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Stroke Interventions Provided by Community Rehabilitation Teams in Auckland

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Thesis(3.4 MB)

Date

2024

Authors

Evans, Melissa

Supervisor

Hocking , Clare
Siegert, Richard
Garrett, Nick

Item type

Thesis

Degree name

Doctor of Philosophy

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Volume Title

Publisher

Auckland University of Technology

Abstract

Community stroke rehabilitation (CSR) provides rehabilitation in the home after a person has had a stroke. It has the important function of returning the person to their abilities as much as possible and the usual activities they participated in before the stroke. Despite the value of this work, there are no mechanisms in place to investigate the type, frequency, and reasons why particular interventions are provided. Without this knowledge, it is difficult to determine whether the services are meeting patient needs, complying with stroke guidelines, and providing equitable interventions to people of all ethnicities. To investigate the provision of interventions and reasons why particular interventions are provided, this research had the following aims: (1) to identify the patterns of community stroke rehabilitation interventions in Auckland; (2) to determine whether CSR interventions were addressing the full scope of patient problems identified by the Extended International Classification of Functioning, Disability and Health Core Set for Stroke (EICSS); (3) to determine whether there were differences in the provision of interventions between Māori and non-Māori; and (4) to explore how the CSR staff explain the identified intervention patterns. This study used a mixed methods sequential explanatory design. Study 1 was a retrospective observational study that extracted interventions from 113 randomly selected digital files of patients who had received CSR between March 2016 and March 2017 in Auckland and had coded interventions to the EICSS. Using 10 files from Study 1 and a contracted researcher, an inter-rater reliability study was used to evaluate and improve the coding methods. In Study 2, 15 CSR staff members were interviewed about their explanations for the frequency of interventions in Study 1. The qualitative data were analysed using thematic analysis and integrated with quantitative data from Study 1. By combining the results from the two studies, it was found that intervention provision was facilitated by the patients’ common experience of physical impairment and patient goal planning and fatigue management education to support patients’ engagement in rehabilitation. Intervention provision was limited by organisational factors such as the duration of service provision, how the CSR resources were used, lack of staff time, low hours of psychological and social worker support, and the outsourcing of interventions to other services. Participants identified that interventions were limited by their lack of training to address somatosensory, vision, and sexuality issues. The observed differences between Māori and non-Māori interventions were thought to be due to barriers to engagement by Māori in the rehabilitation process brought about by the extra pressures of complex medical conditions, low income, and housing insecurity. Uncovering information on exactly what is provided, what is missing, and what is driving intervention choice and frequency has the potential to inform targeted improvements in the quality of service delivery as it enables health funders and policymakers, CSR managers, staff, and health educators to make changes that will improve stroke outcomes for patients receiving CSR.

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http://hdl.handle.net/10292/18200

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Doctoral Theses