Rehabilitation Practices Table 9 Individual Studies – The Effect of Race on Rehabilitation Outcomes

Author Year;
Country
Research Design
Total Sample Size

Methods

Outcome

Meade et al. 2004
USA
Case Control
Initial N=628;
Final N=628

Population: Traumatic SCI from US Model Systems database; matched white vs African American subjects matched by level of function, ASIA Impairment Scale, age and primary care sponsor: Mean age = 34.2 yrs; Gender: males = 84.2%, females = 14.7%; Level of injury: paraplegia, tetraplegia; Severity of injury: AIS: A-D.
Treatment: No treatment per se, but various outcomes associated with inpatient acute and rehabilitation care focusing on race effects by comparing outcomes of African Americans and whites.
Outcome Measures: AIS motor index scores, FIM motor score, Medical complications, discharge disposition, medical procedures and medical management. Collected at admission to acute care and admission to and discharge from rehabilitation.

  • No significant differences between whites vs African Americans for AIS and FIM motor index scores.
  • No significant differences for discharge disposition (P=0.622).
  • African Americans were more likely to be injured as a result of violence and whites were more likely to be injured in MVCs.
  • African Americans were significantly more likely to receive laparotomies (p<0.001) and be catheter free in comparison to caucasians.
  • Whites were more likely to receive spine surgeries (p<0.001) and have more suprapubic cystomies in comparison to African Americans.
  • No significant differences between racial groups in the occurrence of medical complications during either acute care or rehabilitation.

Putzke et al. 2002
USA
Case Control
Study 1:
Initial N=2438;
Final N=374
Study 2:
Initial N=3301;
Final N=316

Population: Traumatic SCI admitted within 1 day of injury to integrated (acute and rehabilitation) US Model Systems Center (Study 1: eligible N=2438) or having 1 year or later follow-up data in the US Model Systems database (Study 2: eligible N=3301), matched white and African American by various injury and demographic factors, tetraplegia, paraplegia, complete, incomplete, Study 1: Mean age = 34.8 yrs (white) & 35.3 yrs (African American); Gender(both groups): males = 90%, females = 10%; Study 2: Mean age = 37.7 (white) & 37.8 (African American) yrs: Gender(both groups): males = 93%, females = 7%.
Treatment: No treatment per se, but race effects on various outcomes associated with integrated acute and rehabilitation care (study 1) or long-term (study 2) studied by comparing results between whites and African Americans.
Outcome Measures: Study 1: FIM motor and efficiency scores, Length of Stay, Discharge destination, medical complications, Charges. Study 2: FIM motor and efficiency scores, CHART, Satisfaction with Life Scale (SWLS), SF-12 (measured the individual’s perception of his/her health status), medical complications and number of hospitalizations. All collected at admission, discharge or at annual follow-up (Study 2 only).

  • Study 1
  • Significant differences between race were not found relating to any of the outcome measures including FIM, Length of Stay (acute or rehabilitation care), Discharge destination and charges (p>0.05).
  • The 2 groups were significantly different (p<0.001) on numerous other demographic and injury-related factors including age, education, gender, race, marital and occupational status, lesion level, and injury duration.
  • Study 2
  • No significant differences were seen with SWLS, SF-12 and CHART (p=0.25).
  • None of the medical outcome variables differed significantly (p>0.05) with race, including days rehospitalized and number of rehospitalizations in the previous year, impairment level, and total medical complications.
  • Despite non-significant results with multivariate analyses, univariate analyses were also conducted and were generally non-significant except that whites reported less handicap on the CHART mobility subscale (p=0.03).
  • As with Study 1, both groups differed significantly on numerous demographic and injury-related factors (p<0.001).

Krause et al. 2006
USA
Case Series
Initial N = 1342
Final N=1278

Population: 72.3% response rate to a survey of outpatients from a large SE US rehabilitation hospital.  Mean age=41.6yrs; Gender & Race: 75% white, 74% male, 56% white male, 21% white female, 18% African American men, 5% African American females; Injury Duration: Mean = 9.7 years; Injury level: Cervical 55%: Injury severity: No sensation or movement = 29.4%, sensation but no movement = 28.5%, movement but not ambulation = 20.8%, useful function including ambulation = 21.5%.
Treatment: Cross-sectional survey to examine the effect of race and gender on health status and healthcare utilization and the mediating effects of education and income.
Outcome Measures: 3 general health indicators from the Behavioural Risk Factor Surveillance (self-rated health, days of poor physical health, days of poor mental health) and 3 healthcare utilization measures (number of hospitalizations, days of hospitalizations, number of doctor visits).

  • A significant difference was seen based on race in 3 of 6 outcomes: African Americans had more days in poor health, more hospitalizations in the past year and more days hospitalized.
  • Inclusion of mediators in MANOVA analysis indicated that variables of income and education accounted for much more of the variance seen for these variables of general health and healthcare utilization than did race.

Note: AIS=ASIA Impairment Scale; FIM=Functional Independence Measure; MVC=motor vehicle collision

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