Suboptimal access to rehabilitation within the first six months after stroke in Brazil (AReA study): a multicenter survey
Year: 2026
Type: article
Abstract: Evidence on the adequacy of rehabilitation services in Brazil is limited to single-centre studies and national health surveys. Moreover, none of these have specifically examined patient access to rehabilitation within the first 6 months after stroke, a critical window for optimising functional recovery. The multicentre Access to Rehabilitation After Stroke in Brazil (AReA) study aimed to characterise access to rehabilitation across different regions of Brazil within the first 6 months after discharge from public hospitals following stroke. Individuals who had a stroke 6 to 12 months earlier completed a structured survey on rehabilitation access during the first 6 months after discharge from public hospitals. The primary outcome was the proportion of participants not assessed at least once by a physiotherapist. A multivariable binary logistic regression was conducted to identify factors associated with the primary outcome. Access to other professionals, rates of rehabilitation referrals, and treatments were also evaluated. A total of 473 patients (50.7% women; mean age, 62.1 ± 15 years) from 16 centres were included. Although 68.9% of patients presented with sensorimotor deficits at the time of the interview, 217 of 473 (45.9%) reported not having received a physiotherapy assessment after hospital discharge. Lower educational attainment (odds ratio [OR], 1.80; 95% confidence interval [CI], 1.15–2.84) and lower stroke severity (OR, 0.86; 95% CI, 0.81–0.90) were independently associated with the absence of a physiotherapy assessment. Only 24 (5.1%) patients reported having been assessed at least once by all three rehabilitation professionals: a physiotherapist, a speech/language therapist, and an occupational therapist. This study confirms that critical gaps exist in post-stroke rehabilitation access across Brazil, particularly for individuals with a comparatively lower education level or stroke severity. Targeted public policies are urgently needed to strengthen the rehabilitation continuum of care and ensure equitable service delivery.
Source: BMC Health Services Research
Authors: Roberta de Oliveira Cacho, Carla Heloisa Cabral Moro, Suzete Nascimento Farias da Guarda, Elen Beatriz Pinto, Gustavo José Luvizutto, Luciane Aparecida Pascucci Sande de Souza, Suellen Mary Marinho dos Santos Andrade, Kelson James Almeida, Rodrigo Bazan, Gabriel Pereira Braga, Cesar Minelli, Renata Viana Brígido de Moura Jucá, Maria Elisa Pimentel Piemonte, Tatiana Souza Ribeiro, Ana Paula Fontana, Lenise Valler, Octávio Marques Pontes-Neto, Millene Rodrigues Camilo, Marco Tulio Araújo Pedatella, Gisela Tinone, Beatriz Malaquias Neves, Isabel Maria Oliveira Macêdo Lima, Luana Aparecida Miranda, Luana Karen Amaral, Larissa Araújo Gomes, Maria Amanda Ferreira Quirino, Luana Karoline Castro Silva, Karen Lúcia de Araújo Freitas, Wesklayne O. Peixoto, Adriana Bastos Conforto
Institutions: Hospital Israelita Albert Einstein, Universidade Federal do Rio Grande do Norte, Universidade Federal da Bahia, Harvard University, Massachusetts General Hospital, D’Or Institute for Research and Education, Escola Bahiana de Medicina e Saúde Pública, Universidade Federal do Triângulo Mineiro, Universidade Federal da Paraíba, Universidade Federal do Piauí, Universidade Estadual Paulista (Unesp), Universidade Federal de Mato Grosso do Sul, Universidade Federal do Ceará, Universidade de São Paulo, Universidade Federal do Rio de Janeiro, Universidade Estadual de Campinas (UNICAMP), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
Language: English
Subfield: Rehabilitation
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,290
OpenAlex ID: W7225608941
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