Do functional mobility and activity of daily living deficits after a cerebrovascular accident influence the referral to physical and occupation therapy?

Cerebrovascular accidents (CVA), commonly referred to as stroke, is the leading cause of disability in the United States and a major public health concern.  The annual total cost of care is estimated at over $43 billion, which includes management of post-CVA functional and activity of daily living (ADL) limitations.  Research demonstrates that participation in physical and occupation therapy can decrease these CVA-related limitations.  Thus, understanding the factors that influence referral to therapy services after CVA can help ensure proper referrals are made in a timely manner.  We abstracted data from the 2012 Health and Retirement Survey and used multiple logistic regression to determine the factors most influential in predicting a referral to physical and occupational therapy in the year after CVA, controlling for socioeconomic and demographic factors.  The results demonstrated that for each additional ADL deficit the likelihood of referral increased by a factor of 1.32 (95%CI 1.01-1.77).  However, functional deficits was not significant (AOR: 1.10, 95%CI 0.85-1.42).  The lack of influence of functional limitations may suggest that a significant population of CVA survivors is not receiving an opportunity to improve.  It is often the case that a CVA survivor requires more physical from a caregiver perform a functional task than an ADL task, thus putting the caregiver at an increased risk of injury.  Based on these analytic findings, public health professionals can work to increase awareness of the need to increase referral to therapy services following CVA to improve the health of CVA survivors and their caretakers.