Need for improved rehabilitation assessment for patients experiencing stroke in Australia

A/Prof Cadilhac

Australian patients with stroke are not being adequately assessed for rehabilitation due to health professionals’ preconceived beliefs about suitability, according to latest research from UniSA undertaken in collaboration with Monash University.

Stroke Foundation data from 2011 and 2013 indicated that fewer than half the patients with acute stroke in Australian hospitals were assessed for rehabilitation.

“These results compare unfavourably with audits conducted the UK and the US where about 90% of patients have received rehabilitation assessments,” said study author Associate Professor Dominique Cadilhac, Head of Translational Public Health and Evaluation Division, Stroke and Ageing Research in the School of Clinical Sciences at Monash Health.

“Australian clinical guidelines include the good practice point that every patient with stroke, who is not for palliative care, should be assessed for further rehabilitation.”

To address concerns regarding the low proportion of Australian patients with stroke being assessed for rehabilitation, the Australian Stroke Coalition developed an evidence-based and patient-centred Rehabilitation Assessment Tool in 2011.

Associate Professor Cadilhac said the Assessment Tool was designed to guide health professionals to make objective decisions regarding the rehabilitation requirements of every patient with stroke admitted to hospital.

“Our latest research reveals that health professionals working on acute stroke units believe there are not enough rehabilitation services to meet the needs of patients with stroke.”

“We’ve also shown that patients with rehabilitation needs are not always referred to rehabilitation services, and beliefs about the purpose of rehabilitation assessments vary between health professionals,” said Associate Professor Cadilhac.

Among the health professionals interviewed within the 10 study stroke units often the patients with severe stroke, stroke-related cognitive deficits or co-existing dementia were considered unlikely to benefit from rehabilitation and so were not referred for assessment.

“It is also significant that two-thirds of patients with stroke in Australian hospitals do not receive documented assessments of mood or continence problems.”

“Rehabilitation interventions can be effective for addressing problems with mood or urinary incontinence after stroke, but without being provided with the opportunity for rehabilitation assessment, it is unlikely that appropriate management plans will be organised for such conditions,” said Associate Professor Cadilhac.

“Consistent use of the Rehabilitation Assessment Tool will enable more holistic plans to be developed for each patient in the early post-stroke period, which we believe will lead to enhanced clinical outcomes.”

 For further information see: http://australianstrokecoalition.com.au/site/media/ASC-Assessment-for-Rehabilitation-Manual-and-Decision-Making-Tool-final2.pdf