Clients with stroke and non-stroke and their guardians’ views on community reintegration status after in-patient rehabilitation

Abstract

AimThe aim of this study was to compare client community reintegration status following discharge from the Kachere Rehabilitation Centre (KRC), Blantyre, Malawi, in 2 consecutive years with client versus guardian perspectives on reintegration status.MethodsUsing quantitative methods, 35 clients with stroke and non-stroke diagnoses (spinal cord dysfunction and neuropathic conditions) and 32 client guardians (the family caregivers in Malawi) were separately interviewed using the WHO Disability Assessment Schedule (DAS) 2.0 (a measure of disability due to reintegration problems back into the community). The results were analyzed using descriptive statistics and the Wilcoxon Signed-Rank Test or the Mann-Whitney U Test, as appropriate, to test for significant differences between groups. The clients' home environments were categorized using an original checklist, the Home Observation Data Form (HOD).ResultsModerate to severe perceived levels of disability related to reintegration difficulties were noted by clients in years 1 and 2. For those with non-stroke diagnoses, there was a significant change in year 2 results compared to year 1, but not for those with stroke diagnoses. Guardians agreed with their client's perceptions of difficulty in year 2. Major areas of concern were taking care of household responsibilities, participating in day-to-day work or school routines, joining in community activities, and walking one kilometer per day.ConclusionsCommunity reintegration challenges in suburban Blantyre, Malawi continued to plague individuals with stroke and non-stroke diagnoses for 2 consecutive years after discharge from KRC. Based on the important role guardians play during their client's rehabilitation phase and when they return to the community, opportunities may exist to improve client perception of disability related to their reintegration status. Future studies are important to replicate these results, investigate the idea of a more important role for guardians in patient-centered care, and the relationship between motor and cognitive function and reintegration status.

Perspectives on Disability and Non-Communicable Diseases in Low- and Middle-Income Countries, with a Focus on Stroke and Dementia

“…In urban South Africa, after at least 6 months following a stroke, 43% of people felt that they had achieved no or minimal re-integration with their families, with particular difficulties reported around being unable to take on family responsibilities or return to work [24]. Similar patterns of participation restriction were reported post-stroke in Malawi in 2018 [25]. In Nigeria, a qualitative study examining the experience of life after stroke found that participants reported “I cannot visit the market as usual; now my outing has been restricted to only once a week” , “I am cut-off from social visits” , and “the only thing I can do now is to sit and look” [26].…”

Dyadic approach to supervised community rehabilitation participation in an Asian setting post-stroke: exploring the role of caregiver and patient characteristics in a prospective cohort study

“…One crucial point for conducting readiness assessment is before discharge to home from inpatient rehabilitation setting. 6 Building on work done by researchers describing stroke survivors' needs related to re-integration into community post-discharge, 45 and caregivers' needs related to caregiving and facilitating community transition, 46 readiness assessment at discharge should focus on stroke survivors' functional needs, community re-integration challenges, caregivers' commitment and capacity to care (ie, assessing for pre-existing health issues and self-care strategies), prior caregiving experience, available resources and overall impact of stroke. 46 study limitations Following are the limitations.…”

Stroke Recovery During the COVID-19 Pandemic: A Position Paper on Recommendations for Rehabilitation

“…41 Increasing community engagement after stroke presents a myriad of challenges, 42 including barriers to engagement because of changes in mobility and self-efficacy with balance, 43 cognitive 44 , language and visual impairment; reduced access to transportation; and psychosocial factors, such as reduced confidence with selfimage. 45 However, community reentry is often a goal for people with stroke and is valued as a mark of independence as well as a modality for continuity of holistic maintenance and remediation of various personal functions.…”