Provision of inpatient rehabilitation and challenges experienced with participation post discharge: quantitative and qualitative inquiry of African stroke patients

Abstract

BackgroundThe provision of rehabilitation differs between developed and developing countries, this could impact on the outcomes of post stroke rehabilitation. The aim of this paper is to present provision of in-patient stroke rehabilitation. In addition the challenges experienced by the individuals with participation post discharge are also presented.MethodsQualitative and quantitative research methods were used to collect data. The quantitative data was collected using a retrospective survey of stroke patients admitted to hospitals over a three- to five-year period. Quantitative data was captured on a validated data capture sheet and analysed descriptively. The qualitative data was collected using interviews from a purposively and conveniently selected sample, audio-taped and analysed thematically. The qualitative data was presented within the participation model.ResultsA total of 168 medical folders were reviewed for a South African sample, 139 for a Rwandan sample and 145 for a Tanzanian sample. The mean age ranged from 62.6 (13.78) years in the South African sample to 56.0 (17.4) in the Rwandan sample. While a total of 98 % of South African stroke patients received physiotherapy, only 39.4 % of Rwandan patients received physiotherapy. From the qualitative interviews, it became clear that the stroke patients had participation restrictions. When conceptualised within the Participation Model participation restrictions experienced by the stroke patients were a lack of accomplishment, inability to engage in previous roles and a perception of having health problems.DiscussionWith the exception of Rwanda, stroke patients in the countries studied are admitted to settings early post stroke allowing for implementation of effective acute interventions. The participants were experiencing challenges which included a lack of transport and the physical geographic surroundings in the rural settings not being conducive to wheelchair use.ConclusionStroke patients admitted to hospitals in certain African countries could receive limited in-patient therapeutic interventions. With the exception of barriers in the physical environment, stroke patients in developing countries where resources are limited experience the same participation restrictions as their counterparts in developed countries where resources are more freely available. Rehabilitation interventions in these developing countries should therefore be community-based focussing on intervening in the physical environment.

Supporting Survivors of Stroke in Low Resource Settings

“…Generally, LOS in African hospitals and other developing countries is short and range from 2 to 30 days [20,[30][31][32][33][34][35][36][37]. Shorter LOS may be indicative of fewer rehabilitation sessions and reduced impact on stroke survivor outcomes [6]. In 2012, 6 ± 4 days were reported in South Africa [32].…”

“…Short hospital stay also means that patients are discharged before they are fully functional [39,42]. This may be an indication that patients are kept in hospital until they are medically stable but not for rehabilitation [6]. As in the Zimbabwean setting, there may be no community services available to cater for the stroke survivors and their caregivers in most instances.…”

“…In some cases, fear and the terrain may not be conducive for mobility. This is because there may be stones around and the terrain may be hilly thus reducing wheelchair mobility [6,87]. Rehabilitation professionals may face difficulties in trying to equip stroke survivors with the skills for community mobilisation in different terrains.…”

“…Rehabilitation professionals may face difficulties in trying to equip stroke survivors with the skills for community mobilisation in different terrains. Further, survivors may not be able to manoeuvre wheelchairs given for mobilisation as the environment plays a role in the outcome of rehabilitation and the patient's recovery after stroke as it may act as a barrier [6,87,88]. This is more so because the objects, their position and orientation in the environment drives the motor pattern in an action as survivors try to move about [6].…”

“…This puts the burden of care at home on the relatives. This is the case in Zimbabwe, Rwanda, Tanzania and South Africa [5,6]. The chapter therefore gives information on supporting informal caregivers in order to New Insight into Cerebrovascular Diseases -An Updated Comprehensive Review 2 improve functional outcomes among survivors of stroke and quality of life among both the survivors and caregivers [7].…”