How is the audit of therapy intensity influencing rehabilitation in inpatient stroke units in the UK? An ethnographic study

Abstract

Objectives Occupational therapy, physiotherapy and speech and language therapy are central to rehabilitation after a stroke The UK has introduced an audited performance target: That 45 min of each therapy should be provided to patients deemed appropriate We sought to understand how this has influenced delivery of stroke unit therapy Design Ethnographic study, including observation and interviews The theoretical framework drew on the work of Lipsky and Power, framing therapists as 'street level bureaucrats' in an 'audit society' Setting Stroke units in three English hospitals Participants Forty-three participants were interviewed, including patients, therapists and other staff Results There was wide variation in how therapy time was recorded and in decision-making regarding which patients were 'appropriate for therapy' or auditable Therapists interpreted their roles differently in each stroke unit Therapists doubted the validity of the audit results and did not believe their results reflected the quality of services they provided Some assumed their audit results would inform commissioning decisions Senior therapy leaders shaped priorities and practices in each therapy team Patients were inactive outside therapy sessions Patients differed regarding the quantity of therapy they felt they needed but consistently wanted to be more involved in decisions and treated as individuals.