Factors shaping the delivery of acute inpatient stroke therapy: a narrative synthesis.

OBJECTIVE To investigate factors shaping the delivery of acute inpatient stroke therapy (i.e. occupational therapy, physiotherapy, and speech and language therapy). DATA SOURCES A systematic search using electronic databases: AMED, CINAHL, Medline, Web of Knowledge and EMBASE. STUDY SELECTION Qualitative studies (n = 31) investigating delivery of inpatient stroke therapy, published since 1998, were included. DATA EXTRACTION Narrative synthesis was used as the review method. Textual descriptions, tabulation and thematic ana-lysis were used to categorize findings and explore relationships between studies. DATA SYNTHESIS DATA SYNTHESIS generated the following themes: the need for a therapeutic environment; power and decision-making; intensity, motivation and appropriateness for active therapy; therapy behind the scenes; the role of teamwork in creating a therapeutic environment. Delivery of therapy was influenced by conceptual, individual and professional factors. CONCLUSION Conceptual, individual and professional factors impact on the delivery of rehabilitation. Further research is needed to examine how therapists negotiate the sometimes conflicting factors shaping delivery of therapy.