Older Adults Receive Limited Physical and Occupational Therapy Poststroke: A Cohort Study in the Veterans Health Administration.

Abstract

Rehabilitation poststroke improves functional recovery but comprehensive, longitudinal evaluations of rehabilitation use are challenging because of the multiple care settings. This study quantified rehabilitation use and its predictors among older adults (≥65y) across postacute and outpatient within 6 months poststroke. This retrospective cohort study quantified physical (PT) and occupational therapy (OT) received in the postacute (inpatient rehabilitation facility [IRF], skilled nursing facility [SNF], and home health) and outpatient settings, within and outside of the VA, in the 6 months after an acute stroke hospitalization between January 1, 2017, and December 31, 2021. All rehabilitation services billed in VA or Medicare (Fee-for-Service and Advantage) were examined. Postacute and community. Veterans who were aged ≥65 years and hospitalized in a VA or non-VA medical center with an ischemic or hemorrhagic stroke. Not applicable. The total amount of rehabilitation, defined as a composite score of length of stay for IRF and SNF and number of home health and outpatient PT and OT visits. The cohort comprised 161,376 hospital admissions for 133,420 unique patients with a mean (SD) age 78.0 (8.2) years. Overall, 65.8% received postacute rehabilitation and 25.6% received outpatient rehabilitation. The median [min, max] number of total rehabilitation encounters was 10 (0-234) over the 6-month period. The significant covariates associated with a slightly higher rate of rehabilitation use per month included age, hemorrhagic stroke, a widowed, divorced, or separated marital status, high neighborhood deprivation, intensive care unit admission, comorbidity, and stroke severity. Rurally residing adults had significantly lower rates of rehabilitation use per month. The low amount of rehabilitation poststroke underscores an important need to enhance opportunities for older adults to receive adequate rehabilitation.