Assessment and selection for rehabilitation following acutestroke: A prospective cohort study in Queensland, Australia

Objective To describe current practice and investigate factors associated with selection for rehabilitation following acute stroke. Design Prospective observational cohort study. Setting Seven public hospitals in Queensland, Australia. Subjects Consecutive patients surviving acute stroke. Measures - Rehabilitation selection processes: assessment for rehabilitation needs, referral for rehabilitation, receipt of rehabilitation. - Functional impairment following stroke: modified Rankin Scale (mRS). Results We recruited 504 patients, median age 73 years (IQR 62, 82) between July 2016 and January 2017. Of these, 90% (454/504) were assessed for rehabilitation needs, 76% (381/504) referred for rehabilitation, and 72% (363/504) received any rehabilitation. There was significant variation in all rehabilitation selection processes across sites (p<0.05). In multivariable analyses (Odds Ratio; 95% CI), stroke unit care (2.7; 1.1, 6.6) and post stroke functional impairment (severe stroke mRS 4-5: 10.9; 4.9, 24.6) were associated with receiving an assessment for rehabilitation. Receipt of rehabilitation was more likely following assessment (6.5; 2.9, 14.6) but less likely in patients with dementia (0.2; 0.1, 0.9), end-stage medical conditions (0.4; 0.2, 0.8) or ischaemic stroke (0.4; 0.1, 0.9). The odds of receiving rehabilitation increased with greater impairment: Odds Ratio 3.0 (1.5, 4.9) for mRS 2-3 and 12.5 (6.5, 24.3) for mRS 4-5. Among patients with mild-moderate impairment (mRS 2-3), 39/117 (33%) received no rehabilitation. Conclusions There was significant inter-site variation in rehabilitation selection processes. The major factors influencing rehabilitation access were assessment for rehabilitation needs, co-morbidities and post stroke functional impairment. Gaps in access to rehabilitation were found in those with mild to moderate functional impairment.