Background 

Patients with cognitive impairment (CI) and stroke do not have consistent access to rehabilitation compared to those without CI, despite evidence of its benefits to them. Lack of rehabilitation team skills and knowledge to treat stroke patients with CI has been identified as a contributing factor. This project aimed to examine inpatient rehabilitation acceptance rates for referred patients with CI before and after the implementation of a knowledge translation (KT) initiative aimed at improving skills in the cognitive-strategy based approach known as Cognitive Orientation to daily Occupational Performance (CO-OP). 

Method

Five inpatient rehabilitation teams from a large Canadian city participated in CO-OP KT, which included a workshop, 4-months implementation support, health system support, and a sustainability plan. Referrals and acceptances were extracted from the E-Stroke Rehabilitation Referral System for 14 months pre CO-OP KT and 6 months post. A chi-squared analysis was completed comparing acceptance for patients across CI severity levels and across sites. 

Results

Overall, 4546/5998 (75.8%) patients with CI were accepted pre-intervention compared to 959/1216 (78.9%) post (p=0.018). Across all sites, significantly more persons with CI were accepted into rehabilitation post intervention (75.3% versus 79.9%; p=0.002), while there was no significant change among those without CI (77.8% versus 75.5%; p=0.421). The largest changes were seen in those with moderate CI (74.3% versus 80.8%; p=0.004). Site-specific differences were also noted. 

Conclusion
Access to inpatient stroke rehabilitation improved for persons with stroke and CI after the implementation of a multi-faceted KT intervention to improve skills in a cognitive strategy-based intervention.

IMPROVED ACCESS TO INPATIENT STROKE REHABILITATION FOR THOSE WITH COGNITIVE IMPAIRMENT FOLLOWING SUPPORTED IMPLEMENTATION OF A COGNITIVE STRATEGY BASED APPROACH