Developing and evaluating a stroke training programme for physiotherapists to improve the long-term care for patients with stroke in Saudi Arabia through the identification of these patients’ needs and gaps in the current system.

Abstract

Abstract There are about 29 strokes per 100,000 people, annually, in Saudi Arabia (SA). These patients require long-term rehabilitation services to enhance their recovery and independence in the community. Views from both patients and physiotherapists on current practice in SA are essential to ensure that services are feasible and acceptable. Additionally, physiotherapists play an important role in meeting the complex clinical and social needs of stroke survivors. Ongoing training is necessary to meet their educational needs to enable them to provide effective long-term rehabilitation. Thus, the overarching aim of this research was to develop and evaluate a stroke training programme for physiotherapists in SA to enhance long-term care for stroke patients, through the identification of the specific needs of patients with stroke and physiotherapists’ perspectives and training needs. Stage 1: This review aimed to investigate the perceived needs of stroke survivors across various domains of care following their discharge from hospital. A meta-ethnographic review of qualitative studies was conducted. Twenty-seven studies were included. Two main issues were revealed concerning the unmet needs of stroke survivors: (1) a lack of information availability and suitability, and (2) inadequacy of care and services. Stage 2: This stage aimed to explore stroke patients’ needs after their discharge from rehabilitation centres in SA. An interpretive phenomenological analysis (IPA) study was undertaken using semi-structured interviews. Twenty-four patients with stroke were recruited from two hospitals in SA. The key findings suggested that patients experienced limited community rehabilitation services post-discharge unless they were financially able to pay for private therapy. Coping barriers, including medical, psychological, social, and financial factors; and facilitators, including faith, recovery, social support and leisure were identified. Participants suggested strategies to improve rehabilitation services, such as addressing the staff shortage and lack of expertise, access to services, and ongoing care. Stage 3: This stage explored physiotherapists’ perspectives on post-discharge stroke care in SA and gaps in their knowledge regarding the provision of long-term care. An exploratory qualitative study was conducted using semi-structured individual interviews and focus groups. Twenty-six physiotherapists participated in this study. The findings suggested that post-discharge services lacked structure and organisation. Physiotherapists perceived that the long-term approaches involved many barriers for patients and therapists, such as lack of education. The findings also indicated a need for training for physiotherapists involving assessment approaches, using outcome measures, setting goals, and providing effective education to patients to improve the level of care provided to patients with stroke. Stage 4: Based on the previous three studies, a Stroke Training Programme (STP) was developed to meet the knowledge gaps for physiotherapists’ training needs and to enable physiotherapists to deliver long-term care following the discharge of stroke patients. Then, an evaluation of the STP using a sequential explanatory mixed methods design was employed. The quantitative part was a ‘pre-and post’ design to assess the change in physiotherapists’ knowledge, confidence and attitude, while the second part comprised qualitative interviews to assess physiotherapists’ perceptions and the acceptability of the STP. Twenty-six participants completed the STP. The results demonstrated a significant increase in the physiotherapists’ knowledge and confidence. Further, physiotherapists gave positive feedback about the STP. However, major applicability limitations were identified. The care for stroke patients in SA can be improved by standardising care and enhancing the long-term care approaches including ongoing patients’ education, self-management and telerehabilitation. Further, providing training programmes for physiotherapists to enhance their knowledge and skills in stroke rehabilitation. Future research should focus on establishing and implementing structured frameworks to guide the process of stroke rehabilitation and ensure consistency in patient care.