Factores asociados al acceso a los servicios de rehabilitación un mes pos-ACV en Brasil: Influencia de los factores sociodemográficos, clínico-funcionales y del período pandémico
DOI:
https://doi.org/10.1590/Palabras clave:
Accidente Cerebrovascular, Servicios de Rehabilitación, COVID-19Resumen
Aunque devastadora, la pandemia ha brindado
oportunidades para analizar el funcionamiento de los servicios
de rehabilitación en diferentes contextos de salud. El objetivo de
este artículo es identificar los factores relacionados con el acceso
de las personas con ACV a los servicios de rehabilitación un mes
después del alta hospitalaria. Se trata de un estudio longitudinal
prospectivo, en el que se reclutaron a individuos con ACV en una
metrópoli brasileña en el período de septiembre de 2019 a febrero
de 2021. Los factores relacionados con el acceso a los servicios de
rehabilitación se evaluaron mediante un análisis de regresión lineal,
considerando 11 variables sociodemográficas y clínico-funcionales
y el período de acceso a los servicios de rehabilitación (antes o
durante la pandemia de la covid-19) (α=5%). Se incluyeron un total
de 150 participantes, de los cuales el 50,7% de ellos tuvo acceso a los
servicios de rehabilitación en el período prepandémico; y el 49,3%
en el período pandémico. El nivel de independencia funcional fue
el único factor significativo, que explica el 27% (F=56,2; p<0,001)
de acceso. El menor nivel de independencia funcional fue el único
factor asociado con el acceso a los servicios de rehabilitación
un mes después del alta hospitalaria en individuos con ACV
independientemente del período de pandemia.
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Referencias
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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Derechos de autor 2026 Zaqueline Fernandes Guerra, Jordana de Paula Magalhães, Nathália Aparecida Gravito Rodrigues, Iza de Faria- Fortini, Christina Danielli Coelho de Morais Faria
Esta obra está bajo una licencia internacional Creative Commons Atribución-CompartirIgual 4.0.
