The value of pre-discharge occupational therapy home visits for patients who have had a stroke: p erceptions of patients, occupational therapists and experts

Pre-discharge occupational therapy home visits after stroke are routinely conducted during the discharge planning process. However, there is limited research evidence about the value of these visits for patients. The aims of this study were two fold. Firstly, to identify and report on the value of pre- discharge occupational therapy home visits for patients returning home after stroke. Secondly, to gain knowledge to inform the design of future research into home visits after stroke. Method A qualitative methodology was used. The research method consisted of semi- structured interviews with three participant groups; experts, senior occupational therapists and patients. Interviews were recorded, transcribed verbatim and analysed using a thematic analysis approach. Key findings Following thematic analysis of the thirty four interviews that were conducted (six with experts, 20 with senior occupational therapists and eight with patients), the findings indicate the perceived value of pre-discharge home visits after stroke: Home visits after stroke offer a bespoke assessment of a patient’s individual needs at home when compared to hospital assessments. The value of pre-discharge occupational therapy home visits has been heavily influenced by their perceived costliness. Consequently the number of home visits seems to have reduced. However, opinions were mixed about their cost- effectiveness. There were differing values placed on completing pre-discharge occupational therapy home visits for the purpose of risk management and equipment provision. Pre-discharge occupational therapy home visits were perceived to be of greatest value to patients with moderately severe levels of disability and/or a reduced social support network on their return home. There was mixed opinion, both within and across the participant groups, about the value of completing pre-discharge occupational therapy home visits with patients who had cognitive impairment after stroke. Suggestions were made across the participant groups as to how pre-discharge occupational therapy home visits after stroke could be improved to provide better value to patients. Conclusion The main values of the pre-discharge home visit identified by this research were minimising risks, improving independence in activities of daily living, enabling a better quality of life and supporting a patient to adjust to life after stroke. There were mixed opinions about these purposes, making it difficult to generalise the value of pre-discharge occupational therapy home visits after stroke. However, the overarching value of the pre-discharge home visit remained its individualised and bespoke nature. In essence, this intervention was felt to be tailored to individual patients, as it varied depending on the impact of stroke, home environment and meaningful activities of daily living. Future research investigating pre-discharge occupational therapy home visits after stroke needs to consider the value of different purposes for which home visits are undertaken. This would support the development and implementation of future practice