1. Marieke Geerars-van der Veen1,2,3,4, Roderick Wondergem1,2,3,5, Martijn F. Pisters1,2,3,5
1Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands; 2Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands; 3Physical Therapy Research, Department of Rehabilitation, Physical Therapy and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands; 4Stichting Axioncontinu Utrecht, Centrum voor Revalidatie en Herstel de Parkgraaf, Utrecht, The Netherlands; 5Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
Decision-making on continuing physiotherapy in primary care after inpatient stroke rehabilitation
A qualitative study.
Background
Acute stroke care Multidisciplinary inpatient rehabilitation Home
Stroke?
Globally, stroke affects over 16 million people every year and is a global health problem. Advances in acute care have resulted that most people after stroke will survive. However, disability rates after stroke are high and people must live with the long-term consequences.
Physiotherapy is one of the key disciplines to improve and remain functions, activities and participation but to prevent deterioration.
When multidisciplinary treatment is not or no longer required, physiotherapy in primary care is considered at discharge.
People with stroke experience various levels of functioning and individual needs differ.
Therefore, the decision-making process concerning referral to primary care physiotherapy is complicated.
Aim
To acquire insight into the decision-making processes of healthcare professionals concerning referral to primary care physiotherapy at the time of discharge.
Methods
A generic qualitative interview study was performed according to the Consolidated Criteria for Reporting Qualitative Research (COREQ).
19 semi-structured interviews with healthcare professionals.
9 hospitals and (geriatric) rehabilitation centers in the Netherlands.
Interview guide was used and adapted to explore emerging themes.
Interviews were transcribed and coded.
Themes were defined and refined.
Results
Decision-making is influenced by:
personal and home environmental factors of the
person with stroke,
organizational factors of the institution and,
intuition and the feeling of social responsibility of the healthcare professional.
The decision to refer is made by the physiotherapist.
Feedback on the decision is not structurally available.
Conclusions
Many elements are considered that may influence referral to primary care physiotherapy. Presently, there is no consensus concerning referrals. Although decision-making is done carefully, the final decision depends on the individual physiotherapist and the care setting. This can essentially lead to differences in access to care.
Clinical implications
A referral policy to stimulate physical activity to avoid sedentary behaviour and ADL deterioration is recommended.
Physiotherapists should stimulate lifestyle changes contributing to secondary disease prevention.
The physician should make it a point to share information of the follow-up examination with the multidisciplinary team in order to learn from the decisions that were made.
Extending post-stroke care to the community by means of collaboration between inpatient settings, primary care physiotherapy practices and physical fitness opportunities could provide better health quality services concerning rehabilitation and safe sports environments.