Disparities in Access to, Use of, and Quality of Rehabilitation Care Following Stroke: A Scoping Review

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Abstract
Despite the clear utility of stroke rehabilitation, our understanding of the extent of disparities in rehabilitation care across specific sociodemographic characteristics (e.g., by age, sex, race, ethnicity, rurality, socioeconomic status) is limited. In this review, we aimed to synthesize the current evidence on disparities in referral to, use of, and quality of rehabilitation following stroke; identify research gaps in our understanding of disparities in rehabilitation care; and make recommendations for future research to advance the field in identifying, understanding the causes of, and minimizing disparities. We searched three electronic databases from 1997 to 2023 for cohort, case-control, cross-sectional, observational, and mixed-method studies that examined disparities in rehabilitation care following stroke. From 7,853 records screened, we identified 49 studies that met our inclusion criteria. Findings from the studies we reviewed varied, with the most consistent findings indicating that individuals with lower socioeconomic status and those living in rural areas (vs urban) are less likely to receive rehabilitation care following stroke. Findings on racial, ethnic, and sex disparities varied with some consistent findings among specific subgroups (e.g., studies examining care in the outpatient setting) and when examining results from analyses that controlled for functional status and other measures of “need” for therapy. Several gaps in our understanding of disparities in rehabilitation care following stroke were identified. Recommendations for future work were also provided.

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