The participants encompass individuals well-represented across socioeconomic groups, age categories, gender, stroke type and level of illness/disability. The findings indicate that in the 12 months post stroke, physiotherapy services were used by 55% of younger survivors, speech therapy by 28% and either of such services by 61%. 96% of those reporting initial disability at 28 days after stoke accessed these rehabilitation services. Disability was the strongest predictor of such use. Other factors that were significant were self-perceptions about the level of power over one’s life decisions, which was negatively associated with use of rehabilitation; and social contacts, as defined by the number of close friends reported, which had a positive relationship.
That self-reported disability at 28 days strongly predicted use of rehabilitation services is encouraging. It suggests that these services are being used according to the extent to which they are needed. This is at odds with some evidence from Canada, where access to rehabilitation has been found to differ by functional status, favouring those with milder impairment
. Indeed the Ontario Stroke Evaluation Report 2011 citing evidence that the proportion of those with severe disability admitted to rehabilitation had been declining between 2003 and 2010 (from 36.7% to 31.9%), recommended that the barriers to care to those with more severe impairment be identified and addressed
Further encouragement can be gained from the findings of this study by the lack of significant effect of socioeconomic and socio-demographic variables, as defined by a variety of measures including income and job type, health insurance status, age and rurality. These findings in concert suggest 'need’ as being the primary determinant in the use of these rehabilitation services in stroke patients and that access to care is not differentiated by socio-demographics. They are consistent with the premise that rehabilitation services are being provided according to the established equity objective of 'equal use for equal need’.
The evidence in relation to this issue internationally is mixed. In the UK, audit data suggests that access to post-stroke rehabilitation is inequitably distributed
 with substantial variation in use observed across regions
. Indeed within the Veterans’ Affairs system there is some evidence that African-Americans are more likely to access such services
One limitation of the study was that it examined only a subset of the suite of rehabilitation services potentially available to patients. Rehabilitation is most effective as a multidisciplinary activity including social work, occupational therapy, specialist nurse support, family care worker, mental health worker and case management. However, the involvement of physiotherapy and to some extent speech therapy in such multidisciplinary care is often integral, and as such, may be viewed as a marker for access more generally to appropriate rehabilitation. The limitation here is that access to rehabilitation has been assessed as a dichotomous outcome; future research should examine in more detail the nature, timing and level of rehabilitation received as these factors highly influence the outcomes of such services
As the study was undertaken in a working age population, it is not possible to generalise to older stoke survivors who, due to the availability of age-related services and government health care concessions, face challenges in accessing care that are very much different.
The current study applied the widely-used SC-IQ to measure the influence of social capital. Taken at face value the findings indicate that those with greater empowerment tend to eschew rehabilitation, whilst the number of social contacts increases the propensity for patients to access such services. These findings provide at least tentative support for peer and family support programs as avenues for encouraging the use of rehabilitation services. Further research would examine in more detail the influence of social networks on utilisation of services and identify ways in which health sector programs can capitalise on these existing structures to promote access to care.