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  • CDC: Rates of Outpatient Rehab Poststroke Low in Several States

    Despite its proven effectiveness at helping individuals recover from stroke and its important role in preventing future events, outpatient rehabilitation poststroke is still underutilized in many states, according to a new study from the US Centers for Disease Control and Prevention (CDC). Researchers found that in the states analyzed, about 1 in 3 patients received outpatient rehab after experiencing a stroke, a rate that the CDC says is "suboptimal" at best—and rife with disparities.

    The latest findings are based on 2 studies—a 2013 survey of 20 states and the District of Columbia, and a follow-up study of 4 of those states in 2015 (Maine, Georgia, Oregon, and Iowa). Researchers found that in 2013, 31.2% of stroke survivors reported receiving outpatient rehabilitation, poststroke, with state percentages ranging from a low of 23.1% in Oregon to a high of 43.6% in Minnesota.

    The 4 states selected for comparison between 2013 and 2015 did record some improvement in rates of outpatient rehab, but none broke the 50% rate: Oregon rose from 22.7% in 2013 to 39.7% in 2015, with similar increases in the other 3 states, from 24.2% to 31.8% in Georgia, 28.4% to 31.3% in Maine, and 41.7% to 49.8% in Iowa.

    Within those lackluster results there was even more bad news for younger adults, women, Hispanics, adults with less than high school education, and non-Hispanic persons of other than black or white races, who all recorded below-average rates of outpatient rehab. Overall, men reported a 33.8% rate of outpatient rehab in 2013, compared with a 29.1% rate for women. Within race/ethnicity categories, the highest rehab rate was recorded in the black non-Hispanic group, at 39.8%. Second was the white non-Hispanic group, with a 30% rate in 2013.

    Authors of the report acknowledge that efforts to increase the number of individuals poststroke who receive assessment and referral for rehabilitation have been successful, with current rates estimated at 90%—but they also point to the reported rates of actual participation in outpatient rehabilitation as a sign of an obvious disconnect.

    "Improving coordination of care to support assessment, referral, and, ultimately, participation in rehab is needed," authors write. "The continued underutilization of outpatient stroke rehab might be related to lack of patient access to outpatient facilities, ineffective referral from health care providers, high out-of-pocket costs, lack of health insurance coverage, or lack of knowledge and awareness of benefits…"

    Researchers cite several limitations to the CDC study, including inaccuracies due to possible patient misreporting of various rehab settings, lack of information on stroke severity, and smaller reporting numbers in some states. Authors also caution that the findings should not be considered nationally representative.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

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