D ISEÑO DE P RUEBAS DE VARIACIÓN DE PRESIÓN

Relationships between predisposing, enabling and need characteristics and the use of services were examined at the bivariate level for individuals assessed with the RAI-HC.

6.3.1.1 Use of OT After RAI-HC Assessment

Bivariate results examining the relationships between independent variables and the use of OT services within 91 days of RAI-HC assessment are displayed in Table 7.At the bivariate level, predisposing characteristics including language and education were associated with OT use. Non- English language (OR: 1.50; 95% CI: 1.08-2.07) was associated with increased odds of receiving OT, while higher education was associated with significantly decreased odds (OR: 0.78; 95% CI: 0.61- 0.99) of receiving OT.

Enabling variables associated with the use of OT included: caregiver distress, CCAC branch, year of hospital discharge and the amount of informal care provided. Individuals with distressed caregivers were 1.57 times more likely (95% CI: 1.17-2.11) to receive OT compared to those without distressed caregivers. There was significant variation in the likelihood of receiving services by CCAC branch and year of hospital discharge at the bivariate level. Those receiving a moderate amount of informal care (20-40 hours/week) were more likely to receive OT services than those receiving 0-20 hours/week; however those receiving more than 40 hours/week did not differ significantly from the 0- 20 hour/week group.

Several need variables were associated with the use of OT at a bivariate level, including comprehension and swallowing difficulties. Individuals with a DRS score indicative of potential depression (3+) and mild-moderate pain (1-2) were also significantly more likely to receive OT. Several variables measuring functional status including triggering the ADL CAP to facilitate improvement of (OR: 1.63; 95% CI: 1.28-2.08), ADL Hierarchy score of 3 or greater (OR: 3.29; 95% CI: 2.25 – 4.82), previous falls (OR: 1.32; 95% CI: 1.05-1.68), unsteady gait (OR: 1.74; 95% CI: 1.37-2.22) and an IADL Capacity Scale score of 5-6 (OR: 2.47; 95% CI: 1.16-5.26) were associated with significantly increased likelihood of receiving OT. There was an overall significant effect of the Rehabilitation Algorithm crosswalk, with higher scores on the algorithm corresponding to a greater proportion of individuals receiving OT. Requiring assistance with stairs (or not using stairs) and using an assistive device for outdoor locomotion were both significantly associated with an increased likelihood of receiving OT. In contrast, individuals who reported leaving their house in a typical week were significantly less likely to receive OT. Other variables associated with increased likelihood of receiving OT included: the Home Environment Optimization CAP (OR: 2.54; 95% CI: 1.46-4.42), bowel incontinence (OR: 1.62; 95% CI: 1.16-2.28), and fractures (OR: 1.87; 95% CI: 1.08-3.23).

6.3.1.2 Use of PT After RAI-HC Assessment

Bivariate results examining the relationships between predisposing, enabling and need variables and the use of OT services within 91 days of RAI-HC assessment are displayed in Table 7. For predisposing characteristics, being married had an increased odds of receiving PT (OR: 1.77; 95% CI: 1.41-2.24) while living alone was associated with decreased odds of receiving PT (OR: 0.71; 95% CI: 0.55-0.92).

With respect to enabling characteristics, individuals who had a co-residing caregiver (OR: 1.70; 95% CI: 1.34-2.16) and those who received more informal care were both significantly more likely to receive PT. Similar to OT, there was a significant overall variation in the proportion of individuals receiving PT by CCAC branch.

Among need variables self-reported health and individual perceptions of the potential for functional improvement were both positively associated with the use of physiotherapy services after stroke. Individuals who reported that their health was poor (OR: 1.40; 95% CI: 1.00-1.97) and those who believed that they were capable of increased function (OR: 1.35; 95% CI: 1.07-1.71) were significantly more likely to receive PT. In contrast, recent communication decline and cognitive impairment (CPS score, ADRD diagnosis) were associated with significantly lower likelihood of receiving PT services. Several variables measuring aspects of functional status were positively associated with the use of PT services. There was an overall significant association between the rehabilitation algorithm crosswalk and the use of PT services, with increasing levels of the algorithm corresponding to greater proportions of individuals receiving PT services. The presence of unsteady gait was associated with increased odds of receiving PT (OR: 2.13; 95% CI: 1.65-2.75). Individuals who had difficulty with stairs (OR: 2.46; 95% CI: 1.65-2.75) and those who did not use stairs (OR: 1.65; 95% CI: 1.25-2.19) were both more likely to receive PT. Similarly, those requiring an assistive device for outdoor locomotion (OR: 2.29; 95% CI: 1.66-3.16) and those for whom outdoor

locomotion did not occur (OR: 2.44; 95% CI: 1.60-3.72) were significantly more likely to use PT services.

6.3.1.3 Use of PT/OT Services After RAI-HC Assessment

Results examining relationships between independent variables and the number of rehabilitation visits, categorized as none, 1-4 visits and 5 or more visits are displayed in Table 8. Predisposing variables significantly associated with the number of rehabilitation visits received included marital status, language and living arrangement. Being married and speaking a language other than English were positively associated with the amount of rehabilitations services received, while living alone was associated with a decrease in the proportion of individuals receiving a higher amount of PT/OT visits.

Enabling variables significantly associated with the number of PT/OT visits included a co- residing caregiver, CCAC branch, and amount of informal care provided. There was significant variation by CCAC branch in the proportion of individuals receiving high amount of PT/OT visits. The presence of a co-residing caregiver, hours of informal care provided per week and caregiver’s beliefs that function could improve were all associated with increased PT/OT utilization.

For need variables, both self-perceived (client believes they are capable of increased functional independence) and evaluated functional improvement potential (good prospects for functional improvement, caregiver believes function can improve) were associated with receiving a greater number of PT/OT visits. Several indicators of functional status were associated with an increased number of PT/OT visits received by stroke survivors including: recent ADL decline, ADL hierarchy scale score, triggering the ADL CAP, IADL Capacity scale score, previous falls, unsteady gait, Rehabilitation Algorithm crosswalk, difficulty with stairs and requiring an assistive device for outdoor locomotion. In contrast, those who reported leaving the house in the past week tended to receive a lower number of PT/OT visits; 23.6% (N=226) of those who left the house received 5+ PT/OT visits as compared to 33% (N=74) of those who were housebound. Other indicators associated

with the number of PT/OT visits included the Home Environment Optimization CAP, bowel incontinence and the presence of an ADRD diagnosis. Individuals who triggered the Home

Environment optimization CAP and those who had bowel incontinence were significantly more likely to receive a greater number of PT/OT visits. An ADRD diagnosis significantly decreased the

likelihood that an individual would receive a high volume of PT/OT services.