How Do You Measure Change?
The Sodring Scale
Goal Attainment Scale
Motor Assessment
Scale
Some psychological
screening
Canadian occupational
performance
measurement
(COPM)
Functional Assessment
Measure
Functional
Independence
Measure
Chessington
Occupational
Therapy
Neurological
Assessment Battery
(COTNAB)
Test d'Evaluation de la
performance des
Membres
Supérieurs des
Personnes Âgées
(TEMPA)
Barthel ADL Index
Nottingham measures
Frenchay tests
Ashworth scale
Rivermead scales
Oxford scale
Action Research Arm
Test
Goniometer
Visual Analogue Scale
Fugl Meyer
Self-rating scales
Videos/photos
9 Hole Peg Test
Tardieu Scale
Tape measure for
oedame
Box & blocks
Phase 2 – Workshop Structure
 Break-out session
 What will make the survey work? Feed-back Highlight:
 Short, quick, easy.
 Electronic and paper
 Differentiate pathway for mild, moderate and severe
stroke
 Include private sector
Workshop 2009 Outcome
 Draft of the 
National Survey of Current Treatment Methods in
Rehabilitation of the Upper Limb After Stroke

For discussion, review and feedback following
presentation
Workshop 2009 Outcome
 Patient Involvement –
 Prospective study – recruiting cohort of 12 patients from
10 stroke units. Quarterly contact to review treatment
received.
 Retrospective study – recruiting cohort of 12 patients
from 10 stroke units. Contact after 12 months to review
treatment received.
Where we are at today
Phase 3 - Pilot
 Continue to refine drafts of the survey
 To date invaluable input from David Turner, Lucy
Yardley, Paul Strike, and Anand
 To pilot among  Workshop attendees
 Salisbury stroke unit
 Christchurch Hospital
Phase 4 – National distribution
 Need to target the 12 month post stroke for overview of
treatment provided for stroke rehabilitation
onset
Stroke Units
Timeframe
12mths
Outreach services?
Community services?
Primary Care Trusts?
Specialist Rehabilitation Centres?
National distribution
Who - aim to target team leads
Where – still issues on how to reach
community services
When
– in the process of completing the
IRAS application and Bournemouth
Ethics Review
National distribution
Support agreed in principle by
Royal College of Physicians
Stroke Improvement Programme
clinical networks
TOTAL NUMBER OF ACUTE STROKE UNITS IN ENGLAND
7
18
116 ASUs
14
6
15
3
18
6
6
13
TOTAL NUMBER OF REHAB STROKE UNITS IN ENGLAND
9
127 RSUs
23
16
8
15
2
21
9
16
8
TOTAL NUMBER OF COMBINED STROKE UNITS IN ENGLAND
6
10
96 CSUs
9
7
7
17
17
8
6
9