Stroke: The silent Cinderella!

Abstract

Australia’s National Stroke Foundation (2004) states that a stroke occurs every 11 min and that it is one of the leading causes of disability in adults. Stroke is a chronic disease, which, with our ageing population, is going to make increasing demands on occupational therapists and stroke services. The search is on for improved outcomes for stroke survivors and improved interventions in stroke management, prevention and health promotion. Dr Graeme Hankey, a world renowned Australian medical specialist in neurology and stroke, nominated stroke as the ‘Cinderella’ in health care, and went on to say that ‘progress in stroke management has been hindered by ignorance, nihilism and negativity’ but that this ‘has all changed in the past decade’ (preface) (Hankey, 2002). For Australian occupational therapists, perhaps the most noticeable change in stroke management in the past decade has been the very recent proliferation of what are being referred to as ‘stroke units’. A stroke unit has been defined as ‘any unit or ward within the hospital/trust that is designated by local agreement as a stroke unit either for the acute care or for the rehabilitation of stroke or both’ (Irwin, Hoffman, Lowe, Pearson & Rudd, 2005, p. 307). This proliferation has been a direct result of one of the most significant items of evidence concerning stroke management. This evidence has been supported by a number of systematic reviews, the highest level of evidence available at present, including three Cochrane reviews (Outpatient Service Trialists, 2003; Stroke Unit Trialists’ Collaboration, 2001, 2005). What is this outstanding piece of evidence? It is the fact that stroke units have been shown to be the single most effective tool in improving outcomes for stroke survivors! This one item of evidence should cause great excitement among occupational therapists, as it has profound implications for our professional contribution into the health-care management of those affected by stroke. Stroke units are phenomena that have been found to be effective as a ‘package’, as opposed to being a single component or variable. Therefore, even if you were able to measure each of the individual variables that makes up this ‘package’, chances are, the sum of the individual variables would not equal the sum of the package. Put another way, there is evidence that the interplay between all the individual components making up a stroke unit appears to be both statistically and clinically significant. A stroke unit incorporates a complex component: the multiprofessional team, which is neither easily defined nor researched. Yet this integral component has been highlighted as a result of using the very research methodology and rating tools that have been so supportive of the biomedical model; a model so much a part of health care in the past decade (Reynolds, 2005). Considering how important this piece of evidence is to the profession of occupational therapy, there appears to be scant awareness among us of this exciting and significant finding. Is it possible that occupational therapists may still be hindered in their progress in stroke management by ‘ignorance, nihilism and negativity’ (Hankey, 2002; preface). This paper will aim to explore these issues.