Tran Phoebe M, Fogelson Benjamin, Heidel Robert E, Baljepally Raj
Author Affiliations: Department of Public Health, University of Tennessee, Knoxville, TN (Dr Trans); and The Department of Medicine (Dr Fogelson and Dr Baljepally) and The Department of Surgery (Dr Heidel, University of Tennessee Graduate School of Medicine, Knoxville, TN.
J Cardiopulm Rehabil Prev. 2025 Jan 1;45(1):65-71. doi: 10.1097/HCR.0000000000000898. Epub 2024 Dec 26.
Great travel distances and long travel times can be barriers to outpatient stroke rehabilitation services (OSR) receipt, but there is limited information on differences in proximity to specific OSR services between urban and potentially medically underserved rural areas. Accordingly, we compared travel distance and time to the nearest service for different OSR services between rural and urban counties in Tennessee.
We conducted data scraping on Google Maps to locate Tennessee facilities offering any of the 13 American Heart Association recognized OSR services. We conducted manual validation by calling located facilities and visiting facility websites. We used the Wilcoxon rank sum test to examine if mean travel distance and time to a specific OSR service differed significantly between rural and urban counties.
All OSR services but audiology were available in Tennessee. In rural counties, social work had the highest median of mean travel distance (135.2 km), chaplaincy the highest median of mean travel time (113.5 min), and physical therapy the lowest distance (37.7 km) and time (36.3 min). Except for social work, rural counties had significantly higher travel distance and time than urban counties ( P < .01) for all OSR services.
Rural Tennessee counties had significantly higher travel distance and time for almost all OSR services compared to urban areas. These findings from a largely rural state with high stroke risk factor prevalence suggest that additional focus on establishing maximum travel limits for OSR are warranted to overcome transportation barriers to enhance post-stroke services access in similar areas.
长途旅行距离和长时间出行可能成为门诊卒中康复服务（OSR）获取的障碍，但关于城市和可能医疗服务不足的农村地区在获取特定OSR服务方面的距离差异信息有限。因此，我们比较了田纳西州农村和城市县到不同OSR服务最近机构的旅行距离和时间。
我们在谷歌地图上进行数据抓取，以定位田纳西州提供美国心脏协会认可的13种OSR服务中任何一种的机构。我们通过致电已定位的机构并访问机构网站进行人工验证。我们使用Wilcoxon秩和检验来检查农村和城市县到特定OSR服务的平均旅行距离和时间是否存在显著差异。
田纳西州除听力服务外，所有OSR服务均有提供。在农村县，社会工作的平均旅行距离中位数最高（135.2公里），牧师服务的平均旅行时间中位数最高（113.5分钟），物理治疗的距离（37.7公里）和时间（36.3分钟）最低。除社会工作外，农村县到所有OSR服务的旅行距离和时间均显著高于城市县（P<.01）。
与城市地区相比，田纳西州农村县几乎所有OSR服务的旅行距离和时间都显著更高。这些来自一个卒中风险因素患病率高的主要农村州的研究结果表明，有必要额外关注设定OSR的最大旅行限制，以克服交通障碍，增强类似地区卒中后服务的可及性。
