Selection for inpatient rehabilitation after severe stroke: What factors influence rehabilitation assessor decision-making?
Sharon Hakkennes , Keith D. Hill, Kim Brock, Julie Bernhardt, Leonid Churilov
Faculty of Health Sciences, School of Physiotherapy, La Trobe University, 3086 Bundoora, Australia. E-mail: email@example.com
Objectives: This study aimed to identify factors that assessors considered important in decision-making regarding suitability for inpatient rehabilitation after acute severe stroke.
Design: Multi-site prospective observational cohort study.
Subjects: Consecutive acute, severe stroke patients and their assessors for inpatient rehabilitation.
Methods: Rehabilitation assessors completed a questionnaire, rating the importance (10 point visual analogue scale) and direction (positive, negative or neutral) of 15 patient related and 2 organisational items potentially affecting their decision regarding patients’ acceptance to rehabilitation.
Results: Of the 75 patients referred to rehabilitation and included in this study 61 (81.3%) were accepted for inpatient rehabilitation. The items considered to be most important in the decision to accept the patient for rehabilitation were pre-morbid cognition, pre-morbid mobility and pre-morbid communication. For those not accepted the most important items were current mobility, social support and current cognition. Factor analysis revealed 3 underlying factors, interpreted as post-stroke status, pre-morbid status, and social attributes, accounting for 61.8% of the total variance. All were independently associated with acceptance for rehabilitation (p < 0.05).
Conclusions: This study highlights the importance of pre-morbid function and social factors in addition to post-stroke function in the decision making process for acceptance to rehabilitation following severe stroke. Future models for selection for rehabilitation should consider inclusion of these factors.
Do you want to comment on this paper? The comments will show up here and if appropriate the comments will also separately be forwarded to the authors.
You need to login/create an account to comment on articles. Click here to login/create an account