title: Selection for inpatient rehabilitation after severe stroke: what factors influence rehabilitation assessor decision-making?
abstract: OBJECTIVE
  This study aimed to identify factors that assessors considered important in decision-making regarding suitability for inpatient rehabilitation after acute severe stroke.
  
  
  METHODS
  Multi-site prospective observational cohort study.
  
  
  METHODS
  Consecutive acute, severe stroke patients and their assessors for inpatient rehabilitation.
  
  
  METHODS
  Rehabilitation assessors completed a questionnaire, rating the importance (10 point visual analogue scale) and direction (positive, negative or neutral) of 15 patient related and 2 organisational items potentially affecting their decision regarding patients' acceptance to rehabilitation.
  
  
  RESULTS
  Of the 75 patients referred to rehabilitation and included in this study 61 (81.3%) were accepted for inpatient rehabilitation. The items considered to be most important in the decision to accept the patient for rehabilitation were pre-morbid cognition, pre-morbid mobility and pre-morbid communication. For those not accepted the most important items were current mobility, social support and current cognition. Factor analysis revealed 3 underlying factors, interpreted as post-stroke status, pre-morbid status, and social attributes, accounting for 61.8% of the total variance. All were independently associated with acceptance for rehabilitation (p < 0.05).
  
  
  CONCLUSIONS
  This study highlights the importance of pre-morbid function and social factors in addition to post-stroke function in the decision making process for acceptance to rehabilitation following severe stroke. Future models for selection for rehabilitation should consider inclusion of these factors.
authors.affiliation: School of Physiotherapy, Faculty of Health Sciences, La Trobe University, Melbourne, Australia. sharonh@barwonhealth.org.au
authors.forename: Sharon
authors.initials: S
authors.lastname: Hakkennes
authors.forename: Keith D
authors.initials: KD
authors.lastname: Hill
authors.forename: Kim
authors.initials: K
authors.lastname: Brock
authors.forename: Julie
authors.initials: J
authors.lastname: Bernhardt
authors.forename: Leonid
authors.initials: L
authors.lastname: Churilov
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D011795:Surveys and Questionnaires