Researchers from the Public Health Institute of the University of Porto (ISPUP) concluded that 70% of survivors of acute cerebrovascular accident (CVA) do not have access to intensive rehabilitation, in a study revealed this Wednesday, April 3, which followed 460 patients .
In a statement, ISPUP clarifies that the study “revealed flaws in the care provided after the acute event” within the National Health System (SNS).
Led by Pedro Maciel Barbosa, as part of his doctoral thesis, the research evaluated a prospective 'cohort' of stroke survivors, from the acute event 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, quoted in the statement, the researcher from ISPUP and the Faculty of Medicine of the University of Porto (FMUP).
The study, which involved 460 stroke survivors, concluded that, after one year, quality of life is “significantly lower than that of the general population, regardless of the type and severity of stroke”.
At the same time, a discrepancy was identified between good practice guidelines and what happens in practice at the rehabilitation level.
According to the study, «70% of survivors do not have access to intensive rehabilitation, while 80% receive a maximum of five physiotherapy sessions per week, lasting less than 45 minutes each».
More than half of survivors (65%) “are not involved in defining the rehabilitation plan” and 30% “do not have access to a discharge plan or transfer between care settings”.
«These gaps in post-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 claiming to be dissatisfied, especially with the rehabilitation care provided in medium-term units, clinics community teams and home teams", says ISPUP.
The study also identified “a lack of correspondence in relation to the recommendations of the Directorate-General for Health (DGS)” regarding the model for referring patients to different types of care.
«This study found that survivors with a similar severity profile obtain different results in different routes», says the institute, highlighting that only three of the nine rehabilitation itineraries proved to be cost-effective.
«In other words, 66% of the network must be reviewed, in order to adapt the best relationship between quality of care, survivors' needs and future sustainability of the SNS», notes the study.
According to the investigation, the social sector units of the National Continuing Care Network, where 48% of survivors were referred, constitute a “barrier to access to care”, as they are based on a “logic of payment according to income” .
The pathways starting in Convalescent units and Rehabilitation Centers proved to be “the most profitable”, indicates the research, noting that moving to more intensive units at an early stage was shown to “influence the results after 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, these would include reviewing the DGS Guidance Standard and the referral process, extending Via Verde beyond the hospital until six months after a stroke through dedicated circuits within the Continuing Care Network», indicates the researcher, who is also a physiotherapist at the Matosinhos Local Health Unit.
Pedro Maciel Barbosa also recommends «reducing the number of available itineraries by defining 3-4 itineraries for different stroke profiles, ensuring intensive and multidisciplinary rehabilitation of up to 3-6 months for around 70% of users and increasing the number and length of stay in Convalescent Units».
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