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Clark B, Truman J, Whitall J, Hughes AM, Turk R, Burridge J. Why do some people who had a stroke not receive the recommended 45 min of occupational therapy and physiotherapy? A Delphi study. BMJ Open 2023; 13:e072276. [PMID: 37993160 PMCID: PMC10668297 DOI: 10.1136/bmjopen-2023-072276] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 09/01/2023] [Indexed: 11/24/2023] Open
Abstract
OBJECTIVES To gain a consensus among therapists for reasons why a person who had a stroke may not receive the Royal College of Physicians' recommended minimum of 45 min of daily therapy. DESIGN Three-round remote e-Delphi study. SETTING National study, based in the UK. PARTICIPANTS Occupational therapists and physiotherapists with experience of delivering therapy after stroke and awareness of the 45 min guideline. RESULTS Forty-five therapists consented to participate in the study. Thirty-five (78%) completed round one, 29 of 35 (83%) completed round 2 and 26 of 29 (90%) completed round three. A consensus (75%) was reached for 32 statements. Reasons why a person may not receive 45 min were related to the suitability of the guideline for the individual (based on factors like therapy tolerance or medical status) or the capability of the service to provide the intervention. In addition to the statements for which there was a consensus, 32 concepts did not reach a consensus. Specifically, there was a lack of consensus concerning the suitability of the guideline for people receiving Early Supported Discharge (ESD) services and a lack of agreement about whether people who need more than 45 min of therapy actually receive it. CONCLUSION Some people do not receive 45 min of therapy as they are considered unsuitable for it and some do not receive it due to services' inability to provide it. It is unclear which reasons for guideline non-achievement are most common. Future research should focus on why the guideline is not achieved in ESD, and why people who require more than 45 min may not receive it. This could contribute to practical guidance for therapists to optimise therapy delivery for people after stroke.
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Affiliation(s)
- Beth Clark
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Juliette Truman
- Department of Rehabilitation and Sports Sciences, Faculty of Health and Social Sciences, Bournemouth University, Poole, UK
| | - Jill Whitall
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Ann-Marie Hughes
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Ruth Turk
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Jane Burridge
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
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2
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Freak-Poli R, Hu J, Phyo AZZ, Barker SF. Social Isolation and Social Support Influence Health Service Utilisation and Survival after a Cardiovascular Disease Event: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4853. [PMID: 36981761 PMCID: PMC10049557 DOI: 10.3390/ijerph20064853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
Both cardiovascular disease (CVD) and social health carry high health and economic burdens. We undertook a systematic review to investigate the association between social isolation, low social support, and loneliness with health service utilisation and survival after a CVD event among people living in Australia and New Zealand. Four electronic databases were systematically searched for the period before June 2020. Two reviewers undertook the title/abstract screen. One reviewer undertook a full-text screen and data extraction. A second author checked data extraction. Of 756 records, 25 papers met our inclusion criteria. Included studies recruited 10-12,821 participants, aged 18-98 years, and the majority were males. Greater social support was consistently associated with better outcomes on four of the five themes (discharge destination, outpatient rehabilitation attendance, rehospitalisation and survival outcomes; no papers assessed the length of inpatient stay). Positive social health was consistently associated with better discharge designation to higher independent living. As partner status and living status did not align with social isolation and social support findings in this review, we recommend they not be used as social health proxies. Our systematic review demonstrates that social health is considered in cardiac care decisions and plays a role in how healthcare is being delivered (i.e., outpatient, rehabilitation, or nursing home). This likely contributes to our finding that lower social support is associated with high-intensity healthcare services, lower outpatient rehabilitation attendance, greater rehospitalisation and poorer survival. Given our evidence, the first step to improve cardiac outcomes is acknowledging that social health is part of the decision-making process. Incorporating a formal assessment of social support into healthcare management plans will likely improve cardiac outcomes and survival. Further research is required to assess if support person/s need to engage in the risk reduction behaviours themselves for outpatient rehabilitation to be effective. Further synthesis of the impact of social isolation and loneliness on health service utilisation and survival after a CVD event is required.
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Affiliation(s)
- Rosanne Freak-Poli
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC 3168, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Jessie Hu
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Aung Zaw Zaw Phyo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - S. Fiona Barker
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
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3
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Ethical Issues in Medical Rehabilitation: The Dilemma of Who to Admit. Am J Phys Med Rehabil 2022; 101:1168-1174. [PMID: 35067558 DOI: 10.1097/phm.0000000000001971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
ABSTRACT Ethical allocation of scare medical resources is a ubiquitous challenge in many, if not all, medical specialties. The field of physical medicine and rehabilitation is no exception and presents its own unique dilemmas. We report on a small inpatient rehabilitation unit at a large university medical center with a large catchment area representing a vast range of socioeconomic classes. The decision of whom to admit is a constant challenge. We review the existing literature regarding ethical considerations in rehabilitation department admission criteria and attempt to analyze criteria used to admit patients to a general physical medicine and rehabilitation ward. Finally, we discuss our medical center approach to the ethical dilemma of admission priority. A systemic search was conducted in six sources (PubMed, Google Scholar, ScienceDirect, Cochrane Library, LILACS, Embase). Searches were limited to English language articles with no date restriction, reflecting all available data. A reviewer applied the inclusion criteria to identify relevant articles.This review highlights a number of important ethical issues in evaluation and selection criteria that may assist clinicians in improving selection procedures and standardizing access to inpatient rehabilitation. Further high-quality empirical studies and reviews of ethical admission practice with regard to rehabilitation acceptance are required.
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Lam Wai Shun P, Bottari C, Dubé S, Grondin M, Swaine B. Factors influencing clinicians' referral or admission decisions for post-acute stroke or traumatic brain injury rehabilitation: A scoping review. PM R 2022; 14:1388-1405. [PMID: 34387943 DOI: 10.1002/pmrj.12691] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 07/05/2021] [Accepted: 08/05/2021] [Indexed: 12/31/2022]
Abstract
Demand for post-acute stroke and traumatic brain injury (TBI) rehabilitation outweighs resource availability. Every day, clinicians face the challenging task of deciding which patient will benefit or not from rehabilitation. The objectives of this scoping review were to map and compare factors reported by clinicians as influencing referral or admission decisions to post-acute rehabilitation for stroke and TBI patients, to identify most frequently reported factors and those perceived as most influential. We searched four major databases for articles published between 1946 and January 2021. Articles were included if they reported clinicians' perceptions, investigated referral or admission decisions to post-acute rehabilitation, and focused on patients with stroke or TBI. Twenty articles met inclusion criteria. The International Classification of Functioning, Disability and Health framework was used to guide data extraction and summarizing. Patient-related factors most frequently reported by clinicians were age, mental status prior to stroke or TBI, and family support. The two latter were ranked among the most influential by clinicians working with stroke patients, whereas age was ranked of low importance. Organizational factors were reported to influence decisions (particularly the availability of post-acute care services) as well as clinicians' characteristics (eg, knowledge). Moreover, clinicians' prediction of patient outcome ranked among the most important driver of referral or admission decisions by clinicians working with stroke patients. Findings highlight the complex nature of decision-making regarding patient selection for rehabilitation and provide insight on important factors that frontline clinicians need to consider when having to make rapid decisions in high-pressured acute care environments.
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Affiliation(s)
- Priscilla Lam Wai Shun
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Québec, Canada
| | - Carolina Bottari
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Québec, Canada
| | - Sandra Dubé
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Myrian Grondin
- Marguerite-d'Youville Library, Université de Montréal, Montréal, Québec, Canada
| | - Bonnie Swaine
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Québec, Canada
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5
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Huygelier H, Schraepen B, Miatton M, Welkenhuyzen L, Michiels K, Note E, Lafosse C, Thielen H, Lemmens R, Bruffaerts R, Demeyere N, Gillebert CR. The Dutch Oxford Cognitive Screen (OCS-NL): psychometric properties in Flemish stroke survivors. Neurol Sci 2022; 43:6349-6358. [DOI: 10.1007/s10072-022-06314-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
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6
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Stein J, Rodstein BM, Levine SR, Cheung K, Sicklick A, Silver B, Hedeman R, Egan A, Borg-Jensen P, Magdon-Ismail Z. Which Road to Recovery?: Factors Influencing Postacute Stroke Discharge Destinations: A Delphi Study. Stroke 2021; 53:947-955. [PMID: 34706561 DOI: 10.1161/strokeaha.121.034815] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The criteria for determining the level of postacute care for patients with stroke are variable and inconsistent. The purpose of this study was to identify key factors influencing the selection of postacute level of care for these patients. METHODS We used a collaborative 4-round Delphi process to achieve a refined list of factors influencing postacute level of care selection. Our Delphi panel of experts consisted of 32 panelists including physicians, physical therapists, occupational therapists, speech-language pathologists, nurses, stroke survivors, administrators, policy experts, and individuals associated with third-party insurance companies. RESULTS In round 1, 207 factors were proposed, with subsequent discussion resulting in consolidation into 15 factors for consideration. In round 2, 15 factors were ranked with consensus on 10 factors; in round 3,10 factors were ranked with consensus on 9 factors. In round 4, the final round, 9 factors were rated with Likert scores ranging from 5 (most important) to 1(not important). The percentage of panelists who provided a rating of 4 or above were as follows: likelihood to benefit from an active rehabilitation program (97%), need for clinicians with specialized rehabilitation skills (94%), need for active and ongoing medical management and monitoring (84%), ability to tolerate an active rehabilitation program (74%), need for caregiver training to return to the community (48%), family/caregiver support (39%), likelihood to return to community/home (39%), ability to return to physical home environment (32%), and premorbid dementia (16%). CONCLUSIONS This study provides an expert, consensus-based set of key factors to be considered when determining where stroke patients are discharged for postacute care. These factors may be useful in developing a decision support tool for use in clinical settings.
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Affiliation(s)
- Joel Stein
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, NY (J.S.).,Department of Rehabilitation Medicine, Weill Cornell Medical College, NY (J.S.).,NewYork-Presbyterian Hospital, NY (J.S.)
| | - Barry M Rodstein
- University of Massachusetts Medical School-Baystate Health, Springfield (B.M.R.)
| | - Steven R Levine
- Departments of Neurology and Emergency Medicine, and Stroke Center, SUNY Downstate Health Sciences University, Brooklyn, NY (S.R.L.).,Department of Neurology, Kings County Hospital Center, Brooklyn, NY (S.R.L.).,Jaffe Stroke Center and Department of Neurology, Maimonides Medical Center, Brooklyn, NY (S.R.L.)
| | - Ken Cheung
- Department of Biostatistics, Columbia University Irving Medical Center, NY (K.C.)
| | | | - Brian Silver
- Department of Neurology, University of Massachusetts Medical School, Worcester (B.S.)
| | | | - Abigail Egan
- The American Heart Association/American Stroke Association, Eastern States, Albany, NY (A.E., P.B.-J., Z.M.-I.)
| | - Pamela Borg-Jensen
- The American Heart Association/American Stroke Association, Eastern States, Albany, NY (A.E., P.B.-J., Z.M.-I.)
| | - Zainab Magdon-Ismail
- The American Heart Association/American Stroke Association, Eastern States, Albany, NY (A.E., P.B.-J., Z.M.-I.).,Capital District Physician's Health Plan, Albany NY (Z.M.-I.)
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7
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Marnane K, Gustafsson L, Bennett S, Rosbergen I, Grimley R. "Everyone needs rehab, but…": exploring post-stroke rehabilitation referral and acceptance decisions. Disabil Rehabil 2021; 44:4717-4728. [PMID: 33974463 DOI: 10.1080/09638288.2021.1918770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To explore the decision-making processes and experiences of acute and rehabilitation clinicians, regarding referral and acceptance of patients to rehabilitation after stroke. MATERIALS AND METHODS Multi-site rapid ethnography, involving observation of multidisciplinary case conferences, interviews with acute stroke and rehabilitation clinicians, and review of key documents within five (5) acute stroke units (ASUs) in Queensland, Australia. A cyclical, inductive content analysis was performed. RESULTS Seven key themes were identified, revealing the complex nature of post-stroke rehabilitation referral and acceptance decision making. Although the majority of clinicians felt that all patients could benefit from rehabilitation, they acknowledged this could not always be the case. Rehabilitation potential and goals were considered by clinicians, but decision making was impacted by ASU context and team processes, rehabilitation service availability and access procedures, and the relationships between the acute and rehabilitation clinicians. Patients and families were not actively involved in the decision-making processes. CONCLUSIONS Post-stroke rehabilitation decision making in Queensland, Australia involves complex processes and compromise. Decisions are not based solely on patients' rehabilitation needs, and patients and families are not actively involved in the decision-making process. Mechanisms are required to streamline access procedures, and improve shared decision making with patients.IMPLICATIONS FOR REHABILITATIONReferral decision making for post-stroke rehabilitation is complex and not always based solely on patients' needs.Clear and straightforward access procedures and positive relationships between acute and rehabilitation clinicians have a positive impact on referral decision making.Stroke services should review their processes to ensure shared decision making is facilitated when patients require access to rehabilitation.
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Affiliation(s)
- Kerry Marnane
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Community and Oral Health Directorate, Metro North Hospital and Health Service, Herston,Australia
| | - Louise Gustafsson
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,School of Allied Health Sciences, Griffith University, Nathan, Australia
| | - Sally Bennett
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Ingrid Rosbergen
- Conjoint Research Fellow Physiotherapy, STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Hospital and Health Service, Australia
| | - Rohan Grimley
- School of Medicine, Griffith University, Sunshine Coast, Australia
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Klaic M, Galea MP. Using the Technology Acceptance Model to Identify Factors That Predict Likelihood to Adopt Tele-Neurorehabilitation. Front Neurol 2020; 11:580832. [PMID: 33343488 PMCID: PMC7738474 DOI: 10.3389/fneur.2020.580832] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022] Open
Abstract
Tele-neurorehabilitation has the potential to reduce accessibility barriers and enhance patient outcomes through a more seamless continuum of care. A growing number of studies have found that tele-neurorehabilitation produces equivalent results to usual care for a variety of outcomes including activities of daily living and health related quality of life. Despite the potential of tele-neurorehabilitation, this model of care has failed to achieve mainstream adoption. Little is known about feasibility and acceptability of tele-neurorehabilitation and most published studies do not use a validated model to guide and evaluate implementation. The technology acceptance model (TAM) was developed 20 years ago and is one of the most widely used theoretical frameworks for predicting an individual's likelihood to adopt and use new technology. The TAM3 further built on the original model by incorporating additional elements from human decision making such as computer anxiety. In this perspective, we utilize the TAM3 to systematically map the findings from existing published studies, in order to explore the determinants of adoption of tele-neurorehabilitation by both stroke survivors and prescribing clinicians. We present evidence suggesting that computer self-efficacy and computer anxiety are significant predictors of an individual's likelihood to use tele-neurorehabilitation. Understanding what factors support or hinder uptake of tele-neurorehabilitation can assist in translatability and sustainable adoption of this technology. If we are to shift tele-neurorehabilitation from the research domain to become a mainstream health sector activity, key stakeholders must address the barriers that have consistently hindered adoption.
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Affiliation(s)
- Marlena Klaic
- Allied Health Department, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Mary P Galea
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, VIC, Australia
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9
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Stroke Survivors' Perspectives on Post-Acute Rehabilitation Options, Goals, Satisfaction, and Transition to Home. J Neurol Phys Ther 2020; 43:160-167. [PMID: 31205230 DOI: 10.1097/npt.0000000000000281] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Patients and caregivers have not typically been involved in the selection of a post-acute care (PAC) provider. In 2015, the Centers for Medicare & Medicaid Services proposed the need to involve patients and their families during discharge planning. Engaging patients in rehabilitation decisions encourages shared decision making among patients and their clinicians. The purpose of this study was to examine stroke survivors' perspectives on their involvement in selecting a PAC provider and their goal setting and their satisfaction with the rehabilitation stay and their discharge advice for stroke survivors, prior to 2015. METHODS This qualitative study utilized semistructured interviews. Thematic content analysis was performed on interviews involving 18 stroke survivors (mean age = 68 years) related to their involvement in planning for their inpatient rehabilitation facility or skilled nursing facility stay, goal setting, and discharge needs. RESULTS More than half the participants were not involved in the selection of their PAC setting and believed that doctors made these decisions. Around two-fifths of stroke survivors reported that they were not involved in rehabilitation goal setting. Most patients were satisfied with their rehabilitation stay. When asked to recommend discharge topics for other stroke survivors, participants recommended additional information on health care services, interventions, and insurance coverage. DISCUSSION AND CONCLUSION Despite recommendations to include stroke patients in PAC selection and goal setting, many former inpatient rehabilitation facility and skilled nursing facility patients report not being involved in either aspect of care.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A273).
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10
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Lam Wai Shun P, Swaine B, Bottari C. Combining scoping review and concept analysis methodologies to clarify the meaning of rehabilitation potential after acquired brain injury. Disabil Rehabil 2020; 44:817-825. [PMID: 32551986 DOI: 10.1080/09638288.2020.1779825] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Purpose: Clinicians make judgments about patients' rehabilitation potential because it is considered by many as a prerequisite for referral to rehabilitation. However, the concept is rarely defined. This research aimed to clarify the concept of rehabilitation potential in the context of acquired brain injury patient referral to post-acute rehabilitation.Method: Literature search (conducted in Medline, CINAHL and Embase) and article selection followed a scoping review methodology while a concept analysis methodology guided data extraction and analysis.Results: Eighteen documents met inclusion criteria. Findings suggest four defining attributes of the concept. Rehabilitation potential (1) emerges from clinicians' interpretation of patient characteristics and is influenced by the health care environment, (2) involves the prediction of how a patient might improve with rehabilitation interventions, (3) is a multi-level concept and (4) can change over time. The most critical consequence to assessing a patient's rehabilitation potential is the impact on the patient's opportunity to access post-acute rehabilitation services.Conclusion: Rehabilitation potential is a concept rooted in clinical reasoning. We propose an operational definition and a conceptual model to provide a solid foundation for future research to advance policy and clinical decision-making regarding equitable access to post-acute rehabilitation.IMPLICATIONS FOR REHABILITATIONRehabilitation potential is a concept rooted in clinical reasoning and emerges from clinicians' prediction of how a patient might improve with rehabilitation interventions.Rehabilitation potential is not a dichotomous concept but a multi-level concept with each level falling along a continuum.It may be inaccurate/inappropriate to definitively state that a patient has or does not have rehabilitation potential, as patients may demonstrate varying levels of rehabilitation potential.Rehabilitation potential can change with time requiring re-assessment to readjust recommendations accordingly with regards to appropriate rehabilitation interventions at any given time.
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Affiliation(s)
- Priscilla Lam Wai Shun
- School of rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada
| | - Bonnie Swaine
- School of rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada
| | - Carolina Bottari
- School of rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Canada
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11
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Stein J, Borg-Jensen P, Sicklick A, Rodstein BM, Hedeman R, Bettger JP, Hemmitt R, Silver BM, Thode HC, Magdon-Ismail Z. Are Stroke Survivors Discharged to the Recommended Postacute Setting? Arch Phys Med Rehabil 2020; 101:1190-1198. [PMID: 32272107 DOI: 10.1016/j.apmr.2020.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/02/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine the processes and barriers involved in providing postdischarge stroke care. DESIGN Prospective study of discharge planners' (DP) and physical therapists' (PT) interpretation of factors contributing to patients' discharge destination. SETTING Twenty-three hospitals in the northeastern United States. PARTICIPANTS After exclusions, data on patients (N=427) hospitalized with a primary diagnosis of stroke between May 2015 and November 2016 were examined. Of the patients, 45% were women, and the median age was 71 years. DPs and PTs caring for these patients were queried regarding the selection of discharge destination. INTERVENTIONS None. MAIN OUTCOME MEASURES Comparison of actual discharge destination for stroke patients with the destinations recommended by their DPs and PTs. RESULTS In total, 184 patients (43.1%) were discharged home, 146 (34.2%) to an inpatient rehabilitation facility, 94 (22.0%) to a skilled nursing facility, and 3 (0.7%) to a long-term acute care hospital. DPs and PTs agreed on the recommended discharge destination in 355 (83.1%) cases. The actual discharge destination matched the DP and PT recommended discharge destination in 92.5% of these cases. In 23 cases (6.5%), the patient was discharged to a less intensive setting than recommended by both respondents. In 4 cases (1.1%), the patient was discharged to a more intensive level of care. In 2 cases (0.6%), the patient was discharged to a long-term acute care hospital rather than an inpatient rehabilitation facility as recommended. Patient or family preference was cited by at least 1 respondent for the discrepancy in discharge destination for 13 patients (3.1%); insurance barriers were cited for 9 patients (2.3%). CONCLUSIONS Most stroke survivors in the northeast United States are discharged to the recommended postacute care destination based on the consensus of DP and PT opinions. Further research is needed to guide postacute care service selection.
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Affiliation(s)
- Joel Stein
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York; Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York; New York-Presbyterian Hospital, New York, New York.
| | - Pamela Borg-Jensen
- The American Heart Association/American Stroke Association, Eastern States, Albany, New York
| | | | | | | | - Janet Prvu Bettger
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Roseanne Hemmitt
- The American Heart Association/American Stroke Association, Eastern States, Albany, New York
| | - Brian M Silver
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Henry C Thode
- Department of Emergency Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | - Zainab Magdon-Ismail
- The American Heart Association/American Stroke Association, Eastern States, Albany, New York
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12
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Exploring discharge destination following severe stroke. BRAIN IMPAIR 2020. [DOI: 10.1017/brimp.2020.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Patients with severe stroke frequently present with substantial impairments but are often not prioritised for post-discharge rehabilitation. There is a need to determine where these patients are discharged to in order to facilitate appropriate allocation of post-discharge pathway resources.Aim:The present study aimed to describe the discharge pathways of patients with severe stroke and to identify predictors of discharge destination for these patients.Method:A descriptive, retrospective design was utilised to determine the discharge destination for 770 patients with severe stroke in Queensland, Australia. Binomial logistic regression was used to determine the variables that predicted discharge destination.Results:The results indicated that 58.44% of patients were discharged home (n = 450). Age, length of stay, discharge ward and geographical region emerged as significant predictors of discharge destination. The full model containing all predictors was statistically significant and, as a whole, explained 36.50% of the variance in discharge destination.Conclusion:These results highlight the importance of these variables in influencing the outcomes of patients with severe stroke, which may assist post-hospital discharge services in allocating resources for patients with severe stroke.
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13
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Labberton AS, Barra M, Rønning OM, Thommessen B, Churilov L, Cadilhac DA, Lynch EA. Patient and service factors associated with referral and admission to inpatient rehabilitation after the acute phase of stroke in Australia and Norway. BMC Health Serv Res 2019; 19:871. [PMID: 31752874 PMCID: PMC6873491 DOI: 10.1186/s12913-019-4713-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/05/2019] [Indexed: 11/25/2022] Open
Abstract
Background Unequal access to inpatient rehabilitation after stroke has been reported. We sought to identify and compare patient and service factors associated with referral and admission to an inpatient rehabilitation facility (IRF) after acute hospital care for stroke in two countries with publicly-funded healthcare. Methods We compared two cohorts of stroke patients admitted consecutively to eight acute public hospitals in Australia in 2013–2014 (n = 553), and to one large university hospital in Norway in 2012–2013 (n = 723). Outcomes were: referral to an IRF; admission to an IRF if referred. Logistic regression models were used to identify and compare factors associated with each outcome. Results Participants were similar in both cohorts: mean age 73 years, 40–44% female, 12–13% intracerebral haemorrhage, ~ 77% mild stroke (National Institutes of Health Stroke Scale < 8). Services received during the acute admission differed (Australia vs. Norway): stroke unit treatment 82% vs. 97%, physiotherapy 93% vs. 79%, occupational therapy 83% vs. 77%, speech therapy 78% vs. 13%. Proportions referred to an IRF were: 48% (Australia) and 37% (Norway); proportions admitted: 35% (Australia) and 28% (Norway). Factors associated with referral in both countries were: moderately severe stroke, receiving stroke unit treatment or allied health assessments during the acute admission, living in the community, and independent pre-stroke mobility. Directions of associations were mostly congruent; however younger patients were more likely to be referred and admitted in Norway only. Models for admission among patients referred identified few associated factors suggesting that additional factors were important for this stage of the process. Conclusions Similar factors were associated with referral to inpatient rehabilitation after acute stroke in both countries, despite differing service provision and access rates. Assuming it is not feasible to provide inpatient rehabilitation to all patients following stroke, the criteria for the selection of candidates need to be understood to address unwanted biases.
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Affiliation(s)
- Angela S Labberton
- Health Services Research Unit, Akershus University Hospital, PO Box 1000, 1478, Lørenskog, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Mathias Barra
- Health Services Research Unit, Akershus University Hospital, PO Box 1000, 1478, Lørenskog, Norway.,Centre for Connected Care, Oslo University Hospital, Oslo, Norway
| | - Ole Morten Rønning
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Bente Thommessen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Leonid Churilov
- Department of Medicine (Austin Health), Melbourne Medical School, The University of Melbourne, Heidelberg, Australia.,NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne and Newcastle, Melbourne, Australia.,Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Dominique A Cadilhac
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne and Newcastle, Melbourne, Australia.,Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.,Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Elizabeth A Lynch
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne and Newcastle, Melbourne, Australia.,Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.,Adelaide Nursing School, University of Adelaide, Adelaide, Australia
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14
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Discharge Patterns for Ischemic and Hemorrhagic Stroke Patients Going From Acute Care Hospitals to Inpatient and Skilled Nursing Rehabilitation. Am J Phys Med Rehabil 2019; 97:636-645. [PMID: 29595584 DOI: 10.1097/phm.0000000000000932] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to explore variation in acute care use of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation after ischemic and hemorrhagic stroke. DESIGN A secondary analysis of Medicare claims data linked to inpatient rehabilitation facilities and skilled nursing facilities assessment files (2013-2014) was performed. RESULTS The sample included 122,084 stroke patients discharged to inpatient or skilled nursing facilities from 3677 acute hospitals. Of the acute hospitals, 3649 discharged patients with an ischemic stroke (range = 1-402 patients/hospital, median = 15) compared with 1832 acute hospitals that discharged patients with hemorrhagic events (range = 1-73 patients/hospital, median = 4). The intraclass correlation coefficient examined variation in discharge settings attributed to acute hospitals (ischemic intraclass correlation coefficient = 0.318, hemorrhagic intraclass correlation coefficient = 0.176). Patients older than 85 yrs and those with greater numbers of co-morbid conditions were more likely to discharge to skilled nursing facilities. Comparison of self-care and mobility across stroke type suggests that patients with ischemic stroke have higher functional abilities at admission. CONCLUSIONS This study suggests demographic and clinical differences among stroke patients admitted for postacute rehabilitation at inpatient rehabilitation facilities and skilled nursing facilities settings. Furthermore, examination of variation in ischemic and hemorrhagic stroke discharges suggests acute facility-level differences and indicates a need for careful consideration of patient and facility factors when comparing the effectiveness of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation.
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Grimley RS, Rosbergen ICM, Gustaffson L, Horton E, Green T, Cadigan G, Cadilhac DA, Kuys S. Assessment and selection for rehabilitation following acute stroke: a prospective cohort study in Queensland, Australia. Clin Rehabil 2019; 33:1252-1263. [DOI: 10.1177/0269215519837585] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Rohan S Grimley
- Sunshine Coast Clinical School, The University of Queensland, Birtinya, QLD, Australia
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Queensland State-Wide Stroke Clinical Network, Clinical Excellence Division, Queensland Department of Health, Brisbane, QLD, Australia
| | - Ingrid CM Rosbergen
- Allied Health Services, Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - Louise Gustaffson
- School of Allied Health Sciences, Griffith University, Brisbane, QLD, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Eleanor Horton
- School of Nursing, Midwifery & Paramedicine, University of the Sunshine Coast, Maroochydore, QLD, Australia
| | - Theresa Green
- Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
- Centre for Clinical Nursing, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
| | - Greg Cadigan
- Queensland State-Wide Stroke Clinical Network, Clinical Excellence Division, Queensland Department of Health, Brisbane, QLD, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne Heidelberg, VIC, Australia
| | - Suzanne Kuys
- Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia
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16
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Scrutinio D, Giardini A, Chiovato L, Spanevello A, Vitacca M, Melazzini M, Giorgi G. The new frontiers of rehabilitation medicine in people with chronic disabling illnesses. Eur J Intern Med 2019; 61:1-8. [PMID: 30389274 DOI: 10.1016/j.ejim.2018.10.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 10/18/2018] [Accepted: 10/24/2018] [Indexed: 01/01/2023]
Abstract
Because of the demographic shift and the increased proportion of patients surviving acute critical illnesses, the number of people living with severely disabling chronic diseases and, consequently, the demand for rehabilitation are expected to increase sharply over time. As underscored by the World Health Organization, there is substantial evidence that the provision of inpatient rehabilitation in specialized rehabilitation units to people with complex needs is effective in fostering functional recovery, improving health-related quality of life, increasing independence, reducing institutionalization rate, and improving prognosis. Recent studies in the real world setting reinforce the evidence that patients with ischemic heart disease or stroke benefit from rehabilitation in terms of improved prognosis. In addition, there is evidence of the effectiveness of rehabilitation for the prevention of functional deterioration in patients with complex and/or severe chronic diseases. Given this evidence of effectiveness, rehabilitation should be regarded as an essential part of the continuum of care. Nonetheless, rehabilitation still is underdeveloped and underused. Efforts should be devoted to foster healthcare professional awareness of the benefits of rehabilitation and to increase referral and participation.
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Affiliation(s)
| | - Anna Giardini
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Luca Chiovato
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy; Dipartimento di Medicina Interna e Terapia Medica, Università di Pavia, Italy
| | - Antonio Spanevello
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy; Università degli Studi dell'Insubria, Varese, Italy
| | | | | | - Gianni Giorgi
- Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
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17
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Longley V, Peters S, Swarbrick C, Bowen A. What factors affect clinical decision-making about access to stroke rehabilitation? A systematic review. Clin Rehabil 2018; 33:304-316. [PMID: 30370792 PMCID: PMC6348456 DOI: 10.1177/0269215518808000] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objectives: To determine the factors affecting clinical decision-making about which patients should receive stroke rehabilitation. Methods: Data sources (MEDLINE, CINAHL, AMED and PsycINFO) were searched systematically from database inception to August 2018. Full-text English-language studies of data from stroke clinicians were included. Studies of patients were excluded. The included studies were any design focussed on clinical decision-making for referral or admission into stroke rehabilitation. Summary factors were compiled from each included study. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. Results: After removing duplicates, 1915 papers were identified, of which 13 met the inclusion criteria. Eight included studies were qualitative and one used mixed methods. A total of 292 clinicians were included in the studies. Quality of the included studies was mixed. Patient-level and organizational factors as well as characteristics of individual clinicians contributed to decisions about rehabilitation. The most often described factors were patients’ pre- and poststroke function (n = 6 studies), presence of dementia (n = 6), patients’ social/family support (n = 6), organizational service pressures (n = 7) and the decision-making clinician’s own knowledge (n = 5) and emotions (n = 5). Conclusion: The results highlight a lack of clinical guidance to aid decision-making and reveal that a subjective approach to rehabilitation decision-making influenced by patient-level and organizational factors alongside clinicians’ characteristics occurs across services and countries.
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Affiliation(s)
| | - Sarah Peters
- MAHSC and The University of Manchester, Manchester, UK
| | | | - Audrey Bowen
- MAHSC and The University of Manchester, Manchester, UK
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18
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Scrutinio D, Guida P, Lanzillo B, Ferretti C, Loverre A, Montrone N, Spaccavento S. Rehabilitation Outcomes of Patients With Severe Disability Poststroke. Arch Phys Med Rehabil 2018; 100:520-529.e3. [PMID: 30056158 DOI: 10.1016/j.apmr.2018.06.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/04/2018] [Accepted: 06/21/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To characterize rehabilitation outcomes of patients with severe poststroke motor impairment (MI) and develop a predictive model for treatment failure. DESIGN Retrospective cohort study. Correlates of treatment failure, defined as the persistence of severe MI after rehabilitation, were identified using logistic regression analysis. Then, an integer-based scoring rule was developed from the logistic model. SETTING Three specialized inpatient rehabilitation facilities. PARTICIPANTS Patients (N=1265) classified as case-mix groups (CMGs) 0108, 0109, and 0110 of the Medicare classification system. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Change in the severity of MI, as assessed by the FIM, from admission to discharge. RESULTS Median FIM-motor (FIM-M) score increased from 17 (interquartile range [IQR] 14-23) to 38 (IQR, 25-55) points. Median proportional recovery, as expressed by FIM-M effectiveness, was 26% (IQR, 12-47). Median FIM-M change was 18 (IQR, 9-34) points. About 38.5% patients achieved the minimal clinically important difference. Eighteen point six percent and 32.0% of the patients recovered to a stage of either mild (FIM-M ≥62) or moderate (FIM-M 38-61) MI, respectively. All between-CMG differences were statistically significant. Outcomes have also been analyzed according to classification systems used in Australia and Canada. The scoring rule had an area under the curve of 0.833 (95% confidence interval, 0.808-0.858). Decision curve analysis displayed large net benefit of using the risk score compared with the treat all strategy. CONCLUSIONS This study provides a snapshot of rehabilitation outcomes in a large cohort of patients with severe poststroke MI, thus filling a gap in knowledge. The scoring rule accurately identified the patients at risk for treatment failure.
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Affiliation(s)
- Domenico Scrutinio
- Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S., Cassano Murge, Italy.
| | - Pietro Guida
- Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S., Cassano Murge, Italy
| | - Bernardo Lanzillo
- Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S., Telese Terme, Italy
| | - Chiara Ferretti
- Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S., Montescano, Italy
| | - Anna Loverre
- Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S., Cassano Murge, Italy
| | - Nicola Montrone
- Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S., Cassano Murge, Italy
| | - Simona Spaccavento
- Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S., Cassano Murge, Italy
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19
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Forti P, Maioli F, Magni E, Ragazzoni L, Piperno R, Zoli M, Coveri M, Procaccianti G. Risk of Exclusion From Stroke Rehabilitation in the Oldest Old. Arch Phys Med Rehabil 2018; 99:477-483. [DOI: 10.1016/j.apmr.2017.08.469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/05/2017] [Accepted: 08/02/2017] [Indexed: 11/24/2022]
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20
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Scrutinio D, Lanzillo B, Guida P, Mastropasqua F, Monitillo V, Pusineri M, Formica R, Russo G, Guarnaschelli C, Ferretti C, Calabrese G. Development and Validation of a Predictive Model for Functional Outcome After Stroke Rehabilitation. Stroke 2017; 48:3308-3315. [DOI: 10.1161/strokeaha.117.018058] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/18/2017] [Accepted: 08/08/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Domenico Scrutinio
- From the Institute of Cassano Murge (Bari), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (D.S., P.G., F.M., V.M., R.F.); Institute of Telese Terme (Benevento), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (B.L., G.R.); Institute of Montescano (Pavia), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (C.G., C.F.); Institute of Marina di Ginosa (Taranto), Istituti Clinici Scientifici Maugeri-SPA SB, Italy (G.C.); and Post-degree Medical School of
| | - Bernardo Lanzillo
- From the Institute of Cassano Murge (Bari), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (D.S., P.G., F.M., V.M., R.F.); Institute of Telese Terme (Benevento), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (B.L., G.R.); Institute of Montescano (Pavia), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (C.G., C.F.); Institute of Marina di Ginosa (Taranto), Istituti Clinici Scientifici Maugeri-SPA SB, Italy (G.C.); and Post-degree Medical School of
| | - Pietro Guida
- From the Institute of Cassano Murge (Bari), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (D.S., P.G., F.M., V.M., R.F.); Institute of Telese Terme (Benevento), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (B.L., G.R.); Institute of Montescano (Pavia), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (C.G., C.F.); Institute of Marina di Ginosa (Taranto), Istituti Clinici Scientifici Maugeri-SPA SB, Italy (G.C.); and Post-degree Medical School of
| | - Filippo Mastropasqua
- From the Institute of Cassano Murge (Bari), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (D.S., P.G., F.M., V.M., R.F.); Institute of Telese Terme (Benevento), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (B.L., G.R.); Institute of Montescano (Pavia), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (C.G., C.F.); Institute of Marina di Ginosa (Taranto), Istituti Clinici Scientifici Maugeri-SPA SB, Italy (G.C.); and Post-degree Medical School of
| | - Vincenzo Monitillo
- From the Institute of Cassano Murge (Bari), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (D.S., P.G., F.M., V.M., R.F.); Institute of Telese Terme (Benevento), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (B.L., G.R.); Institute of Montescano (Pavia), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (C.G., C.F.); Institute of Marina di Ginosa (Taranto), Istituti Clinici Scientifici Maugeri-SPA SB, Italy (G.C.); and Post-degree Medical School of
| | - Monica Pusineri
- From the Institute of Cassano Murge (Bari), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (D.S., P.G., F.M., V.M., R.F.); Institute of Telese Terme (Benevento), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (B.L., G.R.); Institute of Montescano (Pavia), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (C.G., C.F.); Institute of Marina di Ginosa (Taranto), Istituti Clinici Scientifici Maugeri-SPA SB, Italy (G.C.); and Post-degree Medical School of
| | - Roberto Formica
- From the Institute of Cassano Murge (Bari), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (D.S., P.G., F.M., V.M., R.F.); Institute of Telese Terme (Benevento), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (B.L., G.R.); Institute of Montescano (Pavia), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (C.G., C.F.); Institute of Marina di Ginosa (Taranto), Istituti Clinici Scientifici Maugeri-SPA SB, Italy (G.C.); and Post-degree Medical School of
| | - Giovanna Russo
- From the Institute of Cassano Murge (Bari), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (D.S., P.G., F.M., V.M., R.F.); Institute of Telese Terme (Benevento), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (B.L., G.R.); Institute of Montescano (Pavia), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (C.G., C.F.); Institute of Marina di Ginosa (Taranto), Istituti Clinici Scientifici Maugeri-SPA SB, Italy (G.C.); and Post-degree Medical School of
| | - Caterina Guarnaschelli
- From the Institute of Cassano Murge (Bari), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (D.S., P.G., F.M., V.M., R.F.); Institute of Telese Terme (Benevento), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (B.L., G.R.); Institute of Montescano (Pavia), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (C.G., C.F.); Institute of Marina di Ginosa (Taranto), Istituti Clinici Scientifici Maugeri-SPA SB, Italy (G.C.); and Post-degree Medical School of
| | - Chiara Ferretti
- From the Institute of Cassano Murge (Bari), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (D.S., P.G., F.M., V.M., R.F.); Institute of Telese Terme (Benevento), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (B.L., G.R.); Institute of Montescano (Pavia), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (C.G., C.F.); Institute of Marina di Ginosa (Taranto), Istituti Clinici Scientifici Maugeri-SPA SB, Italy (G.C.); and Post-degree Medical School of
| | - Gianluigi Calabrese
- From the Institute of Cassano Murge (Bari), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (D.S., P.G., F.M., V.M., R.F.); Institute of Telese Terme (Benevento), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (B.L., G.R.); Institute of Montescano (Pavia), Istituti Clinici Scientifici Maugeri-SPA SB, I.R.C.C.S., Italy (C.G., C.F.); Institute of Marina di Ginosa (Taranto), Istituti Clinici Scientifici Maugeri-SPA SB, Italy (G.C.); and Post-degree Medical School of
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21
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Murata K, Hinotsu S, Sadamasa N, Yoshida K, Yamagata S, Asari S, Miyamoto S, Kawakami K. Healthcare resource utilization and clinical outcomes associated with acute care and inpatient rehabilitation of stroke patients in Japan. Int J Qual Health Care 2017; 29:26-31. [PMID: 27979962 DOI: 10.1093/intqhc/mzw127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 11/09/2016] [Indexed: 01/14/2023] Open
Abstract
Objective To investigate healthcare resource utilization and changes in functional status in stroke patients during hospitalization in an acute hospital and a rehabilitation hospital. Design Retrospective cohort study. Setting One acute and one rehabilitation hospital in Japan. Participants Patients who were admitted to the acute hospital due to stroke onset and then transferred to the rehabilitation hospital (n = 263, 56% male, age 70 ± 12 years). Main outcome measures Hospitalization costs and functional independence measure (FIM) were evaluated according to stroke subtype and severity of disability at discharge from the acute hospital. Results Median (IQR) costs at the acute hospital were dependent on the length of stay (LOS) and implementation of neurosurgery, which resulted in higher costs in subarachnoid hemorrhage [$52 413 ($49 166-$72 606) vs $14 129 ($11 169-$19 459) in cerebral infarction; and vs $15 035 ($10 920-$21 864) in intracerebral hemorrhage]. The costs at the rehabilitation hospital were dependent on LOS, and higher in patients with moderate disability than in those with mild disability [$30 026 ($18 419-$39 911) vs $18 052 ($10 631-$24 384)], while those with severe disability spent $25 476 ($13 340-$43 032). Patients with moderate disability gained the most benefits during hospitalization in the rehabilitation hospital, with a median (IQR) total FIM gain of 16 (5-24) points, compared with a modest improvement in patients with mild (6, 2-14) or severe disability (0, 0-5). Conclusions The costs for in-hospital stroke care were substantial and the improvement in functional status varied by severity of disability. Our findings would be valuable to organize efficient post-acute stroke care.
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Affiliation(s)
- Kyoko Murata
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Shiro Hinotsu
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Nobutake Sadamasa
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | - Kazumichi Yoshida
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sen Yamagata
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | - Shoji Asari
- Department of Neurosurgery, Kurashiki Rehabilitation Hospital, Okayama, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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22
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Xian Y, Thomas L, Liang L, Federspiel JJ, Webb LE, Bushnell CD, Duncan PW, Schwamm LH, Stein J, Fonarow GC, Hoenig H, Montalvo C, George MG, Lutz BJ, Peterson ED, Bettger JP. Unexplained Variation for Hospitals’ Use of Inpatient Rehabilitation and Skilled Nursing Facilities After an Acute Ischemic Stroke. Stroke 2017; 48:2836-2842. [DOI: 10.1161/strokeaha.117.016904] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 07/14/2017] [Accepted: 08/01/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Ying Xian
- From the Duke Clinical Research Institute, Durham, NC (Y.X., L.T., L.L., J.J.F., L.E.W., E.D.P., J.P.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD (J.J.F.); Department of Neurology, Wake Forest Baptist Health, Winston Salem, NC (C.D.B., P.W.D.); Stroke Service and Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); Department of
| | - Laine Thomas
- From the Duke Clinical Research Institute, Durham, NC (Y.X., L.T., L.L., J.J.F., L.E.W., E.D.P., J.P.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD (J.J.F.); Department of Neurology, Wake Forest Baptist Health, Winston Salem, NC (C.D.B., P.W.D.); Stroke Service and Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); Department of
| | - Li Liang
- From the Duke Clinical Research Institute, Durham, NC (Y.X., L.T., L.L., J.J.F., L.E.W., E.D.P., J.P.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD (J.J.F.); Department of Neurology, Wake Forest Baptist Health, Winston Salem, NC (C.D.B., P.W.D.); Stroke Service and Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); Department of
| | - Jerome J. Federspiel
- From the Duke Clinical Research Institute, Durham, NC (Y.X., L.T., L.L., J.J.F., L.E.W., E.D.P., J.P.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD (J.J.F.); Department of Neurology, Wake Forest Baptist Health, Winston Salem, NC (C.D.B., P.W.D.); Stroke Service and Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); Department of
| | - Laura E. Webb
- From the Duke Clinical Research Institute, Durham, NC (Y.X., L.T., L.L., J.J.F., L.E.W., E.D.P., J.P.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD (J.J.F.); Department of Neurology, Wake Forest Baptist Health, Winston Salem, NC (C.D.B., P.W.D.); Stroke Service and Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); Department of
| | - Cheryl D. Bushnell
- From the Duke Clinical Research Institute, Durham, NC (Y.X., L.T., L.L., J.J.F., L.E.W., E.D.P., J.P.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD (J.J.F.); Department of Neurology, Wake Forest Baptist Health, Winston Salem, NC (C.D.B., P.W.D.); Stroke Service and Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); Department of
| | - Pamela W. Duncan
- From the Duke Clinical Research Institute, Durham, NC (Y.X., L.T., L.L., J.J.F., L.E.W., E.D.P., J.P.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD (J.J.F.); Department of Neurology, Wake Forest Baptist Health, Winston Salem, NC (C.D.B., P.W.D.); Stroke Service and Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); Department of
| | - Lee H. Schwamm
- From the Duke Clinical Research Institute, Durham, NC (Y.X., L.T., L.L., J.J.F., L.E.W., E.D.P., J.P.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD (J.J.F.); Department of Neurology, Wake Forest Baptist Health, Winston Salem, NC (C.D.B., P.W.D.); Stroke Service and Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); Department of
| | - Joel Stein
- From the Duke Clinical Research Institute, Durham, NC (Y.X., L.T., L.L., J.J.F., L.E.W., E.D.P., J.P.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD (J.J.F.); Department of Neurology, Wake Forest Baptist Health, Winston Salem, NC (C.D.B., P.W.D.); Stroke Service and Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); Department of
| | - Gregg C. Fonarow
- From the Duke Clinical Research Institute, Durham, NC (Y.X., L.T., L.L., J.J.F., L.E.W., E.D.P., J.P.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD (J.J.F.); Department of Neurology, Wake Forest Baptist Health, Winston Salem, NC (C.D.B., P.W.D.); Stroke Service and Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); Department of
| | - Helen Hoenig
- From the Duke Clinical Research Institute, Durham, NC (Y.X., L.T., L.L., J.J.F., L.E.W., E.D.P., J.P.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD (J.J.F.); Department of Neurology, Wake Forest Baptist Health, Winston Salem, NC (C.D.B., P.W.D.); Stroke Service and Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); Department of
| | - Cris Montalvo
- From the Duke Clinical Research Institute, Durham, NC (Y.X., L.T., L.L., J.J.F., L.E.W., E.D.P., J.P.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD (J.J.F.); Department of Neurology, Wake Forest Baptist Health, Winston Salem, NC (C.D.B., P.W.D.); Stroke Service and Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); Department of
| | - Mary G. George
- From the Duke Clinical Research Institute, Durham, NC (Y.X., L.T., L.L., J.J.F., L.E.W., E.D.P., J.P.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD (J.J.F.); Department of Neurology, Wake Forest Baptist Health, Winston Salem, NC (C.D.B., P.W.D.); Stroke Service and Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); Department of
| | - Barbara J. Lutz
- From the Duke Clinical Research Institute, Durham, NC (Y.X., L.T., L.L., J.J.F., L.E.W., E.D.P., J.P.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD (J.J.F.); Department of Neurology, Wake Forest Baptist Health, Winston Salem, NC (C.D.B., P.W.D.); Stroke Service and Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); Department of
| | - Eric D. Peterson
- From the Duke Clinical Research Institute, Durham, NC (Y.X., L.T., L.L., J.J.F., L.E.W., E.D.P., J.P.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD (J.J.F.); Department of Neurology, Wake Forest Baptist Health, Winston Salem, NC (C.D.B., P.W.D.); Stroke Service and Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); Department of
| | - Janet Prvu Bettger
- From the Duke Clinical Research Institute, Durham, NC (Y.X., L.T., L.L., J.J.F., L.E.W., E.D.P., J.P.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD (J.J.F.); Department of Neurology, Wake Forest Baptist Health, Winston Salem, NC (C.D.B., P.W.D.); Stroke Service and Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); Department of
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Lynch EA, Cadilhac DA, Luker JA, Hillier SL. Inequities in access to inpatient rehabilitation after stroke: an international scoping review. Top Stroke Rehabil 2017; 24:619-626. [PMID: 28835194 DOI: 10.1080/10749357.2017.1366010] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background Inequities in accessing inpatient rehabilitation after stroke have been reported in many countries and impact on patient outcomes. Objective To explore variation in international recommendations regarding which patients should receive inpatient rehabilitation after stroke and to describe reported access to rehabilitation. Methods A scoping review was conducted to identify clinical guidelines with recommendations regarding which patients should access inpatient rehabilitation after stroke, and data regarding the proportion of patients accessing stroke rehabilitation. Four bibliographic databases and grey literature were searched. Results Twenty-eight documents were included. Selection criteria for post-acute inpatient rehabilitation were identified for 14 countries or regions and summary data on the proportion of patients receiving inpatient rehabilitation were identified for 14 countries. In Australia, New Zealand, and the United Kingdom, it is recommended that all patients with stroke symptoms should access rehabilitation, whereas guidelines from the United States, Canada, and Europe did not consistently recommend rehabilitation for people with severe stroke. Access to inpatient rehabilitation ranged from 13% in Sweden to 57% in Israel. Differences in availability of early supported discharge/home rehabilitation programs and variations in reporting methods may influence the ability to reliably compare access to rehabilitation between regions. Conclusion Recommendations regarding which patients with moderate and severe strokes should access ongoing rehabilitation are inconsistent. Clinical practice guidelines from different countries regarding post-stroke rehabilitation do not always reflect the evidence regarding the likely benefits to people with stroke. Inequity in access to rehabilitation after stroke is an international issue.
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Affiliation(s)
- Elizabeth A Lynch
- a Sansom Institute for Health Research, University of South Australia , Adelaide , Australia.,b Stroke Division , The Florey Institute of Neuroscience and Mental Health , Heidelberg , Australia.,c NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery , Melbourne , Australia.,d Adelaide Nursing School , University of Adelaide , Adelaide , Australia
| | - Dominique A Cadilhac
- b Stroke Division , The Florey Institute of Neuroscience and Mental Health , Heidelberg , Australia.,c NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery , Melbourne , Australia.,e Stroke and Ageing Research Centre, Department of Medicine , Monash University , Melbourne , Australia
| | - Julie A Luker
- a Sansom Institute for Health Research, University of South Australia , Adelaide , Australia.,b Stroke Division , The Florey Institute of Neuroscience and Mental Health , Heidelberg , Australia.,c NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery , Melbourne , Australia
| | - Susan L Hillier
- a Sansom Institute for Health Research, University of South Australia , Adelaide , Australia
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Finding the "Right-Size" Physical Therapy Workforce: International Perspective Across 4 Countries. Phys Ther 2016; 96:1597-1609. [PMID: 27149960 DOI: 10.2522/ptj.20160014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/28/2016] [Indexed: 02/09/2023]
Abstract
Finding the "right-size" physical therapy workforce is an increasingly important issue, but it has had limited study, particularly across nations. This perspective article provides a comprehensive examination of physical therapy workforce issues across 4 countries (United States, Singapore, Portugal, and Bangladesh), which were deliberately selected to allow consideration of key contextual factors. This investigation provides a theoretical model uniquely adapted to focus on variables most likely to affect physical therapy workforce needs. This theoretical model was used to guide acquisition of public domain data across the respective countries. The data then were used to provide a contextualized interpretation about the physical therapy workforce supply (ie, physical therapists per capita) across the 4 countries in light of the following factors: indicators of physical therapy need, financial and administrative barriers affecting physical therapy access and demand, the proportion of physical therapy graduates (with varying trends over time across the countries), and the role of emigration/immigration in supply inequalities among countries of lower and higher income. In addition, both the physical therapy workforce supply and scope of practice were analyzed in the context of other related professions across the 4 countries. This international comparison indicated that there may not be a "one-size-fits-all" recommendation for physical therapy workforce supply across countries or an ideal formula for its determination. The optimal, country-specific physical therapy workforce supply appears to be affected by discipline-specific health care and contextual factors that may vary across countries, and even within the same country. This article provides a conceptual framework and basis for such contextualized evaluations of the physical therapy workforce.
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Lam Wai Shun P, Bottari C, Ogourtsova T, Swaine B. Exploring factors influencing occupational therapists’ perception of patients’ rehabilitation potential after acquired brain injury. Aust Occup Ther J 2016; 64:149-158. [DOI: 10.1111/1440-1630.12327] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Priscilla Lam Wai Shun
- Occupational Therapy; School of Rehabilitation; Faculty of Medicine; Université de Montréal; Montréal Québec Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal; Lucie-Bruneau Rehabilitation Centre; Montréal Québec Canada
| | - Carolina Bottari
- Occupational Therapy; School of Rehabilitation; Faculty of Medicine; Université de Montréal; Montréal Québec Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal; Lucie-Bruneau Rehabilitation Centre; Montréal Québec Canada
| | - Tatiana Ogourtsova
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal; Lucie-Bruneau Rehabilitation Centre; Montréal Québec Canada
- School of Physical and Occupational Therapy; Faculty of Medicine; McGill University; Montréal Québec Canada
| | - Bonnie Swaine
- Occupational Therapy; School of Rehabilitation; Faculty of Medicine; Université de Montréal; Montréal Québec Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal; Lucie-Bruneau Rehabilitation Centre; Montréal Québec Canada
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Lynch EA, Cadilhac DA, Luker JA, Hillier SL. Education-only versus a multifaceted intervention for improving assessment of rehabilitation needs after stroke; a cluster randomised trial. Implement Sci 2016; 11:120. [PMID: 27604792 PMCID: PMC5015218 DOI: 10.1186/s13012-016-0487-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 08/28/2016] [Indexed: 01/19/2023] Open
Abstract
Background In 2011, more than half of the patients with stroke in Australian hospitals were not assessed for the need for rehabilitation. Further, there were no recommended criteria to guide rehabilitation assessment decisions. Subsequently, a decision-making tool called the Assessment for Rehabilitation Tool (ART) was developed. The ART was designed to assist Australian hospital clinicians to identify the rehabilitation needs of patients with stroke using evidence-based criteria. The ART was released and made freely available for use in 2012. This study evaluated the effectiveness of an education-only intervention (1 onsite education session and distribution of the ART) and a multifaceted intervention (2 or more onsite education sessions, distribution of the ART, audit and feedback, barrier identification, site-specific strategy development, promotion of interdisciplinary teamwork, opinion leaders and reminders) for improving assessments of rehabilitation needs after stroke. Methods Ten hospitals in 2 states of Australia were randomly assigned to an education-only or a multifaceted intervention. Medical records were audited by assessors blinded to group allocation before and after the implementation period. Difference in the proportion of patients assessed for rehabilitation before and after the intervention was analysed using mixed-effects logistic regression analysis, with time period as the dependent variable, an interaction between intervention type and time included to test for differences between the interventions, and hospital included as the random effect to account for patient clustering. Results Data from 586 patients (284 pre-intervention; 302 post-intervention; age 76 years, 59 % male) showed that the multifaceted intervention was not more effective than education-only in improving the proportion of patients whose rehabilitation needs were assessed (reference category education-only; odds ratio 1.29, 95 % confidence interval 0.63–2.67, p = 0.483). Post-intervention, the odds of a patient’s rehabilitation needs being assessed was 3.69 times greater than pre-intervention (95 % confidence interval 2.57–5.30, p < 0.001). Evidence-based criteria were not consistently used when patients were deemed to have no rehabilitation needs. Conclusions A multifaceted intervention was not more effective than education-only in improving the assessment of rehabilitation needs of patients with stroke. Further interventions are required to ensure that all patients are assessed for the need for rehabilitation using evidence-based criteria. Trial registration ANZCTR (Australian New Zealand Clinical Trials Registry), ACTRN12616000340437 Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0487-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elizabeth A Lynch
- Department of Health Sciences, International Centre for Allied Health Evidence, University of South Australia, GPO Box 2471, Adelaide, 5001, Australia. .,Stroke Division, The Florey Institute of Neuroscience and Mental Health, 245 Burgundy St, Heidelberg, 3084, VIC, Australia. .,NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Parkville, VIC, Australia.
| | - Dominique A Cadilhac
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, 245 Burgundy St, Heidelberg, 3084, VIC, Australia.,NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Parkville, VIC, Australia.,Department of Medicine, Stroke and Ageing Research Centre, Monash University, Clayton, 3800, VIC, Australia
| | - Julie A Luker
- Department of Health Sciences, International Centre for Allied Health Evidence, University of South Australia, GPO Box 2471, Adelaide, 5001, Australia.,Stroke Division, The Florey Institute of Neuroscience and Mental Health, 245 Burgundy St, Heidelberg, 3084, VIC, Australia.,NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Parkville, VIC, Australia
| | - Susan L Hillier
- Department of Health Sciences, International Centre for Allied Health Evidence, University of South Australia, GPO Box 2471, Adelaide, 5001, Australia
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Cormier DJ, Frantz MA, Rand E, Stein J. Physiatrist referral preferences for postacute stroke rehabilitation. Medicine (Baltimore) 2016; 95:e4356. [PMID: 27537563 PMCID: PMC5370790 DOI: 10.1097/md.0000000000004356] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/13/2016] [Accepted: 07/03/2016] [Indexed: 11/26/2022] Open
Abstract
This study was intended to determine if there is variation among physiatrists in referral preferences for postacute rehabilitation for stroke patients based on physician demographic characteristics or geography.A cross-sectional survey study was developed with 5 fictional case vignettes that included information about medical, social, and functional domains. Eighty-six physiatrist residents, fellows, and attendings were asked to select the most appropriate postacute rehabilitation setting and also to rank, by importance, 15 factors influencing the referral decision. Chi-square bivariate analysis was used to analyze the data.Eighty-six surveys were collected over a 3-day period. Bivariate analysis (using chi-square) showed no statistically significant relationship between any of the demographic variables and poststroke rehabilitation preference for any of the cases. The prognosis for functional outcome and quality of postacute facility had the highest mean influence ratings (8.63 and 8.31, respectively), whereas location of postacute facility and insurance had the lowest mean influence ratings (5.74 and 5.76, respectively).Physiatrists' referral preferences did not vary with any identified practitioner variables or geographic region; referral preferences only varied significantly by case.
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Affiliation(s)
- David J. Cormier
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons
- Division of Rehabilitation Medicine, Weill Cornell Medical College
- New York-Presbyterian Hospital, New York, NY
| | - Megan A. Frantz
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons
- Division of Rehabilitation Medicine, Weill Cornell Medical College
- New York-Presbyterian Hospital, New York, NY
| | - Ethan Rand
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons
- Division of Rehabilitation Medicine, Weill Cornell Medical College
- New York-Presbyterian Hospital, New York, NY
| | - Joel Stein
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons
- Division of Rehabilitation Medicine, Weill Cornell Medical College
- New York-Presbyterian Hospital, New York, NY
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Magdon-Ismail Z, Sicklick A, Hedeman R, Bettger JP, Stein J. Selection of Postacute Stroke Rehabilitation Facilities: A Survey of Discharge Planners From the Northeast Cerebrovascular Consortium (NECC) Region. Medicine (Baltimore) 2016; 95:e3206. [PMID: 27100410 PMCID: PMC4845814 DOI: 10.1097/md.0000000000003206] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/14/2016] [Accepted: 03/05/2016] [Indexed: 11/29/2022] Open
Abstract
The process of determining the level of care and specific postacute care facility for stroke patients has not been adequately studied. The objective of this study was to better understand the factors that influence postacute care decisions by surveying stroke discharge planners. Requests were sent to discharge planners at 471 hospitals in the Northeast United States to complete an online survey regarding the factors impacting the selection of postacute care. Seventy-seven (16%) discharge planners completed the online survey. Respondents were mainly nurses and social workers and 73% reported ≥20 years healthcare experience. Patients and families were found to be significantly more influential than physicians (P < 0.001) and other clinicians (P = 0.04) in influencing postdischarge care. Other clinicians were significantly more influential than physicians (P < 0.001). Insurance and quality of postacute care were the factors likely to most affect the selection of postacute care facility. Insurance was also identified as the greatest barrier in the selection of level of postacute care (70%; P < 0.001) and specific postacute care facility (46%; P = 0.02). More than half reported that pressure to discharge patients quickly impacts a patients' final destination. Nonclinical factors are perceived by discharge planners to have a major influence on postacute stroke care decision making.
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Affiliation(s)
- Zainab Magdon-Ismail
- From the Association/American Stroke Association Founders Affiliate, Albany, NY (ZM-I); Gaylord Specialty Healthcare, Wallingford, CT (AS); Kessler Institute for Rehabilitation, West Orange (RH); Duke Clinical Research Institute, Durham, NC (JPB); Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons, New York, NY (JS); Division of Rehabilitation Medicine, Weill Cornell Medical College, New York, NY (JS); and New York-Presbyterian Hospital, New York, NY (JS)
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Lay S, Bernhardt J, West T, Churilov L, Dart A, Hayes K, Cumming TB. Is early rehabilitation a myth? Physical inactivity in the first week after myocardial infarction and stroke. Disabil Rehabil 2015; 38:1493-1499. [DOI: 10.3109/09638288.2015.1106598] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lynch EA, Luker JA, Cadilhac DA, Hillier SL. Inequities in access to rehabilitation: exploring how acute stroke unit clinicians decide who to refer to rehabilitation. Disabil Rehabil 2015; 38:1415-24. [PMID: 26605671 DOI: 10.3109/09638288.2015.1103791] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Less than half of the patients with stroke in Australian hospitals are assessed by rehabilitation specialists. We sought to explore how clinicians working in acute stroke units (ASUs) determine which patients to refer to rehabilitation services. METHOD Qualitative descriptive study. Team meetings were observed and medical records were reviewed over four weeks at two ASUs. Focus groups were conducted with staff from eight ASUs in two states of Australia. RESULTS Rehabilitation was mentioned in team meetings for 50/64 patients (78%) during the observation period. Rehabilitation referrals were organised for 47 patients (94%) for whom rehabilitation was discussed (74% of the sample); and for no patients when rehabilitation was not discussed. Factors identified that influenced whether referrals were organised included the anticipated discharge destination; severity of stroke; staff expectations of the patient's recovery; and if there was advocacy by families about rehabilitation. Clinicians tended to refer the patients they considered would be accepted by the rehabilitation service. Staff at two ASUs expressed concern that referring all patients with stroke-related deficits to rehabilitation would be unfavourable with rehabilitation providers. CONCLUSIONS Decisions made by ASU staff regarding who to refer to stroke rehabilitation are often not solely based on patients' rehabilitation requirements. Implications for Rehabilitation Not all patients on acute stroke units (ASUs) who may have benefited from rehabilitation were offered rehabilitation referrals. Criteria for rehabilitation referrals need to be made explicit and discussed openly with consumers, ASU clinicians and rehabilitation specialists. A change in rehabilitation assessment practices is required to provide data regarding the unmet rehabilitation needs of patients with stroke. New models of rehabilitation service delivery or increased rehabilitation services may be required to meet the rehabilitation needs of all patients with stroke.
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Affiliation(s)
- Elizabeth A Lynch
- a International Centre for Allied Health Evidence, University of South Australia , Adelaide , Australia
| | - Julie A Luker
- a International Centre for Allied Health Evidence, University of South Australia , Adelaide , Australia.,b Florey Institute of Neuroscience and Mental Health, University of Melbourne , Melbourne , Australia
| | - Dominique A Cadilhac
- b Florey Institute of Neuroscience and Mental Health, University of Melbourne , Melbourne , Australia ;,c Stroke and Ageing Research Group, Monash University , Melbourne , Australia
| | - Susan L Hillier
- a International Centre for Allied Health Evidence, University of South Australia , Adelaide , Australia
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Bilgin S, Guclu-Gunduz A, Oruckaptan H, Kose N, Celik B. Gait and Glasgow Coma Scale scores can predict functional recovery in patients with traumatic brain injury. Neural Regen Res 2015; 7:1978-84. [PMID: 25624828 PMCID: PMC4298893 DOI: 10.3969/j.issn.1673-5374.2012.25.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 08/15/2012] [Indexed: 11/21/2022] Open
Abstract
Fifty-one patients with mild (n = 14), moderate (n = 10) and severe traumatic brain injury (n = 27) received early rehabilitation. Level of consciousness was evaluated using the Glasgow Coma Score. Functional level was determined using the Glasgow Outcome Score, whilst mobility was evaluated using the Mobility Scale for Acute Stroke. Activities of daily living were assessed using the Barthel Index. Following Bobath neurodevelopmental therapy, the level of consciousness was significantly improved in patients with moderate and severe traumatic brain injury, but was not greatly influenced in patients with mild traumatic brain injury. Mobility and functional level were significantly improved in patients with mild, moderate and severe traumatic brain injury. Gait recovery was more obvious in patients with mild traumatic brain injury than in patients with moderate and severe traumatic brain injury. Activities of daily living showed an improvement but this was insignificant except for patients with severe traumatic brain injury. Nevertheless, complete recovery was not acquired at discharge. Multiple regression analysis showed that gait and Glasgow Coma Scale scores can be considered predictors of functional outcomes following traumatic brain injury.
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Affiliation(s)
- Sevil Bilgin
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Arzu Guclu-Gunduz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Hakan Oruckaptan
- Department of Neurosurgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nezire Kose
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Bülent Celik
- Department of Biostatistics, Faculty of Health Sciences, Gazi University, Ankara, Turkey
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Meyer MJ, Pereira S, McClure A, Teasell R, Thind A, Koval J, Richardson M, Speechley M. A systematic review of studies reporting multivariable models to predict functional outcomes after post-stroke inpatient rehabilitation. Disabil Rehabil 2014; 37:1316-23. [DOI: 10.3109/09638288.2014.963706] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Matthew J. Meyer
- Graduate Program in Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada,
- Ontario Stroke Network, Toronto, Ontario, Canada,
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada,
| | - Shelialah Pereira
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada,
| | - Andrew McClure
- Heart and Stroke Foundation of Canada, Toronto, Ontario, Canada,
| | - Robert Teasell
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada,
- Department of Physical Medicine and Rehabilitation, St Joseph's Health Care, London, Ontario, Canada,
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, London, Ontario, Canada,
| | - Amardeep Thind
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada, and
- Centre for Studies in Family Medicine, Western University, London Ontario, Canada
| | - John Koval
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada, and
| | - Marina Richardson
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, Ontario, Canada,
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada, and
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Admission to and Continuation of Inpatient Stroke Rehabilitation in Queensland, Australia: A Survey of Factors that Contribute to the Consultant's Decision. BRAIN IMPAIR 2014. [DOI: 10.1017/brimp.2014.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aim: To evaluate factors that may contribute to the decision of the consultant medical officer (CMO) to: (1) admit a person with stroke to inpatient rehabilitation from acute hospitalisation; and (2) continue or cease inpatient rehabilitation.Methods: A web-based survey of CMOs practising in Queensland Australia, who were members of the Australian and New Zealand Society of Geriatric Medicine (n ~ 90) or the Queensland Stroke Clinical Network (n ~ 30) was completed. The survey contained two sections to explore factors that could: (1) favour or disfavour admission to inpatient rehabilitation from acute hospitalisation; and (2) favour continuation or cessation of inpatient rehabilitation. Open and closed questions were used.Results: Twenty-one CMOs (13–20% response rate, 43% geriatrician) completed the survey. Factors related to physical function, along with the presence of social supports favoured admission, while the presence of behavioural and cognitive impairments and a lack of staff capacity disfavoured admission. Improvements in function favoured continuation of inpatient rehabilitation, while a lack of improvement favoured cessation.Conclusion: Factors related to the patient, their social support network and the organisation were found to influence the decision of the CMO to admit a person with stroke to inpatient rehabilitation from acute hospitalisation. Once in rehabilitation, demonstration of benefit was consistently reported to indicate continued service need.
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Wolfe CDA, Rudd AG, McKevitt C. Modelling, evaluating and implementing cost-effective services to reduce the impact of stroke. PROGRAMME GRANTS FOR APPLIED RESEARCH 2014. [DOI: 10.3310/pgfar02020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BackgroundStroke is a leading cause of death and disability but there is little information on the longer-term needs of patients and those of different ethnic groups.ObjectivesTo estimate risk of stroke, longer-term needs and outcomes, risk of recurrence, trends and predictors of effective care, to model cost-effective configurations of care, to understand stakeholders’ perspectives of services and to develop proposals to underpin policy.DesignPopulation-based stroke register, univariate and multivariate analyses, Markov and discrete event simulation, and qualitative methods for stakeholder perspectives of care and outcome.SettingSouth London, UK, with modelling for estimates of cost-effectiveness.ParticipantsInner-city population of 271,817 with first stroke in lifetime between 1995 and 2012.Outcome measuresStroke incidence rates and trends, recurrence, survival, activities of daily living, anxiety, depression, quality of life, appropriateness and cost-effectiveness of care, and qualitative narratives of perspectives.Data sourcesSouth London Stroke Register (SLSR), qualitative data, group discussions.ResultsStroke incidence has decreased since 1995, particularly in the white population, but with a higher stroke risk in black groups. There are variations in risk factors and types of stroke between ethnic groups and a large number of strokes occurred in people with untreated risk factors with no improvement in detection observed over time. A total of 30% of survivors have a poor range of outcomes up to 10 years after stroke with differences in outcomes by sociodemographic group. Depression affects over half of all stroke patients and the prevalence of cognitive impairment remains 22%. Survival has improved significantly, particularly in the older black groups, and the cumulative risk of recurrence at 10 years is 24.5%. The proportion of patients receiving effective acute stroke care has significantly improved, yet inequalities of provision remain. Using register data, the National Audit Office (NAO) compared the levels of stroke care in the UK in 2010 with previous provision levels and demonstrated that improvements have been cost-effective. The treatment of, and productivity loss arising from, stroke results in total societal costs of £8.9B a year and 5% of UK NHS costs. Stroke unit care followed by early supported discharge is a cost-effective strategy, with the main gain being years of life saved. Half of stroke survivors report unmet long-term needs. Needs change over time, but may not be stroke specific. Analysis of patient journeys suggests that provision of care is also influenced by structural, social and personal characteristics.Conclusions/recommendationsThe SLSR has been a platform for a range of health services research activities of international relevance. The programme has produced data to inform policy and practice with estimates of need for stroke prevention and care services, identification of persistent sociodemographic inequalities in risk and care despite a reduction in stroke risk, quantification of the effectiveness and cost-effectiveness of care and development of models to simulate configurations of care. Stroke is a long-term condition with significant social impact and the data on need and economic modelling have been utilised by the Department of Health, the NAO and Healthcare for London to assess need and model cost-effective options for stroke care. Novel approaches are now required to ensure that such information is used effectively to improve population and patient outcomes.FundingThe National Institute for Health Research Programme Grants for Applied Research programme and the Department of Health via the National Institute for Health Research Biomedical Research Centre award to Guy’s and St Thomas’ NHS Foundation Trust in partnership with King’s College London.
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Affiliation(s)
- Charles DA Wolfe
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, School of Medicine, King’s College London, London, UK
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, UK
| | - Anthony G Rudd
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, School of Medicine, King’s College London, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Christopher McKevitt
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, School of Medicine, King’s College London, London, UK
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, UK
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Kraut JC, Singer BJ, Singer KP. Referrer and service provider beliefs and attitudes towards rehabilitation in the home; factors related to utilisation of Early Supported Discharge. Disabil Rehabil 2014; 36:2178-86. [PMID: 24588069 DOI: 10.3109/09638288.2014.893373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the attitudes and beliefs held by referrers and service providers of an Australian Early Supported Discharge (ESD) service called "Rehabilitation in the Home" (RITH); with particular consideration of factors that may influence referral to RITH. METHODS A cross-sectional online survey based on the Theory of Planned Behaviour was undertaken. RESULTS There were 113 respondents; 90 referrers and 23 service providers. Referrers and RITH staff had a moderately favourable attitude towards RITH. The majority of referrers, and, to a greater degree, RITH staff members, understood and appreciated the advantages ascribed to ESD. However, views varied with regard to some of the factors upon which the decision to refer to RITH rests. Two-fifths of referrers did not think that RITH provided hospital equivalent therapy intensity and over one-fifth of referrers had concerns about the capability of the RITH service to provide specialist stroke rehabilitation. Opinion of RITH staff was also varied on these topics. CONCLUSIONS This study provides evidence that there was a level of uncertainty amongst referrers and RITH service providers regarding issues directly and indirectly related to patient eligibility and RITH service capability. This uncertainty needs to be explored in future research. IMPLICATIONS FOR REHABILITATION Differences in views held by referrers and ESD service providers were identified in this study that could lead to inconsistencies in patient selection for, and under-utilization of, ESD services. Improved communication between referrers and ESD service providers, for instance attendance of RITH staff at inpatient team meetings, could ameliorate some of these misconceptions. On-going education of referrers about service capability is essential to ensure timely transfer of appropriate clients to ESD services.
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Affiliation(s)
- J C Kraut
- The Centre for Musculoskeletal Studies, School of Surgery, Faculty of Medicine, Dentistry and Health Science, The University of Western Australia , Perth, Western Australia , Australia and
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Reistetter TA, Karmarkar AM, Graham JE, Eschbach K, Kuo YF, Granger CV, Freeman J, Ottenbacher KJ. Regional variation in stroke rehabilitation outcomes. Arch Phys Med Rehabil 2014; 95:29-38. [PMID: 23921200 PMCID: PMC4006274 DOI: 10.1016/j.apmr.2013.07.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 06/18/2013] [Accepted: 07/09/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine and describe regional variation in outcomes for persons with stroke receiving inpatient medical rehabilitation. DESIGN Retrospective cohort design. SETTING Inpatient rehabilitation units and facilities contributing to the Uniform Data System for Medical Rehabilitation from the United States. PARTICIPANTS Patients (N=143,036) with stroke discharged from inpatient rehabilitation during 2006 and 2007. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Community discharge, length of stay (LOS), and discharge functional status ratings (motor, cognitive) across 10 geographic service regions defined by the Centers for Medicare and Medicaid Services (CMS). RESULTS Approximately 71% of the sample was discharged to the community. After adjusting for covariates, the percentage discharged to the community varied from 79.1% in the Southwest (CMS region 9) to 59.4% in the Northeast (CMS region 2). Adjusted LOS varied by 2.1 days, with CMS region 1 having the longest LOS at 18.3 days and CMS regions 5 and 9 having the shortest at 16.2 days. CONCLUSIONS Rehabilitation outcomes for persons with stroke varied across CMS regions. Substantial variation in discharge destination and LOS remained after adjusting for demographic and clinical characteristics.
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Affiliation(s)
- Timothy A Reistetter
- Department of Occupational Therapy, University of Texas Medical Branch, Galveston, TX.
| | - Amol M Karmarkar
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
| | - James E Graham
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
| | - Karl Eschbach
- Sealy Center on Aging and Division of Geriatrics, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
| | - Yong-Fang Kuo
- Sealy Center on Aging and Division of Geriatrics, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
| | - Carl V Granger
- Uniform Data System for Medical Rehabilitation, Buffalo, NY
| | - Jean Freeman
- Sealy Center on Aging and Division of Geriatrics, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
| | - Kenneth J Ottenbacher
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
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Bates BE, Kwong PL, Xie D, Valimahomed A, Ripley DC, Kurichi JE, Stineman MG. Factors Influencing Receipt of Early Rehabilitation After Stroke. Arch Phys Med Rehabil 2013; 94:2349-2356. [PMID: 23924439 DOI: 10.1016/j.apmr.2013.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 07/18/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
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A. McNulty P, G. Thompson-Butel A, T. Shiner C, Trinh T. Wii-based Movement Therapy benefits stroke patients with low and very low movement ability. ACTA ACUST UNITED AC 2013. [DOI: 10.1108/scn-04-2013-0018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Zucker I, Laxer I, Rasooli I, Han S, Cohen A, Shohat T. Regional gaps in the provision of inpatient rehabilitation services for the elderly in Israel: Results of a national survey. Isr J Health Policy Res 2013; 2:27. [PMID: 23880420 PMCID: PMC3751559 DOI: 10.1186/2045-4015-2-27] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 05/16/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Medical events, such as stroke, limb fractures, joint replacements and spinal injuries, can lead to acute functional disability at all ages and to chronic disability, especially among the elderly. Rehabilitation is, therefore, essential for the prevention of permanent disability among older individuals. There are international practice guidelines for stroke and hip fracture management, including recommendations that rehabilitation services be an integral part of the provision of treatment in either an inpatient setting or in the community. There are no organized data on provision of rehabilitation services in Israel or on the distribution of these services throughout the country. Such information would be of great assistance in designing these services where they are needed and in making changes in the existing ones where necessary. METHODS Patients aged 65 years or older with stroke or hip fracture were identified through one-day surveys conducted in 2009-2010 in all 26 acute care hospitals in Israel. Data on inpatient and ambulatory rehabilitation services were collected from discharge medical summaries, telephone interviews with the patients or their relatives and reports from the healthcare provider. The extent of rehabilitation services was described and the association between receipt of inpatient rehabilitation and the geographic district based on the patients' listed address was examined in a multivariate analysis. RESULTS A total of 570 patients with stroke and 768 patients with hip fracture were identified and interviews were conducted in regards to 421 and 672 respectively. Out of the stroke patients 238(56.5%) received inpatient rehabilitation, 46(10.9%) received ambulatory rehabilitation treatment without inpatient phase and 137 (32.5%) received no rehabilitation. In fracture these rates were 494(73.5%), 96(14.3%) and 82(12.2%) respectively. Patients living in districts with lower availability of rehabilitation beds were less likely to receive inpatient rehabilitation after controlling for patient characteristics. CONCLUSIONS Regional disparities in the provision of inpatient rehabilitation care for elderly after an acute episode of stroke or hip fracture were identified and could be partially attributed to the distribution of rehabilitation beds. These findings highlight the need to plan the rehabilitation resources based on the population needs and to routinely monitor the provision of these services.
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Affiliation(s)
- Inbar Zucker
- Israel Center of Disease Control, Ministry of Health, Jerusalem, Israel
| | - Irit Laxer
- Geriatrics Department, Ministry of Health, Jerusalem, Israel
| | - Iris Rasooli
- Geriatrics Department, Ministry of Health, Jerusalem, Israel
| | - Shulamit Han
- Geriatrics Department, Ministry of Health, Jerusalem, Israel
| | - Aaron Cohen
- Geriatrics Department, Ministry of Health, Jerusalem, Israel
| | - Tamar Shohat
- Israel Center of Disease Control, Ministry of Health, Jerusalem, Israel
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Factors Influencing Selection for Rehabilitation After Stroke: A Questionnaire Using Case Scenarios to Investigate Physician Perspectives and Level of Agreement. Arch Phys Med Rehabil 2012; 93:1457-9. [DOI: 10.1016/j.apmr.2011.11.036] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 11/07/2011] [Accepted: 11/30/2011] [Indexed: 10/28/2022]
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Béjot Y, Troisgros O, Gremeaux V, Lucas B, Jacquin A, Khoumri C, Aboa-Eboulé C, Benaïm C, Casillas JM, Giroud M. Poststroke Disposition and Associated Factors in a Population-Based Study. Stroke 2012; 43:2071-7. [DOI: 10.1161/strokeaha.112.658724] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The organization of poststroke care will be a major challenge in coming years. We aimed to assess hospital disposition after stroke and its associated factors in clinical practice.
Methods—
All cases of stroke from 2006 to 2010 were identified from the population-based Stroke Registry of Dijon, France. Demographic features, risk factors, and prestroke treatments were recorded. Admission stroke severity was assessed using the National Institutes of Health Stroke Scale score. At discharge, we collected dementia, disability using the modified Rankin Scale, length of stay, and hospital disposition (home, rehabilitation, convalescent home, and nursing home). Multivariate analyses were performed using logistic regression models to identify associated factors of postdischarge disposition.
Results—
Of the patients with 1069 stroke included, 913 survived acute care. Among them, 433 (47.4%) returned home, whereas 206 (22.6%) were discharged to rehabilitation, 134 (14.7%) were admitted to a convalescent home, and 140 (15.3%) to a nursing home. Old patients, those under anticoagulants before stroke, those with severe stroke on admission, severe disability at discharge, dementia, or prolonged length of stay were less likely to return home. Moreover, advanced age, severe initial stroke, severe disability at discharge, and dementia were associated with admission to convalescent and nursing homes rather than rehabilitation centers.
Conclusion—
This population-based study demonstrated that postdischarge destinations are associated with several factors. Our findings may be useful to establish health policy concerning the organization of poststroke care.
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Affiliation(s)
- Yannick Béjot
- From the Dijon Stroke Registry (Y.B., A.J., C.K., C.A.-E., M.G.), EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, Dijon, France; the Department of Rehabilitation (O.T., V.G., C.B., J.-M.C.), University Hospital of Dijon, Dijon, France; and the Department of Rehabilitation (B.L.), Divio Hospital, Dijon, France
| | - Odile Troisgros
- From the Dijon Stroke Registry (Y.B., A.J., C.K., C.A.-E., M.G.), EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, Dijon, France; the Department of Rehabilitation (O.T., V.G., C.B., J.-M.C.), University Hospital of Dijon, Dijon, France; and the Department of Rehabilitation (B.L.), Divio Hospital, Dijon, France
| | - Vincent Gremeaux
- From the Dijon Stroke Registry (Y.B., A.J., C.K., C.A.-E., M.G.), EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, Dijon, France; the Department of Rehabilitation (O.T., V.G., C.B., J.-M.C.), University Hospital of Dijon, Dijon, France; and the Department of Rehabilitation (B.L.), Divio Hospital, Dijon, France
| | - Brigitte Lucas
- From the Dijon Stroke Registry (Y.B., A.J., C.K., C.A.-E., M.G.), EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, Dijon, France; the Department of Rehabilitation (O.T., V.G., C.B., J.-M.C.), University Hospital of Dijon, Dijon, France; and the Department of Rehabilitation (B.L.), Divio Hospital, Dijon, France
| | - Agnès Jacquin
- From the Dijon Stroke Registry (Y.B., A.J., C.K., C.A.-E., M.G.), EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, Dijon, France; the Department of Rehabilitation (O.T., V.G., C.B., J.-M.C.), University Hospital of Dijon, Dijon, France; and the Department of Rehabilitation (B.L.), Divio Hospital, Dijon, France
| | - Catia Khoumri
- From the Dijon Stroke Registry (Y.B., A.J., C.K., C.A.-E., M.G.), EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, Dijon, France; the Department of Rehabilitation (O.T., V.G., C.B., J.-M.C.), University Hospital of Dijon, Dijon, France; and the Department of Rehabilitation (B.L.), Divio Hospital, Dijon, France
| | - Corine Aboa-Eboulé
- From the Dijon Stroke Registry (Y.B., A.J., C.K., C.A.-E., M.G.), EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, Dijon, France; the Department of Rehabilitation (O.T., V.G., C.B., J.-M.C.), University Hospital of Dijon, Dijon, France; and the Department of Rehabilitation (B.L.), Divio Hospital, Dijon, France
| | - Charles Benaïm
- From the Dijon Stroke Registry (Y.B., A.J., C.K., C.A.-E., M.G.), EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, Dijon, France; the Department of Rehabilitation (O.T., V.G., C.B., J.-M.C.), University Hospital of Dijon, Dijon, France; and the Department of Rehabilitation (B.L.), Divio Hospital, Dijon, France
| | - Jean-Marie Casillas
- From the Dijon Stroke Registry (Y.B., A.J., C.K., C.A.-E., M.G.), EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, Dijon, France; the Department of Rehabilitation (O.T., V.G., C.B., J.-M.C.), University Hospital of Dijon, Dijon, France; and the Department of Rehabilitation (B.L.), Divio Hospital, Dijon, France
| | - Maurice Giroud
- From the Dijon Stroke Registry (Y.B., A.J., C.K., C.A.-E., M.G.), EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, Dijon, France; the Department of Rehabilitation (O.T., V.G., C.B., J.-M.C.), University Hospital of Dijon, Dijon, France; and the Department of Rehabilitation (B.L.), Divio Hospital, Dijon, France
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de Peretti C, Nicolau J, Tuppin P, Schnitzler A, Woimant F. Évolutions de la prise en charge hospitalière des accidents vasculaires cérébraux en court séjour et en soins de suite et de réadaptation entre 2007 et 2009 en France. Presse Med 2012; 41:491-503. [DOI: 10.1016/j.lpm.2012.01.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 01/03/2012] [Accepted: 01/27/2012] [Indexed: 10/28/2022] Open
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Hakkennes SJ, Brock K, Hill KD. Selection for Inpatient Rehabilitation After Acute Stroke: A Systematic Review of the Literature. Arch Phys Med Rehabil 2011; 92:2057-70. [DOI: 10.1016/j.apmr.2011.07.189] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 07/03/2011] [Accepted: 07/12/2011] [Indexed: 01/04/2023]
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Abstract
In this article, Ontario's stroke rehabilitation system is used to exemplify the challenges faced by rehabilitation and healthcare systems across Canada who are attempting to provide quality care to patients in the face of increasing demands. Currently, Ontario's rehabilitation system struggles in its efforts to provide accessible and comprehensive care to patients recovering from stroke. We begin our exploration by identifying both the primary stakeholders and the underlying factors that have contributed to the current challenges. The framework put forward in the Canadian Medical Association's recommendations for transformation is then used to suggest a vision for a more patient-focused system incorporating three key principles: a broader perspective, a patient-first approach, and greater unity. The use of health information technology, proper incentives, and greater accountability are discussed as mechanisms to improve the quality and efficiency of care.
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