Table 1.
Summary of the included studies.
| Author and country | Design | Aim | Setting | Sample | Key findings | Study quality appraisal score (%) |
|---|---|---|---|---|---|---|
| Qualitative | ||||||
| Burton et al.,14 UK | Focus groups | To investigate the meaning and influence of rehabilitation potential on clinical practice | Two inpatient and five community rehabilitation teams | 12 clinicians (occupational therapy (OT), physiotherapy, speech and language therapy, rehabilitation assistant) | Rehabilitation potential is predicted by the observation of carry-over and functional gain. Judgement of rehabilitation potential influenced by prioritizing workload, working around the system, balancing optimism and realism. Impacts on patients and staff | 75 |
| Daniëls et al.,15 the Netherlands and Belgium | Focus groups | Identifying occupational therapists (OTs) deliberations in stroke rehabilitation | 12 rehabilitation units | 13 OTs | Difficulties for OTs were around: focusing on adaption while the patient is focussed on recovery, being client centered and protective simultaneously, setting meaningful goals in an institutional environment | 75 |
| Johnson et al.,16 Canada | Ethnography | Examining factors influencing team decision-making when choosing poststroke discharge destination | One acute stroke unit | One team, 12 multidisciplinary team members (psychiatrist, speech therapist, OT, physiotherapy, nurses, social worker, discharge planner) | Decisions about discharge destination influenced by social, economic and policy factors, interactions between team members, condition of patient and social support | 100 |
| Lam Wai Shun et al.,17 Canada | Focus group | Identifying factors influencing OT’s perception of rehabilitation potential after stroke | Three acute and three rehabilitation hospitals | 12 OTs | Agreed on 11 most important patient-related factors to consider when assessing rehabilitation potential, and additional factors of the organizational context and clinician’s expertise | 75 |
| Longley et al.,10 UK | Semi-structured interview | To identify factors influencing clinicians’ decision-making about rehabilitation for people with preexisting cognitive impairment | Four inpatient and two community stroke teams | 23 clinicians (OT, physiotherapy, speech and language therapy, psychology, nursing, physicians) | Decisions influenced by understanding of the individual patient, clinician’s knowledge of dementia/cognitive impairment, predicting rehabilitation potential, organizational constraints and clinician’s perceptions of their role within the team. Impacts on clinical practice | 100 |
| Luker et al.,18 Australia | Semi-structured interview | Exploring factors influencing Allied Health Professionals’ decision-making when prioritizing stroke rehabilitation | Three acute stroke units | 15 Allied Health Professionals (physiotherapy, OT, speech and language therapy, dietician, social worker, psychologists) | Predicted discharge destination was a powerful driver of care decisions. Clinicians considered prestroke status, nature and severity of stroke, course of recovery and multiple factors within the healthcare system to aid decisions | 75 |
| Lynch et al.,19 Australia | Focus groups | Exploring factors perceived to affect why patients are referred to stroke rehabilitation and how assessments were completed | Eight acute stroke units | 32 clinicians (mixed discipline) | Rehabilitation assessment and referral varied between units. People with stroke symptoms not consistently referred for rehabilitation. Perceived roles, beliefs about consequences, relationships with rehabilitation service providers and knowledge influenced decisions and referral practices | 75 |
| Lynch et al.,20 Australia | Observations and focus groups | Investigating how staff determine who to refer to rehabilitation | Eight acute stroke units | 32 clinicians (nurse, physiotherapy, OT, speech therapy, dietician, unit manager). Meetings regarding 64 patients observed | Factors influencing referrals for rehabilitation: anticipated discharge destination, stroke severity, staff expectations, family advocacy; clinicians referred patients who they considered would be accepted | 75 |
| Quantitative | ||||||
| Hakkennes et al.,21 Australia | Prospective observational cohort study, questionnaire | Identifying factors important in decision-making for rehabilitation | Five acute hospitals | 14 rehabilitation assessors, 75 patients | Most important items for acceptance into rehabilitation: premorbid cognition, premorbid mobility, premorbid communication. For non-acceptance most important items: current mobility, social support, current cognition | 100 |
| Hasenbein et al.,22 Germany | Case-based survey | Analysis of medical decisions of allocation to stroke rehabilitation | Acute and rehab hospitals (unknown number) | 33 physicians | Physician expertise and patient age influenced choice between in- or outpatient rehabilitation | 50 |
| Kennedy et al.,23 Australia | Questionnaire | Exploring factors influencing decisions for rehabilitation | 12 rehabilitation units | 17 physicians | Most influential clinical factors for accepting patients to rehabilitation: prognosis, social support, anticipated discharge destination, age, anticipated length of stay. Key non-clinical factors: priority, patient residence, workforce capacity | 75 |
| Magdon-Ismail et al.,24 USA | Survey | Investigating factors influencing selection of postacute discharge destination | 471 acute hospitals | 77 discharge planners | Factors influencing postdischarge care destination: insurance, quality of care facility, pressure to discharge patient. Patients and families more influential than physicians in choosing care facility. Non-clinical factors perceived to have major influence in decision-making | 50 |
| Mixed methods | ||||||
| Putman et al.,25 Europe | Mixed methods: assessment, questionnaire, interview | Exploring factors involved in decision-making for admission to stroke rehabilitation | Six stroke rehabilitation units in four European countries (the United Kingdom, Belgium, Germany, Switzerland) | 532 patients, medical consultants (unknown number) | Clinical criteria for admission evaluated differently between units: the United Kingdom only used diagnosis of stroke as admission criteria, Belgian, German and Swiss units all considered prestroke status and likelihood of discharge home in Swiss units | 25 |
Study quality is scored and ranges from 0% to 100% according to % of criteria met in 25% intervals.13