Predictors of Resuming Therapy Within Four Weeks After Discharge from Inpatient Rehabilitation

Abstract

Purpose-1) Identify the percentage of persons with stroke resuming therapy within four weeks of inpatient rehabilitation discharge, 2) compare the characteristics of those who did and did not resume therapy, and 3) determine the predictors of resuming physical (PT), occupational (OT), and speech (ST) therapy.Method-Socio-demographic, stroke-related, and therapy data for persons with stroke (n=131) were abstracted from inpatient rehabilitation charts. Functional Independence Measure, Stroke Impact Scale, Geriatric Depression Scale and data on therapy received after discharge were also collected.Results-Logistic regression models demonstrated that minorities were less likely to resume PT (OR=.30) and OT (OR=.25). Survivors with neglect/visual-field cut/spatial-perceptual loss were 2-3 times more likely to resume PT, OT, and ST. Survivors with higher scores on the SIS Physical domain sub-scale were less likely to resume PT (OR=0.98) and OT (OR=0.97). Men were 3.3 times more likely to have OT than women. Those with comprehensive health insurance were 11.2 times more likely to receive ST.Conclusions-The benefits of outpatient therapy are not universally available to all persons with stroke. Further research needs to explore the factors that hinder the prompt resumption of therapy for minority and female persons with stroke and to test appropriate interventions.

Effect of health insurance on the utilisation of allied health services by people with chronic disease: a systematic review and meta-analysis

“…Contrasting findings were reported where a reduction in physiotherapy utilisation was observed in non-Caucasian races with osteoarthritis (Cisternas et al 2009), findings supported by another study that demonstrated that non-white or minority race was independently associated with lesser of utilisation of allied health services (e.g. physiotherapy, occupational therapy) (Ostwald et al 2009). Body mass index did not influence utilisation in one study (Cisternas et al 2009) and few other demographic factors were reported.…”

“…Gender was not found to be a significant covariate in some subgroups (Ostwald et al 2009;Montgomery et al 2011) although males were more likely to utilise occupational therapy following stroke (Ostwald et al 2009). Race did influence allied health service utilisation independently of insurance; however, the nature of the relationship varied across clinical populations, for example, one study reported that Hispanics were more likely to use physiotherapy whereas black patients were less likely to use physiotherapy or chiropractic services (Montgomery et al 2011).…”

“…2). Studies placed in category (ii) insurance v. alternate insurance of lesser coverage included a comparison of private insurance versus public insurance on physiotherapy utilisation among people with osteoarthritis (Cisternas et al 2009), and a comparison of 'comprehensive' insurance (Medicare (US) with supplement, private, Veterans affairs) versus 'inadequate' insurance (no insurance, Medicare (US) or Medicaid (US) without supplement) on physical, occupational and speech therapy utilisation among people with stroke recently discharged from hospital (Ostwald et al 2009). There was significant heterogeneity in these studies (n = 4 effect estimates from two publications, I 2 = 74.4%, Cochrane's Q P = 0.008), which were then separated into physiotherapy and non-physiotherapy services for the pooling of results but despite this, still demonstrated moderate heterogeneity for studies examining physiotherapy utilisation (n = 2 effect estimates from two publications, I 2 = 55.7%, Cochrane's Q P = 0.13) and studies examining non-physiotherapy services (n = 2 effect estimates from one publication, I 2 = 41.4%, Cochrane's Q P = 0.19).…”

“…Education was independently associated with utilisation but varied depending on the allied health service with a single study reporting no relationship between education and utilisation (Ostwald et al 2009). However higher education increased physiotherapy utilisation by people with osteoarthritis and rheumatoid arthritis (Cisternas et al 2009;Iversen et al 2011) and people with intermediate education were more frequent utilisers of physiotherapy for back pain (Latza et al 2004).…”

“…Respondents with higher household incomes (>US$60 000) were generally more likely to receive services, for example, people with spinal cord injury, cerebral palsy or multiple sclerosis were more likely to receive physiotherapy (Elrod and DeJong 2008). However, socioeconomic status was not associated with utilisation of allied health services in people who had suffered a stroke 1 month following hospital discharge (Ostwald et al 2009). The ability to drive and access to transport as a personal enabling factor was not examined as a covariate in any study.…”