1 Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK.
2 Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, UK.
Clin Rehabil. 2018 Aug;32(8):1133-1144. doi: 10.1177/0269215518766406. Epub 2018 Mar 28.
To identify factors influencing clinicians decision-making about ongoing stroke rehabilitation for people with pre-existing dementia/cognitive impairment and the impact on clinical practice.
Qualitative semi-structured interviews with stroke specialist healthcare professionals analysed using thematic analysis.
Acute stroke unit, inpatient stroke rehabilitation units, and community stroke services.
Twenty three professionals from six multidisciplinary stroke teams involved in decision-making about stroke patients' rehabilitation potential and clinical pathways.
Factors influencing decision-making about ongoing rehabilitation were (1) gaining understanding of the individual patient, (2) clinician's knowledge of dementia/cognitive impairment, (3) predicting rehabilitation potential, (4) organizational constraints, and (5) clinician's perceptions of their role within the team. Decision-making led to two outcomes, either accommodating the pre-existing dementia/cognitive impairment within delivery of rehabilitation or ending rehabilitation for that patient to allocate limited resources where they were perceived more likely to be effective. Participants felt that patients with pre-existing dementia/cognitive impairment had difficulty demonstrating the required rehabilitation potential within the short timescales available in the current model of service delivery. Participants identified a need for training to improve their knowledge and confidence for decision-making and delivery of rehabilitation for this growing population.
Clinicians' decision-making about ongoing rehabilitation for patients with prestroke dementia/cognitive impairments is influenced by gaps in their knowledge and by service constraints. Increased training and more flexible, patient-centred services would enable clinicians to better accommodate these patients in rehabilitation.
确定影响临床医生对存在预先存在的痴呆症/认知障碍的中风患者进行持续康复治疗决策的因素，以及这些因素对临床实践的影响。
对参与中风患者康复潜力和临床路径决策的六支多学科中风团队的 23 名专业人员进行定性半结构式访谈，并采用主题分析方法进行分析。
急性中风病房、住院中风康复病房和社区中风服务。
参与中风患者康复潜力和临床路径决策的六支多学科中风团队的 23 名专业人员。
影响持续康复决策的因素包括：（1）了解个体患者，（2）临床医生对痴呆症/认知障碍的了解，（3）预测康复潜力，（4）组织限制，以及（5）临床医生对其在团队中角色的看法。决策导致两种结果，要么在提供康复服务时适应预先存在的痴呆症/认知障碍，要么为了在被认为更有可能有效的地方分配有限的资源而结束该患者的康复。参与者认为，患有预先存在的痴呆症/认知障碍的患者在当前服务提供模式下可用的短暂时间内很难表现出所需的康复潜力。参与者认为，需要培训来提高他们在这一不断增长的人群中的决策和康复服务方面的知识和信心。
临床医生对有预先存在的痴呆症/认知障碍的中风患者进行持续康复治疗的决策受到其知识差距和服务限制的影响。增加培训和更灵活、以患者为中心的服务将使临床医生能够更好地为这些患者提供康复服务。
