Comprehensive Analysis of Therapeutic Interventions for Upper Limb Function in Severe and Chronic Patients Post-stroke in Brazil: A Cross-sectional Survey

Research Objectives: This study addresses a gap in the literature by exploring therapeutic approaches for severe upper limb (UL) dysfunctions post-stroke in Brazil, capturing professionals and patients' perspectives.

Design: Cross-sectional survey.

Setting: Referral Center

Participants: Physiotherapists and/or occupational therapists with a minimum of five years of experience selected using social media and the list of the Brazilian Association of Neurofunctional Physiotherapy
Patients with stroke sequelae lasting at least 6 months with severe upper limb impairment recruited through the recommendation of professionals and contacted through social media, to obtain a representative sample

Interventions: The forms containing the questionnaires were developed on the Survey Monkey® platform. The privacy protections were guaranteed. The questionnaire covered topics such as socioeconomic data, educational background, clinical data, therapeutic approach, limitations, and restrictions related to the impairments, motivation, and treatment financing. The interventions most cited in the literature based on a systematic review were described concisely, questioning knowledge, indication, contraindication, and access to the interventions for the target population.

Main Outcome Measures: Quantitative data underwent frequency analysis, and the qualitative data underwent content analysis. The International Classification of Functioning (ICF) was considered the theoretical framework.

Results: 159 individuals from all regions of Brazil participated in the study. The professional cohort, experts in neurofunctional physiotherapy, averaged 14.8 years of experience, mainly in a home environment. Patients with an average of 33.5 ± 26.6 months since injury, predominantly received assistance from the Brazilian Public Health System. Analyzing the data yielded several categories aligned with ICF domains. Patients report that domestic life and personal care are the activities most impacted by stroke, but they mostly maintain positive expectations for recovery (including complete recovery). Professionals more frequently report approaches directed towards body structure and function, using interventions that do not require specific instrumentation and are of lower cost. They also report difficulties in implementing interventions, lack of family preparedness, challenges in referrals, and issues with interdisciplinary collaboration.

Conclusions: The results highlight the therapists' approach focused on body structure and function despite the impact on the individual's activity and participation in domestic life and personal care. It also stresses the vital role of family support and interdisciplinary collaboration. The study recognizes the need to adapt rehab programs to individual and cultural needs and to guide patients on their upper limb prognosis due to their often overly optimistic expectations, underscoring their resilience and optimism.

Author(s) Disclosures: The authors disclosure that they have no conflict of interest