• Vol. 43 No. 3, 136–144
  • 15 March 2014

Post Community Hospital Discharge Rehabilitation Attendance: Self-Perceived Barriers and Participation Over Time

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ABSTRACT

Introduction: This study aimed to examine the attendance rates of post-discharge supervised rehabilitation as recommended by the multidisciplinary team at discharge among subacutely disabled adults and the barriers preventing adherence.

Materials and Methods: Patients were from a community hospital, aged 40 years or older. They had been assessed by a multidisciplinary team to benefit from rehabilitation after discharge, were mentally competent and communicative. We used a sequential qualitative-quantitative mixed methods study design. In the initial qualitative phase, we studied the patient-perceived barriers to adherence to rehabilitation using semi-structured interviews. Emerging themes were then analysed and used to develop a questionnaire to measure the extent of these barriers. In the subsequent quantitative phase, the questionnaire was used with telephone follow-up at 3, 6, 9 and 12 months after discharge.

Results: Patients were from a community hospital, aged 40 years or older. They had been assessed by a multidisciplinary team to benefit from rehabilitation after discharge, were mentally competent and communicative. We used a sequential qualitative-quantitative mixed methods study design. In the initial qualitative phase, we studied the patient-perceived barriers to adherence to rehabilitation using semi-structured interviews. Emerging themes were then analysed and used to develop a questionnaire to measure the extent of these barriers. In the subsequent quantitative phase, the questionnaire was used with telephone follow-up at 3, 6, 9 and 12 months after discharge.

Conclusion: Attendance of post-hospitalisation rehabilitation in Singapore is low. Self-perceived barriers to post-discharge rehabilitation attendance were functional, social, financial and perceptual, and their prevalence varied with time.


As Singapore faces a rapidly ageing population, the national burden of long-term disability is expected to correspondingly increase. Post-discharge rehabilitation of the newly disabled adults, especially during the subacute phase after an acute disabling event where functional recovery is most likely, is an important strategy to reduce the prevalence of severe disability. Besides maximising functional recovery, rehabilitation also improves their quality of life, reduces the costs associated with disability and years lost due to disability, translating into effective usage of limited resources. Community hospitals in Singapore function as one of the primary sites facilitating adult rehabilitation. Anecdotally, however, adherence to supervised rehabilitation within the community, post-discharge, has been demonstrated to be low. Studies in the United States (US) and Australia have shown that the rates of rehabilitation service utilisation by stroke patients in the community is as low as 13% to 31%. A local study by Koh et al on the adherence rates (at day rehabilitation centres) in stroke patients discharged from community hospitals have estimated the rate to be about 28% at 1 year.

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