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.