Work Package 1

1. Work Package 1 Determine Current Treatment Methods and Outcome Measures Used in England for Upper Limb Rehabilitation Following Stroke

2. RefresherObjective for WP1 • Gather information on current • Treatment methods • Outcome measures • Indicative costs • Over the course of the first year following stroke

3. RefresherMethod • Phase 1 – advisory group • Phase 2 – workshop • Phase 3 – pilot • Phase 4 – national distribution

4. Where we are at todayPhase 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

5. Where we are at todayPhase 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%

6. GP Charities Social services Not admitted Community Hospital Nursing Home ASU SRU Home Non ASU Neurorehab ward Community Rehab Team Spasticity Clinic Orthotics OPD Liaison Nurse Private provider

7. 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

8. 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.

9. How Do You Measure Change?

10. 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

11. 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

12. 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.

13. Where we are at todayPhase 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

14. Phase 4 – National distribution • Need to target the 12 month post stroke for overview of treatment provided for stroke rehabilitation onset Timeframe 12mths Stroke Units Outreach services? Community services? Primary Care Trusts? Specialist Rehabilitation Centres?

15. National distributionWho - aim to target team leadsWhere – still issues on how to reach community services When – in the process of completing the IRAS application and Bournemouth Ethics Review

16. National distributionSupport agreed in principle by Royal College of Physicians Stroke Improvement Programme clinical networks

17. TOTAL NUMBER OF ACUTE STROKE UNITS IN ENGLAND 7 116 ASUs 18 14 6 15 3 18 6 6 13

18. TOTAL NUMBER OF REHAB STROKE UNITS IN ENGLAND 9 127 RSUs 23 16 8 15 2 21 9 8 16

19. TOTAL NUMBER OF COMBINED STROKE UNITS IN ENGLAND 6 10 96 CSUs 9 7 7 17 17 8 9 6