What factors affect clinical decision-making about access to stroke rehabilitation? A systematic review.
Verity Longley, Sarah Peters, Caroline Swarbrick and 1 others
PMID 30370792WHAT IT FOUND
Clinicians deciding stroke rehabilitation access weighed age, dementia, pre and poststroke function, social support, motivation, expected discharge, bed shortages, and their own knowledge or gut instinct.
No service reported using formal criteria.
Key findings
01Patient-related factors, organizational factors, and characteristics of individual clinicians were all found to influence clinicians’ decision-making for stroke rehabilitation.
02Older patients with higher levels of prestroke disability or severe stroke appear less likely to be accepted or referred for rehabilitation.
03In one included study, premorbid cognitive disability reduced the likelihood of admission in four out of six stroke rehabilitation units.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The included studies used different designs and settings, and service organization varied across countries, so results may not transfer to your service. Some quantitative studies had poor response rates under 60%, unrepresentative samples, or unclear measures. Searches were limited to English language publications. One included study was written by the review authors, which may affect how factors are weighted. Seven studies were limited to single disciplines, so they may not show how whole teams decide. Some studies did not specify whether patient, organizational, or clinician factors helped or hindered access.
Declared interests
The authors declared no potential conflicts of interest. The project was funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Greater Manchester. One author was partly funded by the Stroke Association and that NIHR collaboration.
The easy way to misread this
Do not read the barriers in this review as evidence that excluding older patients, patients with dementia, patients with severe stroke, or patients with low motivation improves outcomes. The review reports clinicians’ decision-making factors, not tested interventions, and some studies did not specify whether factors helped or hindered access.