Rehabilitation and Regenerative Medicine

Physiatrist Referral Patterns for Post Acute Stroke

Rehabilitation

David J Cormier DO, DPTMegan A Frantz MD

Ethan Rand MDJoel Stein MD

Disclosures• None

Objective• Examining variation in physiatrist referral

patterns for post-acute rehabilitation for stroke patients

Design• A cross-sectional survey study- five fictional case vignettes - medical, social, and functional domains

• Physiatrists - American Academy of Physical Medicine and

Rehabilitation Annual Assembly - (November 13-16, 2014; San Diego, CA)

• 86 surveys were collected over a 3-day period

Demographics

Gender Race/Ethnicity

Regions

Geographic AreaArea of Practice

Type of Practice

Treats Stroke Patients Affiliation

Where do you practice?

Age

Yrs in Practice

Level of Training

Case OneMr. Jones is a 64 year old man, working full time as an attorney, lives with wife in a ranch style single family home. He sustained a Left internal capsule stroke with right hemiparesis arm>leg. Needs moderate assistance with ADL’s and moderate assistance to walk a few steps. His Cognition, language, swallowing are intact. PMH: Hypertension, Type II Diabetes, Coronary Artery Disease, s/p cardiac stents x 2.

Case TwoMr. Smith is an 83 year old man with prior stroke, lives alone, homebound prior to admission, with 24 x 7 home health aide, poor short term memory prior to stroke. He sustained a large Left MCA infarct with global aphasia, dysphagia requiring g tube, and right hemiplegia. Dependent for ADL’s and transfers.

Case ThreeMs. Doe is a 42 year old woman, accountant, married, with 3 school age children. She sustained a brainstem hemorrhage from AVM with severe dysphagia, requiring g tube, tracheostomy tube (now capped), severe dysarthria, hemiplegic on the left, and hemiparetic on the right side. She is Dependent for ADL’s and transfers. She is Alert and cognitively intact.

Case FourMs. Johnson is a 70 year old woman, lives with husband in accessible apartment, both recently retired. She sustained a Right subcortical stroke with left hemiparesis affecting arm>leg. She is able to walk 25 feet with minimal assistance from therapist, and needs minimal assistance with dressing and bathing. She has normal cognition, speech, swallowing. PMH: Hypertension, newly diagnosed atrial fibrillation, now well controlled with warfarin and beta blocker.

Case FiveMs. Thompson is an 86 year old woman, widowed, lives alone in an apartment in an elevator building. Was active prior to stroke as volunteer in hospital. No children and with limited financial resources. She sustained a Left MCA stroke with right hemiplegia, moderate expressive aphasia but with relative sparing of comprehension, dysphagia with g tube in place. Dependent for ADL’s, max assist for transfers. She has newly diagnosed atrial fibrillation, rate well controlled, on Coumadin for secondary stroke prevention.

Results

Factors Influencing Post-Acute Facility Selection - Physiatrists

Factors Influencing Post-Acute Facility Selection – Case Managers

Sicklick et al Northeast Cerebrovascular consortium rehabilitation and recovery work group 2014.

How frequently does the speed with which you are able to help arrange discharge for a stroke patient impact his

or her final destination?

Physiatrist Case Managers

Sicklick et al Northeast Cerebrovascular consortium rehabilitation and recovery work group 2014.

Results

• Bivariate analysis (using chi-square) - No statistically significant relationship between any of

the demographic variables and post-stroke rehabilitation preference for any of the cases

• The highest mean influence ratings- Prognosis for functional outcome (8.63)- Quality of post-acute facility (8.31)

• The lowest mean influence ratings- location of post-acute facility (5.74)- Insurance (5.76)

Conclusion• Physiatrists show a preference for

inpatient rehabilitation facilities• Physiatrists’ referral patterns did not vary

with any identified practitioner variables or geographic region

• Referral patterns varied by case