Decisions about rehabilitation potential have far-reaching consequences for individual patients, including the withdrawal of active rehabilitation. The term ‘rehabilitation potential’ is viewed negatively by stroke survivors and can be inappropriately used by clinicians as justification for rationing access to services. Access to rehabilitation should be driven by the presence of stroke-specific goals. These should not be limited to functional improvement and should include domains such as adjustment, psychological well-being, education regarding stroke, social participation, management of complications, and the management of care needs. All domains should be considered as aspects of rehabilitation and therefore the term ‘no rehabilitation potential’ is not appropriate and should not be used. [2023]
Given the dynamic nature of stroke recovery, fixed decisions around appropriateness of rehabilitation should not be made too early after stroke. Co-existent conditions such as dementia, sensory impairments, or other comorbidities can complicate delivery of rehabilitation, but they should not be the sole reason for not pursuing a rehabilitative approach. [2023]
Selection of an appropriate rehabilitation pathway (e.g. inpatient rehabilitation, early supported discharge) should be determined by the patient’s goals coupled with an understanding of their impairments, abilities, prognosis and the evidence base, informing access to the right service at the right time, at an appropriate intensity. Information should be shared with the person with stroke and their carer(s), to ensure goals and expectations are informed and achievable. There are predictive tools (such as the Orpington Prediction Scale (Mohapatra & Jones, 2015), PREP2 (Stinear et al, 2017a), and TWIST (Smith et al, 2017)) that give useful information at a population level and can be used to inform such discussions. [2023]
Decisions regarding discharge from rehabilitation should be made with involvement of the person with stroke (shared decision making) when stroke-related goals have been met. This should never be an irrevocable decision, but should include the opportunity for review and access back into services at any time via self referral or professional referral. The decision should relate to the person’s rehabilitation needs at a single point in time. It should be understood that a person with stroke may have stroke-related needs or goals at any point following their stroke. Life after stroke services should be available to support and advise during, between, and following different phases of rehabilitation (Section 5.27 Further rehabilitation). [2023]