Introduction: While it is well known that Blacks have a higher risk of death after an index stroke compared to their White counterparts, the influence of Black race on recovery after a stroke is unclear.
Objective: To qualitatively and quantitatively examine the association of Black vs. White race on stroke recovery utilizing a systematic review and meta-analysis.
Methods: We searched PubMed for cohort studies that investigated racial variation issues in stroke motor recovery between January 1970 and July 2015, in which outcome was measured by Functional Independence Measures (FIM) scale. Change scores (the difference score between discharge and admission) or endpoint scores (at the time of discharge) were compared between Whites and Blacks by calculating standardized mean differences (Hedge’s g) to derive a summary effect size. Random Effects model was used to account for data heterogeneity.
Results: We identified six studies (4 studies with changes scores and 4 studies with endpoint scores available) with a total 151,361 subjects. Overall, there was no difference between blacks vs. Whites (Hedge’s g = 0.02, 95% CI = [-0.08, 0.13], p = 0.89) if endpoint scores were used, but Whites seemed to show a non-significant pattern of greater improvement than Blacks during the inpatient hospital rehabilitation (FIM change scores, Hedge’s g = 0.12, 95% CI = [-0.05, 0.30], p = 0.17). This qualitative discrepancy maybe explained by the difference in admission score between the two groups (Hedge’s g = 0.16, 95% CI = [-0.01, 0.34], p = 0.06). Better FIM change scores in Whites maybe explained by longer stays in hospital (Hedge’s g = 0.13, 95% CI = [0.00, 0.25], p = 0.06).
Conclusions: This analysis identifies a significant evidence gap for racial disparities in stroke recovery. Additional studies to assess change scores are needed to address these gaps.