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Title: Assessment and selection for rehabilitation following acute stroke: a prospective cohort study in Queensland, Australia.
Austin Authors: Grimley, Rohan S;Rosbergen, Ingrid Cm;Gustaffson, Louise;Horton, Eleanor;Green, Theresa;Cadigan, Greg;Cadilhac, Dominique A;Kuys, Suzanne
Affiliation: Sunshine Coast Clinical School, The University of Queensland, Birtinya, QLD, Australia
Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
School of Allied Health Sciences, Griffith University, Brisbane, QLD, Australia
School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
Allied Health Services, Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
7 School of Nursing, Midwifery & Paramedicine, University of the Sunshine Coast, Maroochydore, QLD, Australia
Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
Queensland State-Wide Stroke Clinical Network, Clinical Excellence Division, Queensland Department of Health, Brisbane, QLD, Australia
Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
Issue Date: Jul-2019 2019-03-28
Publication information: Clinical rehabilitation 2019; 33(7): 1252-1263
Abstract: To describe current practice and investigate factors associated with selection for rehabilitation following acute stroke. Prospective observational cohort study. Seven public hospitals in Queensland, Australia. Consecutive patients surviving acute stroke. Rehabilitation selection processes are assessment for rehabilitation needs, referral for rehabilitation and receipt of rehabilitation. Functional impairment following stroke is modified Rankin Scale (mRS). 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. 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.
DOI: 10.1177/0269215519837585
ORCID: 0000-0002-7006-6908
PubMed URL: 30919665
Type: Journal Article
Subjects: Stroke
Appears in Collections:Journal articles

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