Trends in outpatient rehabilitation use for stroke survivors

Published:August 17, 2022DOI:


      • Utilization of outpatient rehabilitation is an expanding healthcare resource in stroke patients.
      • The trend in outpatient utilization for stroke recovery was not influenced by patient insurance type.
      • Over time, there was no gender bias in outpatient rehabilitation utilization in stroke survivors.



      Stroke survivors with residual disabling deficits who are medically stable may be recommended for acute rehabilitation or outpatient therapy, depending partly on the severity of their deficits. Here we sought to determine if the location at which patients needing rehabilitation post-stroke has shifted from inpatient to an outpatient setting.


      For analysis, we used our Institutional Review Board-approved Get With The Guidelines®-Stroke Database to study stroke survivors discharged to receive either inpatient or outpatient rehabilitation services between 2014 and 2019. Logistic regression analysis was used to identify clinical factors associated with discharge type. Cochran-Armitage trend analysis was used to assess differences in rehabilitation services used over time.


      A total of 3293 patients were included. Trend analysis demonstrated a significant increase over time in the proportion of patients needing rehabilitation being discharged home with rehabilitation services (P < 0.0001). In addition, older age was associated with discharge to inpatient rehabilitation (OR = 1.018, 95%CI, 1.011–1.026), as was a higher National Institutes of Health Stroke Scale score (OR = 1.149, 95%CI, 1.130–1.168).


      We found that home discharges increased, highlighting outpatient rehabilitation as an expanding healthcare resource for reducing stroke-associated disability in adults.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Neurological Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Simpkins A.N.
        • Janowski M.
        • Oz H.S.
        • et al.
        Biomarker application for precision medicine in stroke.
        Transl. Stroke Res. 2020 Aug; 11: 615-627
        • Virani S.S.
        • Alonso A.
        • Benjamin E.J.
        • et al.
        Heart disease and stroke statistics-2020 update: a report from the American Heart Association.
        Circulation. 2020 Mar 3; 141: e139-e596
        • Feigin V.L.
        • Roth G.A.
        • Naghavi M.
        • et al.
        Global burden of stroke and risk factors in 188 countries, during 1990-2013: a systematic analysis for the global burden of disease study 2013.
        Lancet Neurol. 2016 Aug; 15: 913-924
        • Simpkins A.N.
        • Dias C.
        • Norato G.
        • et al.
        Early change in stroke size performs best in predicting response to therapy.
        Cerebrovasc. Dis. 2017; 44: 141-149
        • Andrew N.E.
        • Busingye D.
        • Lannin N.A.
        • et al.
        The quality of discharge care planning in acute stroke care: influencing factors and association with postdischarge outcomes.
        J. Stroke Cerebrovasc. Dis. 2018 Mar; 27: 583-590
        • Stinear C.M.
        • Lang C.E.
        • Zeiler S.
        • et al.
        Advances and challenges in stroke rehabilitation.
        Lancet Neurol. 2020 Apr; 19: 348-360
        • Gorelick P.B.
        The global burden of stroke: persistent and disabling.
        Lancet Neurol. 2019 May; 18: 417-418
        • Winstein C.J.
        • Stein J.
        • Arena R.
        • et al.
        Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American stroke association.
        Stroke. 2016 Jun; 47: e98-e169
        • Ayala C.
        • Fang J.
        • Luncheon C.
        • et al.
        Use of outpatient rehabilitation among adult stroke survivors - 20 states and the District of Columbia, 2013, and four states, 2015.
        MMWR Morb. Mortal. Wkly Rep. 2018 May 25; 67: 575-578
        • Nagaraja N.
        • Kraus A.R.
        • Rose D.K.
        • et al.
        Benefits of an interdisciplinary stroke clinic: addressing a gap in physical therapy at post-stroke neurology follow-up.
        Disabil. Rehabil. 2021 Dec 3; 6: 1-6
        • Schlegel D.
        • Kolb S.J.
        • Luciano J.M.
        • et al.
        Utility of the NIH stroke scale as a predictor of hospital disposition.
        Stroke. 2003 Jan; 34: 134-137
        • Leira E.C.
        • Russman A.N.
        • Biller J.
        • et al.
        Preserving stroke care during the COVID-19 pandemic: potential issues and solutions.
        Neurology. 2020 Jul 21; 95: 124-133
        • Elfasi A.
        • Echevarria F.D.
        • Rodriguez R.
        • et al.
        Impact of COVID-19 on future ischemic stroke incidence.
        eNeurologicalSci. 2021 Mar; 22: 100325
        • Dickens R.
        • Senetar A.
        • Olasoji E.
        • et al.
        Abstract 15: stay at home orders during the covid-19 pandemic associated with race ethnic disparities in patient access to healthcare for stroke like symptoms.
        Stroke. 2021; 52 (A15-A15)
        • Freburger J.K.
        • Li D.
        • Johnson A.M.
        • et al.
        Physical and occupational therapy from the acute to community setting after stroke: predictors of use, continuity of care, and timeliness of care.
        Arch. Phys. Med. Rehabil. 2018 Jun; 99: 1077-1089.e7
        • Chan L.
        • Wang H.
        • Terdiman J.
        • et al.
        Disparities in outpatient and home health service utilization following stroke: results of a 9-year cohort study in northern California.
        Pm r. 2009 Nov; 1: 997-1003
        • Ellis C.
        • Zhao Y.
        • Egede L.E.
        Racial/ethnic disparities in poststroke outpatient rehabilitation among veterans.
        J. Natl. Med. Assoc. 2010 Sep; 102: 817-822
        • Fradgley E.A.
        • Paul C.L.
        • Bryant J.
        A systematic review of barriers to optimal outpatient specialist services for individuals with prevalent chronic diseases: what are the unique and common barriers experienced by patients in high income countries?.
        Int. J. Equity Health. 2015 Jun 9; 14: 52
        • Shipley J.
        • Luker J.
        • Thijs V.
        • et al.
        How can stroke care be improved for younger service users? A qualitative study on the unmet needs of younger adults in inpatient and outpatient stroke care in Australia.
        Disabil. Rehabil. 2020 Jun; 42: 1697-1704