Abstract WP68: Rehabilitation Therapy Doses Are Low After Stroke And Predicted By Clinical Factors

Abstract

Background: Stroke is a leading cause of disability. Greater rehabilitation therapy after stroke improves functional outcomes but is often not provided. This study examined amount of rehabilitation therapy during the first year after stroke in the U.S. and identified factors that predict rehabilitation therapy dose. Methods: Adults with new radiologically confirmed stroke were enrolled in the STRONG Study 2-10 days after stroke onset at 28 acute care hospitals in the U.S. Following initial assessment during acute hospitalization, the number of PT, OT, and ST sessions was measured at 3-, 6-, and 12-months post-stroke. The 3-month visit included a live exam. Negative binomial regression was used to investigate relationships that clinical and demographic factors had with therapy dose. False discovery rate was used to correct for multiple comparisons. Results: Of 763 patients enrolled during the acute stroke admission, 510 were seen for follow-up. Rehabilitation therapy doses were overall low, with most therapy delivered within the first 3 months; 35.0% of patients received no PT; 48.8%, no OT, and 61.7%, no ST. Discharge destination was significantly related to cumulative therapy; the percentage of patients discharged to an inpatient rehabilitation facility varied from 0-71%. Most demographic factors did not predict therapy dose, though Hispanic patients received lower cumulative amounts of PT and OT. Acutely, severity of clinical factors (grip strength, NIHSS score, and NIHSS subscores for aphasia and neglect) predicted higher subsequent therapy doses. At 3 months post-stroke, measures of impairment and function (FM-UE, mRS, and SIS-ADL) predicted further therapy doses. ConclusionS: Rehabilitative therapy doses during the first year of stroke recovery are low in the U.S. Patients with more severe deficits receive higher doses. Multiple factors, particularly clinical measures assessed as early as acute stroke admission, predict rehabilitation doses. These findings suggest directions to address this unmet need.