Racial disparities in stroke functional outcomes upon discharge from inpatient rehabilitation facilities

Putman, Koen; Horn, Susan D.; Smout, Randall J.; DeJong, Gerben; Deutscher, Daniel; Hsieh, Ching-Hui

doi:10.3109/09638281003611078

Cited by 19 publications

(19 citation statements)

References 20 publications

(22 reference statements)

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“…In direct contrast, Berges et al noted significant differences at 3 months post injury while finding no significant differences at discharge [7]. When examining change over time, another study observed that whites demonstrated greater overall gains in FIM total and cognitive scores from admission to discharge [8], although once admission FIM scores were statistically accounted for, these significant racial/ethnic differences in post-acute rehabilitation outcomes were eliminated [9][10][11][12].…”

Section: Differences In Rehabilitation Outcomementioning

confidence: 77%

Race and Post-acute Stroke Recovery: More Similarities than Differences

Perna¹

2017

Phys Med Rehabil Int

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Race is a significant variable in terms of some health outcomes. Research has produced mixed findings in regards to the influence of race membership and rehabilitation outcomes from cardiovascular insults. More extensive research focused on traumatic brain injury (TBI) has found significant racial differences in post-injury recovery outcome. Stroke rehabilitation research has noted similar findings. However, such differences in functional outcomes were largely predicted by demographic characteristics such as age, education, and socioeconomic status, as well as injury and environmental parameters. The current archival study compared rehabilitation outcomes across two demographically comparable racial/ethnic groups (i.e., Whites of non-Hispanic origin, and Blacks) with a hypothesis that in a sample that does not widely vary in key demographic confounds (age, education, premorbid job status, substance use), there may still be significant racial differences in rehabilitation outcomes. The participants included 317 individuals (White = 224, Black = 93) who had suffered a cerebrovascular incident (CVA) within three months prior to initiating rehabilitation at an urban outpatient multidisciplinary brain injury rehabilitation program. The two racial groups were comparable in terms of mean age (46.3 vs. 48.3), education level (14.4 vs. 15.4), premorbid employment (76.9% vs. 74.2%), and substance use (19% vs. 21.9%), as well as disability severity as measured by admission Mayo Portland Adaptability Inventory (44.6 vs. 45.9). Admission MPAI-4 scores revealed that both groups began treatment with mild limitations in the areas of ability and adjustment as well as mild to moderate interference with community participation. Comparative data via ANOVA indicated that although both groups appeared to have significantly benefitted from rehabilitation, there were no statistically significant differences in the discharge MPAI scores between the two groups. The two groups also did not significantly differ with regard to the MPAI change scores (admission minus discharge). Results suggest that early (within six months post CVA) rehabilitation outcomes measured by MPAI-4 are far more similar than different for these two racial groups, when the groups are comparable on key demographic variables. These findings are consistent with previous research on the topic. Limitations of this study include higher than average educational level of participants, limited outcome measures, and limited racial representation.

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Section: Differences In Rehabilitation Outcomementioning

confidence: 77%

Race and Post-acute Stroke Recovery: More Similarities than Differences

Perna¹

2017

Phys Med Rehabil Int

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“…Ten of the 17 studies reported statistically significant racial/ethnic differences in poststroke rehabilitation outcomes [11, 17–20, 22, 23, 27, 28, 31]. The most widely reported outcome measure was the functional independence measure (FIM) [32].…”

Section: Resultsmentioning

confidence: 99%

Racial/Ethnic Differences in Poststroke Rehabilitation Outcomes

Ellis

Hyacinth

Beckett

et al. 2014

Stroke Research and Treatment

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Background. Significant racial and ethnic disparities in stroke incidence, severity, and morbidity have been consistently reported; however, less is known about potential differences in poststroke rehabilitation outcomes. Objective. To examine racial and ethnic differences in poststroke rehabilitation outcomes. Methods. We completed an in-depth search of Medline and several major journals dedicated to publishing research articles on stroke, rehabilitation, and racial-ethnic patterns of disease over a 10-year period (2003–2012). We identified studies that reported rehabilitation outcomes and the race or ethnicity of at least two groups. Results. 17 studies involving 429,108 stroke survivors met inclusion criteria for the review. The majority (94%) of studies examined outcomes between Blacks and Whites. Of those studies examining outcomes between Blacks and Whites, 59% showed that Blacks were generally less likely to achieve equivalent functional improvement following rehabilitation. Blacks were more likely to experience lower FIM gain or change scores (range: 1–60%) and more likely to have lower efficiency scores (range: 5–16%) than Whites. Conclusions. Black stroke survivors appear to generally achieve poorer functional outcomes than White stroke survivors. Future studies are warranted to evaluate the precise magnitude of these differences, whether they go beyond chance, and the underlying contributory mechanisms.

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“…Early rehabilitation occurs in a specialized stroke unit [12,7]. Rehabilitation involves services that endeavor to decrease impairment while enhancing restoration and adaptation to residue disabilities [13]. As asserted by Putaman [13], rehabilitation is a continuous course that includes identification of challenges and needs.…”

Section: Introductionmentioning

confidence: 99%

“…Rehabilitation involves services that endeavor to decrease impairment while enhancing restoration and adaptation to residue disabilities [13]. As asserted by Putaman [13], rehabilitation is a continuous course that includes identification of challenges and needs. Significantly, the authors indicated that International Classification of Functions (ICF) can be utilized to supervise rehabilitation from hospital to community reintegration.…”

Section: Introductionmentioning

confidence: 99%

“…The course also encompasses the identification of individual and community obstacles in addition to the administration of rehabilitation interventions. Putaman [13] suggest that mobilization exercises, selective movement and balance exercises are among the domains that physiotherapists use during stroke rehabilitation. However, this pathway differs in developing and developed countries.…”

Section: Introductionmentioning

confidence: 99%

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Care process for stroke patients in kenya: mixed study

Kingau¹

2018

Health Edu Care

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Background: Longer-term impairments and activity limitations secondary to stroke can cause inability to return to work, and decreased social participation. Upon stroke episode, patients follow a series of care pathways implemented by healthcare professionals. However, this pathway differs in developing and developed countries. The purpose of this study is to determine the physiotherapy stroke rehabilitation pathway in Kenya.

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Racial disparities in stroke functional outcomes upon discharge from inpatient rehabilitation facilities

Cited by 19 publications

References 20 publications

Race and Post-acute Stroke Recovery: More Similarities than Differences

Race and Post-acute Stroke Recovery: More Similarities than Differences

Racial/Ethnic Differences in Poststroke Rehabilitation Outcomes

Care process for stroke patients in kenya: mixed study

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