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Stroke Survivors' Perspectives on Post–Acute Rehabilitation Options, Goals, Satisfaction, and Transition to Home

Krishnan, Shilpa PT, PhD; Hay, Catherine C. PhD, OTR; Pappadis, Monique R. PhD; Deutsch, Anne PhD, RN, CRRN; Reistetter, Timothy A. PhD, OTR

Journal of Neurologic Physical Therapy: July 2019 - Volume 43 - Issue 3 - p 160–167
doi: 10.1097/NPT.0000000000000281
Research Articles

Background and Purpose: Patients and caregivers have not typically been involved in the selection of a post–acute care (PAC) provider. In 2015, the Centers for Medicare & Medicaid Services proposed the need to involve patients and their families during discharge planning. Engaging patients in rehabilitation decisions encourages shared decision making among patients and their clinicians. The purpose of this study was to examine stroke survivors' perspectives on their involvement in selecting a PAC provider and their goal setting and their satisfaction with the rehabilitation stay and their discharge advice for stroke survivors, prior to 2015.

Methods: This qualitative study utilized semistructured interviews. Thematic content analysis was performed on interviews involving 18 stroke survivors (mean age = 68 years) related to their involvement in planning for their inpatient rehabilitation facility or skilled nursing facility stay, goal setting, and discharge needs.

Results: More than half the participants were not involved in the selection of their PAC setting and believed that doctors made these decisions. Around two-fifths of stroke survivors reported that they were not involved in rehabilitation goal setting. Most patients were satisfied with their rehabilitation stay. When asked to recommend discharge topics for other stroke survivors, participants recommended additional information on health care services, interventions, and insurance coverage.

Discussion and Conclusion: Despite recommendations to include stroke patients in PAC selection and goal setting, many former inpatient rehabilitation facility and skilled nursing facility patients report not being involved in either aspect of care.

Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at:

Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia (S.K.); School of Occupational Therapy, Texas Womens University, Houston, Texas (C.C.H.); Division of Rehabilitation Sciences University of Texas Medical Branch, Galveston, Texas (M.R.P.) and Department of Occupational Therapy, The University of Texas Health San Antonio, San Antonio Texas (T.A.R.); Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois (A.D.); Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois (A.D.); and Quality Measurement and Health Policy Program, RTI International, Chicago, Illinois (A.D.).

Correspondence: Shilpa Krishnan, PT, PhD, School of Medicine, Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, 1462 Clifton Rd, NE, Ste 276-M, Atlanta, GA 30322 (

This work was supported by the Agency for Health Care Research and Quality (R24 HS022134 and R01-HS024711); National Institute on Disability, Independent Living, and Rehabilitation Research (90SFGE0002, 90AR5009); UTMB Institute for Translational Sciences support by an NIH Clinical & Translational Science Award (UL1TR001439); and UTMB Claude D. Pepper Older Americans Independence Center NIH/NIA (P30 AG024832).

The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

© 2019 Academy of Neurologic Physical Therapy, APTA