Abstract P227: Incentives for Uptake and Adherence With Outpatient Stroke Rehabilitation: A Three Arm Randomized Controlled Trial
Young, SHY; Sim, R; YU, C; YAN, X; De Silva, DA; CHAKRABORTY, B; Matchar, DB
Published in: Stroke
While rehabilitation has been demonstrated to be effective in improving outcomes of stroke, uptake of outpatient rehabilitation services (ORS) in Singapore remains relatively low. This study aims to determine if rehabilitation uptake and adherence can be increased by providing coordinated transportation (increased convenience) and eliminating out-of-pocket costs (reduced expense).
It was hypothesized that the uptake rate of ORS over 3 months, number of sessions attended, and time to discontinuation would be greater for participants in the intervention arms of which barriers of transportation and out-of-pocket costs are addressed, as compared to participants in the control arm.
A total of 266 participants were recruited from the stroke and acute rehabilitation units of two tertiary hospitals in Singapore, and randomized to one of three study arms: the control arm, denoted
(
), inclusive of a stroke rehabilitation educational program; the first intervention arm, denoted
(
), inclusive of free transportation services for the first 3 months post-discharge; or the second intervention arm, denoted,
(
), inclusive of up to 3 months of both free transportation and no out-of-pocket costs for participants’ stroke ORS.
The uptake rate of ORS was 73.0% for
(CI, 63.8%-82.3%), 81.8% for
(CI, 73.8%-89.8%), and 84.3% for
(CI, 76.7%-91.8%). The differences of
and
versus the control arm (
) were not statistically significant (p = 0.22 and p = 0.10, respectively). However, the average number of rehabilitation sessions attended were significantly higher in both the intervention arms: 5.50 (SD, 7.65) for
and 7.51 (SD, 9.52) for
versus 3.26 (SD, 4.22) for the control arm (
) (p-value for
vs
= 0.017; p-value for
vs
= 0.000.) Kaplan-Meier analysis indicated that persistence was higher for
compared to
(p=0.029).
This study has demonstrated that incentives can improve utilization of ORS. Such incentives should be considered in finance policy, such as care bundling, for stroke or similar common conditions.