Outcome measure selection in community-based stroke rehabilitation: An exploration of therapists' current practice in Scotland

Background: Stroke rehabilitation needs to be evidence-based, equitable and patient-centred and should therefore achieve outcomes that are of personal relevance to the service user. However, converging evidence indicates a gap between research, policy and clinical practice in terms of stroke outcome assessment.

Aim: To examine the rationale for selection of outcome measures currently in use by UK rehabilitation professionals in community stroke rehabilitation.

Method: Senior stroke rehabilitation therapists were invited to participate in a web-based Scotland-wide survey, which explored current outcome measure, rationale for selection, fit with patient preferences, and professional characteristics. The survey was piloted prior to use and refined with input from steering group members. 12 rehabilitation therapists further took part in in-depth follow-up interviews exploring the rationale behind choosing particular outcome measures.

Results: 110 participants (49 physiotherapists, 39 occupational therapists, 22 Speech and language therapists) completed the web-based survey. Most (60%) reported that relevance to patients was the primary driver for choosing outcome measures. Accessibility was of primary importance to only 8.7% of respondents. 35.6% of therapists reported dissatisfaction with existing outcome measures in terms of their relevance for patients. Interviews revealed the complexities of measuring outcomes, which are relevant to patients in the community setting and different outcome measurement philosophies across disciplines.

Conclusion: As policy and practice is shifting towards greater patient-centredness in rehabilitation and assessment, choice of outcome measures is driven by relevance. However, accessibility is not key to therapists' choice of outcome measures despite emphasis on service user inclusion.