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

Abstract

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.

Comparing two identically protocolized, multicentre, randomized controlled trials on caregiver-mediated exercises poststroke: Any differences across countries?

“…Patient heterogeneity was observed across countries with older age and a higher functional level at baseline in Australia when compared to the Netherlands. In general, age and functional status after stroke are factors known to influence discharge disposition and referral to inpatient rehabilitation after acute care on a Hospital Stroke Unit (HSU) [28][29][30]. In the Dutch study, participating HSUs were unable to recruit patients as a result of their fast discharge policies with a short LOS in the hospital.…”

A register-based study comparing planned rehabilitation following acute stroke in 2011 and 2017

“…Post-stroke referral patterns in Canada showed that younger and more functionally impaired patients were referred for inpatient and outpatient rehabilitation more often than older or functionally independent patients 17 , 18 . ADL dependency prior to stroke and older age have been shown to be unfavorably associated with rehabilitation access 19 . The results from this study indicate an increased awareness of rehabilitation needs for older adults and individuals with dependency in basic ADL.…”

Social Determinants of Health in Physiatry: Challenges and Opportunities for Clinical Decision Making and Improving Treatment Precision

“…In acute care, SDH are reviewed that could impact referral decisions and admissions into post-acute care. The decision to refer is described as “subjective” ( 30 ), yet referral of patients to the appropriate level of care ensures equitable access ( 31 ). Limiting or delaying access to services after severe injuries such as stroke or TBI can worsen functional disability and related outcomes 27 and contributes to health disparities.…”