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A scoping review of physiotherapy interventions in stroke patients that have been researched between 2010 and June 2020

The aim of this study is to collect and synthesize data on the effectiveness wearable robotics have on upper limb rehabilitation following a stroke. Technology is advancing at a rapid rate, allowing robotics to be used for upper limb rehabilitation outside of selective research studies or hospitals. Data will be collected from multiple sources allowing us to analyze positive or negative trends in post stroke recovery where wearable robotics are used.

The main purpose of this project is to determine the effectiveness of external orthoses/ devices and management of shoulder subluxation. There is a gap in literature that still exists on whether external orthoses help with management of a shoulder subluxation post stroke. By conducting this review, we aim to investigate the existing evidence on orthoses and their role of reducing an already subluxed shoulder. Overall, this review could have an impact clinically on physiotherapy intervention when it comes to managing patients post stroke with a shoulder subluxation.

The aim of this systematic review is to analyse the literature regarding “hands on” Physiotherapy interventions, to ascertain their effectiveness for the treatment of mobility in stroke survivors. Articles to be considered will meet the following criteria: publication in English, full text access, RCT study design, peer reviewed journal articles. Primary Outcome(s) There are three broad categories of interest: 1. The types of hands-on interventions that have been investigated to improve mobility in patients post stroke. 2. The protocol regarding the application of hands-on interventions that have been investigated to improve mobility in patients post stroke. 3. The effectiveness of hands-on interventions that have been investigated to improve mobility in patients post stroke. Secondary Outcome(s): N/A Information source: Databases to be used: PubMed, PEDro, CINHAL and Scopus. The completed search strategy will be run through the selected databases with a modified search created for PEDro. Identified citations will be imported into Endnote software. A search for duplicates will then be conducted and resulting duplicates removed. Each reviewer will be allocated one third of the references to screen title and abstract against eligibility criteria with irrelevant articles to be removed. Full texts of remaining articles are to be screened individually by each team member against inclusion criteria. Full text articles that do not meet criteria will be excluded with a reason provided. Any disagreements will be resolved through group discussion. The results of the study selection process are to be displayed in PRISMA Flow Diagram format. Data Items will be split into three categories and were selected to reflect the aims of the review. Characteristics: Author, date, title, study design, population (number, gender, age), stroke details. Intervention: Hands on intervention, protocol, outcome measures, data collection method/statistical analysis. Findings/Conclusion: Aim, outcome, findings/results, conclusion/clinical relevance. All key reference lists of included studies will then be searched for relevant articles. Final search conducted on 12/10/2020

In 2012, stroke affected over 420 000 people within Australia and the number of stroke survivors is anticipated to increase. Many stroke survivors live with a disability which affects their ability to carry out activities of daily living. In Australia stroke survivors are cared for by both publicly and privately funded hospitals. Available to both systems are the Stroke Foundation Clinical Guidelines for the Management of Stroke Survivors (SF 2010a). The Stroke Foundation carries out biannual national audits in Australia, one focusing on acute services and the other on rehabilitation services, to determine hospitals’ quality of care in accordance with the recommendations of the Stroke Foundation clinical guidelines. Participation of privately funded hospitals in both these national audits has been consistently low. Therefore, there is less understanding of how privately funded hospitals manage stroke survivors compared with publicly funded hospitals. Stroke survivors admitted to hospitals often journey through both acute and rehabilitation services. A stroke audit that follows the journey of stroke survivors by auditing both acute and rehabilitation services concurrently is required to gain a better understanding of how the clinical guidelines are applied across each service individually and across the combined services. When developing a stroke audit tool for either local or national use, clinicians tend to have limited input into the selection of audit criteria and tool development. As the overarching framework underpinning this research program, knowledge translation involves clinicians and researchers partnering to develop ready to use research. Therefore, in this research program allied health clinicians (physiotherapists, occupational therapists, social workers, speech pathologists, and dietitians) were invited to assist in the development of a stroke audit tool in a single privately funded hospital and to test its reliability. Establishing the reliability of the stroke audit tool adds to its robustness. The stroke audit tool was used to assess the adherence of allied health clinicians from a privately funded hospital to the selective Stroke Foundation clinical guidelines. The audit included stroke survivors with consecutive admissions to both acute and rehabilitation services. This research comprised two studies. Study 1 developed a stroke audit tool with allied health clinicians selecting the most relevant clinical guidelines from the Stroke Foundation Clinical Guidelines for Stroke Management (SF 2010a). Both inter and intra-rater reliability of the tool were tested with allied health clinicians who were able to agree on eight Stroke Foundation clinical guidelines with 70% agreement. An additional two Stroke Foundation clinical guidelines with 50% agreement and a further two Stroke Foundation clinical guidelines were added to ensure the stroke audit tool was relevant to all disciplines. Interrater reliability for the stroke audit tool was tested across ten clinical records by five (one from each discipline) allied health clinicians or raters. Inter-rater reliability was high with substantial consistency demonstrated across both services. Intra-rater reliability demonstrated substantial to moderate consistency. Study 2 comprised a 12-month retrospective clinical record audit of stroke survivors with consecutive admission to both acute and rehabilitation services. The stroke audit tool assessed the percentage adherence of allied health clinicians against the selected Stroke Foundation’s clinical guidelines included in the audit tool. Adherence was defined as stroke survivor care delivered in accordance with the Stroke Foundation clinical guidelines 2010. A minimal adherence level was set at 60% with an aspirational level set at 80%. Secondary analysis compared adherence across acute and rehabilitation services. Also, a subgroup analysis was undertaken investigating the influence of age, gender and length of stay to allied health clinician’s adherence of Stroke Foundation clinical guidelines. Allied health clinicians met the 60% adherence rate, for nine (out of 12) Stroke Foundation clinical guidelines, including three that were above 80% adherence rate (aspirational level). There was a significant difference across acute and rehabilitation services for eight of the 12 Stroke Foundation clinical guidelines. Age, gender and length of stay did not influence adherence rates of the allied health clinicians across acute and rehabilitation stroke services. Allied health clinicians from a privately funded hospital developed a reliable stroke audit tool. The stroke audit tool highlighted areas of adherence as well as service gaps across acute, rehabilitation and the combined service. Investigating adherence across both acute and rehabilitation services could lead to a co-ordinated approach to improving adherence towards Stroke Foundation clinical guidelines.

Objective: To design and establish reliability of a local stroke audit tool by engaging allied health clinicians within a privately funded hospital. Methods: Design: Two‐stage study involving a modified Delphi process to inform stroke audit tool development and inter‐tester reliability. Participants: Allied health clinicians. Interventions: A modified Delphi process to select stroke guideline recommendations for inclusion in the audit tool. Reliability study: 1 allied health representative from each discipline audited 10 clinical records with sequential admissions to acute and rehabilitation services. Main Outcome Measures: Recommendations were admitted to the audit tool when 70% agreement was reached, with 50% set as the reserve agreement. Inter‐tester reliability was determined using intra‐class correlation coefficients (ICCs) across 10 clinical records. Results: Twenty‐two participants (92% female, 50% physiotherapists, 17% occupational therapists) completed the modified Delphi process. Across 6 voting rounds, 8 recommendations reached 70% agreement and 2 reached 50% agreement. Two recommendations (nutrition/hydration; goal setting) were added to ensure representation for all disciplines. Substantial consistency across raters was established for the audit tool applied in acute stroke (ICC .71; range .48 to .90) and rehabilitation (ICC.78; range .60 to .93) services. Conclusions: Allied health clinicians within a privately funded hospital generally agreed in an audit process to develop a reliable stroke audit tool. Allied health clinicians agreed on stroke guideline recommendations to inform a stroke audit tool. The stroke audit tool demonstrated substantial consistency supporting future use for service development. This process, which engages local clinicians, could be adopted by other facilities to design reliable audit tools to identify local service gaps to inform changes to clinical practice.