Key Physiotherapy Indicators for Quality of Stroke Care

This paper was produced for the intercollegiate Stroke Working Party organised by the Royal College of Physicians. Quality indicators are highlighted which identify minimum performance standards for a physiotherapy service in stroke care in any environment. These indicators have been selected from the standards of practice published by the Chartered Society of Physiotherapy and the Specific Interest Groups representing community physiotherapy, elderly care, and neurology.In the first section of this paper the role of physiotherapists is identified followed by a discussion of structure, process and outcome in stroke rehabilitation. Two stages in stroke care are recognised: an initial acute stage focused on impairment, and a second stage focused on disability and handicap. This paper emphasises that neither specific approaches nor techniques should be prescribed in stroke rehabilitation, as evidence to support the superiority of one approach over another is lacking.Standards have been identified in the areas of assessment, goal setting, teamwork, treatment, education of patients and carers and expected outcomes. Each standard is followed by criteria: the key clinical activities that demonstrate that the standard is being achieved. Some of these standards are integrated into an interdisciplinary audit tool; others which are more profession-specific are included in a physiotherapy audit tool. Both of these tools will be published by the Royal College of Physicians following a consensus exercise and pilot phase.A consensus of good practice in stroke care is essential to improve the organisation and provision of services for patients following stroke. Physiotherapists are encouraged to adopt these quality standards on a national level.