Influence of social determinants of health on post-acute use and outcome: a scoping review

Health Affairs Scholar · 2026-03-01

Introduction: Social determinants of health (SDoH) account for more than half of the variation in health outcomes. However, their role in post-acute care for neurologic conditions remains poorly understood. Clarifying how SDoH influences post-acute utilization and outcomes is critical for improving equity and informing rehabilitation policy. Methods: We conducted a scoping review of U.S.-based studies published between 2005 and 2025 examining associations between SDoH and length of stay, functional improvement, community discharge, and 30-day readmission in inpatient rehabilitation facilities and skilled nursing facilities among adults with stroke and traumatic brain injury. Results: Among 32 studies, social and community context was the most frequently examined SDoH domain, and functional improvement was the commonly studied outcome. Insurance type, race and ethnicity, and marital status were consistently associated with all outcomes. Medicaid and dual-eligible beneficiaries had shorter hospital stays and smaller functional gains compared with those with commercial insurance. Caregivers support increased community discharge. Lower education and Black or Hispanic race/ethnicity increased readmission risk. Despite consistent associations, SDoH were inconsistently measured. Conclusion: Integrating SDoH into post-acute care assessment may improve equity in discharge planning and recovery.

Poststroke Depression and Anxiety: A Comprehensive Topical Review

Stroke · 2026-03-16

Mental health issues after stroke are common and have a significant negative impact on functional outcomes, quality of life, and longevity. Despite their prevalence and impact, these conditions remain underrecognized and undertreated. This topical review synthesizes current evidence on the epidemiology, mechanisms, assessments, and treatments related to poststroke depression and anxiety, the most common neuropsychological sequelae after stroke, and identifies gaps and future directions.

Medicare Advantage Coupled with Dual Eligibility is Associated with Stroke Rehabilitation Outcomes Differences

medRxiv · 2026-05-03

Abstract Importance Medicare–Medicaid dual eligible beneficiaries experience pronounced disparities in stroke recovery. However, it remains unclear whether inpatient rehabilitation services and outcomes are comparable between dual-eligible beneficiaries enrolled in Medicare fee-for-service (FFS) versus Medicare Advantage (MA) plans. Objective To compare rehabilitation therapy utilization and associated outcomes among dual-eligible beneficiaries enrolled in FFS versus MA plans with stroke. Design Retrospective cohort study. Setting Inpatient Rehabilitation Facilities (IRF). Participants Medicare beneficiaries admitted to IRF with stroke ( n =125,782) between 2017 and 2019. Exposure Dual-eligible beneficiaries enrolled in FFS versus MA plans. Main Outcome Measures Total number of minutes of physical and occupational therapy provided within the first 2 weeks of IRF stay, self-care and mobility change scores, and 30-day all-cause hospital readmission. Results For the first 2 weeks of therapy utilization, we did not find significant differences between the four groups. Using the non-dual FFS beneficiaries and low category of change as a reference, we found significantly lower likelihood of achieving high change in self-care scores for the dual FFS (OR=0.73, 95% CI=0.69-0.76), and dual MA (OR=0.93, 95% CI=0.88-0.98). However, non-dual MA patients had a higher likelihood of changes in self-care scores (OR=1.17, 95% CI=1.13-1.22). Similar trends were found for the mobility change scores, compared to non-dual FFS: dual FFS (OR=0.72, 95% CI=0.68-0.75), and dual MA (OR=0.91, 95% CI=0.86-0.96) and non-dual MA (OR=1.16, 95% CI=1.12-1.20). For 30-day readmission risk, dual FFS showed a higher likelihood of readmission (OR=1.19, 95% CI=1.08-1.31), while non-dual MA had a significantly lower likelihood (OR=0.77, 95% CI=0.71-0.83). Conclusions and Relevance Although no differences in rehabilitation therapy utilization for stroke among dual-eligible beneficiaries, they had poorer functional recovery and higher 30-day readmission risk irrespective of FFS vs MA. Whereas non–dual-eligible MA beneficiaries experienced favorable outcomes. These findings underscore the importance of addressing post-IRF discharge needs among disadvantaged populations.

Assessing feasibility of an online caregiver intervention to improve respite: the Time for Living and Caring (TLC) Study (Preprint)

2025-01-26

<sec> <title>BACKGROUND</title> Interventions that are self-administered and delivered online are increasingly being seen as a flexible way to support family caregivers. Respite, defined as a planned break or time away from caregiving, is among the most needed and requested forms of caregiver support; yet, few caregiver interventions address caregivers’ use of respite. </sec> <sec> <title>OBJECTIVE</title> We describe the methodology and data used to assess the feasibility, usability, and acceptability of the Time for Living and Caring (TLC) intervention; a technology delivered intervention (app) for dementia caregivers to improve respite time use. </sec> <sec> <title>METHODS</title> This study’s evaluation effort is theoretically guided by a multidimensional definition of feasibility and employs a mixed-methods approach for feasibility analysis. Stakeholder feedback collected via focus groups during the intervention development (n=15), self-reported surveys from participants enrolled in the pilot trial of the intervention (n=163), surveys of a nationwide sample of respite providers (n=57), and end-user statistics, captured passively by Google Analytics from those using the app, were used in the analysis of the TLC intervention feasibility. </sec> <sec> <title>RESULTS</title> Data and metrics, overall, show high rates of feasibility for the TLC online intervention. Favorable ratings of intervention features ranged from 83-99%, which, when combined with open-ended recommendations for improvements, indicate a high degree of usability. Acceptability was measured through appraisal of the intervention experience (85% positive), potential future use (78%), willingness to recommend (91%), and perceived benefit (&gt; 80%). </sec> <sec> <title>CONCLUSIONS</title> Taken together, these data suggest that TLC is a promising intervention that could be implemented as an on-demand resource for respite-using caregivers irrespective of where they are located or when they choose to access it. Additionally, this paper provides a blueprint for systematically evaluating multiple dimensions of feasibility, using various forms of mixed-methods data collected during intervention development and pilot-testing of an intervention, which should help streamline the eventual implementation of effective interventions in real-world settings. </sec> <sec> <title>CLINICALTRIAL</title> ClinicalTrials.gov NCT03689179 </sec>

Weight stigma and bariatric surgery: Prospective improvements, psychological health, and weight.

Health Psychology · 2025-06-05 · 3 citations

OBJECTIVE: Weight stigma among patients with obesity is a major risk factor for psychological and physical health comorbidities. Little is known, however, about experienced weight stigma (EWS) among metabolic bariatric surgery (MBS) patients in terms of pre- to post-MBS changes and correlates in the setting of significant weight loss. The current study utilized psychometrically validated measures to examine change in weight stigma from pre- to post-MBS and prospective associations with mental health, eating behaviors, and body mass index. METHOD: = 148) completed both pre-MBS psychological evaluation and follow-up assessment 1.5-3 years post-MBS, including measures of EWS, depressive symptoms, anxiety, binge eating, and disordered eating. RESULTS: EWS improved significantly pre- to post-MBS (by both statistical and clinically meaningful standards), and this change was associated with improvements in mental health, dysregulated eating, and reduced BMI. In regression models controlling demographic covariates and each outcome at baseline, both changes in and post-MBS EWS predicted mental health, dysregulated eating, and body mass index. CONCLUSIONS: EWS improves significantly from pre- to post-MBS, and this is associated with improvements in mental health, decreases in dysregulated eating, and reduced weight. However, patients who continue to experience stigma are at elevated risk for ongoing psychological, eating, and weight challenges. Interventions must be designed to buffer the impacts of weight stigma to optimize the quality of life and long-term outcomes following MBS. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Resilience in Stroke survivor-care-partner Dyads (ReStoreD): a study protocol for a randomized-control trial

Trials · 2025-06-04 · 3 citations

BACKGROUND: The impact of stroke is shared between the stroke survivor and their care-partner. An estimated 30-50% of stroke survivors and their care-partners experience depression or anxiety that negatively affects rehabilitation outcomes and quality of life. Yet, interventions to support couples post-stroke are largely insufficient or inaccessible. A novel remotely delivered dyadic intervention to promote Resilience in Stroke survivor-care-partner Dyads (ReStoreD) was developed to address this need. The intervention includes psychoeducation and weekly modules that help couples learn and practice goal-setting, communication strategies, and positive psychology activities like expressing gratitude, finding meaning, and fostering connections. The purpose of this study is to conduct an efficacy trial of the 8-week ReStoreD intervention with a sample of 200 dyads (n = 400) consisting of one individual who has sustained an ischemic or hemorrhagic stroke between 3 months and 3 years prior to enrollment and a cohabitating partner. METHODS: Using a fully powered, randomized waitlist-control design, the efficacy of ReStoreD to reduce emotional distress in both dyad members will be determined (Aim 1). In addition, the effects of ReStoreD on secondary outcomes (resilience, relationship quality, stress-related stroke, meaningful activity engagement) as potential mediators (Aim 2) and moderators to determine whether certain subgroups respond better to the intervention (Aim 3) will be examined. All participants will complete standardized, validated assessments at baseline, 8 weeks, 16 weeks, and 6-month follow-up. All aspects of the study, including intervention activities and assessments, are conducted remotely, online. DISCUSSION: This is the first rigorously designed efficacy trial to test a positive psychology intervention for stroke survivors and their care-partners. When the aims of this study are realized, there will be (1) a remotely delivered, dyadic intervention to support couples post-stroke; (2) a better understanding of the mechanisms involved in the intervention's effect on emotional distress, which can inform future interventions; and (3) the ability to identify a more specific target population for whom the intervention works best. Ultimately, if found efficacious, this intervention will offer sustainable and accessible support for couples who are coping with stroke to improve rehabilitation outcomes and quality of life. TRIAL REGISTRATION: This trial is registered at ClinicalTrials.gov at NCT#04845542. Registered on April 13, 2021.

"Rehabbing the Couple:" Supporting Couples Coping with Stroke through a Novel Dyadic Intervention

Archives of Physical Medicine and Rehabilitation · 2025-04-30

Geographical Disparities in Cardiac Rehabilitation Usage by Race and Dual‐Eligibility

Journal of the American Heart Association · 2025-01-16 · 1 citations

Assessing the Time for Living and Caring (TLC) Study: Mixed-Methods Feasibility Study of a Web-Based Caregiver Intervention to Improve Respite

JMIR Aging · 2025-06-10 · 1 citations

Background: Interventions that are self-administered and delivered online are increasingly being seen as a flexible way to support family caregivers. Intervention research should prioritize the measurement of feasibility throughout all of the stages of intervention development and evaluation to provide the essential feedback loop needed for the iterative development and refinement process. Objective: We describe the methodology and data used to assess the feasibility, usability, and acceptability of the Time for Living and Caring (TLC) intervention, a technology-delivered intervention (app) for dementia caregivers to improve respite time use. Methods: The feasibility analysis is theoretically guided by a multidimensional definition of feasibility and uses a mixed-methods research design. Stakeholder feedback collected via focus groups during intervention development (n=15), self-reported surveys from participants enrolled in the pilot trial of the intervention (n=163), surveys of a nationwide sample of respite providers (n=57), and end-user statistics, captured passively by Google Analytics from those using the app, were used in the feasibility analysis of the TLC intervention. Results: The TLC study used an appropriate design and data collection procedures, along with acceptable recruitment capability. Out of 5 intervention features, 4 received favorable ratings (range of 82%-99%) by intervention participants and respite providers, which, when combined with open-ended recommendations for improvements, indicate a high degree of usability. Acceptability was measured through appraisal of the intervention experience (135/159, 85% positive), potential future use (127/163, 78%), willingness to recommend (148/163, 91%), and perceived benefit (135/163, 83%). Conclusions: Taken together, the data suggest that the TLC app is a promising intervention that could be implemented as an on-demand resource for respite-using caregivers, irrespective of where they are located or when they choose to access it. Additionally, this paper provides a blueprint for systematically evaluating multiple dimensions of feasibility, using various forms of mixed-methods data collected during intervention development and pilot testing of an intervention, which should help streamline the eventual implementation of effective interventions in real-world settings.

Physical and social health needs of postoperative bariatric surgery patients: a focus group

Discover Social Science and Health · 2025-01-20 · 3 citations

This qualitative study explored the health needs of patients after undergoing bariatric surgery. The study specifically aimed to describe the unique physical, emotional, and social challenges patients face following surgery in order to inform the development of future obesity treatment programs. A 90-min focus group was conducted using a semi-structured interview guide. Bariatric surgery patients were enrolled using purposive sampling. The mean number of months since surgery was 20.2 (SD 10.8). The mean age of participants was 53.3 (SD 9.8) years. The focus group was both audio and video recorded, transcribed, and analyzed using topic and analytical coding. Three main themes emerged revealing postoperative needs for (1) assistance with physical changes and reduced barriers to exercise, (2) reinforcement for healthy eating behaviors, and (3) emotional support from peers, family, and community. Findings suggest that rehabilitation following bariatric surgery is complex in nature and patients may benefit from both pre- and post-surgery programs that address their unique needs. Weight maintenance and sustaining healthy behavior change post-surgery requires ongoing personal and professional assistance. Interventions should emphasize healthy eating practices, include practical exercise suggestions, and offer social and emotional support.