Factors influencing receipt of early rehabilitation after stroke.
OBJECTIVE
To identify patient-level characteristics associated with rehabilitation during the acute poststroke phase.


METHODS
Retrospective cohort. Generalized estimating equations modeled the likelihood of rehabilitation during the index hospitalization to account for patient clusters.


METHODS
Rehabilitation facilities.


METHODS
Sample included veterans (N=9681; average age, 68.7y; 97.4% men) diagnosed with new stroke discharged from Veterans Affairs hospitals between October 1, 2006, and September 30, 2008.


METHODS
Not applicable.


METHODS
Receipt of rehabilitation services.


RESULTS
Of the total cohort, 73% received some type of rehabilitation. After adjustment, stroke patients with cerebral arteries occlusion were most likely to receive rehabilitation compared with other stroke types (P<.001). Patients with prestroke conditions of metastatic cancer (odds ratio [OR]=.68, P<.001) and psychosis (OR=.90, P=.045) were less likely to have rehabilitation, whereas those with hypertension (OR=1.26, P<.001) and other neurologic disorders (OR=1.29, P<.001) were more likely. Compared with patients admitted from home, patients transferred from a non-Veterans Affairs hospital (OR=1.4, P<.004) were more likely to receive rehabilitation, whereas patients admitted from extended care (OR=.59, P<.001) were less likely. Married veterans were less likely to receive rehabilitation services (OR=.87, P<.001) than unmarried veterans.


CONCLUSIONS
Within the Veterans Health Administration, initiating rehabilitation in the acute phase poststroke appears to be influenced by patient clinical characteristics and living circumstances.
Veterans Affairs Medical Center, Albany, NY; Physical Medicine and Rehabilitation, Albany Medical College, Albany, NY. Electronic address: barbara.bates@va.gov.
Barbara E
BE
Bates
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
Pui L
PL
Kwong
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
Dawei
D
Xie
Physical Medicine and Rehabilitation, Albany Medical College, Albany, NY.
Ali
A
Valimahomed
Veterans Affairs Medical Center, Gainesville, FL; Division of Health Policy and Outcomes Research, Department of Epidemiology and Health Policy Research, University of Florida, Gainesville, FL.
Diane Cowper
DC
Ripley
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
Jibby E
JE
Kurichi
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA; Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA.
Margaret G
MG
Stineman
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000453:epidemiology; D002536:Cerebral Arteries; D015331:Cohort Studies; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data; D009369:Neoplasms / Q000453:epidemiology; D009422:Nervous System Diseases / Q000453:epidemiology; D010360:Patient Transfer / Q000706:statistics & numerical data; D011618:Psychotic Disorders / Q000453:epidemiology; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data; D020521:Stroke / Q000453:epidemiology; D000071939:Stroke Rehabilitation; D014481:United States / Q000453:epidemiology; D014728:Veterans
CI; CNS; FSOD; Functional Status and Outcome Database; ICD-9-CM; International Classification of Diseases, 9th Revision, Clinical Modification; OR; PFT; Patient Treatment File; Rehabilitation; Stroke; VAMC; VHA; Veterans; Veterans Affairs Medical Center; Veterans Health Administration; central nervous system; confidence interval; odds ratio