Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-24T12:28:41.699Z Has data issue: false hasContentIssue false
  • English
  • Français

Admission to and Continuation of Inpatient Stroke Rehabilitation in Queensland, Australia: A Survey of Factors that Contribute to the Consultant's Decision

Published online by Cambridge University Press:  18 September 2014

Kathryn S. Hayward ,
Philip D. Aitken ,
Ruth N. Barker  and
Sandra G. Brauer
Kathryn S. Hayward
Affiliation:
Division of Physiotherapy, School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
Philip D. Aitken
Affiliation:
Division of Medicine, Princess Alexandra Hospital, Brisbane, Australia
Ruth N. Barker
Affiliation:
School of Public Health, Tropical Medicine & Rehabilitation Sciences, James Cook University, Townsville, Australia Community Rehab Northern Queensland, Townsville Mackay Medicare Local, Townsville, Australia
Sandra G. Brauer*
Affiliation:
Division of Physiotherapy, School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
*
Address for correspondence: Sandra G. Brauer, Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane St Lucia, Queensland, Australia, 4072. E-mail: [email protected]
Get access

Abstract

Aim: To evaluate factors that may contribute to the decision of the consultant medical officer (CMO) to: (1) admit a person with stroke to inpatient rehabilitation from acute hospitalisation; and (2) continue or cease inpatient rehabilitation.

Methods: A web-based survey of CMOs practising in Queensland Australia, who were members of the Australian and New Zealand Society of Geriatric Medicine (n ~ 90) or the Queensland Stroke Clinical Network (n ~ 30) was completed. The survey contained two sections to explore factors that could: (1) favour or disfavour admission to inpatient rehabilitation from acute hospitalisation; and (2) favour continuation or cessation of inpatient rehabilitation. Open and closed questions were used.

Results: Twenty-one CMOs (13–20% response rate, 43% geriatrician) completed the survey. Factors related to physical function, along with the presence of social supports favoured admission, while the presence of behavioural and cognitive impairments and a lack of staff capacity disfavoured admission. Improvements in function favoured continuation of inpatient rehabilitation, while a lack of improvement favoured cessation.

Conclusion: Factors related to the patient, their social support network and the organisation were found to influence the decision of the CMO to admit a person with stroke to inpatient rehabilitation from acute hospitalisation. Once in rehabilitation, demonstration of benefit was consistently reported to indicate continued service need.

Keywords

strokerehabilitationadmissioncontinuum of caresurveys
Type
Articles
Information
Brain Impairment , Volume 15 , Issue 2 , September 2014 , pp. 88 - 98
Copyright
Copyright © Australasian Society for the Study of Brain Impairment 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Australian Stroke Coalition Rehabilitation Working Group. (2012). Assessment for rehabilitation: Pathway and decision-making tool. Melbourne, Australia: Australian Stroke Coalition Rehabilitation Working Group.Google Scholar
Conroy, B.E., DeJong, G., & Horn, S.D. (2009). Hospital-based stroke rehabilitation in the United States. Topics in Stroke Rehabilitation, 16, 34–43.Google Scholar
Hakkennes, S.J., Brock, K.A., & Hill, K.D. (2011). Selection of inpatient rehabilitation after acute stroke: A systematic review of the literature. Archives of Physical Medicine and Rehabilitation, 92, 2057–2070.Google Scholar
Illett, P.A., Brock, K.A., Graven, C.J., & Cotton, S.M. (2010). Selecting patients for rehabilitation after acute stroke: Are there variations in practice? Archives of Physical Medicine and Rehabilitation, 91, 788–793.Google Scholar
Kennedy, G.M., Brock, K., Lunt, A.W., & Black, S.J. (2012). Factors influencing selection for rehabilitation after stroke: A questionnaire using case scenarios to investigate physician perspectives and level of agreement. Archives of Physical Medicine & Rehabilitation, 93, 1457–1459.Google Scholar
Kwakkel, G., Wagenaar, R.C., Kollen, B.J., & Lankhorst, G.J. (1996). Predicting disability in stroke – A critical review of the literature. Age and Ageing, 25, 479–489.CrossRefGoogle ScholarPubMed
Lai, S.M., Alter, M.G., Lai, S.L., & Sobel, E. (1998). Disposition after acute stroke: Who is not sent home from hospital? Neuroepidemiology, 17, 21–29.CrossRefGoogle Scholar
Langhorne, P., & Duncan, P. (2001). Does the organisation of postacute stroke care really matter? Stroke, 32, 268–274.Google Scholar
Lee, A.J., Huber, J.H., & Stason, W.B. (1997). Factors contributing to practice variation in post-stroke rehabilitation. Health Services Research, 32, 197–221.Google ScholarPubMed
Mahler, M.P., Zuger, K., Kaspar, K., Haefeli, A., Jenni, W., Leniger, T., & Beer, J.H. (2008). A cost analysis of the first year after stroke: Early triage and in-patient rehabilitation may reduce long term costs. Swiss Medical Weekly, 138, 459–465.Google Scholar
Mayo, N.E., Hendlisz, M.S., Goldberg, N., Korner-Bitensky, R., Becker, R., & Coopersmith, H. (1989). Destinations of stroke patients discharged from the Montreal area acute-care hospitals. Stroke, 20, 351–356.CrossRefGoogle ScholarPubMed
National Stroke Foundation. (2012). National stroke audit – Rehabilitation services report. Melbourne, Australia: National Stroke Foundation.Google Scholar
New, P.W., Cameron, P.A., Oliver, J.H., & Stoelwinder, J.U. (2011). Inpatient subacute care in Australia: Perceptions of admission and discharge barriers. Medical Journal of Australia, 195, 538–541.CrossRefGoogle ScholarPubMed
Ng, Y.S., Stein, J., Ning, M., & Black-Schaffer, R.M. (2007). Comparison of clinical characteristics and functional outcomes of ischemic stroke in different vascular territories. Stroke, 38, 2309–2314.Google Scholar
Prabhakaran, S., Zarahn, E., Riley, C., Speizer, A., Chong, J.Y., Lazar, R.M., . . . Krakauer, J.W. (2008). Inter-individual variability in the capacity for motor recovery after ischemic stroke. Neurorehabilitation and Neural Repair, 22, 64–71.Google Scholar
Putman, K., De Wit, L., Schupp, W., Beyens, H., Dejaeger, E., De Weerdt, W., . . . Leys, M. (2007). Inpatient stroke rehabilitation: A comparative study for admission criteria to stroke rehabilitation units in four European centres. Journal of Rehabilitation Medicine, 39, 21–26.Google Scholar
Rodgers, H., Dennis, M., Cohen, D., & Rudd, A. (2003). British Association of Stroke Physicians: Benchmarking survey of stroke services. Age and Ageing, 32, 211–217.CrossRefGoogle ScholarPubMed
Rundek, T.H., Mast, A., Hartmann, B., Boden-Albala, L., Lennihan, L., Lin, I.F., . . . Sacco, R.L. (2000). Predictors of resource use after acute hospitalization: The Northern Manhattan stroke study. Neurology, 55, 1180–1187.Google Scholar
Saxena, S.K., Ng, T.P., Yong, D., Fong, N.P., & Gerald, K. (2006). Total direct cost, length of hospital stay, institutional discharges and their determinants from rehabilitation settings in stroke patients. Acta Neurologica Scandinavica, 14, 307–314.CrossRefGoogle Scholar
Schlegel, D., Kolb, S.J., Luciano, J.M., Tovar, J.M., Cucchiara, B.L., Liebeskind, D.S., & Kasner, S.E. (2003). Utility of the NIH stroke scale as a predictor of hospital disposition. Stroke, 34, 134–137.Google Scholar
Tran, C., Nadareishvili, Z., Smurawska, L., Oh, P.I., & Norris, J.W. (1999). Decreasing costs of stroke hospitalisation in Toronto. Stroke, 30, 185–186.CrossRefGoogle ScholarPubMed
Treger, I., Ring, H., Schwartz, R., Tsabari, R., Bornstein, N.B., & Tanne, D. (2008). Hospital disposition after stroke in a national survey of acute cerebrovascular diseases in Israel. Archives of Physical Medicine & Rehabilitation, 89, 435–440.Google Scholar
Veerbeek, J.M., Kwakkel, G., van Wegen, E.E.H., Ket, J.C.F., & Heymans, M.W. (2011). Early prediction of outcome of activities of daily living after stroke: A systematic review. Stroke, 42, 1482–1488.Google Scholar
Wade, D.T. (2003). Selection criteria for rehabilitation services. Clinical Rehabilitation, 17, 115–118.Google Scholar
Willems, D., Salter, K., Meyer, M., McClure, A., Teasell, R.W., & Foley, N.C. (2012). Determining the need for in-patient rehabilitation services post-stroke: Results from eight Ontario hospitals. Healthcare Policy, 7, e105–e118.Google Scholar
World Health Organisation. (2003). Global burden of stroke. Retrieved from http://www.who.int/cardiovascular_diseases/en/cvd_atlas_15_burden_stroke.pdfGoogle Scholar