Qualitative research that explores the perspectives of stroke survivors and multidisciplinary healthcare professionals towards long term stroke rehabilitation is scarce. It is not known whether the provision of long term rehabilitation is feasible in the current healthcare environment in most developing countries, despite the increasing importance of the services. Views from both healthcare providers and healthcare users are important prior to planning long term rehabilitation programmes for stroke survivors. We attempted to address these concerns as well as explore issues surrounding the continuity of care for people with long term stroke from the perspectives of rehabilitation professionals and stroke survivors.
Our study revealed gaps in the provision of rehabilitation to individuals with long term stroke living in the community. Participants generally agreed that further rehabilitation beyond that currently organised in the hospital system would benefit stroke patients to achieve optimal recovery. However, materialising such services remains a challenging task. Barriers related to both healthcare providers and patients were identified. Limited healthcare resource was the major issue attributed to the discontinuity of therapy as recognised by the participants in the study.
Understaffing was perceived as a main reason for the lack of opportunities for long term rehabilitation for individuals with stroke in hospital settings. Our study support previous observation of staff shortages as a key barrier to efficient stroke rehabilitation services [10,11]. Woo and colleagues [10], in a study of three rehabilitation hospitals, reported a significant reduction in function among stroke survivors when the number of hospital staffs was reduced over a ten year period. In many developing countries, rehabilitation professional shortage is a real concern and poses a challenge to the healthcare system [12]. In Malaysia, taking physiotherapist as an example; the most recent statistics on human resources in healthcare shows that currently, there are less than 900 registered physiotherapists available in public hospitals in the country [13]. Even if an estimate of 300 physiotherapists in private healthcare institutions is added to this figure, the ratio of physiotherapists to the population is only 1:25,000, which is far below the targeted ratio of 1:15,000 for the country [14]. This is especially striking when compared to ratios of other countries, such as Singapore’s 1:7500 and the UK’s 1:1400 [15]. The lack of staff directly affects the intensity of therapy and the therapist-patient contact time; these are important factors which influence outcome of stroke rehabilitation [11]. In coping with heavy individual caseloads due to staff shortage, many therapists choose to focus mainly on therapy delivery, with little emphasis given to the educational aspect of patient care. Lack of patient and carer education may be the reason for lack of motivation among stroke patients and low commitment among their carer towards on-going rehabilitation, as also raised by participants in this study.