Functional outcomes post-stroke: Evidence from private rehabilitation facilities in South Africa between 2006 and 2023

Abstract

Background: Effective rehabilitation is crucial for stroke survivors to regain functional independence and reduce the healthcare burden associated with disability and hospital readmission.
Aim: To evaluate the functional outcomes in patients with stroke at private rehabilitation facilities between 2006 and 2023.
Setting: This was a retrospective cohort study of 9010 patients, post-stroke, at private rehabilitation facilities registered with the South African Board of Healthcare Funders.
Methods: The 7-point BETA scale was used to measure inpatients’ ability to perform Activities of Daily Living (ADL) in real time. Secondary analysis was conducted on ADL data sets (N = 9010) from a purposive sample of private rehabilitation facilities (n = 47). Descriptive statistics were used to determine the median functional scores of stroke patients measured by the BETA scale. Linear regression was used to compare functional gain scores by baseline patient demographics, and logistic regression for the association between functional deterioration and patient factors, and to predict risk.
Results: Functional outcomes showed limited improvement; 40.8% of inpatients experienced deterioration, 19.5% showed no functional gain, 31.9% showed modest gain, and a small minority (< 0.5%) achieved substantial functional gains. Predictors of functional outcomes included age, gender, racial demographics, facility type and stroke characteristics.
Conclusion: The findings indicate suboptimal functional outcomes in patients, post-stroke, at private rehabilitation facilities. There is a need for targeted improvements in rehabilitation practices and policy changes to enhance post-stroke functional outcomes.
Contribution: This study provides longitudinal perspectives of patients’ functional outcomes post-stroke in private rehabilitation facilities and an evidence base for informing rehabilitation practice improvements.