Article

Recovery from stroke requires the provision of specialist
rehabilitative care, yet there is a lack of research evidence on optimal methods
of delivery and inequitable service provision across countries. Following
consensus on Early Supported Discharge, our aim was to define core components of
evidence-based community stroke services. DESIGN: We used a modified Delphi
approach with a purposive sample of 26 UK-based expert panellists (10 academics,
15 stroke service leads or commissioners, one stroke survivor). Statements based
on research literature and policy documents were generated by an independent,
mixed academic and service improvement team of nine. In three rounds of
consultation panellists indicated their level of agreement with statements. Free
text comments were analysed thematically. RESULTS: Consensus of opinion (>70%
agreement) was obtained on 76 of 80 statements. Panellists agreed that stroke
specialist care tailored to clinical need should be provided following discharge
from hospital. Flexible care pathways should be commissioned and provided through
strategic and collaborative leadership across health and social care. Teams need
to deliver stroke specialist rehabilitation, handing over responsibility to
non-specialist services when patient rehabilitation goals have been met. Lack of
consensus on whether to provide services exclusively for stroke patients and the
need of support for carers highlights areas for further research. CONCLUSIONS:
Consensus on the provision of evidence-based community stroke rehabilitation has
been reached. Commissioning services with a clearly defined remit, which can
deliver tailored care to individual stroke patients, is a challenge that needs
further exploration.

Langue : ANGLAIS