Initial Physical Grades and Cognitive Stages After Acute Stroke: Who Receives Comprehensive Rehabilitation Services?

Stineman, Margaret G.; Bates, Barbara; Kurichi, Jibby E.; Kwong, Pui L.; Ripley, Diane Cowper; Vogel, William; Xie, Dawei

doi:10.1016/j.pmrj.2013.08.598

Cited by 5 publications

(4 citation statements)

References 22 publications

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“…Pre-specified factors, previously shown to be associated with accessing rehabilitation were recorded [12, 18, 21, 22, 31, 32]. Patient-related factors were: age, sex, pre-stroke place of living (community alone, community with others, nursing home), and pre-stroke mobility (requiring human assistance or not).…”

Section: Methodsmentioning

confidence: 99%

Patient and service factors associated with referral and admission to inpatient rehabilitation after the acute phase of stroke in Australia and Norway

Labberton

Barra

Rønning

et al. 2019

BMC Health Serv Res

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BackgroundUnequal access to inpatient rehabilitation after stroke has been reported. We sought to identify and compare patient and service factors associated with referral and admission to an inpatient rehabilitation facility (IRF) after acute hospital care for stroke in two countries with publicly-funded healthcare.MethodsWe compared two cohorts of stroke patients admitted consecutively to eight acute public hospitals in Australia in 2013–2014 (n = 553), and to one large university hospital in Norway in 2012–2013 (n = 723). Outcomes were: referral to an IRF; admission to an IRF if referred. Logistic regression models were used to identify and compare factors associated with each outcome.ResultsParticipants were similar in both cohorts: mean age 73 years, 40–44% female, 12–13% intracerebral haemorrhage, ~ 77% mild stroke (National Institutes of Health Stroke Scale < 8). Services received during the acute admission differed (Australia vs. Norway): stroke unit treatment 82% vs. 97%, physiotherapy 93% vs. 79%, occupational therapy 83% vs. 77%, speech therapy 78% vs. 13%. Proportions referred to an IRF were: 48% (Australia) and 37% (Norway); proportions admitted: 35% (Australia) and 28% (Norway). Factors associated with referral in both countries were: moderately severe stroke, receiving stroke unit treatment or allied health assessments during the acute admission, living in the community, and independent pre-stroke mobility. Directions of associations were mostly congruent; however younger patients were more likely to be referred and admitted in Norway only. Models for admission among patients referred identified few associated factors suggesting that additional factors were important for this stage of the process.ConclusionsSimilar factors were associated with referral to inpatient rehabilitation after acute stroke in both countries, despite differing service provision and access rates. Assuming it is not feasible to provide inpatient rehabilitation to all patients following stroke, the criteria for the selection of candidates need to be understood to address unwanted biases.

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Section: Methodsmentioning

confidence: 99%

Patient and service factors associated with referral and admission to inpatient rehabilitation after the acute phase of stroke in Australia and Norway

Labberton

Barra

Rønning

et al. 2019

BMC Health Serv Res

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“…However, recent studies suggest this is not the case in practice. An observational study by Stineman et al (2013) in the United States, of over 8,000 acute patients with stroke, found that FIM scores in the severely impaired range (1-3) of the physical domains increased the odds of being admitted to rehabilitation. Similarly, a prospective study of 736 acute patients with stroke in the United States found those with moderate and moderate-severe impairments of activities of daily living according to the Barthel Index (score 25-60), were more commonly referred to inpatient rehabilitation rather than to anywhere else (Stein et al, 2015).…”

Section: Post-stroke Level Of Function and Severity Of Symptomsmentioning

confidence: 99%

“…It has been generally agreed that those with only minimal impairments after stroke may have no rehabilitation goals, or can be managed in a community setting (Australian Stroke Coalition Rehabilitation Working Group, 2012; Mold, Wolfe, & McKevitt, 2006;Roberts et al, 2016;Stineman et al, 2013;Teasell et al, 2013). Level of independence, measured on the AcuteFIM, was found to be a predictor of discharge destination from acute settings in a prospective cohort study in the United States (Roberts et al, 2016): a one point improvement in AcuteFIM score resulted in a 6% increase in discharge to the community (vs inpatient facility).…”

Section: Post-stroke Level Of Function and Severity Of Symptomsmentioning

confidence: 99%

“…Motivation has been associated with psychosocial factors, such as the patient's pre-stroke occupations and life roles, and cognitive factors such as insight and attention, all of which could potentially demonstrate or limit rehabilitation potential (Burton et al, 2015). If a patient has either pre-or post-stroke cognitive impairment, concerns may arise regarding the patient's ability to learn strategies taught in therapy and they may be less likely to be referred and/or accepted to rehabilitation (Longley et al, 2018;Mold et al, 2006;Pollack & Disler, 2002;Stineman et al, 2013;Teasell et al, 2013).…”

Section: Motivation and Tolerance For Rehabilitationmentioning

confidence: 99%

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Rehabilitation referral process in acute stroke: decision-making of multidisciplinary teams and rehabilitation assessors

Marnane¹

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Stroke is a medical emergency that can result in significant loss of independence and impact upon all aspects of a person's life. Patients who have a stroke are often treated in a hospital on an acute stroke unit by a multidisciplinary team, with many then requiring rehabilitation to address the impacts of stroke. There are multiple types of rehabilitation available after stroke, and the acute multidisciplinary team are often involved in complex clinical decision-making processes regarding referral to rehabilitation. These referrals are in turn received by rehabilitation assessors who engage in their own decision-making processes to determine acceptance into their service/s. The literature suggests that decisions about referral and acceptance to rehabilitation are often based on subjective assessments of rehabilitation potential, as well as consideration of contextual factors, and may not always reflect patients' rehabilitation needs. Inequities in access to rehabilitation, as well as observed variations in practice, highlights the need for in-depth exploration of the processes involved, particularly how clinicians engage in rehabilitation referral and acceptance decision-making. The aims of this research were to: 1) explore the decisionmaking processes and experiences of acute stroke teams, around referral to post-stroke rehabilitation, and 2) explore the decision-making processes and experiences of rehabilitation assessors, about acceptance of patients with stroke, for rehabilitation.An ethnography was conducted across five acute stroke units in Queensland, Australia.Observational data were collected at each site to describe the context and practices of the multidisciplinary teams: field notes were completed, key documents analysed, and observations and audio recordings were made at the key meeting of the acute stroke team at each site. Interviews were also conducted with 32 clinicians from a range of health professions, both acute and rehabilitation, who were involved in rehabilitation referral and acceptance decision-making for patients with stroke.There was significant variation in the team structure and processes of the acute stroke units, as well as in the types of rehabilitation available to patients. Seven key themes arose from the study. The theme "Everyone needs rehab, but…" explores the findings that most clinicians believed that all patients with stroke could benefit from rehabilitation, however decisions about rehabilitation referrals and acceptance were complex, subject to revision, and did not always have an ideal solution. The second theme, "Can they participate, and get the most out of it?", explores how the patient's context, including their potential and goals for rehabilitation, was considered by all clinicians. "Sometimes you have to convince them", describes how patients and families generally were not involved in Publications included in this thesisNo publications included.

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Assessment of rehabilitation following intracerebral hemorrhage in China: findings from the Chinese stroke center alliance

Sun

Deng

Wang

et al. 2022

Neurological Research

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Initial Physical Grades and Cognitive Stages After Acute Stroke: Who Receives Comprehensive Rehabilitation Services?

Abstract: Patients' physical grades and cognitive stages assessed early after stroke are strong determinants of referral for comprehensive rehabilitation.

Cited by 5 publications

References 22 publications

Patient and service factors associated with referral and admission to inpatient rehabilitation after the acute phase of stroke in Australia and Norway

Patient and service factors associated with referral and admission to inpatient rehabilitation after the acute phase of stroke in Australia and Norway

Rehabilitation referral process in acute stroke: decision-making of multidisciplinary teams and rehabilitation assessors

Assessment of rehabilitation following intracerebral hemorrhage in China: findings from the Chinese stroke center alliance

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