Study shows inpatient rehabilitation could help 40 percent, but only 16 percent get access
Too many stroke patients in Canada are not getting the rehabilitation they need to return to a healthy, active life, according to a new study which will be presented at the Canadian Stroke Congress in Vancouver tomorrow. The research findings strongly suggest that such decisions are being made based on what services are available in the health system rather than what patients really need. It found that overall just 16 per cent of patients with stroke were discharged to inpatient rehabilitation but that the rates varied widely by province (1% to 26%) and hospital (0% to 48%). Meanwhile, some of the people who do get rehabilitation don't need it. And those who do get rehabilitation don't always get the right amount of services.
Stroke experts agree that about 40 per cent of stroke patients would benefit from rehabilitation which takes place in a specialized rehabilitation unit where patients stay for one to several weeks following discharge from acute care.
"The study suggests there are a large number of Canadian stroke patients who are not getting the help they need at hospital discharge to get back to an active life," says Dr. Michael Hill, director of the stroke unit at the Foothills Medical Centre in Calgary and one of the study authors.
"We found that access to and the use of inpatient rehabilitation after stroke is highly variable, so variable that it likely depends upon practice patterns and resources, rather than patient disability and needs."
"Stroke patients are falling through the cracks," says Dr. Mark Bayley, co-chair of the Canadian Stroke Congress and a physiatrist (rehabilitation specialist). "This has huge implications for their future quality of life and use of healthcare and social service resources."
He adds that the study highlights the need for more formal assessment and triage processes to better match patients and their needs to finite rehabilitation services.
The study examined the database of hospital discharge information maintained by the Canadian Institute of Health Information (CIHI), focusing on the nearly 60,000 stroke or transient ischemic attack (TIA or mini stroke) patients discharged from Canadian hospitals over a two-year period ending in March 2013.
The hospital discharge data are important, says Dr. Hill, because it is crucial for stroke patients to get rehabilitation promptly after their stroke. "There is a window when rehabilitation after stroke is maximally effective," he says. "We need to pay attention to getting people help within this window - before the opportunity for improvement has decreased - if we want to get people back to being as fully functioning as possible in their daily activities and jobs."
He adds that people with moderate and moderately severe disability are the ones that can benefit most from timely access to the right level of rehabilitation services.
Hot Topic in Stroke: Access to Stroke Rehabilitation
A majority of people who have a stroke report that they need some amount of help afterwards and 80 per cent experience restrictions to their daily activities. Recovery from a stroke can continue for years. "Lack of adequate rehabilitation resources means patients and families are denied the opportunity to have as much function restored as possible," says Ian Joiner, director of stroke for the Heart and Stroke Foundation. "Our health and social services systems ultimately pay more because patients do not meet their recovery potential and end up needing more services. It simply makes sense to make stroke rehabilitation a priority." While there have been improvements over the past decade in how quickly stroke survivors are getting access to inpatient rehabilitation, there's still work to be done.
"The Heart and Stroke Foundation recommends that governments explore opportunities to enhance post-stroke rehabilitation services," says Joiner. "In addition to the variation in access to inpatient rehabilitation services, community-based rehabilitation programs are not available in many communities, and those that do exist are not equitably covered by provincial health insurance programs."
Research Creates Survivors
Growing up, Janel Nadeau had a passion for science and imagined travelling to another province to pursue her university studies. At the age of 19, a sudden stroke seemingly robbed her of that dream.
Janel spent six weeks in hospital, where she was one of the lucky ones who received a full complement of rehabilitation support, including occupational, physical and speech therapy. Yet when she got home, the first-year Honour's student at Queen's University was still struggling to relearn the alphabet.
Her mom took four months off work so she could accompany Janel to weekly physical therapy sessions at the hospital and help her with exercises at home. They sought out opportunities in the community, including the local gym for strength training, swimming and yoga, cooking classes through adult education and massage therapy.
The support she received through her recovery allowed her to eventually return to her studies. Today, she is a resident physician who works alongside the doctors who saved her life at Foothills Medical Centre, including Dr. Michael Hill.
Investments in stroke rehabilitation and increased rehabilitation availability will result in more survivors thriving, like Janel.
Stroke's Impact by the Numbers