Differences in rehabilitation evaluation access for rural and socially disadvantaged stroke survivors.
Corey Morrow, Michelle Woodbury, Annie N Simpson and 2 others
PMID 38369788WHAT IT FOUND
Rural and socially disadvantaged stroke survivors received significantly fewer community-based physical and occupational therapy evaluations than their peers.
Access to outpatient therapy was particularly low for these groups, with only 2.0% of the total cohort receiving outpatient occupational therapy.
Key findings
01Rural stroke survivors had significantly lower rates of outpatient physical therapy and home health evaluations for both physical and occupational therapy compared to non-rural survivors.
02Socially disadvantaged stroke survivors had significantly lower rates of outpatient and home health occupational therapy evaluations.
03Overall access to outpatient therapy was very limited, with only 8.7% receiving physical therapy and 2.0% receiving occupational therapy.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study relied on billing codes (CPT) to determine access, which may not capture clinical nuances or the reasons for lack of evaluation. It only included Medicare patients aged 65 and older, so findings may not apply to younger stroke survivors. Comorbidities were not controlled for, meaning patients with severe strokes may have had other health issues limiting their ability to participate in therapy. The socially disadvantaged group represented only 7% of the cohort, which may limit the generalizability of findings for that specific subgroup. Speech therapy services were not included in the analysis despite being integral to stroke rehabilitation.
Declared interests
The authors reported no competing interests.
The easy way to misread this
Do not interpret the low evaluation rates as evidence that these patients did not need therapy. The study shows an association between rural/disadvantaged status and lower access, but it cannot determine if the lack of evaluation was due to patient refusal, provider shortage, or insurance barriers.