Selecting patients for rehabilitation after acute stroke: are there variations in practice?

Objective: To investigate whether there were variations in practice in selection for rehabilitation after stroke, after adjustment for case mix. Design: Prospective multicenter audit. Setting: Seven acute stroke units in metropolitan and regional Victoria, Australia. Participants: Consecutive acute stroke admissions (N=616). Interventions: None. Main Outcome Measures: Mobility Scale for Acute Stroke Score and Modified Barthel Index (MBI) scores for continence at day 3 poststroke, discharge destination from the acute hospital. Results: Data were analyzed for 616 stroke survivors. Considerable variability in the percentage of cases accessing inpatient rehabilitation was observed in severe stroke (27%-67%) and mild stroke (27%-73%). To assess adjustment for case mix, a multinomial logistic regression was conducted with the outcome variable being discharge destination (home, rehabilitation, or nursing home), and the predictors being Mobility Scale for Acute Stroke Score, MBI continence scores, age, and social situation. The overall amount of variability explained in discharge destination by the predictors was 63% (Nagelkerke pseudo R²). The regression analysis was repeated, adding unit code as a predictor. Unit code was a significant contributor to the model (P<.01). Conclusion: The results of the study indicate that, after adjusting for case mix, there may be variations in practice in selection for rehabilitation leading to inequities of access.