Capacity to make a decision about discharge destination after stroke: a pilot study.
OBJECTIVE
To investigate the effect of cognitive problems and other factors on the capacity to make a decision about discharge destination and to compare the impressions of multidisciplinary team (MDT) members regarding capacity with a formal assessment.


METHODS
Between-subjects comparison design.


METHODS
One stroke rehabilitation unit.


METHODS
Thirty-four stroke patients.


METHODS
For six months, all patients admitted to a stroke rehabilitation unit were asked to take part after one week and assessed on the outcome measures.


METHODS
The multidisciplinary team completed questionnaires regarding risk, capacity and referral plans. All participants had a cognitive assessment. Capacity was assessed blind to the results of the cognitive assessment and independently rated by another assessor. Clinical and demographic information were collated.


RESULTS
No significant association was found between cognitive functioning and capacity (P>0.05). Age, weeks post-stroke, Barthel and dysphasia were not significantly associated with capacity (P>0.05). Multidisciplinary team members were often unsure about the capacity of people to make decisions. Inter-rater reliability for the capacity assessment was reasonable (72%; P=0.06).


CONCLUSIONS
The preliminary conclusions are that cognitive test scores, age and dysphasia are not good predictors of capacity to decide about discharge destination in stroke patients receiving rehabilitation. Impressions of capacity should not be used to determine the need for a formal capacity assessment.
Mackenzie
Ja
J
Manchester Mental Health and Social Care Trust, UK. janice.mackenzie@nhs.net
Lincoln
Nb
N
Newby
Gj
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D016743:Mental Competency; D008875:Middle Aged; D010348:Patient Care Team; D010351:Patient Discharge; D010358:Patient Participation / Q000523:psychology*; D010865:Pilot Projects; D012047:Rehabilitation Centers; D020521:Stroke / Q000523:psychology*; D000071939:Stroke Rehabilitation