Racial/ethnic differences in utilization of post-stroke rehabilitation services: a systematic review.

OBJECTIVE: To examine racial/ethnic differences in utilization of stroke-related rehabilitation.
METHODS: We searched Medline (from 1966-2007), CINAHL (from 1982-2007), PsycINFO (1966-2007), REHABDATA (1966-2007), the Cochrane Library, and reference lists of published articles. We identified 82 studies in our initial search, including randomized and quasirandomized controlled trials, working papers, technical reports, and conference presentations of stroke patients that reported utilization of rehabilitation services including physical therapy (PT), occupational therapy (OT), speech-language pathology (SLP), and at least two groups that differed by race/ethnicity. Because of limited information on outcomes and heterogeneity of the studies, a formal meta-analysis was not conducted. A qualitative aggregation of study findings was performed instead.
RESULTS: Ten studies involving 214,229 patients met the final criteria for review. Racial/ethnic minorities were more likely to receive rehabilitation and have longer lengths of stays in studies that reported use of rehabilitation services. In contrast, when studies reported discipline-specific (PT, OT, SLP) utilization of services, the results were mixed.
CONCLUSIONS: Racial/ethnic differences in the utilization of rehabilitation services primarily reflected the manner in which service utilization was reported. Future studies should be designed to ensure an accurate comparison of service utilization by race/ethnicity.