Over the last thirty years, medicine has made enormous progress in the treatment of stroke. Today more and more people survive thanks to timely rescue services, Stroke Units and time-dependent therapies. But, for those who overcome the acute phase, the treatment process is far from over: recovering movement, language, personal autonomy and the possibility of returning to a life that is as independent as possible represents a challenge that can last months or years.
But what happens after the acute phase? ALICE. Italia Odv (Association for the Fight against Cerebral Stroke) points out that it is necessary to guarantee every person affected by a stroke an appropriate, timely and homogeneous rehabilitation path, regardless of where they live. Unfortunately, on this front, there are still critical issues as evidenced by the first national report on hospital rehabilitation, commissioned by the Gianfranco Salvini Foundation, drawn up by Luca Giorgio, Tenure Track Researcher in Business Organization at the European University of Rome and supported by ALICe. Italy Odv. Created by analyzing official data from the Ministry of Health, Hospital Discharge Records (SDO), ministerial Open Data and ISTAT, the report analyzes the evolution of rehabilitation in Italy in the period 2013-2024.
How rehabilitation works
The need for hospital rehabilitation does not only concern people affected by stroke: the Report highlights, in fact, the role of rehabilitation in the post-acute phase also for patients who, following traumatic events, require treatments aimed at functional recovery and reintegration into the activities of daily life, including people who have suffered a serious head injury. These are different conditions, but they have in common the need for an intensive, multidisciplinary and continuous rehabilitation process, capable of accompanying the person in the recovery of their functions and autonomy.
According to the report, in 2024 approximately 292,000 ordinary rehabilitation hospitalizations were carried out, for over 7.6 million days of hospital stay, with a supply of almost 24,000 beds dedicated to rehabilitation. These numbers demonstrate how this phase represents an essential component of the treatment process after an acute event such as a stroke. However, the study also highlights an important critical issue: the system has not yet fully recovered to pre-pandemic levels. Compared to the pre-Covid period, in fact, discharges are still around 8% lower and hospital days are 6.5% lower, despite the availability of beds having now returned almost to 2019 levels.
Leopard patchy Italy
After a stroke, hospital rehabilitation is the phase that determines, more than any other, the possibilities of recovering autonomy, social relationships and quality of life. This is why we need truly integrated rehabilitation networks, continuity of care and organizational models that are able to accompany the patient even after discharge.
But this is not the case throughout the country. The fact that emerges most forcefully concerns the profound territorial differences. The hospitalization rate varies, in fact, from over 8 hospitalizations per thousand inhabitants in Valle d’Aosta to less than 2 hospitalizations per thousand inhabitants in Tuscany, while the availability of rehabilitation beds presents even more marked differences, with some Regions having an offer more than four times higher than others.
Even hospital rehabilitation, fundamental for many patients affected by stroke, is concentrated in a few highly specialized centers, making access to care particularly uneven across the country.
The report also shows that healthcare mobility continues to represent an indicator of existing inequalities: some Regions, such as the Autonomous Province of Trento, Lombardy and Emilia-Romagna, attract patients from all over Italy, while others still record high levels of passive mobility.
For ALICE. Italia Odv, all this means that recovery opportunities also continue to depend on the postcode of residence.
How the route works
Among the data in the Report there is one that summarizes the meaning of rehabilitation well: 82.9% of patients are discharged directly to their home. This is a fact that confirms the function of hospital rehabilitation in accompanying the person towards their return to their living context.
Obviously, discharge does not necessarily coincide with the conclusion of the recovery process. In fact, recovering language, walking again, regaining autonomy in daily activities, reintegrating into family and working life frequently requires the continuation of the rehabilitation process and continuity of care suited to the person’s needs. From this perspective, taking charge in the hospital phase manages to guarantee continuity in the area, until the maximum possible recovery is achieved.
The same principle applies to those who have to recover after a head injury: the conclusion of the acute phase does not coincide with the conclusion of the treatment, but rather opens a phase in which the rehabilitation process can be decisive for functional recovery and the return to daily life.
The Report also shows a plurality of discharge methods: in addition to home, 1.7% of patients are directed to a local residential facility or RSA, 1.6% are discharged with the activation of Integrated Home Care, 1.2% are transferred to another rehabilitation institute, while 3.4% move on to another hospitalization regime or to another activity in the same institute. These data highlight the presence of different care paths, which must be defined according to the clinical conditions and needs of the person, ensuring when necessary the connection between the different care settings.
From this perspective, strengthening rehabilitation does not simply come from increasing the number of beds, but from the ability to build integrated and appropriate pathways, in which hospitals, rehabilitation facilities and local services can operate continuously, each according to their own role.
