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Nominal group technique to establish the core components of home-based rehabilitation for survivors of stroke with severe disability

R. Fisher,Frances Riley-Bennett,Lal Russell,Claire Lee,Ruth Sturt,M. Walker,C. Sackley

Published 2021 in BMJ Open

ABSTRACT

In the UK, over 20% of patients leaving hospital after a stroke will be severely disabled. Despite this, limited clinical guidance is available to teams tasked with providing support for this complex population at home. Additionally, many areas across the UK are not commissioned to treat this patient cohort, leaving them with no specialist support on discharge. Objectives To establish core components of home-based rehabilitation for survivors of stroke with severe disability, based on expert panel consensus. Setting Virtual nominal group technique (vNGT) across the UK. Participants Experts in the field of stroke rehabilitation (n=14) including researchers, clinicians and those with lived experience. Methods Two vNGT were completed using a freely available online platform, Microsoft Teams. The technique’s five stages were completed virtually; introduction, silent idea generation, round robin, clarifications and scoring. Statements were analysed for consensus, those achieving consensus underwent content analysis to form rich overarching consensus statements. Results A combined total of 421 statements achieved positive consensus (>75% in agreement), which formed 11 overarching consensus statements. These outline key components of home-based rehabilitation for survivors of stroke with severe disability including the structure and members of the team, as well as the skills and knowledge required. Conclusion The consensus statements highlight the complexity of managing patients with severe stroke disability following discharge from hospital. This study has the potential to support the provision of services for this patient group, providing a benchmark for commissioners and clinicians as well as setting expectations for stroke survivors and their carers. What remains unknown is how many services currently offer this service to patients with severe disability.

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