Rehabilitation Assessments for Patients With Stroke in Australian Hospitals Do Not Always Reflect the Patients' Rehabilitation Requirements

Objectives: To examine the frequency and factors associated with patients with stroke in Australian hospitals receiving documented rehabilitation assessments; to examine the criteria used when rehabilitation was not recommended; and to examine whether being assessed for rehabilitation affected access to rehabilitation. Design: Retrospective medical record audit of patients with a diagnosis of stroke who were discharged consecutively between 2013 and 2014. Setting: Acute care public hospitals. Participants: Adults with stroke (N=333) receiving care in participating hospitals. Interventions: Not applicable. Main Outcome Measure: Documented assessment regarding patient suitability for rehabilitation during acute hospitalization. Results: Data from 292 patients were included for analysis (60% men; mean age, 72y). Of the patients, 42% were assessed for rehabilitation by a health professional providing care in the hospital, 43% were assessed for rehabilitation by a representative from a rehabilitation service, and 37% did not receive any documented rehabilitation assessment. In multivariable analysis, patients were significantly more likely to be assessed for rehabilitation if they lived in the community before their stroke, had moderate severity strokes, or received occupational therapy during hospital admission. Rehabilitation was not recommended in 9% of assessments despite the presence of stroke-related symptoms. Patients not assessed for rehabilitation were significantly less likely to access rehabilitation than patients who were assessed. Conclusions: More than one third of patients were not assessed for rehabilitation. When assessed, rehabilitation was not consistently recommended for patients with stroke-related symptoms. This study highlights factors that increase the likelihood of being assessed for rehabilitation. (C) 2015 by the American Congress of Rehabilitation Medicine