Introduction: The American Stroke Association recommends neurorehabilitation for those who medically qualify and have access to care. Continued services for stroke recovery at the post-hospital residential and outpatient rehabilitation levels of care result in further functional gains even when provided beyond 6-12 months post onset. Access to neurorehabilitation remains a barrier including third-party limits with funding and coverage restrictions. This study measured outcomes comparing those with state legislated Compulsory Funding (CF) vs. Restricted Funding (RF) for post-hospital neurorehabilitation. Methods: Study participants were selected from a total sample of 753 consecutive admissions to post-hospital residential rehabilitation programs located across 14 states in the United States from 2012 through 2024. Of the 753 subjects with a stroke diagnosis, 590 persons met the criteria to participate. Within the possible 590 persons, 201 individuals were treated in states with RF services, while 394 individuals were treated within the CF group. To reduce random variability inherent in unequal sample sizes, 201 persons were randomly selected with SPSS (Version 29) from the 394 in the CF group. Functional outcome was measured using the Mayo-Portland Adaptability Inventory (MPAI-4). Results: Time to post-hospital admission was significantly shorter in the CF group (116.6 vs 294.6 days) (t(400) = 2.94, p< 0.01 (Cohen’s d = 0.29) as was post-hospital rehabilitation length of stay (93.7 vs. 121.8 days) (LOS), t(400) = 1.72, p < 0.05 (Cohen’s d = 0.17). A Mixed 2x2 RM-MANOVA revealed a significant main effect of time of testing, Pillai’s Trace F(1,398) = 402.6, p < 0.001; power to detect = 0.99, partial eta 2 = 0.50. The analysis also revealed significant between group main effect, F(1,398) = 12.8, p< 0.001, power to detect = 0.94, partial eta 2 = 0.031. The results of Bonferroni post-hoc pairwise comparisons revealed that the CF group realized greater improvement on measures of physical, cognitive and emotional functioning. Conclusions: This study examined the impact of funding (CF vs. RF) with chronicity, LOS, and outcomes for persons receiving neurorehabilitation. Both groups improved by discharge. The state legislated CF group had better outcomes, accessed post-hospital services sooner, discharged more quickly, reducing cost of care with lower levels of disability (MPAI-4 Indices) compared to the RF group at discharge
Horn et al. (Thu,) studied this question.