Racial/Ethnic Differences in Poststroke Rehabilitation Outcomes

Abstract

Background. Significant racial and ethnic disparities in stroke incidence, severity, and morbidity have been consistently reported; however, less is known about potential differences in poststroke rehabilitation outcomes. Objective. To examine racial and ethnic differences in poststroke rehabilitation outcomes. Methods. We completed an in-depth search of Medline and several major journals dedicated to publishing research articles on stroke, rehabilitation, and racial-ethnic patterns of disease over a 10-year period (2003–2012). We identified studies that reported rehabilitation outcomes and the race or ethnicity of at least two groups. Results. 17 studies involving 429,108 stroke survivors met inclusion criteria for the review. The majority (94%) of studies examined outcomes between Blacks and Whites. Of those studies examining outcomes between Blacks and Whites, 59% showed that Blacks were generally less likely to achieve equivalent functional improvement following rehabilitation. Blacks were more likely to experience lower FIM gain or change scores (range: 1–60%) and more likely to have lower efficiency scores (range: 5–16%) than Whites. Conclusions. Black stroke survivors appear to generally achieve poorer functional outcomes than White stroke survivors. Future studies are warranted to evaluate the precise magnitude of these differences, whether they go beyond chance, and the underlying contributory mechanisms.

Race/ethnic Differences in Post-Stroke Depression (PSD): Findings from the Stroke Warning Information and Faster Treatment (SWIFT) Study

“…14 Additionally, Black and Hispanic stroke patients have greater odds of rehospitalization after stroke, have longer hospital stays, are less ambulatory independent at discharge, 14 and have worse post-stroke rehabilitation functional outcomes compared with Whites. 19 Studies have failed to find a consistent relationship between PSD and race/ethnicity, [20][21][22] and only one study has assessed race/ethnic differences in PSD in the United States. The lone US study, 23 conducted among Vet-Race/ethnic DiffeRences in Post-stRoke DePRession (PsD): finDings fRom the stRoke WaRning infoRmation anD fasteR tReatment (sWift) stuDy Race / Ethnic Disparities in PSD -Goldmann et al erans Affairs (VA) patients who received care for acute stroke, reported that non-Hispanic White patients were more likely to be diagnosed with PSD than non-Hispanic Blacks and Hispanics, even after controlling for other sociodemographic and clinical characteristics.…”

Race and Post-acute Stroke Recovery: More Similarities than Differences

“…as a way to measure post-CVA functional recovery in racial/ethnic minorities. Results have documented consistent racial/ethnic differences, such as slower recovery rate and lower ADL/IADLs at 1 year post injury in Black patients relative to Whites [13], as well as reduced likelihood for employment, lower levels of functional independence, and lower levels of driving independence in ethnic minorities and poorer treatment outcomes even after controlling for injury severity and rehabilitation utilization [4].…”

“…In a study, Bhandari et al, observed that Black individuals achieved marginally lower initial functional gains, described as the difference between admission and discharge scores [5]. However, this difference appeared to disappear by 3-months post injury in another study [4]. In direct contrast, Berges et al noted significant differences at 3 months post injury while finding no significant differences at discharge [7].…”

“…In the growing body of rehabilitation research, one significant area of interest has been the potential contribution of one's racial/ethnic membership to stroke outcomes [4,5]. A number of studies have supported significant differences in rehabilitation outcomes as a function of racial/ethnic membership even after adjusting for stroke severity, other prognostic variables (e.g., age, income, education level, etc.…”

Self-Support Biofeedback Training for Recovery From Motor Impairment After Stroke

“…Stroke is the leading cause of long-term disability worldwide. Of more than 750,000 stroke victims in the United States each year [1], approximately two-thirds survive and require immediate rehabilitation to recover lost brain functions [2]. These stroke rehabilitation programs, of which direct and indirect costs were estimated to be 73.7 billion dollars in 2010 [3], aim to help survivors gain physical independence and better quality of life.…”