Evaluating a Shoulder Subluxation Prevention Protocol for Acute Stroke Patients: A Policy Analysis at Korle Bu Teaching Hospital, Ghana

Shoulder subluxation is a frequent and disabling complication after acute stroke, causing pain, impaired function, and extended rehabilitation. In low-resource settings such as Ghana, structured prevention protocols are frequently lacking or inconsistently implemented. This analysis investigates the policy framework for preventing this complication at Korle Bu Teaching Hospital, a leading tertiary facility. This study aimed to critically analyse current policy and practice for preventing shoulder subluxation in acute stroke patients at Korle Bu Teaching Hospital. Its objectives were to identify existing protocols, evaluate their implementation and integration into routine care, and assess barriers to consistent application from a multi-stakeholder viewpoint. A qualitative policy analysis was undertaken. Data collection involved a document review of hospital policies and therapy guidelines, semi-structured interviews with occupational therapists, physiotherapists, and nurses, and non-participant observations of ward practice. Thematic analysis was applied to the data. No formal, hospital-wide policy for shoulder subluxation prevention was identified. Clinical practice relied on individual therapist knowledge, resulting in considerable variation. A principal theme was the critical constraint of staffing shortages, which severely limited the consistent application of positioning and splinting techniques. Observations indicated that recommended positioning protocols were fully implemented for a minority of eligible patients during daytime hours. The lack of a standardised and adequately resourced policy for shoulder subluxation prevention at Korle Bu Teaching Hospital leads to inconsistent, therapist-dependent practice, which undermines care quality and patient outcomes after stroke. Develop and formally adopt a context-appropriate, interprofessional protocol for shoulder subluxation prevention. Integrate protocol training into mandatory staff orientation programmes. Advocate for increased occupational therapy and nursing staffing levels to facilitate protocol adherence. Establish a straightforward audit tool to monitor compliance and patient outcomes. stroke, shoulder subluxation, prevention, policy analysis, occupational therapy, Ghana, low-resource setting This analysis provides evidence on a specific gap in post-stroke care policy within a low-resource African hospital, offering practical recommendations for developing and implementing a standardised prevention protocol.