So, your stroke medical 'professionals' have NO PROTOCOLS to follow and thus are totally flailing in the dark about how to get you 100% recovered. YOU have to change that trajectory, your stroke medical team has ignored that responsibility since their very first patient did not get 100% recovered. Their tyranny of low expectations is complete, that way they don't have to solve the very hard problem of 100% recovery.
Decision-Making on Referral to Primary Care Physiotherapy After Inpatient Stroke Rehabilitation
Key Words
Introduction
Worldwide, stroke is a leading cause of death and disability.1 Although incidence rates are expected to increase over the next few decades, survival rates are expected to improve. Consequently, more stroke survivors will have to learn to live with the consequences(See the tyranny of low expectations in full display, only YOU can change that.). After acute stroke care or rehabilitation, returning home(Really? Have you asked them? I bet without your bias in your questions it would be 100% recovery.) is one of the primary goals for stroke survivors.2 In the Netherlands, 65 % of stroke survivors return home immediately after acute hospital care.3 The remaining 35% continue inpatient rehabilitation in a rehabilitation center (RC) or geriatric rehabilitation center (GRC) before returning home. Only 75% of this group returns home.4
One of the key disciplines involved in rehabilitation after a stroke is physiotherapy. Physiotherapy has been found to be beneficial to restoring and maintaining gait and mobility-related functions as well as improving activities of daily living (ADL).5 This is essential for social reintegration.6 Additionally, physiotherapy is beneficial in restoring motor functions and physical fitness7 and contributes to secondary disease prevention.8
Physiotherapy starts within the first few days post-stroke in acute care9 in the hospital and, if necessary, continues in a (geriatric) rehabilitation center or primary care. When patients are discharged from the hospital or rehabilitation setting, physiotherapy in primary care is taken into consideration to continue rehabilitation or to prevent functional decline. It is unclear on what basis referral to primary care takes place. In practice, some patients are referred, and others are not. Unfortunately, stroke survivors often feel abandoned from facility based care after discharge and have difficulties to re-engage in society.10
The stroke guidelines only give general instructions concerning stroke survivor and informal caregiver needs.11, 12, 13, 14 The recommendations on stopping or continuing physiotherapy are mainly based on consensus opinion and lack current evidence.
This entails the risk that people post-stroke are unnecessarily referred, or wrongly not referred. The Dutch Physiotherapy Guideline15 leaves the decision to stop or continue treatment in the hands of the physiotherapist. Within the population post-stroke, a considerable variation exists in the risk for decline in ADL on the long term.16 Factors that are associated with ADL decline are: ADL dependency, impaired motor function of the leg, insurance status, living alone, age ≥ 80, inactive state, impaired cognitive function, depression and fatigue. It is unclear if these and which other factors play a role in the decision to refer, and who takes the decision. The healthcare professionals that are involved in the decision-making, i.e. physiotherapists, physicians, and physician assistants, might have different considerations, intentions, and goals regarding patient referrals.
Currently, collaboration in networks between hospital, rehabilitation care and primary care needs improvement to support patient-centered care. One of the key elements to optimize this collaboration is communication.17 In literature and in practice, there is no consensus on the organization and content of primary care in the chronic phase. Greater insight into the decision-making process could help healthcare professionals to make more-educated decisions with the aim to address primary care therapy to the right group of patients. Armed with this knowledge, the future of the physiotherapy care provided to stroke survivors returning home could be optimized. This contributes to more sustainable outcomes for people with stroke and possibly to a reduction of secondary complaints. Therefore, this study aimed to explore healthcare professionals' decision-making processes in hospitals and (geriatric) rehabilitation centers in referring patients to primary care physiotherapy at the time of discharge.
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