Elements of a nurse-coordinated post-stroke home care rehabilitation in the Philippines: A cross-sectional study

Stroke is the leading cause of disability and the second leading cause of death worldwide. In the Philippines, there is a lack of a unified system for the care of community-dwelling patients with stroke. Furthermore, rehabilitation facilities are underutilized, and human resources and financial support policies are lacking. Nurses have become valuable human resources in rehabilitation. Current literature has inconsistent and weak evidence on the effectiveness of home-based post-stroke rehabilitation.

This study aimed to determine essential elements that constitute a nurse-coordinated post-stroke home care rehabilitation in the Philippines.

A literature review was conducted to generate items for a tool that would elicit important elements of post-stroke home care rehabilitation in terms of structure, process, and outcome domains. Two rounds of the modified e-Delphi technique were conducted with a panel of 10 experts, and the content validity index (CVI) was calculated. Using the developed tool, a cross-sectional survey was conducted among nurses in the Philippines in March 2024. The responses were subjected to principal component analysis.

The validated tool contains 55 items with an item level CVI range of 0.9-1.0 and a scale level CVI of 0.99. Online survey responses were received from 326 participants. The first principal component for each domain was analyzed. Structure elements involve an interdisciplinary team that integrates policy and funding for home visits and telehealth services, ensuring culturally responsive home environments. Process elements involve collaborative planning and evidence-based treatment processes coordinated by nurses, prioritizing patient and family engagement. Nurses may perform therapies delegated by rehabilitation specialists. Outcomes elements focus on achieving patient- and family-centered goals, enhancing daily activities, and improving overall quality of life.

Given the complexity of community-based rehabilitation, this study determined the essential elements of post-stroke home care rehabilitation. These elements are crucial in providing guidance to policymakers, clinicians, and patients in the delivery of home-based post-stroke care.