title: A qualitative study using the Theoretical Domains Framework to investigate why patients were or were not assessed for rehabilitation after stroke.
abstract: OBJECTIVE
  To explore the factors perceived to affect rehabilitation assessment and referral practices for patients with stroke.
  
  
  METHODS
  Qualitative study using data from focus groups analysed thematically and then mapped to the Theoretical Domains Framework.
  
  
  METHODS
  Eight acute stroke units in two states of Australia.
  
  
  METHODS
  Health professionals working in acute stroke units.
  
  
  METHODS
  Health professionals at all sites had participated in interventions to improve rehabilitation assessment and referral practices, which included provision of copies of an evidence-based decision-making rehabilitation Assessment Tool and pathway.
  
  
  RESULTS
  Eight focus groups were conducted (32 total participants). Reported rehabilitation assessment and referral practices varied markedly between units. Continence and mood were not routinely assessed (4 units), and people with stroke symptoms were not consistently referred to rehabilitation (4 units). Key factors influencing practice were identified and included whether health professionals perceived that use of the Assessment Tool would improve rehabilitation assessment practices (theoretical domain 'social and professional role'); beliefs about outcomes from changing practice such as increased equity for patients or conversely that changing rehabilitation referral patterns would not affect access to rehabilitation ('belief about consequences'); the influence of the unit's relationships with other groups including rehabilitation teams ('social influences' domain) and understanding within the acute stroke unit team of the purpose of changing assessment practices ('knowledge' domain).
  
  
  CONCLUSIONS
  This study has identified that health professionals' perceived roles, beliefs about consequences from changing practice and relationships with rehabilitation service providers were perceived to influence rehabilitation assessment and referral practices on Australian acute stroke units.
authors.affiliation: 1 International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Lynch
authors.affiliation: 1 International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia.|2 Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia.|3 NHMRC Centre of Research Excellence, Stroke Rehabilitation and Brain Recovery.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Luker
authors.affiliation: 2 Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia.|3 NHMRC Centre of Research Excellence, Stroke Rehabilitation and Brain Recovery.|4 Stroke and Ageing Research Centre, Monash University, Victoria, Australia.
authors.forename: Dominique A
authors.initials: DA
authors.lastname: Cadilhac
authors.affiliation: 1 International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia.
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Fryer
authors.affiliation: 1 International Centre for Allied Health Evidence, University of South Australia, Adelaide, Australia.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Hillier
mesh_terms: D000208:Acute Disease; D001291:Attitude of Health Personnel; D001315:Australia; D003657:Decision Making; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D020380:Needs Assessment; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012047:Rehabilitation Centers; D018570:Risk Assessment; D020521:Stroke / Q000175:diagnosis*; D000071939:Stroke Rehabilitation / Q000592:standards* / Q000639:trends
keywords: Stroke; Theoretical Domains Framework; acute stroke unit; assessment for rehabilitation; qualitative study