Most acute stroke survivors do not have access to intensive rehabilitation

Researchers from the Institute of Public Health of the University of Porto (ISPUP) have concluded that 70% of acute cerebrovascular accident (ACI) survivors do not have access to intensive rehabilitation, according to a study published this Thursday involving 460 patients.

In a statement, ISPUP said the study “identified shortcomings in the delivery of care following an acute event” in the National Health System (SNS).

The study, led by Pedro Maciel Barbosa as part of his doctoral dissertation, evaluated a prospective “cohort” of stroke survivors from the acute stage to the chronic phase of the disease.

“This is the first international study that identifies, measures, evaluates and compares the costs and benefits of different rehabilitation pathways for stroke survivors,” explains a researcher from ISPUP and the Faculty of Medicine of the University of Porto (FMUP), quoted in the statement.

The study, which included 460 stroke survivors, concluded that at one year, quality of life was “significantly lower than that of the general population, regardless of stroke type and severity.”

At the same time, a discrepancy was identified between best practice recommendations and what happens in practice at the rehabilitation level.

According to the study, “70% of survivors do not have access to intensive rehabilitation, and 80% receive a maximum of five physical therapy sessions per week lasting less than 45 minutes each.”

More than half of survivors (65%) “are not involved in determining the rehabilitation plan,” and 30% “do not have access to a discharge or transition plan.”

“These gaps in stroke care result in inadequate levels of information, with 70% of the sample unaware of their functional prognosis at the time of hospital discharge and stating that they are dissatisfied, particularly with the rehabilitation care provided on mid-term care units.” community clinic teams and home teams,” says ISPUP.

The study also found “a lack of compliance with Directorate General of Health (DGS) guidelines” regarding referral patterns for different types of care.

“This study showed that survivors with the same severity profile experienced different outcomes across different routes,” the institute says, highlighting that only three of nine rehabilitation routes were found to be cost-effective.

“In other words, 66% of the network needs to be reconsidered to adapt the best balance between quality of care, survivors’ needs and future sustainability of social networks,” the study notes.

The social sector branches of the National Continuing Care Network, where 48% of survivors were referred, pose a “barrier to accessing care” because they are based on an “income-related payment logic,” the investigation found.

Pathways starting in convalescent units and rehabilitation centers were the “most profitable,” the study found, noting that moving to more intensive units early “affected outcomes at 12 months.”

In this sense, the study warns of the need to improve the rehabilitation care provided to stroke survivors in Portugal, one of the European countries “with the greatest potential to reduce the incidence and prevalence of stroke in the coming years.”

“If we had to propose five fundamental measures to reform the rehabilitation care network, they would include a review of the DGS guidance standard and referral process, and the expansion of Via Verde outside the hospital for six months after stroke through dedicated channels in the continuing care network.” . , points out the researcher, who is also a physiotherapist at the local health unit of Matosinhos.

Pedro Maciel Barbosa also recommends “reducing the number of available routes by defining 3–4 routes for different stroke profiles, providing intensive and multidisciplinary rehabilitation lasting up to 3–6 months for approximately 70% of users and increasing the number and length of stay in convalescent units.”