Comprehensive post-stroke rehabilitation: its long-term effects and the socio-environmental factors conditioning access to it
Introduction. Recovery of all brain functions affected after stroke is essential for the patient’s quality of life, with comprehensive rehabilitation key.
Objectives. Identify social and environmental factors affecting access to comprehensive post-ictus rehabilitation, and assess long-term effects of comprehensive rehabilitation on patient functionality.
Patients and method. 171 consecutive patients (84 women and 87 men) hospitalized in 2015 in Neurology Service with first ischemic stroke, without prior functional dependence, candidates for comprehensive rehabilitation are studied. Various socio-environmental and clinical variables potentially associated with access to it are analyzed. The long-term prognostic impact (average period of 54 months) on the functional situation is studied using the Barthel index.
Results. The average age of patients is 69 years. Only 53% were able to access the recommended comprehensive rehabilitation. Predictor variables of access were resulted: residence in urban environment (OR: 2,957; 95% CI: 1,067-8,199; p = 0.037), complement with private rehabilitation (OR: 2,89; 95% CI: 1,130-7,392; p = 0.027), best Rankin to high (OR: 22,437; 95% CI: 3,247-155,058; p = 0.014). After average follow-up for 54 months, of the 137 survivors, access to comprehensive post-ictus rehabilitation was independently associated with better long-term functional situation (OR: 12,441; 95% CI: 4.7-32.5; p < 0.001).
Conclusions. Comprehensive post-ictus rehabilitation is associated with better long-term prognosis, but access to it is conditioned by environmental and social factors such as the place of residence and the possibility of contracting private services.
Key words. Accessibility to health services. Determinants of health. Ischemic stroke. Quality in health care, access and evaluation. Social work. Stroke rehabilitation.