Race and Ethnic Disparities in Rehabilitation Services and Functional Recovery After Stroke

Poststroke rehabilitation provides skilled services that target motor impairments to improve function and maximize independence after stroke. Our objectives are to first describe functional outcomes for those who participated in rehabilitation services, then to identify race/ethnic disparities in rehabilitation services after stroke and characterize the independent association of race/ethnicity to functional recovery after stroke.

Observational data were extracted from the American Heart Association's Get-With-The-Guidelines-Stroke dataset. Rehabilitation services and modified Rankin Scale were recorded at hospital discharge and via follow-up phone calls at 30 and 90 days after.

Large, comprehensive stroke centers.

Stroke survivors throughout the state of Florida (n=1083).

Not applicable.

Descriptive statistics characterize functional change in those who received rehabilitation services. Logistic regression models adjusted for potential confounders were used to determine (1) race/ethnic differences in rehabilitation services received and (2) race/ethnic differences in functional change from discharge to 30 and 90 days, respectively.

Of 1083 individuals, 43% were women, 54% were non-Hispanic White (NHW), 23% non-Hispanic Black (NHB), and 23% Hispanic. At a short-term (30d) follow-up after hospital discharge, 14% of individuals who received rehabilitation services showed functional gains, 68% no change in function, and 18% functional decline. Yet, 30 days is likely inadequate for the full functional benefit of rehabilitation efforts. At 90 days after hospital discharge, 26% showed functional improvements, 58% no change, and 16% functional decline. Irrespective of type of rehabilitation services received, there were no differences in functional change between NHW and NHB individuals, yet Hispanic individuals were less likely to improve (adjusted odds ratio [aOR]=0.647, 95% CI [0.425-0.983]) compared with NHW. In addition, Hispanic individuals were significantly less likely to receive any rehabilitation services (aOR=0.626, 95% CI [0.442-0.886]) and were half as likely to receive outpatient services (aOR=0.543, 95% CI [0.368-0.800]) compared with NHW.

Rehabilitation is key to functional improvement after stroke. We are making strides in health equity between NHW and NHB individuals, yet there remain disparities in functional outcomes and in rehabilitation services particularly for Hispanic individuals after stroke.