title: The implementation of evidence-based rehabilitation services for stroke survivors living in the community: the results of a Delphi consensus process.
abstract: BACKGROUND
  Recovery from stroke requires the provision of specialist rehabilitative care, yet there is a lack of research evidence on optimal methods of delivery and inequitable service provision across countries. Following consensus on Early Supported Discharge, our aim was to define core components of evidence-based community stroke services.
  
  
  METHODS
  We used a modified Delphi approach with a purposive sample of 26 UK-based expert panellists (10 academics, 15 stroke service leads or commissioners, one stroke survivor). Statements based on research literature and policy documents were generated by an independent, mixed academic and service improvement team of nine. In three rounds of consultation panellists indicated their level of agreement with statements. Free text comments were analysed thematically.
  
  
  RESULTS
  Consensus of opinion (>70% agreement) was obtained on 76 of 80 statements. Panellists agreed that stroke specialist care tailored to clinical need should be provided following discharge from hospital. Flexible care pathways should be commissioned and provided through strategic and collaborative leadership across health and social care. Teams need to deliver stroke specialist rehabilitation, handing over responsibility to non-specialist services when patient rehabilitation goals have been met. Lack of consensus on whether to provide services exclusively for stroke patients and the need of support for carers highlights areas for further research.
  
  
  CONCLUSIONS
  Consensus on the provision of evidence-based community stroke rehabilitation has been reached. Commissioning services with a clearly defined remit, which can deliver tailored care to individual stroke patients, is a challenge that needs further exploration.
authors: Division of Rehabilitation and Ageing, Community Health Sciences, University of Nottingham, UK. rebecca.fisher@nottingham.ac.uk
authors: Rebecca J
authors: RJ
authors: Fisher
authors: Marion F
authors: MF
authors: Walker
authors: Ian
authors: I
authors: Golton
authors: Damian
authors: D
authors: Jenkinson
mesh_terms: D003697:Delphi Technique; D055317:Evidence-Based Practice / Q000379:methods*; D006302:Health Services Research / Q000379:methods; D006699:Home Care Services / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D012720:Severity of Illness Index; D000071939:Stroke Rehabilitation; D006113:United Kingdom
keywords: Stroke rehabilitation; evidence-based practice; health services research; implementation; stroke management