Decision-Making on Referral to Primary Care Physiotherapy After Inpatient Stroke Rehabilitation

Abstract

Objective: This study aimed to acquire insight into the decision-making processes of healthcare professionals concerning referral to primary care physiotherapy at the time of discharge from inpatient stroke rehabilitation.

Design: A generic qualitative study using an inductive thematic analysis was performed. Semi-structured interviews were conducted following an interview guide.

Setting: Secondary care centers in the Netherlands: neurology departments of nine hospitals and (geriatric) rehabilitation centers.

Participants: Nineteen healthcare professionals (physiotherapists, specialist in geriatric medicine, physiatrist, physician assistant) participated in the study. All were involved in the decision for referral to primary care physiotherapy.

Results: During the inpatient period, healthcare professionals gather information to form a complete picture of the stroke survivor as a basis for decision-making. The decision on referral is influenced by personal factors and home environment of the stroke survivor, organizational factors within the care setting, and the intuition and feeling of social responsibility of the individual healthcare professional.

Conclusions: After inpatient rehabilitation, many elements are considered that may influence referral to primary care physiotherapy. Presently, there is no consensus concerning referrals. The final decision depends on the individual physiotherapist and care setting. Healthcare professionals mentioned the importance of movement behavior, although there is no consensus if secondary prevention is a primary task of the physiotherapist. More research is needed to identify risk factors for functional decline in order to develop a referral policy that addresses primary care physiotherapy to the right group of stroke survivors.

Keywords: Decision-making; Patient discharge; Physiotherapy; Primary health care; Stroke/Rehabilitation.