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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]

Objective: To compare the sociodemographic and clinico-functional characteristics of patients admitted to a stroke unit immediately before and during two different COVID-19 pandemic phases., Methods: This exploratory study was conducted in the stroke unit of a public hospital in Brazil. Patients consecutively admitted to a stroke unit for 18 months with primary stroke aged ≥20 years were included and divided into three groups: G1: Pre-pandemic; G2: Early pandemic; and G3: Late pandemic. The sociodemographic and clinico-functional characteristics of the groups were compared (α=0.05)., Results: The study included 383 individuals (G1=124; G2=151; G3=108). The number of risk factors (higher in G2; p≤0.001), smoking (more common in G2; p≤0.01), type of stroke (ischemic more common in G3; p=0.002), stroke severity (more severe in G2; p=0.02), and level of disability (more severe in G2: p≤0.01) were significantly different among the groups., Conclusion: A greater number of serious events and risk factors including smoking and higher level of disability was observed in patients in the beginning of the pandemic than in the late phases. Only the occurrence of ischemic stroke increased in the late phase. Therefore, these individuals may have an increased need for rehabilitation services monitoring and care during their lifespan. Additionally, these results indicate that health promotion and prevention services should be strengthened for future health emergencies.