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CC BY 4.0 · Arq Neuropsiquiatr 2022; 80(10): 1067-1074
DOI: 10.1055/s-0042-1758558
Brazilian Academy of Neurology

Access to rehabilitation after stroke in Brazil (AReA study): multicenter study protocol

Acesso à reabilitação após o AVC no Brasil (estudo AReA): protocolo de estudo multicêntrico
Roberta de Oliveira Cacho 
1   Universidade Federal do Rio Grande do Norte, Faculdade de Ciências da Saúde do Trairi, Santa Cruz RN, Brazil.
,
Carla Heloisa Cabral Moro 
2   Hospital Municipal de São José, Joinville SC, Brazil.
,
Rodrigo Bazan 
3   Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, São Paulo SP, Brazil.
,
Suzete Nascimento Farias da Guarda 
4   Universidade Federal da Bahia, Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Salvador BA, Brazil.
,
Elen Beatriz Pinto 
5   Escola Bahiana de Medicina e Saúde Pública, Fundação para o Desenvolvimento das Ciências, Salvador BA, Brazil.
,
Suellen Mary Marinho dos Santos Andrade 
6   Universidade Federal da Paraíba, Departamento de Fisioterapia, João Pessoa PB, Brazil.
,
Lenise Valler 
7   Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Campinas SP, Brazil.
,
Kelson James Almeida 
8   Universidade Federal do Piauí, Centro Universitário UniFacid, Departamento de Medicina Especializada em Neurologia, Teresina PI, Brazil.
,
Tatiana Souza Ribeiro 
9   Universidade Federal do Rio Grande do Norte, Departamento de Fisioterapia, Natal RN, Brazil.
,
Renata Viana Brígido de Moura Jucá 
10   Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza CE, Brazil.
,
Cesar Minelli 
11   Hospital Carlos Fernando Malzoni, Instituto “Você sem AVC”, Matão SP, Brazil.
12   Universidade de São Paulo, Departamento de Neurociências e Ciências Comportamentais, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto SP, Brazil.
,
Maria Elisa Pimentel Piemonte 
13   Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil.
,
Eric Homero Albuquerque Paschoal 
14   Hospital Ophir Loyola, Belém PA, Brazil.
,
Marco Túlio Araújo Pedatella 
15   Hospital Estadual de Urgência de Goiânia Dr Valdemiro Cruz, Goiânia GO, Brazil.
,
Octávio Marques Pontes-Neto 
16   Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto SP, Brazil.
,
Ana Paula Fontana 
17   Universidade Federal do Rio de Janeiro, Faculdade de Fisioterapia, Laboratório Pesquisa em Recuperação Funcional Após AVC, Rio de Janeiro RJ, Brazil.
,
Aline de Souza Pagnussat 
18   Universidade Federal de Ciências da Saúde de Porto Alegre, Departamento de Fisioterapia, Porto Alegre RS, Brazil.
,
Adriana Bastos Conforto 
19   Universidade de São Paulo, Hospital de Clínicas, Divisão de Neurologia Clínica, São Paulo SP, Brazil.
20   Hospital Israelita Albert Einstein, São Paulo SP, Brazil.
,
AReA Study Group › Author Affiliations
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Abstract

Background Most of the Brazilian population relies on public healthcare and stroke is a major cause of disability in this country of continental dimensions. There is limited information about access to rehabilitation after stroke in Brazil.

Objective To provide comprehensive information about Access to Rehabilitation After discharge from public hospitals in Brazil (AReA study), up to 6 months after stroke.

Methods The present study intends to collect information from 17 public health centers in 16 Brazilian cities in the 5 macroregions of the country. Each center will include 36 participants (n = 612). The inclusion criteria are: age ≥ 18 years old; ischemic or hemorrhagic stroke, from 6 months to 1 year prior to the interview; admission to a public hospital in the acute phase after stroke; any neurological impairment poststroke; patient or caregiver able to provide informed consent and answer the survey. Patients can only be recruited in public neurology or internal medicine outpatient clinics. Outcomes will be assessed by a standard questionnaire about rehabilitation referrals, the rehabilitation program (current status, duration in months, number of sessions per week) and instructions received. In addition, patients will be asked about preferences for locations of rehabilitation (hospitals, clinics, or at home).

Trial Status The study is ongoing. Recruitment started on January 31st, 2020 and is planned to continue until June 2022.

Conclusion The AReA study will fill a gap in knowledge about access to stroke rehabilitation in the public health system in different Brazilian regions.

Resumo

Antecedentes Grande parte da população brasileira depende de saúde pública e o acidente vascular cerebral (AVC) é uma das principais causas de incapacidade neste país de dimensões continentais. As informações sobre o acesso à reabilitação após AVC em instalações públicas no Brasil são limitadas.

Objetivo Fornecer informações abrangentes sobre o Acesso à Reabilitação pós-AVC (estudo AReA) nos primeiros 6 meses após a alta hospitalar da rede pública.

Métodos Serão coletadas informações de 17 centros de saúde públicos em 16 cidades brasileiras das cinco macrorregiões do país. Cada centro incluirá 36 participantes (n = 612). Os critérios de inclusão são: idade ≥ 18 anos; AVC isquêmico ou hemorrágico, com tempo de lesão entre 6 meses e 1 ano; admissão em hospital público na fase aguda; qualquer comprometimento neurológico pós-AVC; paciente ou cuidador capaz de fornecer consentimento informado e responder à pesquisa. Os pacientes só podem ser recrutados em ambulatórios públicos de neurologia ou medicina interna. Os resultados serão avaliados por um questionário padrão sobre encaminhamentos de reabilitação, o programa de reabilitação (estado atual, duração em meses, número de sessões por semana) e instruções recebidas. Além disso, os pacientes serão questionados sobre as preferências de locais de reabilitação (hospitais, clínicas ou casa).

Status do estudo O estudo está em andamento. O recrutamento começou em 31 de janeiro de 2020 e está previsto para continuar até junho de 2022.

Conclusão O estudo AReA preencherá uma lacuna no conhecimento sobre o acesso à reabilitação para AVC no sistema público de saúde em diferentes regiões brasileiras.

Keywords

Stroke - Patient Discharge - Referral and Consultation - Rehabilitation

Palavras-chave

Acidente Vascular Cerebral - Alta do Paciente - Encaminhamento e Consulta - Reabilitação

Authors' Contributions

ROC, ABC: conceptualization, writing, review, editing, and validation of the original draft; CHCM, RB, SNFG, EBP, SMMSA, LV, KJA, TSR, RVBMJ, CM, MEPP, EHAP, MTAP, OMPN, APF, ASP: review, editing, and validation of the original draft.




Publication History

Received: 29 September 2021

Accepted: 05 February 2022

Article published online:
19 December 2022

© 2022. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 World Health Organization. https://www.who.int/
  • 2 Clinical Guidelines for stroke management 2017.: Stroke Foundation; 2017
    PubMed
  • 3 Langhorne P, O'Donnell MJ, Chin SL. et al; INTERSTROKE collaborators. Practice patterns and outcomes after stroke across countries at different economic levels (INTERSTROKE): an international observational study. Lancet 2018; 391 (10134): 2019-2027
    CrossrefPubMedGoogle Scholar
  • 4 Lynch EA, Mackintosh S, Luker JA, Hillier SL. Access to rehabilitation for patients with stroke in Australia. Med J Aust 2019; 210 (01) 21-26
    CrossrefPubMedGoogle Scholar
  • 5 Ayala C, Fang J, Luncheon C. et al. Use of Outpatient Rehabilitation Among Adult Stroke Survivors - 20 States and the District of Columbia, 2013, and Four States, 2015. MMWR Morb Mortal Wkly Rep 2018; 67 (20) 575-578
    CrossrefPubMedGoogle Scholar
  • 6 Urimubenshi G, Cadilhac DA, Kagwiza JN, Wu O, Langhorne P. Stroke care in Africa: A systematic review of the literature. Int J Stroke 2018; 13 (08) 797-805
    CrossrefPubMedGoogle Scholar
  • 7 Flores LE, Verduzco-Gutierrez M, Molinares D, Silver JK. Disparities in Health Care for Hispanic Patients in Physical Medicine and Rehabilitation in the United States: A Narrative Review. Am J Phys Med Rehabil 2020; 99 (04) 338-347
    CrossrefPubMedGoogle Scholar
  • 8 Martins SCO, Sacks C, Hacke W. et al. Priorities to reduce the burden of stroke in Latin American countries. Lancet Neurol 2019; 18 (07) 674-683 DOI: 10.1016/S1474-4422(19)30068-7.
    CrossrefPubMedGoogle Scholar
  • 9 Baatiema L, Sanuade O, Kuumuori Ganle J, Sumah A, Baatiema L, Sumankuuro J. An ecological approach to understanding stroke experience and access to rehabilitation services in Ghana: A cross-sectional study. Health Soc Care Community 2021; 29 (05) e67-e78
    CrossrefPubMedGoogle Scholar
  • 10 Janzen S, Mirkowski M, McIntyre A, Mehta S, Iruthayarajah J, Teasell R. Referral patterns of stroke rehabilitation inpatients to a model system of outpatient services in Ontario, Canada: a 7-year retrospective analysis. BMC Health Serv Res 2019; 19 (01) 399
    CrossrefPubMedGoogle Scholar
  • 11 Ntamo NP, Buso D, Longo-Mbenza B. Factors affecting poor attendance for outpatient physiotherapy by patients discharged from Mthatha General Hospital with a stroke. J Physiother 2013; 69 (03) 19-24
    Google Scholar
  • 12 Kamalakannan S, Gudlavalleti Venkata M, Prost A. et al. Rehabilitation Needs of Stroke Survivors After Discharge From Hospital in India. Arch Phys Med Rehabil 2016; 97 (09) 1526-1532.e9
    CrossrefPubMedGoogle Scholar
  • 13 Winstein CJ, Stein J, Arena R. et al; American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Quality of Care and Outcomes Research. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 47 (06) e98-e169
    CrossrefPubMedGoogle Scholar
  • 14 Khan F, Amatya B, de Groote W. et al. Capacity-building in clinical skills of rehabilitation workforce in low- and middle-income countries. J Rehabil Med 2018; 50 (05) 472-479
    CrossrefPubMedGoogle Scholar
  • 15 Lindblom S, Flink M, Sjöstrand C, Laska AC, von Koch L, Ytterberg C. Perceived Quality of Care Transitions between Hospital and the Home in People with Stroke. J Am Med Dir Assoc 2020; 21 (12) 1885-1892
    CrossrefPubMedGoogle Scholar
  • 16 Fuhs AK, LaGrone LN, Moscoso Porras MG, Rodríguez Castro MJ, Ecos Quispe RL, Mock CN. Assessment of Rehabilitation Infrastructure in Peru. Arch Phys Med Rehabil 2018; 99 (06) 1116-1123
    CrossrefPubMedGoogle Scholar
  • 17 Kapral MK, Hall R, Gozdyra P. et al. Geographic Access to Stroke Care Services in Rural Communities in Ontario, Canada. Can J Neurol Sci 2020; 47 (03) 301-308
    CrossrefPubMedGoogle Scholar
  • 18 Labberton AS, Barra M, Rønning OM. 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 (01) 871
    CrossrefPubMedGoogle Scholar
  • 19 Oliveira GMM, Brant LCC, Polanczyk CA. et al. Cardiovascular Statistics - Brazil 2020. Arq Bras Cardiol 2020; 115 (03) 308-439
    CrossrefPubMedGoogle Scholar
  • 20 Bensenor IM, Goulart AC, Szwarcwald CL, Vieira ML, Malta DC, Lotufo PA. Prevalence of stroke and associated disability in Brazil: National Health Survey–2013. Arq Neuropsiquiatr 2015; 73 (09) 746-750
    CrossrefPubMedGoogle Scholar
  • 21 Paim J, Travassos C, Almeida C, Bahia L, Macinko J. The Brazilian health system: history, advances, and challenges. Lancet 2011; 377 (9779): 1778-1797
    CrossrefPubMedGoogle Scholar
  • 22 Safanelli J, Vieira LGDR, Araujo T. et al. The cost of stroke in a public hospital in Brazil: a one-year prospective study. Arq Neuropsiquiatr 2019; 77 (06) 404-411
    CrossrefPubMedGoogle Scholar
  • 23 Goulart AC, Fernandes TG, Santos IS, Alencar AP, Bensenor IM, Lotufo PA. Predictors of long-term survival among first-ever ischemic and hemorrhagic stroke in a Brazilian stroke cohort. BMC Neurol 2013; 13: 51
    CrossrefPubMedGoogle Scholar
  • 24 Conforto A, Cougo P, Neves L. Reabilitação do AVC. Boletim ABNews; 2017: 5-8
    Google Scholar
  • 25 Saúde Md. Primeiro caso de Covid-19 no Brasil permanece sendo o de 26 de fevereiro. 2020
    PubMedGoogle Scholar
  • 26 Cincura C, Pontes-Neto OM, Neville IS. 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 (02) 119-122
    CrossrefPubMedGoogle Scholar
  • 27 Saver JL, Filip B, Hamilton S. et al; FAST-MAG Investigators and Coordinators. Improving the reliability of stroke disability grading in clinical trials and clinical practice: the Rankin Focused Assessment (RFA). Stroke 2010; 41 (05) 992-995
    CrossrefPubMedGoogle Scholar
  • 28 Martins SCO, Pontes-Neto OM, Alves CV. et al; Brazilian Stroke Network. Past, present, and future of stroke in middle-income countries: the Brazilian experience. Int J Stroke 2013; 8 (Suppl A100): 106-111
    CrossrefPubMedGoogle Scholar
  • 29 Dee M, Lennon O, O'Sullivan C. A systematic review of physical rehabilitation interventions for stroke in low and lower-middle income countries. Disabil Rehabil 2020; 42 (04) 473-501
    CrossrefPubMedGoogle Scholar
  • 30 Pollock A, Baer G, Campbell P. et al. Physical rehabilitation approaches for the recovery of function and mobility following stroke. Cochrane Database Syst Rev 2014; (04) CD001920
    PubMedGoogle Scholar
  • 31 Teasell R, Salbach NM, Foley N. et al. Canadian Stroke Best Practice Recommendations: Rehabilitation, Recovery, and Community Participation following Stroke. Part One: Rehabilitation and Recovery Following Stroke; 6th Edition Update 2019. Int J Stroke 2020; 15 (07) 763-788
    CrossrefPubMedGoogle Scholar
  • 32 Pollock A, Farmer SE, Brady MC. et al. Interventions for improving upper limb function after stroke. Cochrane Database Syst Rev 2014; (11) CD010820
    PubMedGoogle Scholar
  • 33 Hendrickx W, Riveros C, Askim T. et al. Identifying factors associated with sedentary time after stroke. Secondary analysis of pooled data from nine primary studies. Top Stroke Rehabil 2019; 26 (05) 327-334
    CrossrefPubMedGoogle Scholar
  • 34 Surya N, Srivastava A, Nagda T, Palande D, Someshwar H. Education, Training, and Practices of Neurorehabilitation in India During the COVID-19 Pandemic. Front Neurol 2021; 12: 626399
    CrossrefPubMedGoogle Scholar
  • 35 Diegoli H, Magalhães PSC, Martins SCO. et al. Decrease in Hospital Admissions for Transient Ischemic Attack, Mild, and Moderate Stroke During the COVID-19 Era. Stroke 2020; 51 (08) 2315-2321
    CrossrefPubMedGoogle Scholar
  • 36 Nakagaki M, Sarpong E. Conectando os desconectados em tempos de crise 2021 [Available from: https://www.nic.br/media/docs/publicacoes/6/20210423094235/panorama_setorial_ano-xiii_n_1_conectando_os_desconectados_em_tempos_de_crise.pdf
  • 37 Montanaro VVA, Hora TF, da Silva CM. et al. Epidemiology of concurrent Chagas disease and ischemic stroke in a population attending a multicenter quaternary rehabilitation network in Brazil. Neurol Sci 2019; 40 (12) 2595-2601
    CrossrefPubMedGoogle Scholar
  • 38 Lennon O, McCabe DJH, Carey A. et al. Early outcome data from the Cardiac Rehabilitation Adapted for TIA and Stroke (CRAFTS) randomized-controlled trial. Int J Stroke 2015; 10: 97
    Google Scholar