Background:
Stroke guidelines recommend 2-3 hours of active practice daily. From other studies, we know that stroke patients spend most of their day inactive and alone in hospital. Therapists are stretched across many clinical and non-clinical responsibilities, including increasing demand for student placements.
Aims:
To establish whether doubling students on neurological placements to four at a time, with an additional supervisor increases the amount of therapy stroke patients receive in inpatient rehabilitation, compared to usual practice.
Methods:
The study design was a non-randomised study of intervention with outcomes from one block of clinical placements compared with the next block of placements when the intervention was introduced. Students within the experimental group had more structured opportunity to demonstrate caseload management and inter-professional communication skills, while stroke patients were offered additional therapy sessions.
Results:
Patients allocated to the experimental group received an average of 10 (95%CI 1 to 18) additional physiotherapy sessions and received an increase of approximately 33% in therapy time. There were no significant changes in functional independence, length of stay or discharge destination. In fact, patients in the experimental group had a significantly less change in FIM efficiency. 43% of respondents in the control care group reported that they felt they received “not quite enough” or “far too little” physiotherapy. However, 100% of respondents in the experimental group reported “just the right amount” of physiotherapy. Student outcomes were not statistically significant between groups.
Conclusion:
Providing a student-led ward model with additional undergraduate students and an additional supervisor was safe and feasible, and resulted in a statistically significant increase in physiotherapy sessions without adversely effecting student outcomes. There was a statistically significant difference in FIM efficiency favouring the control group, which suggests that additional therapy is not the only factor impacting functional change, and that the skill level of the person providing therapy is also likely to impact.