School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
Department of Rehabilitation and Sports Sciences, Faculty of Health and Social Sciences, Bournemouth University, Poole, UK.
BMJ Open. 2023 Nov 22;13(11):e072276. doi: 10.1136/bmjopen-2023-072276.
To gain a consensus among therapists for reasons why a person who had a stroke may not receive the Royal College of Physicians' recommended minimum of 45 min of daily therapy.
Three-round remote e-Delphi study.
National study, based in the UK.
Occupational therapists and physiotherapists with experience of delivering therapy after stroke and awareness of the 45 min guideline.
Forty-five therapists consented to participate in the study. Thirty-five (78%) completed round one, 29 of 35 (83%) completed round 2 and 26 of 29 (90%) completed round three. A consensus (75%) was reached for 32 statements. Reasons why a person may not receive 45 min were related to the suitability of the guideline for the individual (based on factors like therapy tolerance or medical status) or the capability of the service to provide the intervention. In addition to the statements for which there was a consensus, 32 concepts did not reach a consensus. Specifically, there was a lack of consensus concerning the suitability of the guideline for people receiving Early Supported Discharge (ESD) services and a lack of agreement about whether people who need more than 45 min of therapy actually receive it.
Some people do not receive 45 min of therapy as they are considered unsuitable for it and some do not receive it due to services' inability to provide it. It is unclear which reasons for guideline non-achievement are most common. Future research should focus on why the guideline is not achieved in ESD, and why people who require more than 45 min may not receive it. This could contribute to practical guidance for therapists to optimise therapy delivery for people after stroke.
在治疗师中达成共识，即为什么有些人即使患有中风也无法接受皇家内科医师学会推荐的每天至少 45 分钟的治疗。
三轮远程电子德尔菲研究。
基于英国的全国性研究。
有中风后提供治疗经验和了解 45 分钟指南的职业治疗师和物理治疗师。
45 名治疗师同意参与研究。35 名（78%）完成了第一轮，35 名中的 29 名（83%）完成了第二轮，29 名中的 26 名（90%）完成了第三轮。达成了 32 项声明的共识（75%）。一个人没有接受 45 分钟治疗的原因与指南是否适合个人（基于治疗耐受性或医疗状况等因素）或服务提供干预的能力有关。除了达成共识的声明外，还有 32 个概念没有达成共识。具体来说，对于接受早期支持出院（ESD）服务的人来说，指南是否适合存在分歧，并且对于那些需要超过 45 分钟治疗的人实际上是否接受了治疗也存在分歧。
有些人没有接受 45 分钟的治疗，因为他们被认为不适合接受治疗，而有些人没有接受治疗是因为服务无法提供治疗。目前尚不清楚无法达到指南要求的原因中哪些最常见。未来的研究应重点关注 ESD 中指南无法实现的原因，以及为什么需要超过 45 分钟治疗的人可能无法接受治疗。这可能有助于为治疗师提供优化中风后患者治疗的实际指导。
