MAHSC and The University of Manchester, Manchester, UK.
Clin Rehabil. 2019 Feb;33(2):304-316. doi: 10.1177/0269215518808000. Epub 2018 Oct 29.
: To determine the factors affecting clinical decision-making about which patients should receive stroke rehabilitation.
: Data sources (MEDLINE, CINAHL, AMED and PsycINFO) were searched systematically from database inception to August 2018. Full-text English-language studies of data from stroke clinicians were included. Studies of patients were excluded. The included studies were any design focussed on clinical decision-making for referral or admission into stroke rehabilitation. Summary factors were compiled from each included study. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool.
: After removing duplicates, 1915 papers were identified, of which 13 met the inclusion criteria. Eight included studies were qualitative and one used mixed methods. A total of 292 clinicians were included in the studies. Quality of the included studies was mixed. Patient-level and organizational factors as well as characteristics of individual clinicians contributed to decisions about rehabilitation. The most often described factors were patients' pre- and poststroke function ( n = 6 studies), presence of dementia ( n = 6), patients' social/family support ( n = 6), organizational service pressures ( n = 7) and the decision-making clinician's own knowledge ( n = 5) and emotions ( n = 5).
: The results highlight a lack of clinical guidance to aid decision-making and reveal that a subjective approach to rehabilitation decision-making influenced by patient-level and organizational factors alongside clinicians' characteristics occurs across services and countries.
确定影响临床决策的因素，即哪些患者应接受中风康复治疗。
系统检索了从数据库建立到 2018 年 8 月的 MEDLINE、CINAHL、AMED 和 PsycINFO 数据。纳入了针对中风临床医生的数据的全文英文研究。排除了患者研究。纳入的研究是任何专注于转诊或入院接受中风康复治疗的临床决策的设计。从每个纳入的研究中汇总了综合因素。使用混合方法评估工具评估纳入研究的质量。
去除重复项后，共确定了 1915 篇论文，其中 13 篇符合纳入标准。8 项纳入研究为定性研究，1 项采用混合方法。共有 292 名临床医生参与了这些研究。纳入研究的质量参差不齐。患者层面和组织层面的因素以及个体临床医生的特征都对康复决策产生了影响。最常描述的因素是患者中风前后的功能（n=6 项研究）、痴呆症的存在（n=6 项）、患者的社会/家庭支持（n=6 项）、组织服务压力（n=7 项）以及决策临床医生自己的知识（n=5 项）和情绪（n=5 项）。
结果表明缺乏临床指导以帮助决策，并揭示了一种受患者层面和组织因素以及临床医生特征影响的主观康复决策方法，这种方法在不同的服务和国家都存在。
