What factors affect clinical decision-making about access to stroke rehabilitation?: A systematic review

Objectives To determine the factors affecting clinical decision-making about which patients should receive stroke rehabilitation.
Methods Data sources (MEDLINE, CINAHL, AMED and Psychinfo) were searched systematically from database inception date to August 2018. Full text English language studies of data from stroke clinicians were included. Studies of patients were excluded. 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 included studies was assessed using the Mixed Methods Appraisal Tool.
Results After removing duplicates 1915 papers were identified, of which thirteen met the inclusion criteria. Eight included studies were qualitative, one used mixed methods. A total of 292 clinicians were included in the studies. Quality of included studies was mixed. Patient-level and organisational factors, as well as characteristics of individual clinicians contributed to decisions about rehabilitation. The most often described factors were patients’ pre- and post-stroke function (n=6 studies), presence of dementia (n=6), patients’ social/family support (n=6), organisational 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 a subjective approach to rehabilitation decision-making influenced by patient-level and organisational factors alongside clinicians’ characteristics occurs across services and countries.