Referral to Municipal Rehabilitation Services after Stroke: A Danish Nationwide Cohort Study

INTRODUCTION: In more recent years, stroke survival rates have improved, and hospital stays have shortened, increasing the importance of appropriate referrals to municipal rehabilitation. Therefore, this study aimed to examine patterns of referral to municipal rehabilitation among Danish patients with stroke. METHODS: This population-based nationwide cohort study included all individuals aged ≥18 years discharged alive from hospital with a stroke diagnosis between January 2019 and May 2021, as recorded in the Danish Stroke Registry. Individual-level data were linked with information from the Danish Civil Registration System and Statistics Denmark to describe referral patterns to municipal rehabilitation services. Descriptive statistics were reported using frequencies and percentages, and propensity scores were estimated with a multivariate logistic regression model. Alluvial plots were created to illustrate patient flow. RESULTS: A total of 26,230 patients were eligible for inclusion. The median age was 74 years (interquartile range: 64-81), 56.8% were male, and 66.4% had mild strokes. Up to 30 days after discharge, 58.5% patients received a referral to municipal rehabilitation services. Patients with referrals were older, had longer hospital stays, and had a lower 30-day mortality rate compared with patients without referrals. Propensity score stratification revealed differences in patient profiles, rehabilitation referrals, and regional patterns. CONCLUSION: Over 40% of stroke patients did not receive a referral to municipal rehabilitation post-hospitalisation. While this may reflect a lack of rehabilitation needs in some cases, it could also indicate inconsistencies in referral practices that warrant further attention.