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Kathryn M. Gulfo, MD; Glen Gillen EdD, OTR, FAOTA; Lauri Bishop, DPT; Clare C. Bassile PT, EdD; Randy B. Kolodny PT, DPT, MA; Joel Stein, MD


Background: Significant variation exists in post-acute care for stroke survivors. This study examines referral practices of occupational and physical therapists for patients after acute stroke.

Method: Occupational therapists (OTs) and physical therapists (PTs) were surveyed either electronically or in person at a national conference. The respondents selected the most appropriate referral for each of five case vignettes. The referral choices included Inpatient Rehabilitation Facility (IRF), Skilled Nursing Facility (SNF), Long-Term Acute Care Hospital (LTACH), home with home services, or home with outpatient services. Demographic data included practice location, setting, and duration. The respondents were also asked to rate how strongly 15 clinical factors influence their referral decisions.

Results: The 33 OTs and 41 PTs favored similar referrals. Consensus was observed in four of the five cases. No differences were observed among the respondents based on practice location, practice setting, or number of years in practice and the referrals. Prognosis for functional improvement and pre-stroke functional status were identified as the most important factors influencing referral decisions.

Conclusion: Further studies are needed to define areas of broad consensus as well as areas of disagreement, with subsequent efforts to clarify optimal treatment algorithms for patients who currently receive variable rehabilitative care.