Percorrer por autor "Cruz, Vitor Tedim"
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- From healthcare system to individuals through stroke rehabilitation pathways. Outcomes, information, and satisfaction along 12 months prospective cohort in PortugalPublication . Barbosa, Pedro Maciel; Machado, João Firmino; Ferreira, Lara Noronha; Cruz, Vitor Tedim; Szrek, Helena; Barbosa, PedroThe nature and quality of stroke survivor rehabilitation varies throughout Europe,including in Portugal, having not been widely monitored or benchmarked. This study analyses the stroke care pathway from three perspectives: healthcare system, process, and patient. The study uses data from a one-year single-center prospective cohort of first stroke patients, assessed at baseline, 3, 6, and 12 months. Care pathways and settings were described interms of organizational model, funding, patient involvement, frequency and intensity and multi-disciplinary team. Patient-level information and satisfaction were evaluated using a 10-point numeric rating scale. Kruskal – Wallis and post-hoc tests were used to compare EQ-5D-3 L, National Institute of Health Stroke Scale (NIHSS), Modified Rankin Scale (mRS), Barthel Index, Mini-Mental State Examination scores between pathways and settings. A total of 391 acute stroke patients, with a mean disability of 3.7 (mRS) and severity of 11.7(NIHSS) participated. Six pathways and eight settings were described. A lack of compliance between guidelines and care was identified. There were significant differences in the four outcomes between the six pathways (p-values 0.007 to 0.020) suggesting inefficiency and inequalities, with an inadequate level of information and patient satisfaction. After post-hoc analysis, pathways 1 and 2 showed highest outcomes (p-values 0.001 to 0.002). Within settings, short-term units showed high scores,followed by rehabilitation center, outpatient hospital, and community clinic (p-values 0.001 to 0.040).A multilevel characterization of the post-stroke rehabilitation pathway showed a more complete perspective on stroke management which may contribute to future rehabilitation and stroke policies.
- Healthcare, clinical factors and rehabilitation predicting quality of life in first-time stroke patients: a 12-month longitudinal studyPublication . Barbosa, Pedro Maciel; Ferreira, Lara Noronha; Cruz, Vitor Tedim; Silva, Augusta; Szrek, HelenaOne of the long-term rehabilitation goals in stroke survivors is to achieve the best health-related quality of life (HRQoL). This study analyzes the evolution of HRQoL one-year post-stroke to establish the main pre-stroke, clinical, health care and rehabilitation predictors. This study uses patient-level data from a one-year single-center prospective cohort study of first stroke patients, assessed at baseline, 3, 6 and 12 months. A generalized linear model with a linear response determined independent predictors of HRQol with EQ-5D-3L and SF-6D. The model included age, gender, scholarity, monthly income, residence, occupation, National Institute of Health Stroke Scale (NIHSS), Modified Rankin Scale (mRS), Barthel Index (BI), Mini-Mental State Examination (MMSE), length of stay, door-to-neurological examination time, access, frequency, and satisfaction with rehabilitation care. A total of 391 acute stroke patients, with a mean disability of 3.7 and severity of 11.7 participated. A decline of HRQoL was observed from baseline to the first three months in both indexes, with an increase in HRQoL at 3 months until 12 months. Scores were significantly lower compared to corresponding population norms throughout follow-up, mostly affected by stroke severity, disability, rehabilitation access and frequency. Higher HRQoL was associated with lower mRS, NIHSS, age, length of stay, and with higher BI, MMSE, scholarity, occupation, and rehabilitation care. Clinical measures and rehabilitation care were the strongest HRQoL predictors of stroke survivors regardless of severity levels. These findings may contribute to the development of future health policies that focus on post-stroke recovery.