OBJECTIVES

Outpatient rehabilitation is essential for the continuum of post-stroke care to optimize recovery after discharge to home. However, despite receiving referrals, only a small percentage of stroke survivors utilize these services. With the ongoing pandemic, access to outpatient post-stroke care has become a serious concern, particularly for patients living in rural Texas. This study is to examine geographic disparities in access to outpatient stroke rehabilitation clinics, including telerehabilitation (TR), across Texas.

METHODS

Outpatient stroke clinics in Texas were identified through internet research. A telephonic survey was conducted to collect clinic-level data on physical therapy (PT), occupational therapy (OT), speech-language therapy, and TR availability. Prevalence of post-stroke hospitalization discharge to home was estimated from 2019 Texas Hospital Inpatient Discharge Public Use Data. Descriptive statistics were used to identify the availability of post-stroke therapy in outpatient settings and compare between metropolitan, micropolitan, and non-core counties.

RESULTS

Clinics from 222 Texas counties (57 metropolitan, 40 micropolitan, and 125 non-core) were surveyed. Compared to micropolitan counties, non-core counties had more stroke survivors went back home after hospitalization (71.25% vs 78.03%, p = 0.028), indicating greater needs for outpatient rehabilitation in non-core counties. However, over 60% of the non-core counties had zero stroke rehabilitation clinics. The number of clinics in non-core counties per 1,000 stroke patients discharged to home was significantly lower compared to micropolitan counties (53.97 vs 33.81, p = 0.048). Only 1 in 10 non-core counties offered TR to stroke patients, in contrast, 1 in 2 metropolitan and micropolitan counties offered TR. Less than 50% of the non-core counties had PT, OT, and SLP.

CONCLUSIONS

Stroke patients living in non-core Texas counties have poor access to outpatient and tele rehabilitation services despite high demand for post-stroke care. Immediate attention and actions are needed to reduce geographic disparities in access to stroke rehabilitation services in rural Texas.