Assessment and selection for rehabilitation following acute stroke: a prospective cohort study in Queensland, Australia

Abstract

Assessment and selection for rehabilitation following acute stroke: a prospective cohort study in Queensland, Australia. Objective To describe current practice and investigate factors associated with selection for rehabilitation following acute stroke. Design Prospective observational cohort study. Setting Seven public hospitals in Queensland, Australia. Subjects Consecutive patients surviving acute stroke. Measures Rehabilitation selection processes: assessment for rehabilitation needs, referral for rehabilitation, receipt of rehabilitation. Functional impairment following stroke: modified Rankin Scale (mRS). Results We recruited 504 patients, median age 73 years (IQR 62, 82) between July 2016 and January 2017. Of these, 90% (454/504) were assessed for rehabilitation needs, 76% (381/504) referred for rehabilitation, and 72% (363/504) received any rehabilitation. There was significant variation in all rehabilitation selection processes across sites (p<0.05). In multivariable analyses (Odds Ratio; 95% CI), stroke unit care (2.7; 1.1, 6.6) and post stroke functional impairment (severe stroke mRS 4-5: 10.9; 4.9, 24.6) were associated with receiving an assessment for rehabilitation. Receipt of rehabilitation was more likely following assessment (6.5; 2.9, 14.6) but less likely in patients with dementia (0.2; 0.1, 0.9), end-stage medical conditions (0.4; 0.2, 0.8) or ischaemic stroke (0.4; 0.1, 0.9). The odds of receiving rehabilitation increased with greater impairment: Odds Ratio 3.0 (1.5, 4.9) for mRS 2-3 and 12.5 (6.5, 24.3) for mRS 4-5. Among patients with mild-moderate impairment (mRS 2-3), 39/117 (33%) received no rehabilitation. Conclusions There was significant inter-site variation in rehabilitation selection processes. The major factors influencing rehabilitation access were assessment for rehabilitation needs, co-morbidities and post stroke functional impairment. Gaps in access to rehabilitation were found in those with mild to moderate functional impairment.

Assessment of rehabilitation following subarachnoid haemorrhage in China: Findings from the Chinese Stroke Center Alliance

“…According to guidelines from around the world, it is recommended that all patients receive early assessment and begin rehabilitation in the stroke unit. This is because early and coordinated rehabilitation is one of the main factors contributing to the positive effects of stroke units 23 . Therefore, patients hospitalized in the stroke unit are more likely to receive rehabilitation assessments.…”

“…In both Australia and Norway, the median hospital length of stay for acute stroke in recent years has been ve days. The rehabilitation of acute inpatient cases is usually carried out in separate wards or in hospitals that provide care through inpatient rehabilitation facilities, and decisions regarding rehabilitation need to be made early 23,28 . Moreover, recent research has shown that approximately 50% of surviving SAH patients have different levels of injuryrelated neurological impairment and persistent physical, social, emotional, and cognitive di culties that prevent return to independent life and work 5,29 .…”

Dose and setting of rehabilitation received after stroke in Queensland, Australia: a prospective cohort study

“…Further details of recruitment and data collection for the acute hospital stay, including site characteristics, have previously been published. 16 Demographic and clinical data including premorbid conditions and stroke-related information were extracted from the medical records by trained project officers. Participants were tracked through all rehabilitation episodes provided up to six months after stroke.…”

Targeted rehabilitation may improve patient flow and outcomes: development and implementation of a novel Proactive Rehabilitation Screening (PReS) service

“…25 Although not specifically explored in this project, such a screening process may also minimise variations in access to rehabilitation services which currently rely on ad hoc referral processes. [26][27][28][29] In the group of patients identified by screening alone (ie, those not referred via traditional methods), 24.1% were deemed ready by a rehabilitation physician for transfer to a subacute inpatient rehabilitation facility on the same day or within 1 day of screening. This finding is consistent with New et al, 7 who found that 62.7% of the patients referred and assessed by a rehabilitation consult service was deemed to be ready for transfer to inpatient rehabilitation on the same day of assessment.…”