Resuming Rehabilitation Therapy After Stroke


NEW ORLEANS—Race, ethnicity, and accessibility of health insurance were statistically associated with the prompt resumption of outpatient therapy, and Stroke Impact Scale (SIS) physical domain score was associated with resumption of occupational therapy and physical therapy, according to Sharon K. ­Ostwald, PhD, a Professor at the University of Texas at Houston School of Nursing, and colleagues.

As presented at the 2008 International Stroke Conference, Dr. ­Ostwald’s group sought to identify the percentage of stroke survivors who resumed rehabilitation therapy within four weeks after discharge from inpatient rehabilitation. The investigators analyzed sociodemographic, stroke-related, and therapy data from the rehabilitation charts of 135 stroke survivors who were discharged to their homes. Immediately after discharge, the researchers collected the Functional Independence Measure (FIM), the SIS, and the Geriatric Depression Scale–Short Form (GDS-SF) from the patients. Data on type and amount of therapy during the first four weeks at home were also tracked on special calendars.

Within four weeks of discharge from inpatient rehabilitation, minorities were 70% to 75% less likely to resume physical or occupational therapy, men were 3.3 times more likely to have occupational therapy than were women, and those with comprehensive health insurance were 11.2 times more likely to receive speech therapy than those without comprehensive coverage.

The survivors’ perceptions of their physical recovery, as measured by the SIS physical domain score, were better predictors of resumption of therapy than were more objective measures, such as the FIM score. Patients with neglect, visual-field cut, and/or spatial-perceptual deficits, and those with aphasia, were more likely to resume prompt therapy after discharge than were others.

The researchers found significant differences between stroke survivors who resumed physical, occupational, and speech therapy within four weeks after discharge and those who did not. For example, 58% of the patients who resumed physical therapy had neglect, visual-field cut, and spatial-perceptual problems, as opposed to 36% of those who did not resume physical therapy. Eighty-four percent of those who resumed occupational therapy were men, compared with 65% of those who did not resume occupational therapy. In addition, 57% of patients who resumed speech therapy had aphasia, compared with 21% who did not resume speech therapy.

“Benefits of therapy are not universally available to all stroke survivors,” reported Dr. Ostwald and colleagues. “Minorities, women, and those without comprehensive insurance coverage still lack prompt access to therapy.”

—Lawrence Lubiner

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