Article

OBJECTIVE: To assess black-white differences in functional outcomes, controlling
for patient characteristics, use of nontherapy ancillaries (NTAs), and use of
physical (PT) and occupational therapy (OT) activities and interventions. DESIGN:
Multicenter prospective observational cohort study of poststroke rehabilitation.
SETTING: Six U.S. inpatient rehabilitation facilities. PARTICIPANTS: Patients
(N=732) subdivided into case-mix subgroups (CMGs; CMGs 104-107 for moderate
strokes [n=397], CMGs 108-114 for severe strokes [n=335]). INTERVENTIONS: Not
applicable. MAIN OUTCOME MEASURE: Discharge Motor FIM. RESULTS: Taking into
account patient characteristics, NTAs, and therapy activities, multivariate
regressions explained (R(2)) 54% and 69% of variation in outcomes between
patients with moderate and severe stroke, respectively. Black race was associated
with lower outcomes than white race in the severe group. However, race was no
longer associated with outcomes after including interventions used within PT and
OT activities. Including interventions within therapy activities increased R(2)
to 64% and 74% for moderate and severe strokes, respectively. Some PT and OT
activities were provided more to blacks than whites and vice versa. Greater
intensity sometimes was associated with better and sometimes with poorer
functional outcomes. CONCLUSIONS: After controlling for interventions within
activities, no racial differences were found in functional outcomes at discharge
despite racial differences in rehabilitation care, possibly because each racial
group received a mixture of interventions that were negatively and positively
associated with outcome. Clinicians should provide therapies associated with
better outcomes with high and similar intensities for black and white patients
poststroke.
CI - Copyright (c) 2010 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS