title: Adherence to Canadian Best Practice Recommendations for Stroke Care: vascular cognitive impairment screening and assessment practices in an Ontario inpatient stroke rehabilitation facility.
abstract: BACKGROUND
  The Canadian Best Practice Recommendations for Stroke Care suggest that (1) all patients with stroke should be screened for cognitive impairment and (2) persons who are detected as having cognitive impairment on a screening test should receive additional cognitive assessment. The purpose of this study is to determine whether care in an Ontario inpatient stroke rehabilitation facility is consistent with these recommendations.
  
  
  METHODS
  Stroke patients discharged from an inpatient stroke rehabilitation program located in Southwestern Ontario, Canada, from May to October 2009 were included in this study. Charts were reviewed to identify current screening and assessment practices. The percentages of patients formally screened and/or assessed as well as differences between those who were and were not screened are reported.
  
  
  RESULTS
  The study included 123 patients (62 male; mean age = 67.3,SD 15.1). During inpatient rehabilitation, 82.9% of patients were screened using a formal cognitive screening instrument. Patients with cognitive and/or communication deficits were significantly less likely to be screened than those with intact cognitive and communicative abilities. Although 77.5% of those screened scored below the threshold for cognitive impairment, evidence of referral for a comprehensive cognitive assessment was found for only 3 patients.
  
  
  CONCLUSIONS
  Although the majority of patients were screened for cognitive impairment while in inpatient rehabilitation, few patients were referred for a comprehensive diagnostic examination. On the basis of these results from a single inpatient stroke rehabilitation unit, it appears that specific cognitive deficits are likely underidentified in stroke rehabilitation patients in Ontario.
authors.affiliation: Lawson Health Research Institute, London, Ontario, Canada.
authors.forename: J Andrew
authors.initials: JA
authors.lastname: McClure
authors.forename: Katherine
authors.initials: K
authors.lastname: Salter
authors.forename: Norine
authors.initials: N
authors.lastname: Foley
authors.forename: Hannah
authors.initials: H
authors.lastname: Mahon
authors.forename: Robert
authors.initials: R
authors.lastname: Teasell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000209:etiology / Q000534:rehabilitation*; D003147:Communication Disorders / Q000209:etiology / Q000534:rehabilitation; D015140:Dementia, Vascular / Q000150:complications / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards*; D008875:Middle Aged; D009864:Ontario; D017410:Practice Guidelines as Topic; D017064:Process Assessment, Health Care / Q000592:standards*; D012189:Retrospective Studies; D000071939:Stroke Rehabilitation