Access to post-stroke physical rehabilitation after acute reperfusion therapy– the neglected link in ischemic stroke management: a retrospective cohort study

Background: The burden of stroke is high in Romania and data regarding access to post – stroke rehabilitation are almost non–existent. We aimed to determine the percentage of patients who benefited from post–stroke rehabilitation and to describe the most common rehabilitation settings. Methods: A structured telephone-based questionnaire regarding access to post–stroke rehabilitation therapy and outcomes was administered to all patients with ischemic stroke who benefited from reperfusion therapy in a tertiary center in 2019. Results: 211 stroke patients received reperfusion therapy during the studied period. Out of these, 208 patients were included in the initial analysis and 109 patients were deemed eligible for post–stroke rehabilitation therapy. 57 patients (55.8%) performed post–stroke rehabilitation. In-hospital rehabilitation was reported by 35 patients (32.1%) with a median length of hospital stay of 14 days. 28 patients (25.6%) performed home based physical therapy with a median frequency of 3 sessions per week. 12 patients (11.1%) were admitted to nursing homes. Compared to stroke patients who did not perform in–hospital rehabilitation, those who did were younger (median age 65 years vs. 73 years, p=0.01) and more likely to have moderate–severe post–stroke disability (mRS score 3 – 5 at discharge 80% vs. 59.4%, p=0.03). mRS score at discharge ≤ 2 was a significant predictor for not pursuing post-stroke rehabilitation (p < 0.001). Conclusion: Approximately 50% of the stroke patients treated with reperfusion therapies were eligible for post–stroke rehabilitation and approximately 50% of them had access to rehabilitation therapy while only 30% had access to in-hospital rehabilitation. Keywords: Stroke rehabilitation; Eastern Europe; Romania; Rehabilitation Center; Physical Therapy