Abstract
Deutscher D, Horn SD, Smout RJ, DeJong G, Putman K. Black-white disparities in motor
function outcomes taking into account patient characteristics, nontherapy ancillaries,
therapy activities, and therapy interventions.
Objective
To assess black-white differences in functional outcomes, controlling for patient
characteristics, use of nontherapy ancillaries (NTAs), and use of physical (PT) and
occupational therapy (OT) activities and interventions.
Design
Multicenter prospective observational cohort study of poststroke rehabilitation.
Setting
Six U.S. inpatient rehabilitation facilities.
Participants
Patients (N=732) subdivided into case-mix subgroups (CMGs; CMGs 104–107 for moderate
strokes [n=397], CMGs 108–114 for severe strokes [n=335]).
Interventions
Not applicable.
Main Outcome Measure
Discharge Motor FIM.
Results
Taking into account patient characteristics, NTAs, and therapy activities, multivariate
regressions explained (R2) 54% and 69% of variation in outcomes between patients with moderate and severe stroke,
respectively. Black race was associated with lower outcomes than white race in the
severe group. However, race was no longer associated with outcomes after including
interventions used within PT and OT activities. Including interventions within therapy
activities increased R2 to 64% and 74% for moderate and severe strokes, respectively. Some PT and OT activities
were provided more to blacks than whites and vice versa. Greater intensity sometimes
was associated with better and sometimes with poorer functional outcomes.
Conclusions
After controlling for interventions within activities, no racial differences were
found in functional outcomes at discharge despite racial differences in rehabilitation
care, possibly because each racial group received a mixture of interventions that
were negatively and positively associated with outcome. Clinicians should provide
therapies associated with better outcomes with high and similar intensities for black
and white patients poststroke.
Key Words
List of Abbreviations:
CMG (case-mix group), NTA (nontherapy ancillary), OT (occupational therapy), PSROP (Post-Stroke Rehabilitation Outcomes Project), PT (physical therapy)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Heart disease and stroke statistics—2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.Circulation. 2008; 117: e25-e146
- Heart disease and stroke statistics—2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.Circulation. 2009; 119: e21-e181
- Projected costs of ischemic stroke in the United States.Neurology. 2006; 67: 1390-1395
- Quality of life of stroke survivors: a research synthesis.J Neurosci Nurs. 2001; 33: 310-316
- Quality of life after stroke.Stroke. 1995; 26: 402-408
- Factors influencing stroke survivors' quality of life during subacute recovery.Stroke. 2005; 36: 1480-1484
- Assessing quality of life after stroke.Stroke. 1997; 28: 1541-1549
- Impact of stroke on health-related quality of life in the noninstitutionalized population in the United States.Stroke. 2006; 37: 2567-2572
- Racial variations in ischemic stroke-related physical and functional impairments.Stroke. 1991; 22: 1497-1501
- Racial disparities in the pathogenesis and outcomes for patients with ischemic stroke.Manag Care Interface. 2004; 17: 28-34
- Disparities between black and white patients in functional improvement after hospitalization for an acute illness.J Am Geriatr Soc. 2005; 53: 1811-1816
- Racial/ethnic differences in utilization of post-stroke rehabilitation services: a systematic review.Ethn Dis. 2008; 18: 365-372
- Racial/ethnic differences in poststroke rehabilitation utilization in the USA.Expert Rev Cardiovasc Ther. 2009; 7: 405-410
- Variables associated with occupational and physical therapy stroke rehabilitation utilization and outcomes.J Allied Health. 2005; 34: 3-10
Weech-Maldonado R. Raciel-ethnic differences in nursing home rehabilitation care. Presented at the 6th Annual Medicaid Policy and Research Conference; State Health Care Innovation: Cost Quality and Access, September 11-12, 2008, Tallahassee-Leon Civic Center, Tallahassee, Florida; 2007.
- Black-white differences in patient characteristics, treatments, and outcomes in inpatient stroke rehabilitation.Arch Phys Med Rehabil. 2010; 91: 1712-1721
- disparities in health: descriptions, causes, and mechanisms.Annu Rev Public Health. 2008; 29: 235-252
- Effects of race and income on mortality and use of services among Medicare beneficiaries.N Engl J Med. 1996; 335: 791-799
- 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
- Racial disparities in the quality of care for enrollees in Medicare managed care.JAMA. 2002; 287: 1288-1294
- Unequal treatment: confronting racial and ethnic disparities in health care.National Academy Pr, Washington (DC)2003
- Racial disparities in outcomes of inpatient stroke rehabilitation.Arch Phys Med Rehabil. 2005; 86: 2081-2086
- 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
- Patient-related predictors of rehabilitation use for community-dwelling older Americans.J Am Geriatr Soc. 1992; 40: 336-342
- Racial and ethnic differences in postacute rehabilitation outcomes after stroke in the United States.Stroke. 2008; 39: 1514-1519
- Use of stroke secondary prevention services: are there disparities in care?.Stroke. 2009; 40: 1811-1819
- Ethnic disparities in stroke: epidemiology, acute care, and postacute outcomes.Stroke. 2005; 36: 374-386
- Defining the content of individual physiotherapy and occupational therapy sessions for stroke patients in an inpatient rehabilitation setting.Clin Rehabil. 2007; 21: 450-459
- 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
- The development of the Stroke Physiotherapy Intervention Recording Tool (SPIRIT).Disabil Rehabil. 2004; 26: 1184-1188
- Barriers to rehabilitation research, and overcoming them.Clin Rehabil. 2003; 17: 1-4
- Quantification of physiotherapy treatment time in stroke rehabilitation—criterion-related validity.Aust J Physiother. 2000; 46: 291-298
- Applying the clinical practice improvement approach to stroke rehabilitation: methods used and baseline results.Arch Phys Med Rehabil. 2005; 86: S16-S33
- Stroke rehabilitation patients, practice, and outcomes: is earlier and more aggressive therapy better?.Arch Phys Med Rehabil. 2005; 86: S101-S114
- Medicare program; prospective payment system for inpatient rehabilitation facilities; final rule.Fed Regist. 2001; 68: 45704
- The early impact of the inpatient rehabilitation facility prospective payment system on stroke rehabilitation case mix, practice patterns, and outcomes.Arch Phys Med Rehabil. 2005; 86: S93-S100
- Practice-based evidence study design for comparative effectiveness research.Med Care. 2007; 45: S50-S57
- Performance profiles of the functional independence measure.Am J Phys Med Rehabil. 1993; 72: 84-89
- The Functional Independence Measure: a new tool for rehabilitation.Adv Clin Rehabil. 1987; 1: 6-18
- What you see may not be what you get: a brief, nontechnical introduction to overfitting in regression-type models.Psychosom Med. 2004; 66: 411-421
- Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors.Stat Med. 1996; 15: 361-387
- Disparities in outpatient and home health service utilization following stroke: results of a 9-year cohort study in Northern California.PM R. 2009; 1: 997-1003
- Disparities in stroke rehabilitation: results of a study in an integrated health system in northern California.PM R. 2009; 1: 29-40
Article info
Footnotes
Supported by the National Institute on Disability and Rehabilitation Research, Department of Education (grant no. H133G050153).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Reprints are not available from the author.
Identification
Copyright
© 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Black-White Differences in Patient Characteristics, Treatments, and Outcomes in Inpatient Stroke RehabilitationArchives of Physical Medicine and RehabilitationVol. 91Issue 11
