Deans' stroke musings: Disparities in Post-Acute Stroke Rehabilitation Utilization

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, September 21, 2017

Disparities in Post-Acute Stroke Rehabilitation Utilization

With NO objective diagnosis of damage it becomes impossible to write up discharge care that would point exactly to what therapy protocols are needed.
https://wakespace.lib.wfu.edu/handle/10339/86352

abstract: Despite the fact that rehabilitation services are integral in the recovery of an individual’s functional abilities after stroke, the method by which these services are recommended and then utilized are ill-defined. This study analyzes data from the ongoing COMprehensive Post-Acute Stroke Services (COMPASS) pragmatic clinical trial to explore factors that may influence referrals to rehabilitation services at hospital discharge and clinic follow-up visits and receipt of those recommended rehabilitation services for patients who have experienced an acute stroke. Out of 1,695 enrolled COMPASS participants, 604 (35.6%) were referred to rehabilitation at hospital discharge. Factors that influenced referral included age, stroke severity category [National Institute of Health Stroke Scale (NIHSS)], and ambulatory status. Elderly participants (≥age 65) had the greatest odds referral at discharge (81%). Those with NIHSS scores in the minor category (NIHSS 1-4) had more than double the odds (OR=2.65) and those in the moderate to severe category (NIHSS 5-42) had more than five times the odds (OR=5.61) of being referred at discharge than those with no stroke symptoms (NIHSS 0). Participants unable to ambulate at discharge had more than eight times the odds (OR=8.81) of being referred than those who independently ambulated. Receipt of recommended rehabilitation, however, was low. Only 50 (44%) and 29 (35%) of participants referred for home health or to outpatient rehabilitation, respectively, actually received all the care to which they were referred, which limited the robustness of data analysis. Non-white participants had a 78% decreased odd of receiving recommended outpatient services. Ethnicity, gender, or hospital location did not influence receipt of services, even after adjusting for stroke severity, ambulatory status at admission and age. These findings indicate that a significant gap exists between referral to and receipt of recommended post-acute stroke rehabilitation services; mechanisms to bridge the gap are required to optimize functional outcomes and qualities of life of survivors of stroke.