Assessment and selection for rehabilitation following acute stroke: A prospective cohort study in Queensland, Australia
Journal article
Grimley, Rohan S., Rosbergen, Ingrid C. M., Gustaffson, Louise, Horton, Eleanor, Green, Theresa, Cadigan, Greg, Cadilhac, Dominique A. and Kuys, Suzanne. (2019). Assessment and selection for rehabilitation following acute stroke: A prospective cohort study in Queensland, Australia. Clinical Rehabilitation. 33(7), pp. 1252 - 1263. https://doi.org/10.1177/0269215519837585
Authors | Grimley, Rohan S., Rosbergen, Ingrid C. M., Gustaffson, Louise, Horton, Eleanor, Green, Theresa, Cadigan, Greg, Cadilhac, Dominique A. and Kuys, Suzanne |
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Abstract | 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 are assessment for rehabilitation needs, referral for rehabilitation and receipt of rehabilitation. Functional impairment following stroke is modified Rankin Scale (mRS). Results: We recruited 504 patients, median age 73 years (interquartile range (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, stroke unit care (odds ratio (OR) = 2.7; 95% confidence interval (CI) = 1.1, 6.6) and post stroke functional impairment (severe stroke mRS 4–5: OR = 10.9; 95% CI = 4.9, 24.6) were associated with receiving an assessment for rehabilitation. Receipt of rehabilitation was more likely following assessment (OR = 6.5; 95% CI = 2.9, 14.6) but less likely in patients with dementia (OR = 0.2; 95% CI = 0.1, 0.9), end-stage medical conditions (OR = 0.4; 95% CI = 0.2, 0.8) or ischaemic stroke (OR = 0.4; 95% CI = 0.1, 0.9). The odds of receiving rehabilitation increased with greater impairment: OR = 3.0 (95% CI = 1.5, 4.9) for mRS 2–3 and OR = 12.5 (95% CI = 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. |
Keywords | Stroke; rehabilitation; selection |
Year | 2019 |
Journal | Clinical Rehabilitation |
Journal citation | 33 (7), pp. 1252 - 1263 |
Publisher | Sage Publications Ltd. |
ISSN | 0269-2155 |
Digital Object Identifier (DOI) | https://doi.org/10.1177/0269215519837585 |
Scopus EID | 2-s2.0-85063572038 |
Page range | 1252 - 1263 |
Research Group | School of Allied Health |
Publisher's version | File Access Level Controlled |
Place of publication | United Kingdom |
https://acuresearchbank.acu.edu.au/item/899zx/assessment-and-selection-for-rehabilitation-following-acute-stroke-a-prospective-cohort-study-in-queensland-australia
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