Combining scoping review and concept analysis methodologies to clarify the meaning of rehabilitation potential after acquired brain injury

Dubé

et al. 2021

PM&R

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Demand for post-acute stroke and traumatic brain injury (TBI) rehabilitation outweighs resource availability. Every day, clinicians face the challenging task of deciding which patient will benefit or not from rehabilitation. The objectives of this scoping review were to map and compare factors reported by clinicians as influencing referral or admission decisions to post-acute rehabilitation for stroke and TBI patients, to identify most frequently reported factors and those perceived as most influential. We searched four major databases for articles published between 1946 and January 2021. Articles were included if they reported clinician's perceptions, investigated referral or admission decisions to postacute rehabilitation and focused on stroke or TBI patients. Twenty articles met inclusion criteria. The International Classification of Functioning, Disability and Health framework was used to guide data extraction and summarizing. Patient-related factors most frequently reported by clinicians were patient's age, mental status prior to stroke or TBI and family support. The two latter were ranked amongst the most influential by clinicians working with stroke patients, whereas age was ranked of low importance. Organizational factors were reported to influence decisions (particularly availability of post-acute care services) as well as clinicians' characteristics (e.g., knowledge). Moreover, clinicians' prediction of patient outcome ranked amongst the most important driver of referral or admission 3 decisions by clinicians working with stroke patients. Findings highlight the complex nature of decision-making regarding patient selection for rehabilitation and provide insight on important factors frontline clinicians need to consider when having to make rapid decisions in high-pressured acute care environments.

Section: Discussionmentioning

confidence: 99%

Factors influencing clinicians' referral or admission decisions for post‐acute stroke or traumatic brain injury rehabilitation: A scoping review

Dubé

et al. 2021

PM&R

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“…Both novices and experts use hypothetico‐deductive processes, especially when situations are complex or ill‐defined (Moulton et al, 2007). Determining rehabilitation potential within the pressured acute care environment is a complex problem to solve and the concept of rehabilitation potential has been until recently poorly defined (Lam Wai Shun et al, 2020). This might explain why even the most experienced occupational therapists in this study used this type of reasoning.…”

Section: Discussionmentioning

confidence: 99%

“…However, this study further suggests that these factors can be better understood by examining three interrelated concepts, that is, how clinicians attempt to predict patients' recovery, estimate rehabilitation potential, and F I G U R E 3 Decision-making algorithm (how occupational therapists decide referral to postacute rehabilitation) determine rehabilitation candidacy. Authors in the field of brain injury rehabilitation have reported that clinicians' perceptions of patients' recovery potential influence referral to postacute care (Foster et al, 2004); some have discussed the concept of rehabilitation potential (Enderby et al, 2017;Lam Wai Shun et al, 2020), whereas others have proposed candidacy criteria for admission to inpatient rehabilitation (Willems et al, 2012). Moreover, a recent study investigating occupational therapists' and physiotherapists' assessment of older patients' rehabilitation potential in acute care found that clinicians think about recovery in terms of the likelihood of patients returning to their baseline level of functioning and about the importance of observing patients' responses to rehabilitation (Bradley et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

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Clinical reasoning underlying acute care occupational therapists' assessment of rehabilitation potential after stroke or brain injury: A constructivist grounded theory study

Swaine

2021

Aus Occup Therapy J

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Introduction: In acute care hospitals, clinicians are expected to rapidly provide recommendations regarding patients' rehabilitation potential and candidacy for postacute rehabilitation. Some studies have investigated factors influencing referral to rehabilitation, but few have examined clinical reasoning underlying referral decisions. This study aimed to investigate what occupational therapists were thinking about (factors influencing reasoning), how they reasoned (thought processes) when evaluating stroke or traumatic brain injury patients' rehabilitation potential, and how they decided on referral to postacute rehabilitation.Methods: Using a constructivist grounded theory approach, the clinical reasoning of 10 acute care occupational therapists working in a large Canadian city was examined. Participant recruitment, data collection, and analysis were performed simultaneously following theoretical sampling procedures.Therapists' thoughts on patients' rehabilitation potential were collected twice (during chart consultation and initial patient assessment) using think-aloud protocols and semi-structured interviews. Constant comparison, memoing, and diagramming methods were employed during coding to help categorisation and conceptualisation.Findings: Numerous patient, clinician, and organisation-related factors were found to influence clinical reasoning. Occupational therapists interpreted these factors in an attempt to (1) predict recovery, (2) estimate rehabilitation potential, and (3) determine rehabilitation candidacy. They used two types of thought processes: (1) building a representation of patients' rehabilitation potential (involving eight steps including gathering and interpreting factors);(2) activating bottom-up and top-down scripts (comparing the expected impact of impairments on activity performance to behaviours observed during activity performance). Furthermore, an algorithm was developed describing how occupational therapists decide on referral to postacute rehabilitation. Conclusion:Findings can be used to teach students and novice occupational therapists how to identify and interpret key factors in the assessment of stroke

“…Our recent analysis of the concept of rehabilitation potential of adults with ABI 3 suggested that ‘… rehabilitation potential consists of a clinician’s prediction of a patient’s expected improvement with rehabilitation intervention’. Predicting how a patient will improve with rehabilitation is an arduous task for clinicians working with adult patients with ABI.…”

mentioning

confidence: 99%

Redesigning neurorehabilitation services for children with acquired brain injury

Swaine

Develop Med Child Neuro

2021

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