Stroke Research and Treatment / 2014 / Article / Tab 1

Review Article

Racial/Ethnic Differences in Poststroke Rehabilitation Outcomes

Table 1

Summary of studies reporting racial or ethnic differences in rehabilitation outcomes.

Study ref. no. Data sourceSampleOutcomeTime of measureSeverity controlledResults valueComment

Horner et al., 2003 [11]Patients hospitalized in 9 VAMCs 1995–1997738 (31.2% Black)Rankin
% change
Admit-D/CYesImprovement after 3 days of rehab
16% of Blacks
35% of Whites
0.007Low income Blacks had worse recovery; delay in rehab initiation had greater impact on Blacks

Moorthy et al., 2004 [16]Patients in IP rehabBlack: 56 
White: 55 
Hispanic: 18
FIMAdmit-D/CNoImprovement at D/C
Blacks: 7.1
White: 8.9
Hispanic: 10.1
NRSmall statistically significant differences in FIM gain scores among ethnic groups

Bhandari et al., 2005 [17]Patients in community based IP rehab facility
1995–2001
Black: 419 
White: 421 
Hispanic: 33 
Asian: 96 
Other: 33
FIMD/C-3 monthsNoImprovement 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

Nichols-Larsen et al., 2005 [18]EXCITE trial White: 153 
Non-White: 63
SIS3–9 months after strokeNoNon-Whites reported lower HRQOL in the physical domain0.003

Keng et al., 2005 [19]Patients in urban community hospital Black: 83 
White: 20 
Hispanic: 68
FIMAdmit-D/CNoImprovement 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 ( )

Chiou-Tan et al., 2006 [20]UDSMR data 2000–2003Black: 83 
White: 20 Hispanic: 68
FIMAdmit-D/CNoImprovement 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) ( )

Hinson et al., 2007 [21]Patients seen at outpatient medical centerBlack: 66  
White: 52
, 
6-min walk test, and 
30 ft walking velocity
Admit 
only
NoWalking velocity 
BM-.60
BF-.50
WM-.61
WF-.41
6 min walk test 
BM: 223
BF: 198 
WM: 226 
WF: 157 

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

Ottenbacher et al., 2008 [22]UDSMR data; IP rehab in 2002-2003Black: 25,334 
White: 123,537 
Hispanic: 7,994 
Other: 4,827
FIMAdmit-D/CNoD/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.

Hinojosa et al., 2009 [23]Veterans in the US and Puerto RicoBlack: 30 
White: 42 
Puerto Rican: 49
FIMD/C
1 months
6 months
12 months
18 months
24 months
NoD/C motor FIM 
Black: 80.94 
Caucasian: 78.29 
Puerto Rican: 67.66
0.000In HLM models and controlling for time, Blacks had average FIM 4.66 points higher than Whites ( ) and Puerto Ricans had FIM 5.64 points lower than Whites ( )

Horn et al., 2010 [24]Six US inpatient rehabilitation facilities Black: 239 
White: 493
FIMAdmit-D/CNoImprovement 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

Deutscher et al., 2010 [25]Six US inpatient rehabilitation facilitiesBlack: 239 
White: 493
FIMAdmit-D/CNoBlacks with lower discharge FIM (In OLS models using patient variables, nontherapy ancillaries, and use of PT/OT)0.015

Liu et al.,
2010 [26]
Medicare assessment and claims dataBlack: 33,639 
White: 216,664 
Asian: 3,157 
Hispanic: 4,575 
North American Natives: 839
FIM: 12Admit-D/CNoBlacks had lower functional status than Whites after adjusting for covariatesNR

Putnam et al., 2010 [27]Six US inpatient rehabilitation facilitiesBlacks: 239 
Whites: 493
FIMAdmit-D/CNoImprovement 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

Roth et al., 2011 [28]Patients enrolled in REGARDS studyBlacks: 40 
Whites: 72
BI
MRS
SIS
MMSE
Admit-1 yearNoRace-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

Wang et al., 2011 [29]Inpatient rehabilitation hospital
2002–2006
1908  
Black: 13.5% 
White: 63.9% 
Hispanic: 8.4% 
Asian: 14.1%
FIMAdmit-D/CNoImprovement 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

Rabadi et al., 2012 [30]Acute stroke rehabilitation unitBlack: 115 
White: 504 
Hispanic: 38 
Asian: 13
FIMAdmit-D/CNoImprovement at D/C
Cognitive FIM
Whites: 1.6
Blacks: 2.1
Hispanics: 3.1
Asians: 3.5
0.028No significant differences noted in total FIM, FIM-ADL, or motor FIM

Berges et al., 2012 [31]11 US IP facilitiesBlack: 150 
White: 783 
Hispanic: 57
FIMAdmit-D/C
3 months
12 months
NoImprovement 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.