Original article| Volume 91, ISSUE 11, P1712-1721, November 2010

Black-White Differences in Patient Characteristics, Treatments, and Outcomes in Inpatient Stroke Rehabilitation


      Horn SD, Deutscher D, Smout RJ, DeJong G, Putman K. Black-white differences in patient characteristics, treatments, and outcomes in inpatient stroke rehabilitation.


      To describe racial differences in patient characteristics, nontherapy ancillaries, physical therapy (PT), occupational therapy (OT), and functional outcomes at discharge in stroke rehabilitation.


      Multicenter prospective observational cohort study of poststroke rehabilitation.


      Six U.S. inpatient rehabilitation facilities.


      Black and white patients (n=732), subdivided in case-mix subgroups (CMGs): CMGs 104 to 107 for moderate strokes (n=397), and CMGs 108 to 114 for severe strokes (n= 335).


      Not applicable.

      Main Outcome Measure



      Significant black-white differences in multiple patient characteristics and intensity of rehabilitation care were identified. White subjects took longer from stroke onset to rehabilitation admission and were more ambulatory prior to stroke. Black subjects had more diabetes. For patients with moderate stroke, black subjects were younger, were more likely to be women, and had more hypertension and obesity with body mass index greater than or equal to 30. For patients with severe stroke, black subjects were less sick and had higher admission FIM scores. White subjects received more minutes a day of OT, although black subjects had significantly longer median PT and OT session duration. No black-white differences in unadjusted stroke rehabilitation outcomes were found.


      Reasons for differences in rehabilitation care between black and white subjects should be investigated to understand clinicians' choice of treatments by race. However, we did not find black-white differences in unadjusted stroke rehabilitation outcomes.

      Key Words

      List of Abbreviations:

      CSI (Comprehensive Severity Index), OT (occupational therapy), PSROP (Post-Stroke Rehabilitation Outcomes Project), PT (physical therapy)
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        • Adler N.E.
        • Rehkopf D.H.
        U.S. disparities in health: descriptions, causes, and mechanisms.
        Ann Rev Public Health. 2008; 29: 235-252
        • Gornick M.E.
        • Eggers P.W.
        • Reilly T.W.
        • et al.
        Effects of race and income on mortality and use of services among Medicare beneficiaries.
        N Engl J Med. 1996; 335: 791-799
        • Oddone E.Z.
        • Petersen L.A.
        • Weinberger M.
        • Freedman J.
        • Kressin N.R.
        Contribution of the Veterans Health Administration in understanding racial disparities in access and utilization of health care: a spirit of inquiry.
        Med Care. 2002; 40: I3-I13
        • Schneider E.C.
        • Zaslavsky A.M.
        • Epstein A.M.
        Racial disparities in the quality of care for enrollees in Medicare managed care.
        JAMA. 2002; 287: 1288-1294
        • Smedley B.D.
        • Stith A.Y.
        • Nelson A.R.
        • Institute of Medicine (U.S.)
        Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care.
        National Academy Press, Washington, DC2003
        • Ellis C.
        • Breland H.L.
        • Egede L.E.
        Racial/ethnic differences in utilization of post-stroke rehabilitation services: a systematic review.
        Ethn Dis. 2008; 18: 365-372
        • Ellis C.
        • Egede L.E.
        Racial/ethnic differences in poststroke rehabilitation utilization in the USA.
        Exp Rev Cardiovasc Ther. 2009; 7: 405-410
        • Ross J.S.
        • Halm E.A.
        • Bravata D.M.
        Use of stroke secondary prevention services: are there disparities in care?.
        Stroke. 2009; 40: 1811-1819
        • Goldstein L.B.
        • Matchar D.B.
        • Hoff-Lindquist J.
        • Samsa G.P.
        • Horner R.D.
        Veterans Administration Acute Stroke (VASt) Study: lack of race/ethnic-based differences in utilization of stroke-related procedures or services.
        Stroke. 2003; 34: 999-1004
        • Mayer-Oakes S.A.
        • Hoenig H.
        • Atchison K.A.
        • Lubben J.E.
        • De Jong F.
        • Schweitzer S.O.
        Patient-related predictors of rehabilitation use for community-dwelling older Americans.
        J Am Geriatr Soc. 1992; 40: 336-342
        • Bhandari V.K.
        • Kushel M.
        • Price L.
        • Schillinger D.
        Racial disparities in outcomes of inpatient stroke rehabilitation.
        Arch Phys Med Rehabil. 2005; 86: 2081-2086
        • Ottenbacher K.J.
        • Campbell J.
        • Kuo Y.F.
        • Deutsch A.
        • Ostir G.V.
        • Granger C.V.
        Racial and ethnic differences in postacute rehabilitation outcomes after stroke in the United States.
        Stroke. 2008; 39: 1514-1519
        • Stansbury J.P.
        • Jia H.
        • Williams L.S.
        • Vogel W.B.
        • Duncan P.W.
        Ethnic disparities in stroke: epidemiology, acute care, and postacute outcomes.
        Stroke. 2005; 36: 374-386
        • De Wit L.
        • Kamsteegt H.
        • Yadav B.
        • Verheyden G.
        • Feys H.
        • De Weerdt W.
        Defining the content of individual physiotherapy and occupational therapy sessions for stroke patients in an inpatient rehabilitation setting: development, validation and inter-rater reliability of a scoring list.
        Clin Rehabil. 2007; 21: 450-459
        • Pomeroy V.M.
        • Cooke E.
        • Hamilton S.
        • Whittet A.
        • Tallis R.C.
        Development of a schedule of current physiotherapy treatment used to improve movement control and functional use of the lower limb after stroke: a precursor to a clinical trial.
        Neurorehabil Neural Repair. 2005; 19: 350-359
        • Tyson S.F.
        • Selley A.
        The development of the Stroke Physiotherapy Intervention Recording Tool (SPIRIT).
        Disabil Rehabil. 2004; 26: 1184-1188
        • Wade D.T.
        Barriers to rehabilitation research, and overcoming them.
        Clin Rehabil. 2003; 17: 1-4
        • Wittwer J.E.
        • Goldie P.A.
        • Matyas T.A.
        • Galea M.P.
        Quantification of physiotherapy treatment time in stroke rehabilitation—criterion-related validity.
        Aust J Physiother. 2000; 46: 291-298
        • Gassaway J.
        • Horn S.D.
        • DeJong G.
        • Smout R.J.
        • Clark C.
        • James R.
        Applying the clinical practice improvement approach to stroke rehabilitation: methods used and baseline results.
        Arch Phys Med Rehabil. 2005; 86: S16-S33
        • Horn S.D.
        • DeJong G.
        • Smout R.J.
        • Gassaway J.
        • James R.
        • Conroy B.
        Stroke rehabilitation patients, practice, and outcomes: is earlier and more aggressive therapy better?.
        Arch Phys Med Rehabil. 2005; 86: S101-S114
        • Horn S.D.
        • Gassaway J.
        Practice-based evidence study design for comparative effectiveness research.
        Med Care. 2007; 45: S50-S57
        • Hatfield B.
        • Millet D.
        • Coles J.
        • Gassaway J.
        • Conroy B.
        • Smout R.J.
        Characterizing speech and language pathology outcomes in stroke rehabilitation.
        Arch Phys Med Rehabil. 2005; 86: S61-S72
        • Jette D.U.
        • Latham N.K.
        • Smout R.J.
        • Gassaway J.
        • Slavin M.D.
        • Horn S.D.
        Physical therapy interventions for patients with stroke in inpatient rehabilitation facilities.
        Phys Ther. 2005; 85: 238-248
        • Latham N.K.
        • Jette D.U.
        • Slavin M.
        • et al.
        Physical therapy during stroke rehabilitation for people with different walking abilities.
        Arch Phys Med Rehabil. 2005; 86: S41-S50
        • Richards L.G.
        • Latham N.K.
        • Jette D.U.
        • Rosenberg L.
        • Smout R.J.
        • DeJong G.
        Characterizing occupational therapy practice in stroke rehabilitation.
        Arch Phys Med Rehabil. 2005; 86: S51-S60
        • American Physical Therapy Association
        Guide to physical therapist practice: second edition.
        Phys Ther. 2001; 81: 9-746
        • Bravata D.M.
        • Wells C.K.
        • Gulanski B.
        • et al.
        Racial disparities in stroke risk factors: the impact of socioeconomic status.
        Stroke. 2005; 36: 1507-1511