Stroke Rehabilitation in Low- and Middle-Income Countries

Kayola, Grace; Mataa, Mataa M; Asukile, Melody; Chishimba, Lorraine; Chomba, Mashina; Mortel, Dominique; Nutakki, Aparna; Zimba, Stanley; Saylor, Deanna

doi:10.1097/phm.0000000000002128

Cited by 15 publications

(13 citation statements)

References 67 publications

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“…However, there were also some negative aspects. Not all service users had a smartphone, and furthermore, low levels of literacy and digital skills were barriers to implementing telerehabilitation in line with previous papers [ 3 , 4 , 25 ]. Although there were examples of some apps being used by therapists, they were not felt to be culturally relevant for the Ghanaian context as they were in English rather than the local dialect and tended to have White people (generally Americans or Europeans) demonstrating the activity, which had the potential to reduce engagement of service users.…”

Section: Discussionsupporting

confidence: 83%

“…Like previous studies of telerehabilitation generally [ 11 , 13 , 20 ] and specifically in relation to LMICs [ 3 , 23 ], participants reported a number of benefits to telerehabilitation especially the convenience, requiring less travel time and reduced travel cost. Some HCPs raised that telerehabilitation improved access to rehabilitation services for patients, especially those who stayed a distance from the clinic.…”

Section: Discussionmentioning

confidence: 54%

“…Much of the research in telerehabilitation has been undertaken in high-income countries, with notably fewer studies in LMICs [ 6 , 14 , 15 ], where the rehabilitation context, as well as the barriers and facilitators to the feasibility, adoption, scalability, and sustainability of telerehabilitation, may be quite different. In terms of neurological conditions, most telerehabilitation research in LMICs has been conducted in stroke [ 3 , 14 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Views of Service Users, Their Family or Carers, and Health Care Professionals on Telerehabilitation for People With Neurological Conditions in Ghana: Qualitative Study

Paul,

Thomson,

Asibey

et al. 2024

JMIR Mhealth Uhealth

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Background Up to 50% of people in low- and middle-income countries do not receive the rehabilitation they require. Telerehabilitation has the potential to improve access to neurorehabilitation services especially in low- and middle-income countries. Although there are reports of the barriers and facilitators to telerehabilitation in such settings, almost all are anecdotal. Furthermore, family or carers have a significant influence on the adoption and success of telerehabilitation, but their views have not been reported. Objective This study aimed to investigate the views of service users, their family or carers, and health care professionals (HCPs) on telerehabilitation for people with neurological conditions in Ghana. Methods Two focus groups were held at Komfo Anokye Hospital in Kumasi, Ghana: one in person for service users (n=11) and their family or carers (n=9), conducted in the Ghanaian language of Twi, and one hybrid for HCPs (n=18) conducted in English. The mean (SD) age of the service users was 59.8 (8.6) years; 5 users had a stroke and 6 had Parkinson disease. The HCP group consisted of 7 speech and language therapists, 3 physiotherapists, 3 occupational therapists, 3 medical staff, 1 nurse, and 1 industry representative. Focus groups were semi-structured and explored previous experiences of telerehabilitation, perceived benefits and challenges, and solutions to overcome these challenges. Focus groups were audio transcribed, and the service user transcript was translated into English. The resulting transcripts were analyzed using thematic analysis. Results Overall, participants were positive about the role of telerehabilitation but recommended hybrid delivery, with in-person rehabilitation in the early stages and telerehabilitation in the later stages. In relation to telerehabilitation in Ghana, there were 3 main themes: benefits, challenges or barriers, and implementation. Benefits included the convenience and lower cost for service users, the higher dose of therapy possible, and increased access for people in remote areas. However, challenges included lack of a stable internet connection, cost of phones and data packages, and low levels of literacy. Implementation issues included cultural relevance, information governance, and the platform used to deliver telerehabilitation, with most participants being familiar with WhatsApp. Conclusions Telerehabilitation has the potential to be a useful method of delivering rehabilitation to people with neurological conditions in Ghana, especially in a hybrid rehabilitation model with telerehabilitation augmenting in-person sessions. However, many people were unaware of telerehabilitation, and challenges such as a reliable internet connection, cultural relevance, and costs need to be addressed. Clinical trials of low-cost telerehabilitation interventions contextualized to the specific user group are required.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 54%

Section: Introductionmentioning

confidence: 99%

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Views of Service Users, Their Family or Carers, and Health Care Professionals on Telerehabilitation for People With Neurological Conditions in Ghana: Qualitative Study

Paul,

Thomson,

Asibey

et al. 2024

JMIR Mhealth Uhealth

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“…Individual-level factors include limited health literacy, financial constraints, and limitations in transportation. 37 The proportion of patients receiving rehabilitation after stroke and type of rehabilitation support varies widely. For instance, in Rwanda, access to rehabilitation has been reported for 40% of patients with stroke, compared with 98% in South Africa.…”

Section: Challenges Of Stroke Care In Resource-limited Settingsmentioning

confidence: 99%

Developing Systems of Care for Stroke in Resource-limited Settings

Silva,

Rocha

2024

Semin Neurol

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Although stroke prevention and treatment strategies have significantly advanced in recent years, implementation of these care elements in resource-limited settings can be challenging, since the burden of stroke is higher and access to stroke care is lower. Barriers to stroke care in resource-limited settings include insufficient prevention, reduced awareness of stroke symptoms, limited prehospital care and lack of triage systems, limited access to comprehensive stroke centers, inadequate personnel education, lack of staff and resources, as well as limited access to neuroimaging, thrombolytics, mechanical thrombectomy, neurosurgical care, and rehabilitation. Here, we suggest strategies to improve stroke care in these settings, including public health campaigns, protocols for prehospital notification, organized flow to specialized stroke centers, development of dedicated stroke units, and utilization of telemedicine and telerehabilitation. We also highlight the role of international organizations and governments in reducing the global burden of stroke.

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“…Noncommunicable diseases, including conditions that cause spasticity, represent a growing proportion of disease burden in low- and middle-income countries (LMICs) 2 . These countries are characterized by having various barriers to access rehabilitation, which can be classified into health system factors (high demand for services, lack of facilities and equipment, low number of specialists, and limited resources in rural areas) and individual factors (limited transportation options, financial burdens, low health literacy, and absence of caregivers) 3 . This chronic situation complicates noncommunicable disease and spasticity management in patients living in LMICs.…”

mentioning

confidence: 99%