Article

OBJECTIVE: To explore the factors perceived to affect rehabilitation assessment
and referral practices for patients with stroke. DESIGN: Qualitative study using
data from focus groups analysed thematically and then mapped to the Theoretical
Domains Framework. SETTING: Eight acute stroke units in two states of Australia.
SUBJECTS: Health professionals working in acute stroke units. INTERVENTIONS:
Health professionals at all sites had participated in interventions to improve
rehabilitation assessment and referral practices, which included provision of
copies of an evidence-based decision-making rehabilitation Assessment Tool and
pathway. RESULTS: Eight focus groups were conducted (32 total participants).
Reported rehabilitation assessment and referral practices varied markedly between
units. Continence and mood were not routinely assessed (4 units), and people with
stroke symptoms were not consistently referred to rehabilitation (4 units). Key
factors influencing practice were identified and included whether health
professionals perceived that use of the Assessment Tool would improve
rehabilitation assessment practices (theoretical domain 'social and professional
role'); beliefs about outcomes from changing practice such as increased equity
for patients or conversely that changing rehabilitation referral patterns would
not affect access to rehabilitation ('belief about consequences'); the influence
of the unit's relationships with other groups including rehabilitation teams
('social influences' domain) and understanding within the acute stroke unit team
of the purpose of changing assessment practices ('knowledge' domain). CONCLUSION: This study has identified that health professionals' perceived roles, beliefs
about consequences from changing practice and relationships with rehabilitation
service providers were perceived to influence rehabilitation assessment and
referral practices on Australian acute stroke units.

Langue : ANGLAIS