An examination of current stroke rehabilitation practice in Peru: Implications for interprofessional education

This study aimed to better understand current clinical practice of rehabilitation professionals in Lima, Peru, and to explore the existence of and potential for interprofessional collaboration. A secondary purpose was to assess rehabilitation professionals’ agreement with evidence-based stroke rehabilitation statements and confidence performing stroke rehabilitation tasks prior to and following an interprofessional stroke rehabilitation training. Current clinical practice for rehabilitation professionals in Peru differs from high-income counties like the United States, as physical therapists work with dysphagia and feeding, prosthetist orthotists serve a strictly technical role, and nurses have a limited role in rehabilitation. Additionally, while opportunity for future interprofessional collaboration within stroke rehabilitation exists, it appears to be discouraged by current health system policies. Pre- and post-training surveys were conducted with a convenience sample of 107 rehabilitation professionals in Peru. Survey response options included endorsement of professionals for rehabilitation tasks and a Likert scale of agreement and confidence. Training participants largely agreed with evidence-based stroke rehabilitation statements. Differences in opinion remained regarding the prevalence of dysphagia and optimal frequency of therapy post-stroke. Substantially increased agreement post-training was seen in favour of early initiation of stroke rehabilitation and ankle foot orthosis use. Participants were generally confident performing traditional profession-specific interventions and educating patients and families. Substantial increases were seen in respondents’ confidence to safely and independently conduct bed to chair transfers and determine physiological stability. Identification of key differences in rehabilitation professionals’ clinical practice in Peru is a first step toward strengthening the development of sustainable rehabilitation systems and interprofessional collaboration.本研究旨在深入了解秘鲁利马康复专业人员的当前临床实践现状，并探索跨专业协作（interprofessional collaboration）的存在情况与发展潜力。次要研究目标为评估康复专业人员在接受跨专业卒中康复（stroke rehabilitation）培训前后，对循证（evidence-based）卒中康复相关表述的认同度，以及完成卒中康复任务的自信心水平。 秘鲁康复专业人员的现行临床实践与美国等高等收入国家存在显著差异：物理治疗师（physical therapists）会开展吞咽障碍（dysphagia）与进食相关诊疗工作，假肢矫形师（prosthetist orthotists）仅承担严格的技术类职责，而护士在康复领域的参与度较为有限。此外，尽管卒中康复领域存在未来开展跨专业协作的机遇，但当前的卫生系统政策似乎对该协作模式形成了阻碍。 本研究采用便利抽样法，招募秘鲁107名康复专业人员开展培训前后的问卷调查。问卷选项包含康复任务相关的专业人员认可度评估，以及用于测量认同度与自信心的李克特量表（Likert Scale）。 参训人员整体上对循证卒中康复相关表述持认同态度。但在卒中后吞咽障碍的患病率与最优治疗频率这两个议题上，仍存在意见分歧。 培训后，参训人员在支持卒中康复早期启动与踝足矫形器（ankle foot orthosis）使用方面的认同度显著提升。 参与者普遍能够自信完成本专业传统的干预操作，并对患者及家属开展健康教育。而在安全独立完成床-轮椅转移以及判断生理稳定性这两项任务上，受访者的自信心得到了显著增强。 明确秘鲁康复专业人员临床实践中的核心差异，是推动可持续康复体系建设与跨专业协作发展的首要步骤。