ABSTRACT
ABSTRACT After hospital discharge, it is recommended that post-stroke individuals receive follow-up by a physical therapist throughout all the stages of recovery. Despite clinical recommendations, few studies have investigated physical therapy care to community-dwelling individuals with stroke. This study aimed to describe physical therapy care to community-dwelling individuals with stroke in primary care setting and identify clinical-functional and sociodemographic characteristics that determined physical therapy assistance. This is an exploratory cross-sectional study. Community-dwelling individuals with stroke who were assisted by the primary healthcare team from an important Brazilian metropolis were included. Their medical records were analyzed to identify the care provided by physical therapists. Individuals who received and did not receive physical therapy care were compared (α=0.05). Out of the 100 included individuals, 55% received assistance from the multidisciplinary primary healthcare team and 44% from physical therapists. Physical therapy approaches consisted mainly of general orientations (89%) and assessments (75%). Only 45% of the individuals who received physical therapy care were followed-up, and those who received this type of care had significantly more stroke events and higher levels of disability (p<0.001). It was observed that many individuals with various levels of disabilities have not received physical therapist assistance. Moreover, follow-up care and referrals were not frequent physical therapy approaches. Therefore, physical therapy care in primary care needs to be expanded to ensure that all individuals with some level of disability receive treatment. Moreover, it is necessary to increase the number of individuals receiving follow-up and encourage multidisciplinary work between physical therapists and other primary healthcare professionals.
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RESUMO Após a alta hospitalar, recomenda-se que pacientes pós-AVC sejam acompanhados por um fisioterapeuta durante toda a recuperação. Apesar das recomendações clínicas, poucos estudos investigaram os cuidados fisioterapêuticos a indivíduos pós-AVC residindo na comunidade. O estudo objetivou descrever os cuidados fisioterapêuticos prestados a indivíduos que sofreram AVC residentes na comunidade em contexto de atenção primária e identificar as características clínico-funcionais e sociodemográficas que determinam a assistência de fisioterapia. Este é um estudo transversal exploratório. Foram incluídos pacientes pós-AVC, residentes na comunidade e que foram atendidos pela equipe multidisciplinar de quatro unidades de atenção primária à saúde de uma importante metrópole brasileira. Os prontuários foram analisados para identificar os cuidados prestados pelos fisioterapeutas. Os indivíduos que receberam e não receberam cuidados fisioterapêuticos foram comparados (α=0,05). Dos 100 indivíduos incluídos, 55% receberam assistência de profissionais da equipe multidisciplinar e 44% foram atendidos por fisioterapeutas. As abordagens de fisioterapia consistiram principalmente em instruções (89%) e avaliações (75%). Apenas 45% dos indivíduos que receberam cuidados fisioterapêuticos foram acompanhados, e aqueles que receberam esses cuidados apresentaram um número significativamente maior de eventos de AVC e níveis mais altos de incapacidade (p<0,001). Observou-se que muitas pessoas com diferentes níveis de incapacidade não receberam assistência fisioterapêutica. Além disso, o acompanhamento e os encaminhamentos não foram frequentes nas práticas fisioterapêuticas. Portanto, os cuidados fisioterapêuticos na atenção primária precisam ser ampliados para garantir que todos os indivíduos com algum nível de incapacidade recebam tratamento. Ademais, é preciso aumentar o número de indivíduos que recebem acompanhamento e incentivar o trabalho multidisciplinar entre fisioterapeutas e outros profissionais da área de saúde.
ABSTRACT
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.
Subject(s)
COVID-19 , Stroke , Humans , Pandemics , Smoking/epidemiology , Brazil/epidemiologyABSTRACT
ABSTRACT 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.
ABSTRACT
OBJECTIVE: To explore the relationship between walking measurements (i.e., walking speed, walking performance and walking confidence), and participation in ambulatory people with chronic stroke. MATERIALS AND METHODS: Participation was measured using the mobility domain of Brazilian version of the Stroke Impact Scale 3.0. Walking measures were walking speed, assessed by 10-m Walk Test, walking performance, assessed by ABILOCO, walking confidence, assessed by mGES. Pearson correlation coefficients were used to explore the relationships between the walking measures and social participation, and step-wise multiple linear regression analysis was used to identify which walking measures would explain participation after stroke. RESULTS: Ninety-five chronic stroke individuals (38 men), with a mean age of 67 (SD 13) years were assessed. Significant positive correlations, of high magnitude, were found between participation and all walking measures (r ≥ .53; p < .001). Regarding the regression analysis, walking confidence alone explained 44% (F = 72.4; p < .001) of the variance in participation. When perceived locomotion ability was included in the model, the explained variance increased to 48% (F = 42.8; p < .001). CONCLUSION: All walking measures were correlated with social participation after stroke, but only perceived locomotion ability and walking confidence explained the variance in participation. Clinicians should be encouraged to evaluate real-life performance and personal factors that may limit community participation after stroke.
