Impacting Outcomes: Exploring Functional Changes and Barriers to Care in Underserved Patients at Volunteer-Run Outpatient Rehabilitation Clinic

Background and/or Objectives: Few studies have assessed the interaction between sociodemographic disparities and functional improvement after spinal cord injury (SCI), traumatic brain injury (TBI), cerebrovascular accident (CVA), or amputation. This study evaluated the efficacy of a free outpatient rehabilitation clinic for medically underserved patients, measuring improvements in functional independence and characterization of barriers these patients reported in seeking health care.

Design: Retrospective cohort study

Setting : Free rehabilitation clinic for uninsured individuals with SCI, TBI, CVA, and amputation.

Participants : 81 patients: SCI (n=24), CVA (n=21), TBI (n=18), amputation (n=18). 46 completed the barriers-to-care survey.

Interventions: N/A

Main Outcome Measures: Functional status at intake and discharge from the clinic was assigned using the 7-point Functional Independence Measure (FIM) (1=Total Assistance, 7=Complete Independence). FIM was scored based on estimated average across multiple domains.

Results: 100% of patients were uninsured, 72% male, 88% Hispanic/Latino, and 77% primary language Spanish. Average age: 42.4 years old (range:15-89). 70% were seen within 6 months of injury. 70% had ≥4 multi-disciplinary clinic visits (avg:6.5, max:35). FIM Averages: SCI: 78.56% functional increase, Intake=4.08 vs Discharge=5.60 (p=0.0341); TBI: 73.89% functional increase, Intake=4.33 vs Discharge=5.29 (p=0.0618); CVA: 56.02% functional increase, Intake=4.33 vs Discharge=4.60 (p=0.2848); Amputation: 43.24% functional increase, Intake=4.17 vs Discharge=4.42 (p=0.0177). Barriers-to-care survey: 41% could not access care due to cost, 59% did not have a primary care physician, and 83% visited the Emergency Department ≥1 time in 5 years (avg:1.7, max:12). Other barriers included transportation, insurance, language, and immigration status.

Conclusions: Patients with SCI and amputation showed statistically significant functional gains. While CVA and TBI changes were not statistically significant, clinically meaningful improvements were observed. Disparities in healthcare access, particularly among uninsured Hispanic males, highlight the need for more equitable solutions in rehabilitation. These findings suggest that volunteer-based rehabilitation clinics can improve function for underserved patients and serve as a model for future disparity initiatives.