What factors affect clinical decision-making about access to stroke rehabilitation? A systematic review.
Clin Rehabil
; 33(2): 304-316, 2019 Feb.
Article
en En
| MEDLINE
| ID: mdl-30370792
ABSTRACT
OBJECTIVES:
To determine the factors affecting clinical decision-making about which patients should receive stroke rehabilitation.METHODS:
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.RESULTS:
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).CONCLUSION:
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.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Selección de Paciente
/
Toma de Decisiones Clínicas
/
Rehabilitación de Accidente Cerebrovascular
Tipo de estudio:
Guideline
/
Prognostic_studies
/
Qualitative_research
/
Systematic_reviews
Límite:
Humans
Idioma:
En
Año:
2019
Tipo del documento:
Article