Risk, functional outcomes, and the utilization of rehabilitation services among survivors of cerebrovascular accident: A pooled, cross-sectional population-based study

Many studies conducted on risk factors for cerebrovascular accident (CVA) rely on homogeneous populations from small geographic areas and lack information about relevant personal and clinical features. Very few studies have looked at long-term functional ability following CVA. CVA clinical guidelines for recommend on-going use of rehabilitation by CVA survivors, but little is known about the extent to which this occurs. The Health and Retirement Study, a nationally, representative sample from the US, and linked Medicare claims data were used to study incidence and effects of first CVA, functional ability of CVA survivors, and the utilization of rehabilitation by survivors. The data were pooled cross-sectionally and Generalized Estimating Equations were utilized as the primary analysis method. Results confirm previous findings that age, gender, and smoking status increase CVA risk. The study also found that: 1) Individuals who were disabled had increased risk for CVA. 2) Age, education, and overweight BMI had a significant effect on the odds of dying in those sustaining a CVA. 3) Of those who survived CVA more than 2 years, age and type of CVA were predictive of worse functional ability. 4) Age, race, co-morbidity, current use of rehabilitation, and depressive symptoms were all associated with worse post-CVA functional ability. 5) Employment status and physical activity behaviors at baseline, better cognition, social support, and mild initial severity of CVA were all predictive of better post-CVA functional ability. 6) Age, type of CVA, and recurrent CVA were the primary predictors of rehabilitation use. 7) Those who were employed at baseline used less rehabilitation services overall. Study findings suggest that 1) the role of employment and BMI in CVA risk and severity should be further studied; 2).attention by healthcare providers to post-CVA depression, cognition, and social support might improve CVA survivors' functional ability; and 3) health system factors, such as medical provider knowledge and attitudes about rehabilitation services, may need to be studied to understand variation in CVA clinical guideline implementation. Overall, this study demonstrates the value of using large databases to study utilization of rehabilitation services.

clinical decision-making