ArticleBMJ open2018
How is the audit of therapy intensity influencing rehabilitation in inpatient stroke units in the UK? An ethnographic study.
Article in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Factors influencing clinical decision-making in inpatient rehabilitation: A scoping review.Clinical rehabilitation · 2026Article
- Improving How Healthcare Staff Support the Psychological Well-Being of People Living With Post-Stroke Aphasia: A Co-Created Study.Health expectations : an international journal of public participation in health care and health policy · 2025Article
- How and why do community stakeholders participate in the national stroke audit in England? Findings from a mixed-method online survey.BMC health services research · 2024Article
- 'Physical well-being is our top priority': Healthcare professionals' challenges in supporting psychosocial well-being in stroke services.Health expectations : an international journal of public participation in health care and health policy · 2024Article
- Article
- Why do some people who had a stroke not receive the recommended 45 min of occupational therapy and physiotherapy? A Delphi study.BMJ open · 2023Article
- Improving multidisciplinary hospital care for acute cerebral circulation disorders in Kazakhstan.Heliyon · 2023Article
- Exploring liminality in the co-design of rehabilitation environments: The case of one acute stroke unit.Health & place · 2021Article
- A lifeworld theory-led action research process for humanizing services: improving "what matters" to older people to enhance humanly sensitive care.International journal of qualitative studies on health and well-being · 2020Article
- Current therapy for the upper limb after stroke: a cross-sectional survey of UK therapists.BMJ open · 2019Article
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesOccupational therapy, physiotherapy and speech and language therapy are central to rehabilitation after a stroke. The UK has introduced an audited performance target: that 45 min of each therapy should be provided to patients deemed appropriate. We sought to understand how this has influenced delivery of stroke unit therapy.
designEthnographic study, including observation and interviews. The theoretical framework drew on the work of Lipsky and Power, framing therapists as 'street level bureaucrats' in an 'audit society'.
settingStroke units in three English hospitals.
participantsForty-three participants were interviewed, including patients, therapists and other staff.
resultsThere was wide variation in how therapy time was recorded and in decision-making regarding which patients were 'appropriate for therapy' or auditable. Therapists interpreted their roles differently in each stroke unit. Therapists doubted the validity of the audit results and did not believe their results reflected the quality of services they provided. Some assumed their audit results would inform commissioning decisions. Senior therapy leaders shaped priorities and practices in each therapy team. Patients were inactive outside therapy sessions. Patients differed regarding the quantity of therapy they felt they needed but consistently wanted to be more involved in decisions and treated as individuals.
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