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Background Rehabilitation is a critical method for preventing and controlling disabilities. However, the majority of the global demand for rehabilitation services remains unmet, particularly in low- and middle-income countries. This study aims to explore the complex and concealed stratified relationships between socioeconomic status and the utilization of rehabilitation services among older persons with physical disabilities (PD) from gender and age perspectives. Methods A total of 19,782 observations of older persons with PD were included from the 2007–2013 China National Disabled Persons Condition Monitoring data. This study employs a multiplicative interaction effect model based on logistic regression to analyze the differential association between individual socioeconomic status and the utilization of rehabilitation services, considering gender and age. Results From a gender perspective, the positive correlations between high income, high education and the utilization of rehabilitation services are smaller in males (high income: OR = 0.801, 95% CI 0.653–0.983; high education: OR = 0.679, 95% CI 0.433–1.066). From an age perspective, the positive correlation between high income and the utilization of rehabilitation services is greater among middle- to oldest-old individuals with PD (OR = 1.310, 95% CI 1.077–1.593). Conclusion There are structural gender and age differences in the relationship between the socioeconomic status of older persons with PD and their utilization of rehabilitation services. It is recommended to enhance financial subsidies for rehabilitation services and implement tiered payment structures for low-income groups to alleviate their financial burden. To mitigate gender disparities in healthcare, efforts should focus on increasing awareness of rehabilitation services within health education programs, with community health workers playing a more active role in identifying and assisting those in need. Furthermore, strengthening support for family caregiving and integrating medical and nursing services within the framework of long-term care insurance are essential. Additionally, efforts should be made to the development of preventive rehabilitation programs and the establishment of a multi-tiered integrated rehabilitation system that ensures access to basic services for low-income populations and provides premium options to accommodate diverse needs.

Background Continuance utilization of rehabilitation services among children with disabilities is not optimal. However, little is known about the factors that influence whether rehabilitation is continued. Therefore, a cross-sectional study was conducted in a sample of family caregivers in China to explore the relationship between perceived rehabilitation benefit, expectation, satisfaction, self-efficacy, continuance intention and continuance behavior. Methods A total of 368 family caregivers of children with disabilities were recruited from rehabilitation institutions through the convenience sampling method in Shanghai and Kunshan, China. We developed a research model that drives continuance utilization of rehabilitation services and proposed 13 research hypotheses based on the Expectation Disconfirmation Theory (EDT) and the extended Expectation-Conformation Model of Information System Continuance (extended ECM-ISC model). A structure equation model was built to test the hypotheses. Results Among the 13 research hypotheses we proposed, 11 of them were supported. The results suggest that family caregivers’ continuance intention of taking children with disabilities for rehabilitation services was associated with their continuance behavior. Satisfaction and self-efficacy were associated with continuance intention. Perceived rehabilitation benefit and expectation were associated with satisfaction. Expectation was associated with perceived rehabilitation benefit. Furthermore, we found that perceived rehabilitation benefit was positively associated with continuance behavior from three different paths, whereas expectation had an indirect correlation with continuance behavior via the sequential mediation variables of satisfaction and continuance intention. In addition, satisfaction and self-efficacy were found to have a significant indirect correlation with continuance behavior via continuance intention. Conclusions Based on these findings, improvements in perceived rehabilitation benefit, expectation, self-efficacy, satisfaction, and continuance intention are the important issues contributing to the enhancement of continuance utilization of rehabilitation services among children with disabilities.

Background: The intersection of aging and disability is an important social issue. The rehabilitation system of older adults with disabilities is a complex social system including various social units. This study aims to investigate the impact of the “inclusion of rehabilitation services in basic medical insurance” (IRSMI) policy on the utilization of rehabilitation services and annual household healthcare expenditure among older adults with disabilities. Methods: Using the data of China Disabled Persons’ Condition Monitoring Survey (2009–2012), this study employed the difference-in-differences method to analyze the impact of IRSMI on rehabilitation services utilization and household healthcare expenditure, and further examined the differential effects of the policy on service utilization across subpopulations with different demographic characteristics, including gender, age, and disability severity. The Heckman two-stage model corrects for sample selection bias caused by the share of households with zero health expenditures. Event-study specification was applied to assess the validity of the parallel trends assumption in the DID framework. Baron & Kenny’s three-step method was used to explore the potential mediating mechanism. Results: (1) IRSMI significantly increased the likelihood of utilizing rehabilitation services among older adults with disabilities (OR = 1.349), but this kind of promotive effect mainly focus on males (OR = 1.530), middle-aged and older disabled individuals (OR = 1.423), and those with mild disabilities (OR = 1.444). (2) The implementation of IRSMI contributed to an approximately 20.3% increase in annual healthcare expenditures for households with older adults with disabilities (β = 0.185). (3) IRSMI significantly promoted the increase in household healthcare expenditures for high-income older adults with disabilities (β = 0.181), but had limited impact on low- and middle-income groups. (4) Rehabilitation services utilization played a mediating role in the relationship between IRSMI and household healthcare expenditure, with about 19.0% of the increase in annual household healthcare expenditures attributable to the enhanced utilization of rehabilitation services. Conclusions: In the complex social system of rehabilitation for older adults with disabilities, the IRSMI policy significantly increases the likelihood of rehabilitation services utilization and substantially raises annual household healthcare expenditures. However, the heterogeneous effects across gender, age, disability severity, and income levels reflect structural inequities embedded in the rehabilitation system, underscoring the need for adaptive and equity-oriented interventions.

Background: Rehabilitation is probably one of the most important phases of recovery for many stroke survivors. The current study was conducted with the objective to assess the utilization of rehabilitation services and factors affecting nonutilization of rehabilitation services among the stroke survivors. Materials and Methods: The current study was carried out in the Neuro Outpatient Department of a tertiary care hospital in India. It was a descriptive study. Consecutive 55 stroke survivors who had met the inclusion and exclusion criteria were recruited in this study. Self-structured rehabilitation tool was used to collect the data. Results: Data were analyzed using the descriptive and inferential statistics. Majority of the patients comprised 70.9% of males and 29.1% of females. Among participants, 70.90% were aware about rehabilitation, 67% were utilizing rehabilitation services, whereas 33% were not utilizing rehabilitation services. In the current study, certain reasons were found behind not utilizing rehabilitation services. There were 83.3% of participants who had lack of awareness about rehabilitation services and 61.1% of participants who had no availability of rehabilitation services. Only 45.5% of rural inhabitants were utilizing rehabilitation services as compared to 81.2% of urban inhabitants and 83.23% of suburban inhabitants. Conclusion: Rehabilitation is of utmost importance. Hemiparesis, difficulty in performing activity of daily living, difficulty in performing social activities, and difficulty in reasoning were the most common problems faced by people suffering stroke after discharge from the hospital. There was lack of awareness and utilization of rehabilitation services by patients among Indian stroke population. Hence, health workers have an immense role in educating, motivating, and ensuring that rehabilitation services in rural inhabitants.

Objective Cardiac rehabilitation (CR) is pivotal in preventing recurring events of myocardial infarction (MI). This study aims to investigate the effect of a smartphone-based home service delivery (Care Assessment Platform) of CR (CAP-CR) on CR use and health outcomes compared with a traditional, centre-based programme (TCR) in post-MI patients. Methods In this unblinded randomised controlled trial, post-MI patients were randomised to TCR (n=60; 55.7±10.4 years) and CAP-CR (n=60; 55.5±9.6 years) for a 6-week CR and 6-month self-maintenance period. CAP-CR, delivered in participants’ homes, included health and exercise monitoring, motivational and educational material delivery, and weekly mentoring consultations. CAP-CR uptake, adherence and completion rates were compared with TCR using intention-to-treat analyses. Changes in clinical outcomes (modifiable lifestyle factors, biomedical risk factors and health-related quality of life) across baseline, 6 weeks and 6 months were compared within, and between, groups using linear mixed model regression. Results CAP-CR had significantly higher uptake (80% vs 62%), adherence (94% vs 68%) and completion (80% vs 47%) rates than TCR (p<0.05). Both groups showed significant improvements in 6-minute walk test from baseline to 6 weeks (TCR: 537±86–584±99 m; CAP-CR: 510±77–570±80 m), which was maintained at 6 months. CAP-CR showed slight weight reduction (89±20–88±21 kg) and also demonstrated significant improvements in emotional state (K10: median (IQR) 14.6 (13.4–16.0) to 12.6 (11.5–13.8)), and quality of life (EQ5D-Index: median (IQR) 0.84 (0.8–0.9) to 0.92 (0.9–1.0)) at 6 weeks. Conclusions This smartphone-based home care CR programme improved post-MI CR uptake, adherence and completion. The home-based CR programme was as effective in improving physiological and psychological health outcomes as traditional CR. CAP-CR is a viable option towards optimising use of CR services. Trial registration number ANZCTR12609000251224.

Racial disparities in trauma outcomes have been documented, but little is known about racial differences in post-discharge healthcare utilization. This study compares the utilization of post-discharge healthcare services by African-American and Caucasian trauma patients. Trauma patients with an Injury Severity Score (ISS)≥9 from three Level-I trauma centers were contacted between 6 and 12 months post-injury. Utilization of trauma-related healthcare services was asked. Coarsened exact matching (CEM) was used to match African-American and Caucasian patients. Conditional logistic regression then compared matched patients in terms of post-discharge healthcare utilization. 182 African-American and 1,117 Caucasian patients were followed. Of these, 141 African-Americans were matched to 628 Caucasians. After CEM, we found that African-American patients were less likely to use rehabilitation services [OR:0.64 (95% CI:0.43–0.95)] and had fewer injury-related outpatient visits [OR:0.59 (95% CI:0.40–0.86)] after discharge. This study shows the existence of racial disparities in post-discharge healthcare utilization after trauma for otherwise similarly injured, matched patients. •African Americans were less likely to use post-discharge rehabilitation services.•African Americans were less likely to attend injury-related outpatient visits.•No differences in ED visits were found between African Americans and Caucasians. Racial disparities in trauma outcomes have been documented, but little is known about racial differences in the utilization of post-discharge healthcare services after trauma. This multi-institutional study used long-term patient-reported data to examine and compare the utilization of post-discharge healthcare services between African-American and Caucasian trauma patients. After Coarsened Exact Matching (CEM) and conditional logistic regression analysis, African American patients were less likely to use post-discharge rehabilitation services and less likely to be seen in the outpatient setting for injury-related services as compared to Caucasian counterparts. No differences were found regarding injury-related ED visits between African-Americans and Caucasians.

U.S. policy interventions encourage earlier provision of Vocational Rehabilitation (VR) services to support students and youth with disabilities such as autism spectrum disorder (ASD) during the transition from school to work. We analyzed Rehabilitation Services Administration (RSA-911) data using multivariable logistic regression to determine the association of VR services receipt with employment outcomes for students ages 16–21, same-age non-student youth and young adults with ASD. Students with autism received job-related services (job search, job placement, and on-the-job supports) at rates significantly below comparison groups, even though odds of successful employment at VR exit were significantly higher if they received these services. Findings suggest that rates of employment among students with autism might be improved with intentional delivery of job-related services.

This paper identifies family characteristics associated with use of autism-related services. A telephone or in-person survey was completed during 2003-2005 by 383 North Carolina families with a child 11 years old or younger with ASD. Access to care is limited for racial and ethnic minority families, with low parental education, living in nonmetropolitan areas, and not following a major treatment approach. Service use is more likely when parents have higher stress. Families use a broad array of services; the mix varies with child ASD diagnosis and age group. Disparities in service use associated with race, residence and education point to the need to develop policy, practice and family-level interventions that can address barriers to services for children with ASD.

Introduction Fear of cancer recurrence (FCR) is the most frequently cited unmet need among cancer survivors. Theoretical models of FCR suggest that patients with elevated levels of FCR will more frequently consult health care professionals for reassurance about their health. However, the relationship between FCR and health care utilization has not yet been firmly established. We examined the relationship between FCR and quantity of medications, number of emergency room (ER) visits, outpatient visits, specialist visits, allied health visits, and hospital overnight visits. Methods A total of 231 participants diagnosed with breast, colon, prostate, or lung cancer in the past 10 years were recruited from a cancer survivor registry. Participants were sent a survey package that included demographic and medical characteristics, a health care utilization questionnaire, and the Fear of Cancer Recurrence Inventory. Results A multiple regression analysis indicated that higher FCR significantly predicted greater number of outpatient visits in the past 6 months ( ß =  .016, F (1, 193) = 5.08, p  = .025). A hierarchical multiple regression indicated that higher FCR significantly predicted greater number of ER visits in the past 6 months when controlling for relationship status and education level ( F (1, 179) = 4.00, p  = .047). Conclusions The relationship between FCR and health care use has been understudied. Results indicate that patients with elevated FCR may indeed use more health care services. We recommend that clinicians monitor health care use in patients who are struggling with FCR.

Objective To evaluate the effectiveness of an integrated care programme, combining a patient directed and a workplace directed intervention, for patients with chronic low back pain.Design Population based randomised controlled trial.Setting Primary care (10 physiotherapy practices, one occupational health service, one occupational therapy practice) and secondary care (five hospitals).Participants 134 adults aged 18-65 sick listed for at least 12 weeks owing to low back pain.Intervention Patients were randomly assigned to usual care (n=68) or integrated care (n=66). Integrated care consisted of a workplace intervention based on participatory ergonomics, involving a supervisor, and a graded activity programme based on cognitive behavioural principles.Main outcome measures The primary outcome was the duration of time off work (work disability) due to low back pain until full sustainable return to work. Secondary outcome measures were intensity of pain and functional status.Results The median duration until sustainable return to work was 88 days in the integrated care group compared with 208 days in the usual care group (P=0.003). Integrated care was effective on return to work (hazard ratio 1.9, 95% confidence interval 1.2 to 2.8, P=0.004). After 12 months, patients in the integrated care group improved significantly more on functional status compared with patients in the usual care group (P=0.01). Improvement of pain between the groups did not differ significantly.Conclusion The integrated care programme substantially reduced disability due to chronic low back pain in private and working life.Trial registration Current Controlled Trials ISRCTN28478651.