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

There should be no problems assessing rehabilitation needs. You look at their objective damage diagnosis and map the stroke protocols with the highest efficacy to get the results the survivor wants(100% recovery). This may not exist today but that is what the perfect stroke rehab would look like, you don't have to be medically trained to understand that process.

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

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Rohan S Grimley, Ingrid CM Rosbergen, Louise Gustaffson, ...

First Published March 28, 2019 Research Article

https://doi.org/10.1177/0269215519837585

Article information

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(There should be no variation). 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.