Bishop Lauri, Gardener Hannah, Brown Scott C, Veledar Emir, Johnson Karlon H, Marulanda-Londono Erika T, Gutierrez Carolina M, Kirk-Sanchez Neva, Romano Jose, Rundek Tatjana
University of Miami, Miller School of Medicine, Department of Physical Therapy.
University of Miami, Miller School of Medicine, Department of Neurology.
medRxiv. 2025 Jan 7:2025.01.06.25320085. doi: 10.1101/2025.01.06.25320085.
To identify race/ethnic disparities in rehabilitation services after stroke and characterize the independent associations of each of race/ethnicity and rehabilitation to functional recovery post-stroke.
The Transitions of Care Stroke Disparities Study (TCSD-S) is a prospective cohort study designed to reduce disparities and to optimize the transitions of care for stroke survivors throughout the state of Florida. Participant characteristics were extracted from the American Heart Association's Get-With-The-Guidelines-Stroke dataset. Rehabilitation services, and modified Rankin Scale were recorded via follow up phone calls at 30- and 90-days after hospital discharge. Logistic regression models adjusted for potential confounders were used to determine: 1) race/ethnic differences in rehabilitation services received; 2) race/ethnic differences in functional change from discharge to 30- and 90-days, respectively; and 3) the influence of rehabilitation on functional change from discharge to 30- and 90-days.
Of 1,083 individuals, 43% were female, 52% were Non-Hispanic White (NHW), 22% were Non-Hispanic Black (NHB), and were 22% Hispanic. Individuals who engaged in rehabilitation were more likely to show improvements [aOR=1.820, 95%CI (1.301,2.545)] at 90-days from hospital discharge. Irrespective of rehabilitation services, there were no differences in functional change between NHW and NHB individuals, yet Hispanic individuals were less likely to improve [aOR=0.647, 95%CI (0.425,0.983)] compared to NHW. Additionally, Hispanic individuals were significantly less likely to receive any rehabilitation services [aOR=0.626, 95%CI (0.442,0.886)] and were half as likely to receive outpatient services [aOR=0.543, 95%CI (0.368,0.800)] as compared to NHW.
Rehabilitation is key to functional improvement after stroke. We are making strides in health equity between NHW and NHB individuals, yet there remain disparities in functional outcomes and in rehabilitation services particularly for Hispanic individuals after stroke.
确定卒中后康复服务中的种族/族裔差异，并描述种族/族裔以及康复各自与卒中后功能恢复的独立关联。
卒中护理过渡差异研究（TCSD-S）是一项前瞻性队列研究，旨在减少差异并优化佛罗里达州卒中幸存者的护理过渡。参与者特征从美国心脏协会的“遵循卒中指南”数据集中提取。通过出院后30天和90天的随访电话记录康复服务和改良Rankin量表。使用针对潜在混杂因素进行调整的逻辑回归模型来确定：1）接受康复服务的种族/族裔差异；2）出院至30天和90天功能变化的种族/族裔差异；3）康复对出院至30天和90天功能变化的影响。
在1083名个体中，43%为女性，52%为非西班牙裔白人（NHW），22%为非西班牙裔黑人（NHB），22%为西班牙裔。接受康复治疗的个体在出院90天时更有可能显示出改善[aOR = 1.820，95%CI（1.301，2.545）]。无论康复服务如何，NHW和NHB个体之间的功能变化没有差异，但与NHW相比，西班牙裔个体改善的可能性较小[aOR = 0.647，95%CI（0.425，0.983）]。此外，与NHW相比，西班牙裔个体接受任何康复服务的可能性显著降低[aOR = 0.626，95%CI（0.442，0.886）]，接受门诊服务的可能性只有一半[aOR = 0.543，95%CI（0.368，0.800）]。
康复是卒中后功能改善的关键。我们在NHW和NHB个体之间的健康公平方面正在取得进展，但在功能结局和康复服务方面仍然存在差异，尤其是卒中后的西班牙裔个体。
