International Journal of Environmental Research and Public Health · 9 authors, 1 centre
This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.
This review of 10 clinical trials found that clinical audits improve the quality of stroke rehabilitation when they include expert teams, active training with facilitators, and short-term feedback. However, the evidence for audits improving stroke prevention is conflicting and insufficient to draw firm conclusions. The findings highlight that audit effectiveness may depend on the phase of stroke care, with rehabilitation showing clearer benefits than prevention.
**Background:** Stroke is a leading cause of death and disability worldwide, causing 5 million deaths annually. The acute phase offers a critical therapeutic window for intervention, and organized stroke unit care improves outcomes. Clinical audits—systematic analyses of medical care quality—are proposed as tools to evaluate and improve stroke care processes, but no consensus exists on the most effective audit methodologies. This review aimed to investigate the effectiveness of clinical audits in improving the quality of stroke rehabilitation and prevention.
**Methods:** A descriptive review was conducted searching PubMed (1972–2022), Web of Science (1991–2022), and Cochrane Library (1989–2022) databases for studies published before 7 October 2022. Search keywords included "stroke" AND "audit" with related terms. Inclusion criteria were: studies of audits; prevention and rehabilitation of stroke; clinical trials; studies in English; no reviews. Of 2543 initial studies, 10 met inclusion criteria after three rounds of evaluation by a single researcher over approximately 1 month.
**Key Results:** Of the 10 included studies, 7 examined rehabilitation and 3 examined prevention. Among rehabilitation studies, 5 audited both intervention and control groups, while 2 audited only the intervention group. Power et al. (2014) reported a 10.9% improvement after implementing a Breakthrough Series intervention including expert teams, training meetings, and implementation phases. McGillivray et al. (2017) and Hinchey et al. (2010) found audit effectiveness when feedback was given within one day by a coordinating nurse and when multifaceted interventions were included. Joliffe et al. (2020) showed improvement when therapists received facilitator-mediated guideline packages. Sulch et al. (2002) studied 152 patients and found Integrated Care Pathway associated with greater improvement in initial assessments, better documentation of diagnosis, and higher discharge rates within 24 hours compared to routine care. Lynch et al. (2016) studied 586 patients over 14 months in Australia, finding odds of receiving rehabilitation assessment were 3.69 times greater post-intervention regardless of intervention type. Machine-Carrion et al. (2019) found patients in intervention hospitals more likely to receive all acute therapies.
For prevention studies, Wright et al. (2007) studied approximately 2800 patients in the UK, finding significantly greater improvement in adherence to atrial fibrillation and TIA therapy in the intervention group attending 5 guideline adherence meetings. Williams et al. (2016) compared 12 US hospitals and 2164 patients, finding training plus indicator feedback improved DVT prophylaxis but the effect was not sustained long-term. Geary et al. (2019) studied 12,766 patients in Sweden, finding improvement in TIA diagnosis but not ischemic stroke diagnosis, and no improvement in preventive drug use for ischemic stroke/TIA.
**Clinical Implications:** Clinical audits appear effective for improving stroke rehabilitation quality, particularly when incorporating expert teams, active facilitator-led training, and concurrent short-term feedback. However, audit effectiveness for stroke prevention remains uncertain due to conflicting results and limited studies. The review highlights significant variability in audit methodologies across studies, preventing meta-analysis. Key barriers to audit success may include lack of resources, expertise, organizational support, clear feedback, and clinician motivation. The authors note this is the first review to systematically evaluate clinical trial evidence on audit effectiveness for stroke care, identifying that audits may work differently depending on whether applied to rehabilitation or prevention. Standardized audit protocols are needed to enable systematic comparisons and advance stroke care quality improvement.