Show simple item record

Incentives for Uptake of and Adherence to Outpatient Stroke Rehabilitation Services: A Three-Arm Randomized Controlled Trial.

dc.contributor.author Matchar, David Bruce
dc.contributor.author Young, Sherry Hsueh Yi
dc.contributor.author Sim, Rita
dc.contributor.author Yu, Christine Jia Ying
dc.contributor.author Yan, Xiaoxi
dc.contributor.author De Silva, Deidre Anne
dc.contributor.author Chakraborty, Bibhas
dc.date.accessioned 2021-11-15T01:23:53Z
dc.date.available 2021-11-15T01:23:53Z
dc.date.issued 2021-09-10
dc.identifier S0003-9993(21)01422-2
dc.identifier.issn 0003-9993
dc.identifier.issn 1532-821X
dc.identifier.uri https://hdl.handle.net/10161/23984
dc.description.abstract <h4>Objective</h4>To determine if rehabilitation uptake and adherence can be increased by providing coordinated transportation (increased convenience) and eliminating out-of-pocket costs (reduced expense).<h4>Design</h4>Three-arm randomized controlled trial Setting: Stroke units of two Singapore tertiary hospitals Participants: Singaporeans or permanent residents aged ≥21 years who were diagnosed with stroke and discharged home with physician's recommendation to continue outpatient rehabilitation.<h4>Interventions</h4>A Transportation Incentives arm (T), which provides free transportation services, a Transportation & Sessions Incentives arm (T&S), offering free transportation and prescribed stroke rehabilitation sessions, and a control arm, Education (E), consisting of a stroke rehabilitation educational programme.<h4>Main outcome measures</h4>The primary study outcome was uptake of outpatient rehabilitation services (ORS) amongst post-stroke patients, and key pre-defined secondary outcomes being number of sessions attended and adherence to prescribed sessions.<h4>Results</h4>Uptake rate of ORS was 73.0% for E (CI, 63.8%-82.3%), 81.8% for T (CI, 73.8%-89.8%), and 84.3% for T&S (CI, 76.7%-91.8%). Differences of T and T&S versus E were not statistically significant (p=0.22 and p=0.10, respectively). However, average number of rehabilitation sessions attended were significantly higher in both intervention arms: 5.50 (SD, 7.65) for T and 7.51 (SD, 9.52) for T&S versus 3.26 (SD, 4.22) for control arm (E) (p-value for T vs E =0.017; p-value for T&S vs E =0.000.) Kaplan-Meier analysis indicated that persistence was higher for T&S compared to E (p=0.029).<h4>Conclusions</h4>This study has demonstrated a possibility in increasing the uptake of and persistence to stroke ORS with free transportation and sessions. Incentivizing stroke survivors to take up ORS is a new strategy worthy of further exploration for future policy change in financing ORS or other long-term care services.
dc.language eng
dc.publisher Elsevier BV
dc.relation.ispartof Archives of physical medicine and rehabilitation
dc.relation.isversionof 10.1016/j.apmr.2021.08.013
dc.subject Motivation
dc.subject Outpatients
dc.subject Patient compliance
dc.subject Rehabilitation
dc.subject Stroke rehabilitation
dc.subject Transportation
dc.title Incentives for Uptake of and Adherence to Outpatient Stroke Rehabilitation Services: A Three-Arm Randomized Controlled Trial.
dc.type Journal article
duke.contributor.id Matchar, David Bruce|0063297
dc.date.updated 2021-11-15T01:23:51Z
pubs.organisational-group School of Medicine
pubs.organisational-group Duke Global Health Institute
pubs.organisational-group Pathology
pubs.organisational-group Medicine, General Internal Medicine
pubs.organisational-group Duke
pubs.organisational-group University Institutes and Centers
pubs.organisational-group Institutes and Provost's Academic Units
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Medicine
pubs.publication-status Published
duke.contributor.orcid Matchar, David Bruce|0000-0003-3020-2108


Files in this item

Thumbnail

This item appears in the following Collection(s)

Show simple item record