Introduction: Loss of walking occurs frequently after stroke, and recovering mobility is often survivors’ highest priority. For those who remain non-ambulant one month post-stroke, factors for access to rehabilitation are not clear. This study aimed to describe discharge pathways from acute hospital for adults who were non-ambulant at one month post-stroke and to explore clinicians’ perspectives on discharge pathways.
Methods: Eighty adults, non-ambulant one month post-stroke, were recruited from acute and sub-acute metropolitan hospitals. Clinical data, including demographics, type of stroke and discharge pathways, were analysed descriptively. For stroke survivors recruited during their acute stay (n=31), clinicians participated in semi-structured interviews about the discharge pathway. Transcripts were analysed using inductive content analysis.
Results: Participants’ mean age was 67 years (range 22-97) with 51% male. Stroke included embolus (48%), intra-cerebral haemorrhage (41%), and subarachnoid haemorrhage (11%). Median (IQR) acute length of stay was 29 (26) days. Sixty-eight (85%) participants transferred from acute care to subacute rehabilitation. Remaining destinations included care awaiting placement (n=5), transitional ward awaiting subacute rehabilitation (n=2), residential aged care (n=2), family home (n=1), disability accommodation (n=1), and one participant deceased without acceptance to rehabilitation. Preliminary analysis of interviews indicated that some participants experienced straightforward acceptance into rehabilitation without re-referrals, particularly with clear signs of progress. However, others encountered varying criteria for rehabilitation admission. Barriers included impaired alertness or participation, high need for physical assistance, and lack of agreement on rehabilitation site. There were often delays affecting transfer to rehabilitation, such as establishing ongoing enteral feeding.
Conclusion: Transfer to subacute rehabilitation can involve multiple re-referrals and have significant delays. Rehabilitation acceptance is aided by clinicians having skills to optimise participation and advocate for needs.
Relevance to clinical practice or patient experience
Achieving early progress for non-ambulant individuals can be crucial for access to rehabilitation, evidence is needed to guide the optimal clinical approach.