Predictors of Community-based Physical and Occupational Therapy Use After Stroke.

Area of Science:

• Neurology
• Rehabilitation Medicine
• Health Services Research

Background:

• Stroke rehabilitation, including physical and occupational therapy (PT and/or OT), is crucial for recovery.
• Access to post-stroke therapy services can be influenced by various individual, hospital, and community factors.

Purpose of the Study:

• To identify predictors of home health and outpatient PT and/or OT utilization following stroke.
• To examine individual, hospital, and community-level factors associated with therapy use and timing.

Main Methods:

• Observational, secondary analysis of the COMPASS pragmatic trial data linked to insurance claims.
• Included 6,754 patients with stroke or transient ischemic attack discharged home from 40 acute care hospitals in North Carolina.
• Used multivariable, generalized estimating equations to analyze predictors of 30-day and 90-day PT and/or OT use, time to first visit, and visit intensity.

Main Results:

• 28% and 35% of patients used PT and/or OT within 30 and 90 days, respectively.
• Individual factors like female sex, metropolitan residence, higher community education, specific insurance types, informal caregiver access, and primary care provider access predicted greater therapy use.
• Medicaid insurance was linked to lower use and delayed initiation; hospital characteristics showed limited predictive power, while community therapist supply was associated with increased use and faster initiation.

Conclusions:

• Individual and community-level factors significantly impact post-stroke rehabilitation therapy access and timing.
• Findings suggest opportunities for targeted interventions to enhance community-based rehabilitation access for stroke survivors.
• Addressing disparities in access, particularly for those with Medicaid, is essential for equitable stroke recovery.