Factors associated with access to rehabilitation services one month after stroke in Brazil: Influence of sociodemographic, clinical-functional factors and the pandemic
DOI:
https://doi.org/10.1590/Keywords:
Stroke, Rehabilitation Services, COVID-19Abstract
Despite being devastating, the pandemic brought opportunities to investigate the operation of rehabilitation services in different health contexts. To
identify the factors associated with access to rehabilitation services among individuals with stroke one month after hospital discharge. This is a prospective longitudinal study, in which individuals with stroke were recruited in a Brazilian city from September 2019 to February 2021. The factors
associated with access to rehabilitation services were investigated using linear regression analysis, considering 11 sociodemographic and clinical-functional variables and the period of access to rehabilitation services (prepandemic
or during the COVID-19 pandemic) (α=5%). In total, 150 participants were included; 50.7% had access to rehabilitation services pre-pandemic and 49.3% during the pandemic. Functional independence was the only significant factor, explaining 27% of the variance in access (F=56.2; p<0.001). A lower level of functional independence was the only factor associated with access to rehabilitation services one month after hospital discharge among individuals with stroke, regardless of the pandemic period
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References
1. Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, et al.
Guidelines for adult stroke rehabilitation and recovery: a
guideline for healthcare professionals from the American
Heart Association/American Stroke Association. Stroke.
2016;47(6):e98-e169. doi: 10.1161/STR.0000000000000098
2. Bernhardt J, Hayward KS, Kwakkel G, Ward NS, Wolf SL, et
al. Agreed definitions and a shared vision for new standards
in stroke recovery research: the stroke recovery and
rehabilitation roundtable taskforce. Neurorehabil Neural Repair.
2017;31(9):793-9. doi: 10.1177/1545968317732668
3. Weinstein SM. How COVID-19 informed the future impact of
the specialty of physical medicine and rehabilitation across
the health care continuum. PM & R. J Injury Func Rehabil.
2021;13(6):551-3. doi: 10.1002/pmrj.12620
4. Olmedo-Vega V, Aguilar-Idáñez MJ, Arenillas-Lara JF.
Comprehensive post-stroke rehabilitation: its long-term effects
and the socio-environmental factors conditioning access to it.
Rev Neurol. 2021;73(1):1-9. doi: 10.33588/rn.7301.2021037
5. Ostwald SK, Godwin KM, Cheong H, Cron SG. Predictors of
resuming therapy within four weeks after discharge from
inpatient rehabilitation. Topics Stroke Rehabil. 2009;16(1):80-91.
doi: 10.1310/tsr1601-80
6. Vázquez-Guimaraens M, Caamaño-Ponte JL, Seoane-Pillado
T, Cudeiro J. Factors related to greater functional recovery
after suffering a stroke. Brain Scienc. 2021;11(6). doi: 10.3390/
brainsci11060802
7. Dawkins B, Renwick C, Ensor T, Shinkins B, Jayne D, Meads
D. What factors affect patients’ ability to access healthcare?
An overview of systematic reviews. Trop Med Int Health.
2021;26(10):1177-88. doi: 10.1111/tmi.13651
8. Demenech LM, Dumith SC, Vieira MECD, Neiva-Silva L.
Income inequality and risk of infection and death by
COVID-19 in Brazil. Rev Bras Epidemiol. 2020;23:e200095.
doi: 10.1590/1980-549720200095
9. Hamiduzzaman M, De-Bellis A, Abigail W, Fletcher A. Critical
social framework on the determinants of primary healthcare
access and utilisation. Family Med Community Health.
2021;9(Suppl 1):e001031. doi: 10.1136/fmch-2021-001031
10. Magalhães JP, Faria-Fortini I, Menezes KK, Lara IA,
Batista LR, et al. Determinants of access to rehabilitation
professionals by individuals with stroke in the first six months
after hospital discharge in Brazil: a study based on the
Andersen model. Topics Stroke Rehabil. 2024;31(6):615-24.
doi: 10.1080/10749357.2024.2304969
11. Silva SM, Dutra TMFV, Braga MAF, Silva EAM, Faria-Fortini I,
et al. Predictors of access to healthcare services within 1 month
after stroke in a developing country: a longitudinal prospective
study. Physiother Res Int. 2023:e2000. doi: 10.1002/pri.2000
12. Dalise S, Tramonti F, Armienti E, Niccolini V, Caiglia-Tenaglia M,
et al. Psycho-social impact of social distancing and isolation
due to the COVID-19 containment measures on patients with
physical disabilities. Eur J Phys Rehabil Med. 2021;57(1):158-65.
doi: 10.23736/S1973-9087.20.06535-1
13. Castro MC, Kim S, Barberia L, Ribeiro AF, Gurzenda S, et al.
Spatiotemporal pattern of COVID-19 spread in Brazil. Science.
2021;372(6544):821-6. doi: 10.1126/science.abh1558
14. Benevides ML, Elias S, Costa PB, Martins ALP, Martins GL, et
al. Acute ischemic stroke and COVID-19 pandemic in Brazil: a
comparative study of frequency and risk factors before and
during SARS-CoV-2 era. Neurol Sci. 2022;43(8):4611-7. doi:
10.1007/s10072-022-05873-8
15. Cuschieri S. The STROBE guidelines. Saudi J Anaesth.
2019;13(Suppl.1):S31-4. doi: 10.4103/sja.SJA_543_18
16. Herbert R, Jamtvedt G, Hagen KB, Mead J. Practical evidencebased
physiotherapy. 2nd ed. Oxford: Elsevier Health Sciences,
2011. 186 p.
17. Cincura C, Pontes-Neto OM, Neville IS, Mendes HF, Menezes DF,
et al. Validation of the National Institutes of Health Stroke Scale,
modified Rankin Scale and Barthel Index in Brazil: the role of
cultural adaptation and structured interviewing. Cerebrovasc
Dis. 2009;27(2):119-22. doi: 10.1159/000177918
18. Collin C, Wade DT, Davies S, Horne V. The Barthel ADL
Index: a reliability study. Int Disabil Stud. 1988;10(2):61-3. doi:
10.3109/09638288809164103
19. Kwon S, Hartzema AG, Duncan PW, Min-Lai S. Disability
measures in stroke: relationship among the Barthel Index,
the Functional Independence Measure, and the Modified
Rankin Scale. Stroke. 2004;35(4):918-23. doi: 10.1161/01.
STR.0000119385.56094.32
20. Lees R, Fearon P, Harrison JK, Broomfield NM, Quinn TJ.
Cognitive and mood assessment in stroke research: focused
review of contemporary studies. Stroke. 2012;43(6):1678-80.
doi: 10.1161/STROKEAHA.112.653303
21. Audigé L. Veterinary Epidemiologic Research: I. Dohoo, W.
Martin, H. Stryhn, Atlantic Veterinary College, Charlottetown,
PE, Canada, 2003. Prev Vet Med. 2005;68(2-4):289-92.
doi: 10.1016/j.prevetmed.2004.11.001
22. Baccaro A, Wang YP, Candido M, Conforto AB, Brunoni AR,
et al. Post-stroke depression and cognitive impairment: Study
design and preliminary findings in a Brazilian prospective
stroke cohort (EMMA study). J Affect Disord. 2019;245:72-81.
doi: 10.1016/j.jad.2018.10.003
23. Kamakura W, Mazzon JA. Critérios de estratificação e
comparação de classificadores socioeconômicos no
Brasil. Rev Admin Empres. 2016;56:55-70. doi: 10.1590/
s0034-759020160106
24. Taylor-Rowan M, Wilson A, Dawson J, Quinn TJ. Functional
assessment for acute stroke trials: properties, analysis,
and application. Front Neurol. 2018;9:191. doi: 10.3389/
fneur.2018.00191
25. Jan S, Essue BM, Glozier N, Lindley R, Li Q, Hackett ML. Are
rehabilitation services following stroke accessed equitably
in Australia?: findings from the psychosocial outcomes in
stroke (POISE) cohort study. BMC Public Health. 2013;13:884.
doi: 10.1186/1471-2458-13-884
26. Labberton AS, Barra M, Rønning OM, Thommessen B, Churilov
L, et al. Patient and service factors associated with referral and
admission to inpatient rehabilitation after the acute phase
of stroke in Australia and Norway. BMC Health Serv Res.
2019;19(1):871. doi: 10.1186/s12913-019-4713-x
27. Haan R, Limburg M, van der Meulen J, van den Bos GA.
Use of health care services after stroke. Qual Health Care.
1993;2(4):222-7. doi: 10.1136/qshc.2.4.222
28. Paim J, Travassos C, Almeida C, Bahia L, Macinko J.
The Brazilian health system: history, advances, and
challenges. Lancet. 2011;377(9779):1778-97. doi: 10.1016/
S0140-6736(11)60054-8
29. Odone A, Lugo A, Amerio A, Borroni E, Bosetti C, et al.
COVID-19 lockdown impact on lifestyle habits of Italian
adults. Acta Biomed. 2020;91(9-S):87-9. doi: 10.23750/abm.
v91i9-S.10122
30. Rimmer A. Covid-19: GPs can stop health checks for over 75s and
routine medicine reviews. BMJ. 2020;368:m1157. doi: 10.1136/
bmj.m1157
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Copyright (c) 2026 Zaqueline Fernandes Guerra, Jordana de Paula Magalhães, Nathália Aparecida Gravito Rodrigues, Iza de Faria- Fortini, Christina Danielli Coelho de Morais Faria
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