More Than 30% of US Stroke Survivors Receive Outpatient Rehabilitation

May 25, 2007 — Slightly more than 30% of stroke survivors in a sample of US states received outpatient rehabilitation, according to the results of a study reported in the May 25 issue of the Morbidity and Mortality Weekly Report. Prevalence of outpatient stroke rehabilitation was higher among men, non-Hispanic blacks, unemployed or retired adults, and persons living in the center city of a metropolitan statistical area (MSA) than in comparison groups."Approximately 700,000 persons in the United States have a new or recurrent stroke each year; among those who survive, only 10% recover completely, and many of the remaining survivors need rehabilitation because of resulting impairments," write J. Xie, MD, PhD, and colleagues from the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, US Centers for Disease Control and Prevention (CDC). "Long-term disability not only affects functional status and social roles among stroke survivors but also results in substantial costs; the combined direct and indirect costs of stroke are projected to be $62.7 billion in the United States in 2007. "Although studies have established that timely and intensive rehabilitation can substantially improve patients' functional outcomes and quality of life after an acute stroke, few studies have provided population-based estimates of the prevalence of acute stroke rehabilitation," the authors write. The CDC analyzed data from the 2005 Behavioral Risk Factor Surveillance System (BRFSS) survey on stroke survivors in 21 states and the District of Columbia (DC). The BRFSS is a state-based, random-digit–dialed telephone survey of the noninstitutionalized, US civilian population aged 18 years and older. The median response rate, based on Council of American Survey and Research Organizations (CASRO) guidelines, was 51.3% (range, 34.6% - 66.7%). The median cooperation rate, defined as the proportion of all respondents interviewed among all eligible persons who were contacted, was 74.3% (range, 63.2% - 85.3%). Of 129,761 survey respondents, 4689 (2.6%; 95% confidence interval [CI], 2.5 - 2.8) reported ever having a stroke.Analysis of the BRFSS data showed that 30.7% of the stroke survivors (n = 1297; 95% CI, 28.5 - 33.1) received outpatient rehabilitation, which was lower than would be expected if clinical practice guideline recommendations for all stroke patients had been followed.Stroke survivors in all 3 age groups had a similar prevalence of outpatient stroke rehabilitation, but the age-adjusted prevalence of receiving outpatient stroke rehabilitation was higher in men than in women (adjusted odds ratio [AOR], 1.31; 95% CI, 1.05 - 1.63). Compared with non-Hispanic whites, non-Hispanic blacks had a higher prevalence of outpatient stroke rehabilitation (AOR, 1.49; 95% CI, 1.10 - 2.00). Compared with stroke survivors who were employed at the time of the survey, respondents who were unemployed (AOR, 1.59; 95% CI, 1.16 - 2.18) or retired (AOR, 1.45; 95% CI, 1.01 - 2.09) were more likely to receive stroke rehabilitation. Adults living in a non-MSA had a lower prevalence of outpatient stroke rehabilitation than did those living in the center city of an MSA (AOR, 0.72; 95% CI, 0.55 - 0.93). Marital status, education level, income level, or insurance status did not significantly affect receipt of outpatient stroke rehabilitation. "Increasing the number of stroke survivors who receive needed outpatient rehabilitation might lead to better functional status and quality of life in this population," the authors write. An accompanying editorial note identifies several study limitations: lack of data on inpatient rehabilitation services or referral to rehabilitation services; inability to calculate nationwide prevalence of outpatient stroke rehabilitation; lack of data on disease severity and patient medical status; employment status determined at the time of the survey, not at the time of stroke; self-report of stroke and stroke rehabilitation; and low BRFSS response rate."Availability of and access to rehabilitation facilities and specialized staff in the community, policies encouraging family support, and physician and patient education might improve [the] rehabilitation rate among stroke survivors," the editorial note concludes. "In addition, more research is needed to assess the prevalence of referral and receipt of both inpatient and outpatient stroke rehabilitation at the state and national levels. Public health measures should continue focusing on improving systems of care, from stroke onset through final rehabilitation, to improve overall outcomes among stroke patients." MMWR Morb Mortal Wkly Rep. 2007;56(20):504-507.