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

Wrong, wrong, wrong. The neglected link is the fact your doctor is doing nothing

to stop the 5 causes of the neuronal cascade of death in the first week. Allowing billions of neurons to die. I bet your doctor doesn't tell you how many neurons they let die because they DID NOTHING.

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

RADU Răzvan Alexandru 1,2, TERECOASĂ Elena Oana 2,3, CĂȘARU Bogdan 3
,
ENACHE Iulian 3, 

GHIȚĂ Cristina 3,

TIU Cristina 2,3

1. Department of Interventional Radiology, University Emergency Hospital Bucharest, Bucharest, Romania
2. “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
3. Stroke Unit, Department of Neurology, University Emergency Hospital Bucharest, Bucharest, Romania
Corresponding author: TERECOASĂ Elena Oana, E-mail: oana_ter@yahoo.com

Abstract

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,
Introduction
As an overwhelming disease of huge medical, social and
economic significance, stroke is now the second leading
cause of disability and death worldwide.(1) Eastern
Europe, where Romania is located, is the region with the
second highest stroke incidence in the world, after east
Asia, being estimated that around 30% of the adult
population is at risk of suffering a stroke during their
lifetime.(2,3) Despite this high stroke burden, this region
reports overall low access to appropriate acute and post –
acute stroke care and reperfusion therapies.(4) In order to
offset the dramatic impact that a future increase in stroke
prevalence is expected to have in Europe, a Stroke Action
Plan for Europe (SAP-E) was recently developed. This
paper emphasizes the importance of national stroke plans
that should encompass an entire “stroke chain”, from
primary prevention to life after stroke and also offers
targets and guidance for every link in this chain.(5)
In order to provide equal access to proven effective
therapies for all stroke patients, healthcare policy makers,
public healthcare specialists and clinicians across the
world should first analyse their existing individual
capabilities and unique infrastructure. Assessment of the
existing status is a key reference point that should lead to
the settlement of an interconnected stroke network rather
than myopic singular stroke ready hospitals.(6) This
implies focusing on every link in the stroke care chain
starting from stroke awareness and ending with
comprehensive rehabilitation and adequate post-stroke
care.(5)
The 2006 Helsingborg declaration stated that all stroke
patients in Europe should have access to appropriate
rehabilitation by 2015.(7) However, in 2017 access to
post - stroke inpatient rehabilitation was found to vary
widely, the percentages of those actually benefiting from
this therapy ranging from 15.1 to 44.3% in different
European countries.(8) Access to post – stroke
rehabilitation is expected to be low in Eastern Europe but
available high – quality data on this subject are scarce or
even non – existent for most of the countries from this
region. Available published data shows unequal and scant
availability of rehabilitation services. Moreover, post –
stroke rehabilitation in Eastern Europe is usually focused