Determinants of rehabilitation assessment and referral following acute stroke. Early results from Building Efficient and Effective Pathways to and through Rehabilitation after Stroke (BEEPRS)

Abstract

Background: National guidelines and standards recommend that stroke survivors be assessed for, and receive rehabilitation. However available data suggests variable practice. Aims: To describe current practice and determinants of rehabilitation assessment and referral following acute stroke in Queensland. Methods: Prospective multi-centre observational cohort study of consecutive patients surviving acute stroke in six Queensland hospitals with acute stroke units. We collected demographics, clinical history, initial stroke impairments, modified Rankin Scale (mRS) (premorbid and 72-hours post stroke), and rehabilitation assessment and referral details. Descriptive statistics were used to quantify assessment and referral patterns. Multivariable logistic regression models were derived to determine predictors of rehabilitation assessment and referral, including age, gender, premorbid conditions, premorbid mRS, 72-hour mRS, early post stroke impairments, and clustering by hospital. Results: Data from the first 205 patients (mean age 72 +/-14 years, 42% female) were available. 90% were assessed (inter-site range 68%-100%, p<0.001) and 78% were referred for rehabilitation (range 67% - 91%, p=0.09). Predictors of assessment for rehabilitation were: pre morbid independence (mRS 0-2) (OR 5.8, CI 1.0, 28.8 p=0.04); and functional dependence at 72-hours (mRS>2) (OR 5.8, CI 1.3, 25.8 p=0.02). Predictors of referral for rehabilitation were: assessment (OR 104.7, CI 15.4, 711.3 p<0.001), functional dependence at 72-hours (OR 20.6, CI 6.1, 70.3 p<0.001) and presence of a cognitive or perceptual deficit (OR 4.0, CI 1.4, 10.9 p<0.005). Conclusions: Rehabilitation assessment practices vary significantly. Assessment for rehabilitation is the primary determinant of subsequent referral and should be the target for efforts to improve access.L618235816 <br />