Health Care Disparities in Stroke Rehabilitation

Chavez, Audrie A.; Simmonds, Kent P.; Venkatachalam, Aardhra M.

doi:10.1016/j.pmr.2023.06.030

Cited by 3 publications

(4 citation statements)

References 52 publications

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“…The finding corresponds with prior literature showing that NHB (versus NHW) patients were actually more likely to receive stroke rehabilitation care. 3 , 22 Second, the magnitudes of disparities were not consistent as treatment differences were smaller for complications with higher visibility (eg, neurogenic bowel/bladder) or clinical acuity (eg, seizures). The signs and symptoms of poststroke complications may be subtle and require a trusting physician–patient relationship (eg, fatigue/mood disorders) or specialized physical examination skills (eg, spasticity).…”

Section: Discussionmentioning

confidence: 99%

“… 2 However, a significant proportion of patients with stroke survive and are at a considerable risk of debility due to poststroke complications. 3 The cumulative impact of these complications contributes to stroke being one of the leading causes of preventable disability. Unfortunately, racial and ethnic disparities in stroke extend beyond incidence and mortality to effect poststroke function among surviors.…”

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confidence: 99%

“…Unfortunately, racial and ethnic disparities in stroke extend beyond incidence and mortality to effect poststroke function among surviors. 1 , 3 , 4 Identification of the specific causes that contribute to racial and ethnic differences in poststroke function remains unclear, as prior studies have not identified clear racial and ethnic differences in prestroke function, the amount of rehabilitation therapies that patients receive, or access to specialized postacute care at inpatient rehabilitation facilities or skilled nursing facilities. 3 , 4 , 5 , 6 …”

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confidence: 99%

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Racial and Ethnic Disparities in the Medical Management of Poststroke Complications Among Patients With Acute Stroke

Simmonds,

Atem,

Welch

et al. 2024

JAHA

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Background To inform clinical practice, we sought to identify racial and ethnic differences in the medical management of common poststroke complications. Methods and Results A cohort of acutely hospitalized, first‐time non‐Hispanic White (NHW), non‐Hispanic Black, and Hispanic patients with stroke was identified from electronic medical records of 51 large health care organizations (January 1, 2003 to December 5, 2022). Matched propensity scores were used to account for baseline differences. Primary outcomes included receipt of medication(s) associated with the management of the following poststroke complications: arousal/fatigue, spasticity, mood, sleep, neurogenic bladder, neurogenic bowel, and seizure. Differences were measured at 14, 90, and 365 days. Subgroup analyses included differences restricted to patients with ischemic stroke, younger age (<65 years), and stratified by decade (2003–2012 and 2013–2022). Before matching, the final cohort consisted of 348 286 patients with first‐time stroke. Matching resulted in 63 722 non‐Hispanic Black–NHW pairs and 24 009 Hispanic–NHW pairs. Non‐Hispanic Black (versus NHW) patients were significantly less likely to be treated for all poststroke complications, with differences largest for arousal/fatigue (relative risk (RR), 0.58 [95% CI, 0.54–0.62]), spasticity (RR, 0.64 [95% CI, 0.0.62–0.67]), and mood disorders (RR, 0.72 [95% CI, 0.70–0.74]) at 14 days. Hispanic–NHW differences were similar, albeit with smaller magnitudes, with the largest differences present for spasticity (RR, 0.67 [95% CI, 0.63–0.72]), arousal/fatigue (RR, 0.77 [95% CI, 0.70–0.85]), and mood disorders (RR, 0.79 [95% CI, 0.77–0.82]). Subgroup analyses revealed similar patterns for ischemic stroke and patients aged <65 years. Disparities for the current decade remained significant but with smaller magnitudes compared with the prior decade. Conclusions There are significant racial and ethnic disparities in the treatment of poststroke complications. The differences were greatest at 14 days, outlining the importance of early identification and management.

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confidence: 99%

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Racial and Ethnic Disparities in the Medical Management of Poststroke Complications Among Patients With Acute Stroke

Simmonds,

Atem,

Welch

et al. 2024

JAHA

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“…A robust body of evidence has documented health disparities in stroke rehabilitation based on geographic location (eg, rural and urban settings), racial and ethnic differences, sex, and socioeconomic status (eg, lower income; insured and uninsured). 4 Geographic location substantially affects access to rehabilitation care as demonstrated by the 71% of all‐rural, US counties that do not have outpatient clinics that provide stroke rehabilitation services compared with 19% of nonrural counties. 5 Among patients receiving inpatient rehabilitation services post stroke, women—along with Black patients—were less likely to achieve optimal improvements according to the Functional Independence Measure, an 18‐item clinician reported scale that assesses functional capacity in six domains—mobility, transfers, self‐care, continence, cognition, and communication.…”

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confidence: 99%

Implementation Science to Advance Health Equity in Stroke Rehabilitation

Juckett,

Owolabi,

Gustavson

et al. 2024

JAHA

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Characterizing the Longitudinal Impact of Backward Locomotor Treadmill Training on Walking and Balance Outcomes in Chronic Stroke Survivors: A Randomized Single Center Clinical Trial

Awosika,

Drury,

Garver

et al. 2024

Preprint

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Background and Purpose: Walking and balance impairments after stroke are a global health concern, causing significant morbidity and mortality. However, effective strategies for achieving meaningful recovery in the chronic stages are limited. Backward locomotor treadmill training (BLTT) is a novel walking rehabilitation protocol that is safe, feasible, and likely beneficial in stroke survivors; however, its efficacy has not been tested. This single-center, randomized, assessor-blind clinical trial aims to test the preliminary efficacy of BLTT compared to forward locomotor treadmill training (FLTT) on walking speed, symmetry, and postural stability. Methods: Forty stroke survivors [BLTT (N=19), FLTT (N=21); mean age= 56.3 ? 8.6 years; 53% Female; 30% Non-Hispanic Black] with mild-moderate walking impairment were enrolled. Participants underwent nine 30-minute BLTT or FLTT sessions over three weeks. The primary outcome was the mean change in the 10-meter walk test (10 MWT) at 24 hours post-training (24 hr POST). Secondary outcome measures were changes in spatiotemporal walking symmetry and postural stability during quiet standing at 24 hr POST. Retention was explored at Days 30- and 90 POST. Results: We report clinically meaningful (? 0.16 m/s) improvements in overground walking speed at 24 hr POST, with retention up to Day 90 POST with BLTT and FLTT. However, contrary to our working hypothesis, no between-group differences in walking speed were observed. Nonetheless, we found that BLTT resulted in offline improvements in spatial symmetry and retention of subcomponents of the modified clinical test of sensory interaction on balance (mCTSIB), including the testing of proprio-vestibular integration up to Day 30 POST. Conclusion: Among chronic stroke patients with mild-moderate walking impairment, BLTT and FLTT both resulted in long-lasting and clinically meaningful improvement in walking speed. However, preliminary findings suggest that BLTT may better comprehensively target walking asymmetry and sensory systems processing and integration.

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Health Care Disparities in Stroke Rehabilitation

Cited by 3 publications

References 52 publications

Racial and Ethnic Disparities in the Medical Management of Poststroke Complications Among Patients With Acute Stroke

Racial and Ethnic Disparities in the Medical Management of Poststroke Complications Among Patients With Acute Stroke

Implementation Science to Advance Health Equity in Stroke Rehabilitation

Characterizing the Longitudinal Impact of Backward Locomotor Treadmill Training on Walking and Balance Outcomes in Chronic Stroke Survivors: A Randomized Single Center Clinical Trial

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