Table 1.
Summary of studies reporting racial or ethnic differences in rehabilitation outcomes.
| Study [ref. no.] | Data source | Sample | Outcome | Time of measure | Severity controlled | Results | P value | Comment |
|---|---|---|---|---|---|---|---|---|
| Horner et al., 2003 [11] | Patients hospitalized in 9 VAMCs 1995–1997 | 738 (31.2% Black) | Rankin % change |
Admit-D/C | Yes | Improvement after 3 days of rehab 16% of Blacks 35% of Whites |
0.007 | Low income Blacks had worse recovery; delay in rehab initiation had greater impact on Blacks |
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| Moorthy et al., 2004 [16] | Patients in IP rehab |
‡Black: 56 White: 55 Hispanic: 18 |
FIM | Admit-D/C | No | Improvement at D/C ‡Blacks: 7.1 White: 8.9 Hispanic: 10.1 |
NR | Small statistically significant differences in FIM gain scores among ethnic groups |
|
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| Bhandari et al., 2005 [17] | Patients in community based IP rehab facility 1995–2001 |
Black: 419 White: 421 Hispanic: 33 Asian: 96 Other: 33 |
FIM | D/C-3 months | No | Improvement at D/C Blacks: 1.9 points (7% less) Improvement at 3 months Asians 16% less than Whites |
0.02 0.005 |
Blacks with less improvement but more likely to be discharged home |
|
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| Nichols-Larsen et al., 2005 [18] | EXCITE trial | White: 153 Non-White: 63 |
SIS | 3–9 months after stroke | No | Non-Whites reported lower HRQOL in the physical domain | 0.003 | |
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| Keng et al., 2005 [19] | Patients in urban community hospital |
‡Black: 83 ∞White: 20 Hispanic: 68 |
FIM | Admit-D/C | No | Improvement at D/C Hispanic: 31.4 Caucasian: 28.4 Blacks: 18.9 |
FIM gain higher for Hispanic and Caucasian but only significant between Hispanics and Blacks (P = 0.045) | |
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| Chiou-Tan et al., 2006 [20] | UDSMR data 2000–2003 | Black: 83 White: 20 Hispanic: 68 |
FIM | Admit-D/C | No | Improvement at D/C Black: 21.53 White: 21.70 Hispanic: 26.78 Efficiency to D/C Black: 1.43 White: 1.20 Hispanic: 1.70 |
0.014 0.035 |
Blacks with higher scores on admission (68.89), compared to Whites (66.50) and Hispanics (58.89) (P = 0.005) |
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| Hinson et al., 2007 [21] | Patients seen at outpatient medical center | Black: 66 White: 52 |
VO2 peak, 6-min walk test, and 30 ft walking velocity |
Admit only |
No | Walking velocity BM-.60 BF-.50 WM-.61 WF-.41 6 min walk test BM: 223 BF: 198 WM: 226 WF: 157 VO2 peak BM: 15 BF: 11.5 WM: 15.1 WF: 12.3 |
NS NS NS |
Reported as BM: Black male; BF: Black female; WM: White male; WF: White female |
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| Ottenbacher et al., 2008 [22] | UDSMR data; IP rehab in 2002-2003 | Black: 25,334 White: 123,537 Hispanic: 7,994 Other: 4,827 |
FIM | Admit-D/C | No | D/C FIM Black: 80.23† White: 81.54 Hispanic: 79.43† Other: 81.77 Efficiency to D/C Black: 1.53† White: 1.61 Hispanic: 1.57 Other: 1.59 |
†0.01 †0.01 |
Differences in functional status across race groups were related to age. White was reference group. |
|
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| Hinojosa et al., 2009 [23] | Veterans in the US and Puerto Rico |
‡Black: 30 ∞White: 42 Puerto Rican: 49 |
FIM | D/C 1 months 6 months 12 months 18 months 24 months |
No | D/C motor FIM Black: 80.94 Caucasian: 78.29 Puerto Rican: 67.66 |
0.000 | In HLM models and controlling for time, Blacks had average FIM 4.66 points higher than Whites (P < 0.01) and Puerto Ricans had FIM 5.64 points lower than Whites (P < 0.05) |
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| Horn et al., 2010 [24] | Six US inpatient rehabilitation facilities | Black: 239 White: 493 |
FIM | Admit-D/C | No | Improvement at D/C Moderate stroke Blacks: 24.9 Whites: 26.9 Severe stroke Blacks: 28.1 Whites: 32.2 |
0.066 0.019 |
Moderate and severe strokes analyzed separately No Black/White differences found in unadjusted stroke rehabilitation outcomes |
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| Deutscher et al., 2010 [25] | Six US inpatient rehabilitation facilities | Black: 239 White: 493 |
FIM | Admit-D/C | No | Blacks with lower discharge FIM (In OLS models using patient variables, nontherapy ancillaries, and use of PT/OT) | 0.015 | |
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| Liu et al., 2010 [26] |
Medicare assessment and claims data | Black: 33,639 White: 216,664 Asian: 3,157 Hispanic: 4,575 North American Natives: 839 |
FIM: 12 | Admit-D/C | No | Blacks had lower functional status than Whites after adjusting for covariates | NR | |
|
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| Putnam et al., 2010 [27] | Six US inpatient rehabilitation facilities |
‡Blacks: 239 Whites: 493 |
FIM | Admit-D/C | No | Improvement at D/C Motor FIM Whites: 24.5 Blacks: 22.6 Cognitive FIM Whites: 4.9 Blacks: 3.7 |
<0.05 <0.01 |
Significant differences among those with severe stroke; no differences among moderate stroke |
|
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| Roth et al., 2011 [28] | Patients enrolled in REGARDS study | Blacks: 40 Whites: 72 |
BI MRS SIS MMSE |
Admit-1 year | No | Race-Adjusted Coefficients BI MMSE SIS memory SIS ADL SIS mobility SIS hand SIS social |
<0.05 <0.01 <0.01 <0.01 <0.05 <0.05 <0.05 |
Blacks showed greater deficits on multiple 1-year outcome measures |
|
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| Wang et al., 2011 [29] | Inpatient rehabilitation hospital 2002–2006 |
1908 Black: 13.5% White: 63.9% Hispanic: 8.4% Asian: 14.1% |
FIM | Admit-D/C | No | Improvement at D/C Severe Impairment Cognitive FIM Black (−0.09) Hispanic (0.42) Asian (−0.78) |
0.7893 0.2963 0.0180 |
Moderate and severe strokes analyzed separately |
|
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| Rabadi et al., 2012 [30] | Acute stroke rehabilitation unit | Black: 115 White: 504 Hispanic: 38 Asian: 13 |
FIM | Admit-D/C | No | Improvement at D/C Cognitive FIM Whites: 1.6 Blacks: 2.1 Hispanics: 3.1 Asians: 3.5 |
0.028 | No significant differences noted in total FIM, FIM-ADL, or motor FIM |
|
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| Berges et al., 2012 [31] | 11 US IP facilities | Black: 150 White: 783 Hispanic: 57 |
FIM | Admit-D/C 3 months 12 months |
No | Improvement at D/C Blacks: 82.9 Whites: 78.8 Hispanics: 80.3 Improvement at 3-month follow-up Blacks: 101.9 Whites: 102.3 Hispanics: 92.0 Improvement at 12-month follow-up Blacks: 105.0 Whites: 105.9 Hispanics: 98.7 |
0.15 0.01 0.18 |
No significant racial differences on admission |
Admit: admission; D/C: discharge; NR: not reported; NS: not significant; IP: inpatient; IRH: inpatient rehab hospital; FIM: functional independence measure; BI: Barthel Index; MRS: Modified Rankin Scale; SIS: Stroke Impact Scale; MMSE: Mini Mental Status Exam; IRF-PAI: inpatient rehabilitation facilities-patient assessment instrument; HRQOL: health related quality of life; UDSMR: Uniform Data System for Medical Rehabilitation; EXCITE: extremity constraint induced therapy evaluation; REGARDS: reasons for geographic and racial differences in stroke.
‡Reported as African American in study.
∞Reported as Caucasian in study.
†Refers to group statistically significant.