Suboptimal access to rehabilitation within the first six months after stroke in Brazil (AReA study): a multicenter survey

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.

Authors

Institutions

Publication Details

Journal
BMC Health Services Research
Published
2026-11-09
DOI
https://doi.org/10.1186/s12913-026-15641-5
Primary Topic
Stroke Rehabilitation and Recovery
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
article

Suboptimal access to rehabilitation within the first six months after stroke in Brazil (AReA study): a multicenter survey

Larissa Araujo Gomes, Carla Heloísa Cabral Moro, Adriana Bastos Conforto, Suzete Nascimento Farias da Guarda et al.
BMC Health Services Research
Stroke Rehabilitation and Recovery
article

Suboptimal access to rehabilitation within the first six months after stroke in Brazil (AReA study): a multicenter survey

Larissa Araujo Gomes, Carla Heloísa Cabral Moro, Adriana Bastos Conforto, Suzete Nascimento Farias da Guarda, Elen Beatriz Pinto, Kelson James Almeida, Lenise Valler, Millene Rodrigues Camilo, Renata Viana Brígido de Moura Jucá, Suellen Marinho Andrade, Maria Elisa Pimentel Piemonte, Gustavo José Luvizutto, Gisela Tinone, ISABEL MARIA OLIVEIRA MACEDO LIMA, Tatiana Souza Ribeiro, Marco Túlio Araújo Pedatella, OCTÁVIO MARQUES PONTES-NETO, César Minelli, Luana Aparecida Miranda, Ana Paula Fontana, Roberta de Oliveira Cacho, Rodrigo Bazán, Luana Karoline Castro Silva, Maria Amanda Ferreira Quirino, Gabriel Pereira Braga, Beatriz Malaquias Neves, Karen Lúcia de Araújo Freitas, Luana Karen Amaral, Wesklayne O. Peixoto, Luciane Aparecida Pascucci Sande de Souza
article en

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.

BMC Health Services Research
Universidade Federal do Rio de Janeiro (BR), Universidade Federal de Mato Grosso do Sul (BR), Universidade Federal da Bahia (BR), Escola Bahiana de Medicina e Saúde Pública (BR), Harvard University (US), Universidade Federal da Paraíba (BR), Universidade de São Paulo (BR), Universidade Estadual de Campinas (UNICAMP) (BR), Universidade Federal do Ceará (BR), Hospital Israelita Albert Einstein (BR), Universidade Federal do Piauí (BR), Universidade Federal do Rio Grande do Norte (BR), Massachusetts General Hospital (US), D’Or Institute for Research and Education (BR), Universidade Federal do Triângulo Mineiro (BR), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (BR), Universidade Estadual Paulista (Unesp) (BR)
Stroke Rehabilitation and Recovery
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.

Laika access coming soon