Among patients aged 65 and older, white Americans were 1.38 times more likely than black Americans to use any type of rehabilitation services, while more black patients had low functional mobility, say authors of a study e-published November 8 in the Journal of the American Geriatrics Society (abstract only available for free). Better access to rehab, they suggest, “has the potential to improve late-life function” among black Americans.
Using in-person interview data from the 2016 National Health and Aging Trends Study (NHATS), authors compared self-reported use of rehabilitation services, therapy setting, reason for rehabilitation, and perceived change in function following rehabilitation. The study sample included 6,309 community-dwelling adults enrolled in Medicare, of which 1,276 reported receiving rehabilitation services in the previous 12 months. Individuals were asked about “rehabilitation” services broadly, which included physical therapy, speech therapy, and outpatient therapy.
Researchers identified several predictors of rehabilitation use that varied by therapy setting (home-based, outpatient, or inpatient). The study’s co-authors included APTA members Tamra Keeney, PT, DPT, and Alan M. Jette, PT, PhD, editor in chief of Physical Therapy (PTJ), APTA's scientific journal.
Some of the major findings include:
White patients were more likely to receive home-based and inpatient rehabilitation. After adjusting for other variables, white patients were 1.53 times more likely than black patients to have used home-based rehab services, and 1.63 times more likely to have used inpatient care. Researchers found no significant differences in use of outpatient rehab services. Lower functional mobility and the presence of more chronic conditions also predicted the use of home-based and inpatient rehab.
A greater percentage of black individuals had low functional mobility. For all rehab settings, more black individuals (49.2%) compared with whites (29.6%) were in the lowest functional category in the prior year, according to the Short Physical Performance Battery. In inpatient care, 66.8% of black patients vs 58.4% of white patients were in the lowest functional mobility level; in outpatient care, 47.9% of black patients were at the lowest functional level compared with 33.5% of white patients.
Access to reliable transportation may influence provider referral patterns. Individuals who had access to reliable transportation were more likely to have used outpatient rehab services, but those who had little or no access were more likely to have used inpatient rehab or home-based therapy.
Out-of-pocket costs may influence the type of rehab setting accessed. Overall, 29.4% of black interviewees who received any type of rehab services were “dual eligible” for Medicare and Medicaid, compared with 7.7% of white individuals. Among individuals who received services in an outpatient or home-based setting, white individuals more often had supplemental insurance (74.7%) than did black individuals (66.3%), write authors. Dual Medicare-Medicaid coverage “usually covers inpatient rehabilitation services,” authors note, while outpatient care usually requires a copayment, and “these differences in payment mechanism and added costs may be contributing to the differences in use of rehabilitation according to income level and for those with Medicare supplemental insurance.”
There were no significant differences between the groups with respect to self-reported functional improvement or meeting patient goals. Over 60% of both blacks and whites reported “overall improvement,” and over half said they met their rehab goals. More than one-third of interviewees indicated no change after receiving rehabilitation services.
While the survey data did not allow authors to account for diagnosis, severity of condition, or differences in type of therapy and was based purely on patient self-reported information, authors found the results useful to inform future research.
“A higher proportion of older blacks were low functioning, and they had lower odds of undergoing rehabilitation, suggesting that greater use of rehabilitation services by older black Americans has the potential to improve late-life functioning in this population,” authors write.
Future study, they say, should focus on “the contribution of rehabilitation to differences in functional decline and resultant disability prevalence at the population level and to quantify the likely effects on population-level disparities of equalizing access,” as well as “strategies aimed at identifying possible barriers to use of rehabilitation services for vulnerable groups of aging individuals, particularly those who are black, dually eligible, and of the oldest age groups and lowest functioning.”
APTA offers resources on addressing racial disparities at its Racial and Ethnic Health Disparities webpage. Resources include information on the role of cultural competence in addressing health care disparities in the physical therapy clinic.
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA.