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Capacity to make a decision about discharge destination after stroke: a pilot study
Ja Mackenzie1, Nb Lincoln, Gj Newby
1Manchester Mental Health and Social Care Trust, UK. janice.mackenzie@nhs.net
Clinical Rehabilitation
|December 5, 2008
Summary
Cognitive function and other factors do not predict discharge decision capacity in stroke patients. Multidisciplinary team impressions of capacity are unreliable and should not replace formal assessments.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Cognitive Science
Background:
- Assessing decision-making capacity is crucial in stroke rehabilitation.
- Cognitive impairments can affect a patient's ability to participate in discharge planning.
Purpose of the Study:
- To determine if cognitive problems and other factors influence discharge destination decision-making capacity in stroke patients.
- To compare multidisciplinary team (MDT) members' capacity assessments with formal evaluations.
Main Methods:
- A between-subjects comparison design was used in a stroke rehabilitation unit.
- Thirty-four stroke patients underwent cognitive assessments and capacity evaluations.
- MDT members completed questionnaires, and capacity was assessed blindly and independently.
Main Results:
- No significant association was found between cognitive functioning, age, weeks post-stroke, Barthel score, or dysphasia and capacity.
- MDT members frequently expressed uncertainty regarding patient capacity.
- Inter-rater reliability for capacity assessment was reasonable (72%).
Conclusions:
- Cognitive test scores, age, and dysphasia are not reliable predictors of discharge decision capacity in stroke rehabilitation.
- Informal MDT impressions of capacity should not substitute formal capacity assessments.