Stroke Care Planner: A Delphi Study

Abstract

Abstract Objective: The objective of the study was to analyse the efficacy and acceptability of a care planning tool for comprehensive post-stroke rehabilitation. Materials and Methods: An expert panel of physiatrists from Kerala, India, participated in a three-round Delphi study. Intervention: Nil. Results: Consensus was reached on 13 deficit-oriented modules with best practice key statements. They stress the need for supervised rehabilitation interventions provided by trained health professionals early after discharge from the acute care setting to optimise patient outcomes. Patient-specific, centre-specific and culturally appropriate factors were considered during formulation. Acute care, triage, routine workflow, outcome assessment, trajectory assessment and rationale were recommended, and several standardised outcome measures were identified. Follow-up and community-based rehabilitation suggestions were provided. Specifics on timing, service providers, need for long-term follow-up and interventions differed per module. Conclusion: A rigorous consensus method led to key recommendations in modular form using the available evidence and consideration of contextual factors to facilitate clinical practice. This is an important step towards reducing practice variation, closing the evidence–practice gap and improving the quality of rehabilitation services after stroke. Significance and Innovations: This is the first formal consensus process to integrate available evidence and expert opinion with a ‘deficit to metric to treatment to outcome’ approach to recommend key aspects of post-stroke rehabilitation from admission to return to the community. The expert panel recommended structured physiatrist-led rehabilitation, initiated early to optimise patient outcomes. In addition to physical rehabilitation, it is important to recognise cognitive and psycho-social deficits along with the influence of contextual factors that impact rehabilitation structures, processes and outcomes.