Barriers to Rehabilitation After Stroke in Young Adults

Abstract

Introduction: Stroke in working-age adults has important functional, social, and economic consequences. Although functional recovery is influenced by clinical factors, contextual barriers may also limit access to and adherence to rehabilitation. This thesis investigated the functional status of working-age stroke survivors, the perceived barriers to rehabilitation, and the prognostic value of these barriers for short-term functional recovery. Materials and Methods: This thesis comprised two studies. The first was a cross-sectional study that evaluated functional status and its association with perceived rehabilitation barriers. The second was a prospective cohort study that investigated whether perceived rehabilitation barriers after hospital discharge predicted functional recovery over a two-month follow-up. A total of 59 working-age adults with ischemic stroke were recruited from rehabilitation clinics in northeastern Brazil. Participants were assessed using the National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), modified Barthel Index (mBI), Stroke Impact Scale (SIS), and Cardiac Rehabilitation Barriers Scale (CRBS). Results: Participants presented with mild to moderate neurological impairment, substantial functional limitations, particularly in motor domains, and reduced independence in activities of daily living. Functional independence was moderately to strongly correlated with the SIS mobility and activities of daily living domains. Perceived rehabilitation barriers were primarily related to contextual and personal factors, especially perceived needs and access to rehabilitation services, with limited associations between barrier scores and functional severity. In the longitudinal analysis, modest improvements were observed in neurological impairment, muscle strength, and perceived rehabilitation needs over the two-month follow-up. After adjustment for baseline functional status, higher baseline CRBS scores were associated with higher follow-up functional independence scores. However, overall perceived rehabilitation barriers showed limited prognostic value for short-term functional recovery. Conclusions: Working-age stroke survivors experience persistent functional limitations and face rehabilitation barriers that are predominantly related to contextual and personal
factors rather than clinical severity. Although these barriers demonstrated limited prognostic value for short-term functional recovery, their assessment may help identify unmet needs and support individualized, multidisciplinary rehabilitation strategies, contributing to a more comprehensive approach to the challenges experienced by this population.