Disparities in Access to, Use of, and Quality of Rehabilitation Following Stroke in the United States: A Scoping Review.

Objectives: To summarize current reports in the literature on disparities in rehabilitation following stroke; identify gaps in our understanding of rehabilitation disparities; and make recommendations for future research.

Data sources: A Health Sciences librarian developed a search string based on an a priori protocol and searched MEDLINE (Ovid) Embase (Elsevier), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL, EBSCO).

Study selection: A two-step screening process of titles and abstracts followed by full-text review was conducted. Primary observational studies conducted in the United States that reported on disparities in rehabilitation (i.e., physical, occupational, or speech therapy) among adults following stroke were retained. Eligible disparity populations included racial minorities; ethnic minorities; sex and gender minorities; older population; socioeconomically disadvantaged populations; and geographic minorities (inner city/rural).

Data extraction: Data extracted from retained articles included: aims/objectives; data source; sample characteristics, rehabilitation outcomes examined; types of disparities examined; statistical methods used; and disparity findings.

Data synthesis: 7,853 titles and abstracts were screened, and 473 articles underwent full-text review. 49 articles were included for data extraction and analysis. Many articles examined more than one disparity type with most examining disparities in race and/or ethnicity (n=43, 87.7%), followed by sex (n=25, 53.0%), age (n=23, 46.9%), socioeconomic status (n=22, 44.9%), and urban/rural status (n=8, 16.3%). Articles varied widely by sample characteristics, data sources, rehabilitation outcomes, and methods of examining disparities.

Conclusions: While we found some consistent evidence of disparities in rehabilitation for older individuals, non-White races, and individuals of lower socioeconomic status, the variability in methods made synthesis of findings challenging. Further work, including additional well-designed studies and systematic reviews and/or meta-analyses of current studies are needed to better understand the extent of rehabilitation disparities following stroke.