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

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.

Brazilian practice guidelines for stroke rehabilitation: Part II

“…Access to rehabilitation after stroke in different Brazilian regions has been evaluated by the Access to Rehabilitation after Stroke (AReA) study. 185 Therapies based on new technologies do not always result in clinical benefits and are sometimes accompanied by costs that make them unaffordable for many. Therefore, it is crucial to choose evidence-based rehabilitation interventions suited for our reality.…”

Reply to the letter regarding the article entitled: “Access to rehabilitation after stroke in Brazil (AReA study): multicenter study protocol”

“…We appreciate Montanaro's 1 interest in our article "Access to rehabilitation after stroke in Brazil (AReA study): multicenter study protocol" 2 and the opportunity to emphasize the goal of the AReA study, to investigate access to post-stroke rehabilitation within the first 6 months after discharge from public hospitals. 2 Access is defined as the opportunity to utilize healthcare services at the ideal time for the rehabilitation process, regardless of an individual's needs. 3 A recent review of stroke guidelines for the care of people with stroke conducted by the World Stroke Organization Guideline Committee highlighted the need of rehabilitation provided not only by multidisciplinary but also by interdisciplinary teams, to provide comprehensive care for people with stroke.…”

“…We appreciate Montanaro's 1 interest in our article “Access to rehabilitation after stroke in Brazil (AReA study): multicenter study protocol” 2 and the opportunity to emphasize the goal of the AReA study, to investigate access to post-stroke rehabilitation within the first 6 months after discharge from public hospitals. 2 Access is defined as the opportunity to utilize healthcare services at the ideal time for the rehabilitation process, regardless of an individual's needs. 3 …”

“…For this reason, we included questions about referrals to physical therapists, physiatrists, speech therapists, neurologists, psychologists, occupational therapies, and nutritionists (Table 1). 2 The first five questions are repeated in regard to referrals for each of these professionals, as stated in the line highlighted in gray, below the fifth question. In addition, the kind of rehabilitation service is asked in question 6.…”

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

“…Cacho et al 1 intend to conduct a nationwide study that focuses on access to rehabilitation for patients after a stroke. This research is fundamental and necessary.…”