Authors' objectives: BACKGROUND: Stroke is the UK s greatest cause of adult disability. Therapy (physical, occupational and speech therapy) is an important aspect of stroke care that helps stroke patients regain movement, communication and thinking skills so they can look after themselves and return to important activities. We know therapy is effective but in the UK, most patients receive sub-optimal amounts of therapy1 AIMS: We want to improve this situation. So we need to understand WHY insufficient therapy is provided. In the UK, we have a unique opportunity using data from the Sentinel Stroke National Audit Programme (SSNAP). SSNAP is a national stroke register that audits care from admission to 6 month follow-up, involving all acute stroke services in England and Wales (95% of all stroke admissions, ~80,000 per year) and ~250 community services SSNAP regularly publishes detailed information describing the following for hospital and community services1: stroke therapy provision; processes of care; how services are organised; outcomes from the patients and organisations point of view. However it only describes what happens. It does not explain HOW these factors are inter-linked; WHY therapy does not happen; how much therapy services COST, nor which are the MOST EFFECTIVE ways to organise them. We will work this out. A challenge for stroke therapy is that stroke can cause many types of difficulties, disabilities and potential to recover. These factors affect which therapy best suits each individual. Recently the idea of stratified health care has emerged, based on the recognition that treatment works best when it is closely tailored to individuals needs. As a secondary aim, we wish to apply this principle to stroke therapy. We will use SSNAP data to investigate how disabilities occur together (or cluster ) and, for particular groups, whether these are associated with different levels of therapy and recovery. This information will help to develop specific treatments and pathways for patient sub-group in the future. As the treatments will more accurately suit individual patients, we can expect them to be more effective, enabling greater recovery and less long-term support from health and social care services, resulting in cost savings to an overburdened health system. DESIGN: We will analyse the most up-to-date, relevant SSNAP data available to us; a huge data-set involving ~160,000 patient records. The managers of the SSNAP programme will use established methods to identify the relevant data for candidates for therapy . These are stroke survivors who are in-patient for at least 3 days, conscious; not receiving end-of life care, and disabled by the stroke. We will then use sophisticated statistical and health economics techniques to answer the study objectives. PATIENT AND PUBLIC INVOLVEMENT: We have an established partnership with the PPI panel at the Manchester's Stroke Research Centre. They recognise stroke therapy as a priority and consider the questions important and appropriate. They will collaborate throughout the project, have contributed to this plain English summary and will contribute to the detailed analysis plan, interpretation of results and material to publicise the findings to stroke survivors.

Project Status: Completed

URL for project: http://www.nets.nihr.ac.uk/projects/hsdr/1419809

Year Published: 2020

URL for published report: https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/1419809/#/

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Services and Delivery Research programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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