Quality of rehabilitation care in Portuguese stroke units: findings from 2017-2018 and 2023 national cross‑sectional surveys.

Abstract

To evaluate adherence to stroke rehabilitation guidelines in Portuguese stroke units from the physicians' perspective and examine changes over 6 years. A national cross-sectional survey across 2 time periods (2017-2018 and 2023). Stroke units recognized by the Portuguese Stroke Society were invited to participate: 27 in 2017-2018 and 35 in 2023. A structured questionnaire, aligned with national and international guidelines, assessed 5 domains: team composition, care coordination, early assessment and planning, dysfunction assessments, and post-discharge planning. Response rates were 93% (n = 25) and 80% (n = 28). Most units (> 75%) had a physiatrist, physiotherapist, speech therapist, rehabilitation nurse, and social worker; only 20% had the full recommended team. Weekly stroke unit meetings were stable (88-89%), while rehabilitation team meetings increased markedly between the 2 periods (20% vs 72%). Rehabilitation started earlier on weekdays (89% vs 79%) than at weekends (68% vs 57%). Dysphagia screening was common (96% vs 89%), but neurogenic bladder assessment was rare (< 8%). The Modified Rankin Scale and Barthel Index were consistently used. Post-discharge planning remained high (92% vs 89%), with improved coordination between teams (48% vs 89%). Portuguese Stroke Units demonstrated moderate-to-high adherence to rehabilitation guidelines, with progress in teamwork communication and care coordination, although important gaps remain.