Are rehabilitation services following stroke accessed equitably in Australia?: findings from the psychosocial outcomes in stroke (POISE) cohort study
1 The George Institute for Global Health, PO Box M201, Missenden Road, Sydney, NSW 2050, Australia
2 Brain and Mind Research Institute, Sydney Medical School, University of Sydney, 94 Mallett St, Camperdown, NSW 2050, Australia
BMC Public Health 2013, 13:884 doi:10.1186/1471-2458-13-884Published: 24 September 2013
Stroke recovery is generally optimised through the provision of multidisciplinary rehabilitation. However not much is known about how equitably such services are utilised. This study examines the determinants of physiotherapy and speech therapy utilisation in rehabilitation within a cohort of young stroke survivors in Australia.
Psychosocial Outcomes in StrokE (POISE) was a three-year prospective observational study involving stroke survivors between the ages of 18 and 65 years recruited within 28 days of stroke. It was conducted in 20 stroke units in Australia. Participants were interviewed at 28 days (baseline), 6 and 12 months after stroke about their demographic and socioeconomic background, economic and health outcomes and the use of services. The primary outcome in this paper is utilisation of rehabilitation in the 12 months after stroke.
Of 414 participants, 254 (61%) used some rehabilitation in the 12 months post stroke. The strongest predictor of use of these rehabilitation services was dependency at 28 days, as assessed by need for assistance in activities of daily living (OR=33.1; p<0.0001). Other significant variables were two dimensions of social capital - an individuals’ ability to make important decisions, which had a negative relationship (OR = 0.43; p=0.04) and number of close friends (OR= 1.042; p=0.02).
These findings demonstrate that socio-demographic factors exert little influence on the use of rehabilitation services in working age stroke patients and that the use of such services is primarily determined by 'need’. Such findings suggest that services are being provided equitably.