Project Description
Assessing and managing rehabilitation needs of people with stroke
The Project
Between 2012-2015, a cluster-randomised trial was run at 10 hospitals, aiming to improve the way rehabilitation needs were identified, & the way referrals to rehabilitation services were being made. The effectiveness of a one-off education session & provision of the Assessment for rehabilitation Tool (ART) (a nationally endorsed evidence-based decision-making tool) was compared to the effectiveness of a multifaceted approach for improving the way rehabilitation needs of stroke survivors are identified & managed.
Clinical practice was observed, staff were interviewed & medical records were audited.
The Problem
Stroke is the leading cause of adult disability in Australia. One in 5 Australians will have a stroke at some point in their life, and nearly two-thirds of stroke survivors need assistance for their regular daily activities. Rehabilitation after stroke can help to address disability & maximise function & quality of life. It has been reported that there are not enough stroke rehabilitation services available, yet prior to 2015, no data were available to quantify the degree of unmet rehabilitation need after stroke in Australia.
The Impact
Researchers found that judgements about stroke survivors’ rehabilitation needs tended to be based on whether staff expected that the stroke survivor would be able to access a rehabilitation service. Both the education intervention & the more hands-on multifaceted intervention improved the way rehabilitation needs were identified, but did not change the proportion of patients who were referred to rehabilitation services, nor the proportion of patients who accessed rehabilitation. Some acute hospital staff reported reluctance to refer all patients with rehabilitation needs to rehabilitation services for fear of damaging their relationship with the rehabilitation service providers.
The findings were shared with consumer, clinical & research audiences. Advice and mentoring has been provided to clinicians on how to implement the ART, and the importance of referring patients with rehabilitation needs to rehabilitation services.
The Stroke Clinical Guidelines now explicitly recommend use of the ART, & recommend that every person with rehabilitation needs be referred to a rehabilitation service. The national stroke audit also now routinely collects data on a patient’s rehabilitation needs and reasons why patients with rehabilitation needs are not referred to rehabilitation services. These data are important to allow advocacy for increasing the availability of rehabilitation services. The impact of the new Stroke Clinical Guidelines has yet to be evaluated.
Prior to 2015 data were not routinely collected about rehabilitation needs of people after stroke. One study indicated only 43% of people in hospital after stroke were assessed for the need for rehabilitation in 2013-14. Following introduction and implementation of the ART, these figures have steadily risen so that by 2019, 61% of stroke survivors were assessed for rehabilitation, and 83% of hospitals providing care to people with stroke now have standardised processes that ensure ALL stroke patients are assessed for rehabilitation.
