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Stroke rehabilitation outcomes differ for blacks, whites, and Asian Americans

Stroke rehabilitation outcomes differ by race, according to a study supported in part by the Agency for Healthcare Research and Quality (HS11415). Researchers found that blacks who suffered a stroke did not improve their functioning by the end of inpatient rehabilitation as much as whites did, despite receiving similarly intense rehabilitation services. Despite their poorer functioning at discharge, blacks were nearly twice as likely as whites to be discharged home than to a rehabilitation facility. However, this did not appear to hinder their recovery, since their lower functioning at discharge compared to whites was no longer apparent 3 months later.

In contrast, Asian-Americans recovered about as much function as whites by the time they left the inpatient rehabilitation facility, and were just as likely to be discharged home. Yet, they showed less improvement 3 months later. This suggests that Asian Americans may be more dependent for recovery on the intensive services available in a rehabilitation facility and that use or quality of post-discharge services was suboptimal for them.

The findings were based on analysis of stroke rehabilitation and outcome among 1,002 stroke patients admitted to an inpatient rehabilitation facility between 1995 and 2001. Researchers used the Functional Improvement Instrument (FIM) to assess functional motor and cognitive status, a measure of the severity of disability and amount of assistance required to perform daily activities. The FIM includes 18 items, each scored on a 7-point scale, with 7 indicating complete independence and 1 indicating total dependence. After accounting for sociodemographic and other factors, black race was associated with 1.9 points (7 percent) less improvement than whites at discharge, a difference that was no longer apparent 3 months later. Yet Asian American patients showed 16 percent less functional improvement (6.3 fewer points) than whites at 3 months.

See "Racial disparities in outcomes of inpatient stroke rehabilitation," by Vijay K. Bhandari, M.S., Margot Kushel, M.D., Leonard Price, Ph.D., and Dean Schillinger, M.D., in the November 2005 Archives of Physical Medicine and Rehabilitation 86, pp. 2081-2086.

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