Introduction: An international expert group, in consultation with people with lived experience, has identified defining criteria and discrete, measurable indicators of Centres of Clinical Excellence in stroke recovery and rehabilitation. This study aims to evaluate the aspirational criteria and key performance indicators at global stroke rehabilitation centres, including sites from metropolitan and regional Australia, as well as low, middle, and high-income countries.
Methods: International Stroke rehabilitation centres were invited to evaluate the indicators via a survey or an in-depth evaluation (semi-structured interview questions). The survey and interview guide were developed using the Consolidated Framework for Implementation Research. The responses from the survey and interviews were descriptively analysed. Additionally, the responses from the interviews were thematically analysed using the Framework Analysis method.
Results: In total, 13 international centres (including two Australian centres) from low, middle and high-income countries participated in this study. Respondents acknowledged that the indicators set useful benchmarks for aspirational centres of excellence but also identified some barriers to using the measurable indicators. These included the workload demands (Outer Setting Domain), clinical priority and gaps in services (Inner Setting Domain) that influenced the availability of evidence required by the indicators. Respondents noted that the process of testing the indicators highlighted several gaps in service and service delivery, prompting consideration for future improvement. Additionally, the results highlighted the disparities between metropolitan and regional Australian centres, with resource availability identified as a barrier to achieving indicators.
Conclusion: The clinicians reported that the indicators were relevant to their practice and the stroke rehabilitation centres but emphasised the need for further refinement to improve the usability.
Relevance to clinical practice or patient experience: The outcome of this study contributes to the progress towards standardising the framework for excellent stroke care and outcomes for stroke survivors.