Incentives for Uptake of and Adherence to Outpatient Stroke Rehabilitation Services: A Three-Arm Randomized Controlled Trial

ABSTRACT Objective: To determine if rehabilitation uptake and adherence can be increased by providing coordinated transportation (increased convenience) and eliminating out-of-pocket costs (reduced expense). Design: Three-arm randomized controlled trial Setting: Stroke units of two Singapore tertiary hospitals Participants: Singaporeans or permanent residents aged ≥21 years who were diagnosed with stroke and discharged home with physician's recommendation to continue outpatient rehabilitation. Interventions: A Transportation Incentives arm (T), which provides free transportation services, a Transportation & Sessions Incentives arm (TS p-value for T&S vs E =0.000.) Kaplan-Meier analysis indicated that persistence was higher for T&S compared to E (p=0.029). Conclusions: This study has demonstrated a possibility in increasing the uptake of and persistence to stroke ORS with free transportation and sessions. Incentivizing stroke survivors to take up ORS is a new strategy worthy of further exploration for future policy change in financing ORS or other long-term care services.