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Bates BE, Kwong PL, Xie D, Valimahomed A, Ripley DC, Kurichi JE, Stineman MG. Factors influencing receipt of early rehabilitation after stroke. Archives of physical medicine and rehabilitation. 2013 Dec 1; 94(12):2349-56.
OBJECTIVE: To identify patient-level characteristics associated with rehabilitation during the acute poststroke phase. DESIGN: Retrospective cohort. Generalized estimating equations modeled the likelihood of rehabilitation during the index hospitalization to account for patient clusters. SETTING: Rehabilitation facilities. PARTICIPANTS: 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. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: 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.