Selecting Patients for Rehabilitation After Acute Stroke: Are There Variations in Practice?

Ilett, Paul; Brock, Kim; Graven, Christine; Cotton, Sue

doi:10.1016/j.apmr.2009.11.028

Cited by 50 publications

(55 citation statements)

References 25 publications

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“…Les études réalisées aux États-Unis pour les patients pris en charge par le programme Medicare montrent des taux d'hospitalisation après la phase aiguë plus élevés que ceux observés dans cette étude, avec des disparités entre États [18][19][20]. Concernant la réadap-tation, différentes études soulignent l'hétérogénéité des ressources et des pratiques [21][22][23][24][25]. De fait, les ressources disponibles et leur proximité ont un impact sur l'orientation [21,26].…”

Section: Résultatsunclassified

Évolutions de la prise en charge hospitalière des accidents vasculaires cérébraux en court séjour et en soins de suite et de réadaptation entre 2007 et 2009 en France

et al. 2012

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Section: Résultatsunclassified

Évolutions de la prise en charge hospitalière des accidents vasculaires cérébraux en court séjour et en soins de suite et de réadaptation entre 2007 et 2009 en France

et al. 2012

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“…One question included in the audit is whether the patient had a formal assessment for inpatient rehabilitation. To address concerns regarding the low proportions of patients assessed for rehabilitation, and variability in rehabilitation assessment and referral processes [13, 14], the Australian Stroke Coalition (an alliance of organisations and groups working in the stroke field) developed the Assessment for Rehabilitation Pathway and Decision-Making Tool (ART) in 2011 [15]. The ART was developed collaboratively by a multidisciplinary working group and consultation with stakeholders following a systematic review of the literature.…”

Section: Introductionmentioning

confidence: 99%

Education-only versus a multifaceted intervention for improving assessment of rehabilitation needs after stroke; a cluster randomised trial

2015

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BackgroundIn 2011, more than half of the patients with stroke in Australian hospitals were not assessed for the need for rehabilitation. Further, there were no recommended criteria to guide rehabilitation assessment decisions. Subsequently, a decision-making tool called the Assessment for Rehabilitation Tool (ART) was developed. The ART was designed to assist Australian hospital clinicians to identify the rehabilitation needs of patients with stroke using evidence-based criteria. The ART was released and made freely available for use in 2012. This study evaluated the effectiveness of an education-only intervention (1 onsite education session and distribution of the ART) and a multifaceted intervention (2 or more onsite education sessions, distribution of the ART, audit and feedback, barrier identification, site-specific strategy development, promotion of interdisciplinary teamwork, opinion leaders and reminders) for improving assessments of rehabilitation needs after stroke.MethodsTen hospitals in 2 states of Australia were randomly assigned to an education-only or a multifaceted intervention. Medical records were audited by assessors blinded to group allocation before and after the implementation period. Difference in the proportion of patients assessed for rehabilitation before and after the intervention was analysed using mixed-effects logistic regression analysis, with time period as the dependent variable, an interaction between intervention type and time included to test for differences between the interventions, and hospital included as the random effect to account for patient clustering.ResultsData from 586 patients (284 pre-intervention; 302 post-intervention; age 76 years, 59 % male) showed that the multifaceted intervention was not more effective than education-only in improving the proportion of patients whose rehabilitation needs were assessed (reference category education-only; odds ratio 1.29, 95 % confidence interval 0.63–2.67, p = 0.483). Post-intervention, the odds of a patient’s rehabilitation needs being assessed was 3.69 times greater than pre-intervention (95 % confidence interval 2.57–5.30, p < 0.001). Evidence-based criteria were not consistently used when patients were deemed to have no rehabilitation needs.ConclusionsA multifaceted intervention was not more effective than education-only in improving the assessment of rehabilitation needs of patients with stroke. Further interventions are required to ensure that all patients are assessed for the need for rehabilitation using evidence-based criteria.Trial registrationANZCTR (Australian New Zealand Clinical Trials Registry), ACTRN12616000340437 Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0487-2) contains supplementary material, which is available to authorized users.

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“…This method would provide valuable information to regional administration and the MOHLTC. Much of the information needed for this evaluation is already collected and similar methods have been applied elsewhere 25 .…”

Section: Composite Indicators For Population-level Efficiencymentioning

confidence: 99%

Stroke Rehabilitation in Ontario: An Opportunity for Health Care Transformation

Meyer

Foley

et al. 2011

Can. J. Neurol. Sci.

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In this article, Ontario's stroke rehabilitation system is used to exemplify the challenges faced by rehabilitation and healthcare systems across Canada who are attempting to provide quality care to patients in the face of increasing demands. Currently, Ontario's rehabilitation system struggles in its efforts to provide accessible and comprehensive care to patients recovering from stroke. We begin our exploration by identifying both the primary stakeholders and the underlying factors that have contributed to the current challenges. The framework put forward in the Canadian Medical Association's recommendations for transformation is then used to suggest a vision for a more patient-focused system incorporating three key principles: a broader perspective, a patient-first approach, and greater unity. The use of health information technology, proper incentives, and greater accountability are discussed as mechanisms to improve the quality and efficiency of care.

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Selecting Patients for Rehabilitation After Acute Stroke: Are There Variations in Practice?

Cited by 50 publications

References 25 publications

Évolutions de la prise en charge hospitalière des accidents vasculaires cérébraux en court séjour et en soins de suite et de réadaptation entre 2007 et 2009 en France

Évolutions de la prise en charge hospitalière des accidents vasculaires cérébraux en court séjour et en soins de suite et de réadaptation entre 2007 et 2009 en France

Education-only versus a multifaceted intervention for improving assessment of rehabilitation needs after stroke; a cluster randomised trial

Stroke Rehabilitation in Ontario: An Opportunity for Health Care Transformation

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