Most Important Factors for Deciding Rehabilitation Provision for Severe Stroke Survivors Post Hospital Discharge: A Study Protocol for a Best–Worst Scaling Experiment

Abstract

Efficient decision-making is crucial to ensure adequate rehabilitation with optimal use of healthcare resources. Establishing the factors associated with making decisions concerning rehabilitation provision is important to guide clinical staff towards person-centred decisions for rehabilitation after severe stroke. In this study we conduct a best–worst scaling (BWS) experiment to identify the most important factors and their relative weight of importance for deciding the type of ongoing rehabilitation services a person with severe stroke might receive post hospital discharge. Fractional, efficient designs are applied regarding the survey design. Key multidisciplinary staff regularly involved in making decisions for rehabilitation in a stroke unit will be recruited to participate in an online BWS survey. Hierarchical Bayes estimation will be used as the main analysis method, with the best–worst count analysis as a secondary analysis. The survey is currently being piloted prior to commencing the process of data collection. Results are expected by the end of September 2021. The research will add to the current literature on clinical decision-making in stroke rehabilitation. Findings will quantify the preferences of factors among key multi-disciplinary clinicians working in stroke units in the UK, involved in decision-making concerning rehabilitation after stroke.

Which body functions and activities matter for stroke patients? Study protocol for best–Worst scalings to value core elements of the International Classification of Functioning, Disability and Health

“…To our knowledge, this is the first study assessing the relative importance of (sub-)chapters of the ICF against the background of decision-making for neurorehabilitation following stroke. When designing and evaluating rehabilitation care, it is important to understand the preferences of patients on how they value various factors, to be able to optimize patient-centered care [8,16].…”

“…The decision and evaluation of rehabilitation for patients with neuro-disabilities is therefore subject to several manifold dilemmas and subjective biases, including clinicians' assessments for the best treatments for patients [16,17], overestimation or underestimation of the impact of stroke on the patient's health status, quality of life [14] and expected activities, all of which may contribute to differential decision making [16].…”

“…The decisions for rehabilitation of severe stroke patients must not be based on known prognostic indicators or rehabilitation requirements alone, but on patient-relevant characteristics [16,18]. To assess the degree of impairment in clinical functions and activities following stroke, most clinicians use the universal International Classification of Functioning, Disability and Health (ICF) [19].…”

“…Currently, there is no established guideline for the minimal sample size for BWS applications. Based on previous BWS studies, with sample sizes up to 800 participants [16,36], this study aims to recruit approximately 1000 respondents from the general, ensuring at least 300 respondents participate in each of the three experiments (arm paresis, neglect and activities; sample 1).…”

Feasibility of Testing Client Preferences for Accessing Injectable Opioid Agonist Treatment (iOAT): A Pilot Study

“…Developed with input from service users, best-worst scaling (BWS) is a quantitative preference elicitation tool where participants select both the best and worst items from a list of at least three levels across multiple choice sets. 36 BWS has built a strong reputation in healthcare research 37 , 38 across healthcare settings including cancer research, 39 , 40 stroke care, 41 and mental health services. 42 BWS has also been implemented with priority populations including unhoused women 40 , 43 and Indigenous peoples.…”