Factors influencing selection for rehabilitation after stroke: a questionnaire using case scenarios to investigate physician perspectives and level of agreement

Objectives: To explore the key factors involved in decision making when selecting patients for rehabilitation after stroke and to examine the level of agreement among physician assessors regarding admission to rehabilitation.

Design: Questionnaire.

Setting: Health services with rehabilitation units in Victoria, Australia.

Participants: Rehabilitation unit physicians.

Interventions: Not applicable.

Main outcome measure: Questionnaire with 2 components: the clinical and nonclinical factors that influence decision making and clinical case scenarios.

Results: Responses were received from 17 physicians from 12 of the 18 health services in Victoria. The most influential clinical factors listed by the respondents were prognosis, social supports, anticipated discharge destination, age, and anticipated length of stay. Key nonclinical factors were prioritization of internal health service referrals, patient's residence, and workforce capacity. Analysis of the clinical scenarios of patients with severe stroke showed that there was variability in the responses, with high levels of agreement for some cases and low levels for others. Almost all respondents agreed that prognosis was a key factor, yet, within the case scenarios, the reasons given for accepting or not accepting the patient demonstrated different opinions on the prognosis of the case presented.

Conclusions: The decision-making processes in selection for rehabilitation and the factors that influence that decision require further investigation to optimize the use and outcomes from rehabilitation resources.