Changing occupational therapy and physiotherapy practice through guidelines and audit in the United Kingdom

Background: The National Clinical Guidelines for Stroke (NCGS) were produced and three rounds of the National Sentinel Audit of Stroke conducted to improve the quality of stroke care in the UK. Objective: To compare the results of the occupational therapy and physiotherapy elements of the most recent national sentinel audit with the occupational therapy- and physiotherapy-specific recommendations of the NCGS. Methods: Retrospective case-note audit. Results: Over 95% of hospitals/sites who manage stroke in England, Wales and Northern Ireland took part in the most recent round of the sentinel audit. The clinical audit took place from 1 April to 30 June 2001 and incorporated 235 hospitals/sites. The organizational audit took place in January 2002 and incorporated 240 hospitals/sites. Data are presented from the 235 with both clinical and organizational data, under the headings of: approaches to rehabilitation, carers/families; rehabilitation interventions, and transfer to the community. Low rates of compliance with national standards were observed for all domains. Conclusion: Our findings suggest that occupational therapists and physiotherapists are not fully complying with the national standards for stroke care.