As the new focus on preventative medicine has emerged, research continues to expand on diseases that impact physical and cognitive functioning, lead to long-term disability, and increase the risk of mortality. Stroke or cerebral vascular accident (CVA) has been identified as one of such diseases by the Centers for Disease Control (2007). Past literature has identified disparities between ethnicity, socioeconomic status, and other diseases in the recovery of stroke. The aim of the current study was to investigate the effects of ethnicity and psychosocial factors on stroke recovery during inpatient rehabilitation. The study included 446 patients who had suffered an ischemic and/or hemorrhagic stroke and were admitted into inpatient rehabilitation for stroke recovery at Loma Linda Rehabilitation Institute from January 1005 through August 2009. Functional Independence Measurement (FIM) scores were used to measure change in overall functioning and cognitive functioning between the ethnic groups, type of insurance, marital status, and socioeconomic status. Supporting past stroke literature, ethnic differences between Caucasians, African Americans, and Hispanics were predicted to emerge in cognitive and overall improvement, time delay from onset of stroke to admission into inpatient rehabilitation, and length of stay. It was further predicted that overall improvement would be associated with the patient's type of insurance, marital status, and socioeconomic status. In contrary to the predictions, significant differences in overall and cognitive functioning, time delay and length of stay did not emerge between the Caucasian, African American, and Hispanic ethnic groups. Overall improvement was not associated with marital status or socioeconomic status. However, significant differences in overall improvement did emerge between the group of patients who had private insurance and those who had Medicare plus medical insurance. The patients with private insurance had better overall improvement. No significant differences were found between private insurance patients and those with Medicare or MediCal alone. The results suggest that the margin on ethnic and socioeconomic status disparities may be closing in at one facility, as every patient regardless of the socioeconomic status, race/ethnicity, type of insurance, or marital status is treated with the same highest quality of care.

LLU Discipline

Clinical Psychology




School of Science and Technology

First Advisor

Vermeersch, David A.

Second Advisor

Fogel, Travis G.

Third Advisor

Gilewski, Michael J.

Fourth Advisor

Ropacki, Susan A.

Degree Name

Doctor of Philosophy (PhD)

Degree Level


Year Degree Awarded

January 2011

Date (Title Page)




Library of Congress/MESH Subject Headings

Health services accessiblity; Equality - Health aspects - United States; Health- social aspects; Health - economic aspects; Stroke; Stroke - Therapy; Cerebrovascular disease; Medicare; Insurance, Health - United States

Subject - Local

Stroke; Cerebral Vascular Accident; Rehabilitation; Ethnicity; Health Insurance; Marital Status; Socioeconomic Status; Cognitive functioning; Health Care Disparities



Page Count

111 p.

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses & Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives