Audit of Current Practices and Outcomes for Upper Limb Management after Stroke Bailey C1, Low Choy NL1,2 1 Physiotherapy Department, The Prince Charles Hospital, 2 School of Physiotherapy, Australian Catholic University Background National Stroke Foundation Clinical Guidelines for Stroke Management (2012) are available to guide translational studies in practice .

Aim Methods To investigate: Adherance to stroke guidelines for the upper limb (UL) in stroke survivors receiving rehabilitation in the Rehabilitation and Acute Stroke (RAS) Unit at the Prince Charles Hospital Methods Medical charts and outcomes for sixty (60) stroke survivors (32 male, mean age: 76+/-14.12, range 32-97years) were audited over a 14 month period using multidisciplinary team reports. The audit sought documented evidence for: Guideline categories for UL dysfunction, severe weakness & subluxation Functional Independence Measure (FIM motor scores), shoulder flexion/abduction strength, subluxation, shoulder pain & LOS.

Results Guideline compliance was relatively low, ranging between: 26.7-30% for severe weakness 0-42.9% for UL dysfunction, 50% for subluxation. Patients with subluxation at admission to RAS were significantly more likely to have a longer LOS (p=0.000) and patients with severe weakness on admission (shoulder strength ≤ 3/5) showed a trending increase LOS (p=0.050). Patients with severe weakness (p=0.000) or UL dysfunction on admission (p=0.003) were significantly more likely to have lower FIM scores on discharge. Patients with severe weakness (p=0.016) or subluxation (p=0.002) on admission were significantly more likely to have shoulder pain on discharge. *** ** ** *** P=0.050 **

Implications for Changing Clinical Practice in RAS based on outcomes showing relatively low adherence to Clinical Guidelines Educate staff, family & patients on subluxation and pain prevention Identify & prevent subluxation on acute ward Commence UL support & FES immediately on admission to acute ward environment - prior to transfer to Rehabilitation & Acute Stroke (RAS) Unit Implement FES protocol for active motor return & task orientated practice Implement collaborative UL goal setting sessions to optimise recovery Use weekly planning meetings with OT / PT (shared goal setting / collaborative program content) Explore opportunities for increasing intensity of practice (individualised programs / workstation model of care)

Clinical Guidelines requiring attention: 1. For people with severe weakness at risk of developing a subluxed shoulder, management should include 1 or more of the following interventions: Electrical stimulation Firm support devices Education and training for the patient, family/carer & clinical staff on how to correctly handle / position the UL 2. For people who have developed a subluxed shoulder, management may include firm support devices to prevent further subluxation

Conclusions Low adherence to UL stroke guidelines was evident in RAS unit. Severe weakness on admission significantly increased LOS, presence of shoulder pain on discharge & decreased functional independence (FIM motor) at discharge. Subluxation at admission increased LOS & presence of shoulder pain on discharge. Attention to severe shoulder weakness & subluxation at admission may improve outcomes for stroke survivors.

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