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2010,
Research Report
Knowledge and attitudes of allied health professional students regarding
the stroke rehabilitation team and the role of the Speech and
Language Therapist
Aine Byrne and Catharine M. Pettigrew
Department of Speech and Hearing Sciences, University College Cork, Cork, Ireland
(Received April 2009; accepted July 2009)
Abstract
Background: One of the major barriers to effective team working among healthcare professionals is a lack of
knowledge of each others roles. The importance of understanding Irish healthcare students attitudes towards team
working and each others roles led to the development of this study.
Aims: The aims were to investigate allied health professional students perceptions and experiences of the stroke
rehabilitation team and the role of the Speech and Language Therapist (SLT).
Methods & Procedures: A survey first developed by Felsher and Ross (1994) and further developed by Insalaco et al. (2007)
was adapted to the Irish healthcare setting. The survey was administered to final-year Occupational Therapy (n 23),
Speech and Language Therapy (21) students and Physiotherapy (20) students (64 in total) (a 98.5% response rate).
Outcomes & Results: Results indicate that students had a good understanding of teamwork in the healthcare setting and
the possible benefits and challenges it presents. Students had a strong appreciation for interprofessional collaboration,
with the majority (79%) choosing shared leadership as their preferred option for the stroke rehabilitation team. Further
to this, the team approaches that students felt were most appropriate for the stroke rehabilitation setting were the more
collaborative approaches of interdisciplinary (43.5%) and transdisciplinary (37.1%). The students had clear perceptions
of the SLTs role in aphasia, dysphagia, dysarthria, apraxia and auditory agnosia, but were less knowledgeable of the SLTs
role in the acquired disorders of alexia and agraphia ( p , 0.05). More than half of all students perceived that the SLT is
involved in the treatment of hemispatial neglect (55.5%), depression (71.5%) and visual agnosia (59.4%).
Conclusions & Implications: The results provide valuable information for further developments in interprofessional
education at an undergraduate level. Further opportunities should be provided to students to collaborate with each other,
particularly in their final year of training as, by then, students have a well-established knowledge of their own roles and
would be more capable of sharing this role with other professions. Through this collaboration students would also gain
valuable insight into the importance of teamwork, which they could take with them into their professional careers.
Keywords: allied health professions (AHPs), speech and language therapists, stroke, education.
Address correspondence to: Catharine M. Pettigrew, Department of Speech and Hearing Sciences, University College Cork, Brookfield Health
Sciences Complex, University College Cork, College Road, Cork, Ireland; e-mail: C.Pettigrew@ucc.ie
International Journal of Language & Communication Disorders
ISSN 1368-2822 print/ISSN 1460-6984 online q 2010 Royal College of Speech & Language Therapists
http://www.informahealthcare.com
DOI: 10.3109/13682820903222791
511
Intercollegiate Working Party for Stroke (2004), stress
that a multidisciplinary team approach is the most
appropriate service for stroke rehabilitation.
According to Langthorne and Legg (2003), the
multidisciplinary stroke rehabilitation team consists of
medical, nursing, physiotherapy, occupational therapy
(OT), speech and language therapy (SLT), and social
work staff. Soklaridis et al. (2007) report that there is
ambiguity with regards to different health professionals
roles and responsibilities. This lack of understanding of
each others roles can impact negatively on the success
of the multidisciplinary team by creating what
Soklaridis et al. (2007) termed interprofessional
tension. Ryan and McKenna (1994) state that such
tensions are believed to contribute to work dissatisfaction and poor interprofessional communication, with
negative implications for patient care.
Hall and Weaver (2001) state that while each health
care professional learns about their role through their
professional education, when faced with working as
part of a team they have poor understanding of the
other members roles. Nisbet et al. (2008) found that a
pre-qualification interprofessional learning programme
for medical, nursing, and allied health professional
students resulted in enhanced understanding of the
roles of other team members and positively influenced
their ability to work effectively together. The need for
such education was first highlighted by Felsher and
Ross (1994), and more recently in a similar study by
Insalaco et al. (2007). Both of these studies investigated
the perceptions of final year OT, SLT and physiotherapy (PT) students towards stroke rehabilitation teams
and the SLTs role. The results of these studies
suggested that students had a fairly good understanding
of the concepts of rehabilitation and teamwork, but a
lack of recognition/understanding of team members
knowledge and training. Insalaco et al. (2007) advised
that students need further knowledge about the
specialities of the other professionals that they will be
working with. Such knowledge of students attitudes
towards each others disciplines is vital to ensure that
stereotypes and role confusion do not exist as students
enter their professional careers. Furthermore, knowledge surrounding students ideas and perceptions of
teamwork in the rehabilitation setting is especially
useful as it is so well documented that teamwork is an
integral part of health care services (for example,
Strasser et al. 2008).
The importance of understanding students attitudes towards teamwork and knowledge of each others
roles has led to the development of the current study.
Furthermore, despite the widely acknowledged view
that coordinated, team-based stroke care can result in
patients being more likely to survive and regain
independence, multidisciplinary team provision for
512
stroke patients in Ireland is of a limited and usually
non-specialist nature (Irish Heart Foundation 2008).
The aim of this study was therefore to adapt Insalaco
et al.s (2007) study to the Irish population,
investigating the knowledge and attitudes of final year
allied health professional students towards teamwork in
the rehabilitation setting and specifically, the perception of the SLTs role in this team. Such research has yet
to be undertaken in this country, and thus the results of
this study provide valuable information for further
developments in interprofessional education at the
undergraduate level.
Methods
Subjects
Twenty-one final-year students from the Speech and
Language Therapy course and 23 final-year students
from the Occupational Therapy course at University
College, Cork, were recruited as well as 20 final-year
students from the Physiotherapy course at University of
Limerick. Both the OT and SLT students had
experienced interdisciplinary coursework with each
other over the duration of their undergraduate course,
and similarly, the PT students experienced shared
coursework with OT students at their institution
(University of Limerick). In addition to this, each
participating OT and SLT student had participated in
an interprofessional education workshop with medical
students as part of their third year modules at
University College, Cork. Ethical approval for this
study was granted from the Clinical Research Ethics
Committee of the Cork Teaching Hospitals.
Survey
The survey used in this study was adapted from Insalaco
et al.s (2007) survey, with permission obtained from
the authors and Elsevier, Inc. publishing. This survey
was originally developed using part of a survey
completed by Felsher and Ross (1994), which
investigated the perceptions of PT, OT, and SLT
students on the role of the SLT in stroke rehabilitation
in South Africa.
The survey in this study consisted of three sections.
Section A related to the students previous experiences
of stroke rehabilitation teams and interprofessional
collaboration. Section B focused on which approach to
teamwork the students consider the most appropriate
for stroke rehabilitation teams and the possible
advantages/disadvantages of working in such a team.
This section also presented the students with a case
study of a patient in order to investigate their opinions
on team leadership. Finally, Section C investigated the
513
a high percentage of students in all three groups had
experience of a multidisciplinary team (MDT)
(SLT 95.2%, OT 100%, PT 95%), less experience was reported of interdisciplinary teams (IDT)
(SLTs 28.6%, OTs 40.9%, PTs 45%). Of the
three approaches, students reported the least experience
of transdisciplinary teams (TDT) (SLT 9.5%,
OT 4.5%, PT 45%). Further to this, Chi-square
analysis revealed a significant association between
student group (PT versus non-PT) and experience of
TDTs (x 2(1, n 64) 12.799, p , 0.01).
When asked which team approach the students
considered to be most appropriate for stroke
rehabilitation, a Kruskal Wallis ANOVA revealed no
significant differences between the students responses
(as a whole group) to the three types of teams (IDT,
MDT, TDT) ( p . 0.05). Overall, IDT appeared to be
the most popular choice with 43.5%, followed by TDT
with 37.1% and MDT with 19.4%. When analysed
by profession, however, there were mixed results.
For example, Chi-square analysis revealed a significant
association between student group (SLT versus nonSLT) and chosen team approach (IDT versus nonIDT), such that SLTs tended to choose IDT more than
MDT or TDT (x 2(1, n 21) 6.000, p 0.05).
In contrast to this, OT students chose TDT more than
IDT or MDT, also resulting in a significant association
(x 2(1, n 22) 5.063, p , 0.05). Responses within
the PT group were more evenly spread across the three
types of team approaches (MDT 26.3%,
IDT 36.8%, TDT 36.8%) ( p . 0.05).
Chi-square analysis was conducted to determine if
there was an association between students previous
experiences of teamwork and their preferred team for
stroke rehabilitation. The results indicated a significant
association between students who had experience of
IDTs, who then chose IDT as their preferred approach
(x 2(1, n 63) 12.390, p , 0.01). There was no
association between students having experience of TDT
or MDTs and then choosing them as their preferred
approaches ( p . 0.05).
Qualitative analysis of the comments provided by
some students regarding the most appropriate team
approach identified a number of common themes
(Table 1). The first of these was the opinion of some
students that TDTs are difficult to establish. Some
students felt that because of this, IDT would be better
suited to stroke rehabilitation, but others were of the
opinion that teams should persevere and undergo
training that would allow TDTs to work properly.
Another common theme identified was patient-centred
teams, with students reporting that IDT and TDTs
appear to be more patient-centred and therefore allow a
more holistic approach to patient care. In contrast to
this, another theme identified was professional skills,
514
Table 1.
Themes identified in comments to question on preferred team approach for stroke rehabilitation
Theme identified
Illustrations of theme
I feel a TDT approach is the ideal one, however it is often an unrealistic goal . . . (SLT student 8)
TDT is not easy to achieveoften difficulties with sharing roles . . . (OT student 8)
it is more patient centred if team members can share assessment etc (PT student 6)
TDT is the most client centred and allows for others to understand OT/PT/SLT role, refer
appropriately and view the client holistically (OT student 13)
[MDT] better because each member actually sees assesses and treats the pts [patients] and reports back
accordingly (PT student 3)
IDT may be more applicable than TDT as specialist ax (assessment) of skills may still need to be applied
by that professional (OT student 14)
the more communication and sharing of ideas within a team the better for the patient (PT student 9)
With IDT I feel that there would be more communication in the team and clients goals would be more
widely known and adhered to (SLT student 20)
Patient-centred teams
Professional skills
Communication
Strongly agree or
agree, n (%)
64 (100.0%)
61
60
58
43
(96.8%)
(93.8%)
(90.6%)
(67.2%)
Undecided,
n (%)
0
2 (3.2%)
3 (4.7%)
6 (9.4%)
12 (18.8%)
Disagree or
strongly disagree, n (%)
0
0
1 (1.6%)
0
19 (14.0%)
515
(78.2%)
(71.8%)
(67.2%)
(65.7%)
(61.0%)
(38.1%)
(37.5%)
Undecided, n (%)
4
7
5
6
11
9
15
(6.3%)
(10.9%)
(7.8%)
(9.4%)
(17.2%)
(14.3%)
(23.4%)
516
50
40
30
20
10
0
Shared
Figure 1.
PT
SLT
Psych
Doc
(100%)
(100%)
(98.4%)
(98.4%)
(95.3%)
(79.7%)
(79.3%)
(71.5%)
(63.4%)
(59.4%)
(55.5%)
(38.7%)
(38.7%)
(23.5%)
(9.4%)
Undecided, n (%)
1
1
3
5
6
14
9
9
10
10
13
15
15
(1.6%)
(1.6%)
(4.7%)
(7.8%)
(9.5%)
(22.2%)
(14.3%)
(14.1%)
(15.9%)
(16.1%)
(21.0%)
(23.4%)
(23.4%)
8 (12.5%)
7 (11.1%)
4 (6.4%)
14 (22.2%)
17 (26.6%)
18 (28.6%)
28 (45.2%)
24 (40.3%)
34 (53.1%)
43 (67.2%)
517
agreed rehabilitation goals (one of the fundamental
characteristics of IDTs) are considered to be one of
twelve key indicators of quality of stroke care.
Despite the confusion surrounding these terms,
clear distinctions must be made between the two team
approaches. Such a distinction was made by Cifu and
Stewart (1999) who conducted a meta-analysis of
eleven Level 1 studies of MDT versus IDT teamwork
and demonstrated that IDTs are associated with more
improved functional outcomes, decreased length of stay
and decreased costs. Moreover, IDT was the only team
approach in the current study that yielded a positive
association between students previous experience and
current opinions on their preferred team approach.
This suggests that students have had particularly
positive experiences of IDTs in practice. Hopefully, as
students enter the healthcare system, they will take these
positive experiences with them. This is especially
important in the Irish healthcare context, as, according
to the NASC (Irish Heart Foundation 2008) much
reform is needed in the coming years, and one of the
main areas of reform will be teamwork. It is reported in
the NASC (Irish Heart Foundation 2008) that while
agreed rehabilitation goals are considered to be one of
twelve key indicators of quality of stroke care, this
occurred for only 22% of Irish stroke teams.
Additionally, it was found that the majority of allied
health professionals did not meet as a team to discuss
new referrals, thus indicating that Irish stroke care
currently provides a multidisciplinary service rather
than a multidisciplinary team service (Irish Heart
Foundation 2008).
Team leadership
Further evidence of students preferences towards
interprofessional collaboration is evident in their
answers to the team leadership question, with a
significant majority choosing shared leadership as the
most appropriate option. While this is not in
accordance with the Council on Stroke of the Irish
Heart Foundation (2000), who recommends that the
physician manage the team, it is similar to the findings
of previous studies that looked at students perceptions
of teamwork, namely Insalaco et al. (2007) and Felsher
and Ross (1994). When asked to give reasons for their
choice of leadership, the majority of students who chose
shared leadership identified the perceived primary
impairments of the patient and assigned the leadership
role to the professional or professionals most qualified
to treat said impairments. This idea of situational
leadership results in no sole leader of the team, rather
the leaders are assigned depending on their level of
involvement with the patient. Nisbet et al. (2008) stress
that as all professions of the stroke rehabilitation team
518
have individual leadership skills, this method of
situational leadership is highly recommended. Despite
this recommendation and the fact that the students in
this study favoured shared leadership, it is a practice
rarely found in the Irish healthcare setting. Further
investigation of team leadership is therefore warranted
in order to alleviate future difficulties in establishing
effective interprofessional collaboration.
Advantages and disadvantages of teamwork
As well as asking their preferred team approach and
leader, the students in this study were asked about the
perceived advantages and disadvantages of teamwork.
The students had a clear understanding of the possible
benefits of teamwork in the healthcare setting such as it
being an opportunity for learning through exchange of
ideas (Ingram and Desombre 1999). Overall, they
indicated that communication problems and problems
of role definition are the biggest possible disadvantages.
These results indicate that the students surveyed have a
very realistic view of working as part of a team,
especially as good communication is described as being
one of two main factors contributing to effective
teamwork (Golper 2001). These results are similar to
those found by Insalaco et al. (2007). Further evidence
of this realistic view of teamwork was seen in the
comments provided by some students, which described
the need for a clear team structure in order to overcome
any possible problems. Students also noted that the
problem of role definition is harder for newer
professions if there is a lack of knowledge of what
their role is.
Role of the Speech and Language Therapist
Similar to the results found by Felsher and Ross (1994)
and Insalaco et al. (2007), there was general agreement
among the students on the role of the SLT in the
treatment of disorders following stroke with which the
SLT is more commonly involved (for example, aphasia,
dysphagia, dysarthria, apraxia of speech and auditory
agnosia). There was, however, some confusion evident
among PT and OT students with regard to the
treatment of alexia and agraphia, in particular agraphia,
despite these disorders being considered primary areas
of the role of the SLT in stroke rehabilitation (Royal
College of Speech and Language Therapists 2005).
These results were also reported by Felsher and Ross
(1994). In order to ensure adequate referrals and
consistent evidence based practice, the role of the SLT
in the impairments of alexia and agraphia may need to
be more widely acknowledged by all professions
working in stroke rehabilitation.
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