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Background: Recovery of manual ability is a critical issue in rehabilitation. Currently, little is known regarding the baseline predictors of self-perceived manual ability, which could capture information on individual's perceived functional ability, especially in carrying-out routine tasks outside clinical settings., Objective: To identify baseline predictors, which can be easily obtained within clinical settings, of self-perceived manual ability at three and six months after discharge from a stroke unit., Methods: A 6-month longitudinal study was carried-out. Participants were recruited from a stroke unit of a public hospital. The dependent outcome was self-perceived manual ability, and the following predictors were investigated: age, stroke severity, upper-limb motor impairments, cognitive function, muscle strength, and functional capacity. Linear regression analyses were employed to identify multivariate predictors of manual ability at three and six months after discharge (α=5%)., Results: Participated 131 individuals, 69 women (mean age of 60 years). Regression analyses revealed that stroke severity and age accounted for 31% and 47% of the variance in manual ability at three and six months after stroke, respectively. Stroke severity was the best predictor of manual ability at three (R 2 =29%; F=44.7; p<0.0001) and six months (R 2 =45%; F=88.2; p<0.0001) after stroke, respectively., Conclusion: Stroke severity showed to be the best predictor of manual ability at both three and six months after stroke. Although significant, age added little to the explained variance., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

AbstractPurposeMaterials and MethodsResultsConclusion\nImplications for RehabilitationTo identify barriers and facilitators to accessing post-stroke rehabilitation services six months after discharge from the stroke unit of a Brazilian public hospital.This cross-sectional and descriptive study collected sociodemographic and clinical-functional data during hospitalization. Then, barriers and facilitators for accessing the post-stroke rehabilitation services were collected six months after discharge. We considered economic conditions and displacement, the quality and organization of post-stroke rehabilitation services, and personal conditions.A total of 174 patients were included. Among the 20 aspects analyzed, 17 (85.0%) were reported as facilitators, while three (15.0%) were as barriers. The identified barriers included financial income available for healthcare (49.4%), waiting time to schedule or to be seen (47.0%), and process to scheduling (45.4%). The main facilitators (> 79.0%) were the expectation of the patient with the treatment and assistance from family and friends. Moreover, most patients indicated as facilitators all aspects related to the quality of post-stroke rehabilitation services.Access to post-stroke rehabilitation services presented more facilitators than barriers. Public policies to subsidize health costs, optimize waiting time, and process for scheduling post-stroke rehabilitation services should be considered to reduce barriers. Likewise, human and financial resources must promote the facilitators.Public policies to subsidize health costs, optimize waiting times and scheduling in post-stroke rehabilitation services should be considered to facilitate access to rehabilitation services for post-stroke patients.The involvement of family and friends in the treatment of post-stroke patients should be encouraged.Patients’ motivation and positive expectations can facilitate access to post-stroke rehabilitation services.Public policies to subsidize health costs, optimize waiting times and scheduling in post-stroke rehabilitation services should be considered to facilitate access to rehabilitation services for post-stroke patients.The involvement of family and friends in the treatment of post-stroke patients should be encouraged.Patients’ motivation and positive expectations can facilitate access to post-stroke rehabilitation services. [ABSTRACT FROM AUTHOR]

Currently, the best strategy to deal with disabilities after stroke is rehabilitation. National and international clinical guidelines recommend that all post-stroke individuals have access to rehabilitation professionals within 72 hours after hospital discharge. In addition, access should be continued until the individual's functional goals are achieved. However, the determinants of access to rehabilitation professionals by post-stroke individuals in middle-income countries, where the burden of this disease is high, are little known. To identify the determinants of access to rehabilitation professionals by post-stroke individuals one, three and six months after hospital discharge in Brazil and to compare the access obtained in each period with that referred by the multidisciplinary team at the time of hospital discharge. A longitudinal, prospective, and exploratory study, carried out in Belo Horizonte, Minas Gerais, Brazil. Individuals after primary stroke, without previous disabilities were included. During hospital discharge, the number of rehabilitation professionals referred by the multidisciplinary team was recorded. One, three and six months after hospital discharge, individuals were contacted by telephone to identify the rehabilitation professionals accessed. Possible determinants of access were classified according to Andersen's behavioral model for using health services and included: a) predisposing factors: age, sex, education, and belief that it could improve with treatment; b) need factors: stroke severity and level of disability; c) facilitating factors: socioeconomic status, disposable income for health care and quality of care provided by rehabilitation professionals. Multiple linear regression model and Wilcoxon test were used (α=5%). 201 individuals were included. Higher level of disability and stroke severity explained 31%, 34% and 39% of access to rehabilitation professionals one, three and six months after hospital discharge (p<0.01) respectively. Three months after discharge, having less education added 4% of explanation to the variation in access (p<0.01). In all evaluated periods, the number of professionals accessed was significantly lower than recommended at discharge (p<0.01). In general, individuals with a more severe stroke and a higher level of disability were those who had greater access to rehabilitation professionals one, three and six months after hospital discharge. In addition, the comprehensiveness care for post-stroke individuals were compromised was compromised in all periods evaluated, indicating that current legislation in Brazil on post-stroke individuals care was partially complied. Access to rehabilitation professionals has been directed equitably and in insufficient quantity to post-stroke individuals. Therefore, health management services must direct human and financial resources to expand immediate and comprehensive access to rehabilitation professionals for all post-stroke individuals after hospital discharge. These resources can improve the resolution of the transfer from hospital care to community care, as recommended. [ABSTRACT FROM AUTHOR]

Post-stroke individuals should have immediate and full access to rehabilitation services after hospital discharge. This access must be obtained in the first six months of the event, a period where the chances of recovery are greater. Thus, it becomes relevant to know the barriers and facilitators of this access. However, studies on this topic were not found in developing countries such as Brazil. To identify barriers and facilitators to access to rehabilitation services for post-stroke individuals discharged from a stroke unit of a public hospital in Brazil in the first six months of recovery. A cross-sectional and descriptive study was developed. Sociodemographic and clinical-functional data were collected in the hospital during the acute phase. Six months after discharge, data on barriers and facilitators to access to rehabilitation services were collected, considering 20 aspects related to the economic conditions and displacement to rehabilitation services, quality, and organization of rehabilitation services, as well as individual's personal conditions. 174 individuals (62±21 years old) were included. Among the 20 aspects analyzed, 17 (85%) were most frequently pointed out as facilitators. The main facilitators pointed out was the patient's expectation of the treatment and the quality of care offered, identified by the vast majority (>79%) of the individuals. In addition, all aspects related to the quality of rehabilitation services were pointed out as facilitators by the majority of the subjects. Three (15%) aspects were most frequently pointed out as barriers: income available for health care (49.4%), waiting time to make an appointment and be attended (47.2%), and scheduling process (45.4%). More facilitators than barriers were pointed out. That is, in the first six months of recovery, aspects related to economic conditions and displacement to rehabilitation services, organization of rehabilitation services, quality of rehabilitation services and personal conditions of the individual, have, for the most part, positively influenced the access to rehabilitation services for post-stroke individuals. Considering the identified barriers, public policies to subsidize health costs and optimize the waiting time and scheduling process in rehabilitation services should be considered relevant tools to facilitate access to rehabilitation services for post-stroke individuals. Likewise, human, and financial resources must be directed towards promoting the enabling factors. [ABSTRACT FROM AUTHOR]