Anthea Rhoda

Activity limitations and factors influencing functional outcome of patients with stroke following rehabilitation at a specialised facility in the Western Cape

BACKGROUND Determining the functional abilities and factors influencing outcome of patients with stroke following rehabilitation are essential for the planning of future interventions and services in order to optimise recovery. OBJECTIVES To determine the activity limitations and factors influencing functional outcome of patients with stroke managed at a specialised rehabilitation centre. METHODOLOGY A longitudinal study design was used to determine the functional outcomes of patients admitted to the centre on admission and discharge. A data gathering sheet was developed to collect information pertaining to the demographicand medical profile and process of rehabilitation, whereas the Barthel Index was used to collect data relating to functional abilities. For analysis, descriptive statistics as well as inferential statistics (Student t test) were utilised to determine the paired differences. Six prognostic factors influencing functional outcome were selected and tested using linear (bivariate) regression. RESULTS The mean Barthel Index scores on admission and at discharge were 58.85 and 81.59 respectively. A significant improvement was noted in the execution of functional task of patients with stroke (p< 0.01) between the data collection points. Despite the significant overall improvement, results show a high prevalence of dependence with walking and stair climbing at discharge. Only functional ability on admission (r=0.49) predicted a favourable functional outcome at discharge. CONCLUSION This study highlights the limitations of younger stroke survivors and the need for continued rehabilitation following in-patient care. It further underscores the administration of a functional rating scale on admission in order to aggressively manage activity limitations.

Peripheral neuropathy and quality of life of adults living with HIV/AIDS in the Rulindo district of Rwanda

Although the life expectancy of people living with HIV/AIDS (PLWH) has increased in the past years, they could experience secondary illness such as peripheral neuropathy (PN). Therefore, they need to adapt to chronic disablement which could affect their quality of life (QoL). The research that informed this article aimed at determining the prevalence of PN among adults living with HIV/AIDS and attending the outpatients’ clinic at Rutongo Hospital in the Rulindo district of Rwanda. Another aim was to determine these patients’ QoL. A cross-sectional descriptive quantitative research design was used. A time-constrained method was used to sample 185 adults living with HIV/AIDS and attending the outpatients’ clinic at Rutongo Hospital. The subjective PN screen and the World Health Organization Quality of Life Scale Brief Version were used to collect the data. Data were analysed using the Statistical Package for the Social Sciences. Students t-test and one-way analysis of variance were performed to determine if significant differences existed between QoL scores in participants with and without PN symptoms. The results indicated that 40.5% of respondents experienced PN. QoL in participants with PN showed significantly lower scores in the physical (p = 0.013) and psychological (p = 0.020) domains when compared with those who did not have PN. These results indicate a high prevalence of neuropathy among PLWH attending the outpatients’ clinic at Rutongo Hospital. In addition, patients with neuropathy had lower QoL scores in the physical and psychological domains than those without neuropathy symptoms. The management of PLWH should therefore include interventions to optimise QoL as well as screening for neuropathy symptoms so that sufferers can liaise with their medical providers to find medical and supportive therapies that could assist them.

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

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.

Motor and functional recovery after stroke: a comparison between rehabilitation settings in a developed versus a developing country

BackgroundRecovery post stroke is well documented in the field of stroke rehabilitation. The structure and process of rehabilitation are different between developed and developing countries. The aim of the present study was to compare the motor and functional recovery of stroke patients in Germany versus stroke patients receiving rehabilitation in South Africa.MethodsThis study used secondary data analysis of patient protocols collected in two independent studies conducted in Germany and South Africa respectively. A total of 73 patients from the two separate studies were matched for age at stroke onset, gender, and initial motor functioning. Motor and functional recovery were assessed at baseline, two and six months post stroke using the Rivermead Motor Assessment Scale and the Barthel Index (BI) respectively. Significant differences in motor and functional recovery were found, using the Wilcoxon rank sum test on admission to the centre, and at two and six months after stroke. A generalized linear mixed-methods model (GLIMMIX) was used to compare the recovery patterns between the participants from the two settings over time.ResultsThe results of the GLIMMIX revealed a significant difference in favour of the German participants for gross motor (RMA-GF) and upper limb (RMA-A) recovery, while no significant difference was found for lower limb (RMA-LT) and functional (BI) recovery patterns between the participants of the two settings. No significant differences existed in RMA-A and BI-scores on admission to the CHC/SRU. At two and six months after stroke, both the RMA-A and BI-scores were significantly lower in the South African than the German sample.ConclusionThe results of this study provide empirical evidence for differential recovery patterns for patients in developed and developing countries. A detailed exploration of the factors to which this difference in recovery patterns can be attributed was beyond the scope of the present study, and is recommended for future research.

Research productivity of academics in a physiotherapy department : a case study

Objective: Research productivity is an important activity among academics. This study was done to document the research productivity of the academics of a physiotherapy department in South Africa. Method: An archival research design was used to document the research productivity for the physiotherapy department between the period of 2002 and 2009. Data was analysed by two independent reviewers and consensus was reached on the information to be included in the study. Results: Among the nine academics there were 67 publications, 20 articles in progress, 7 under review and 63 conferences attended. While the overall research productivity of the department seems to be good, the bulk of the productivity rests in the hands of the senior academics. Conclusion: There is thus a need to facilitate the acquisition of research skills in academic staff, particularly in upgrading staff to PhD level and improving publication output.

Knowledge of nurses regarding dysphagia in patients post stroke in Namibia

Background Stroke patients commonly experience dysphagia post stroke. Complications of dysphagia include aspiration leading to chest infection and pneumonia, malnutrition, dehydration, and a subsequent increased risk of death. Its early diagnosis and management is an important prerequisite for recovery from stroke during the rehabilitation phase. As nurses are the first health personnel that interact with a patient post stroke, it is important that they are knowledgeable and skilled in the screening of these patients for dysphagia. Objective The aim of the study was to determine the knowledge and factors associated with knowledge of nurses regarding dysphagia in stroke patients. Methods The study used a quantitative survey to determine the knowledge of the nurses employed at an intermediate hospital in Namibia. A convenient sample of 182 participants completed a self-administered questionnaire with closed-ended questions, which was developed by the researcher. The data was analysed using descriptive and inferential statistics. Results The findings of the study confirmed that nurses have a moderate knowledge of the signs, symptoms, and complications of dysphagia, but poor knowledge about its management. Training and experience in the care of dysphagia patients was a stronger predictor of knowledge than the initial qualification or years of experience as a nurse. Conclusion Post basic training in dysphagia would better equip nurses to manage stroke patients in the acute phase.

Using appreciative inquiry to develop a research capacity development programme

With academics struggling to find the balance between research and teaching, there is a need to identify strategies that would assist academics in making the necessary changes to manage their time. Appreciative inquiry is a strength-based change process based on the premise that academics are change agents who possess knowledge and experience that can make a difference. This article proposes an appreciative inquiry methodological framework for an academic development strategy focussing on integrating research into teaching. Currently few measures exist that focus on assisting academics in incorporating research into teaching and learning. The article aims to describe the strategies used to initiate a process that builds on the positive experiences of academics in teaching in an environment where academics may become overwhelmed when focussing only on barriers. The process described focuses on the aims of the academic development programme at each stage as well as the roles of the participants. The Appreciative Inquiry approach is a novel framework that can be used to initiate research capacity building among academics.

Barriers to and facilitators of rehabilitation services for people with physical disabilities: A systematic review

Background As health care practitioners, it is important to have an understanding of the common barriers to and facilitators of the rehabilitation services we provide. Objectives This article aimed to review the relevant literature regarding barriers to and facilitators of rehabilitation services for people with disabilities. Method Articles for the period 1990–2010 using descriptors related to rehabilitation services, barriers, facilitators and the physically disabled population were retrieved for this review. Results A total of 19 article titles were identified from references of other articles but following application of the inclusion criteria selected for this review, only six articles were chosen. Five of these articles were qualitative studies and one was a quantitative study. Barriers and facilitators regarding rehabilitation services highlighted by participants in the studies included a perception that health professionals have a lack of understanding of rehabilitation for people with disabilities and there was a lack of information sharing from health professionals about the rehabilitation process. On the other hand some participants reported that health professionals demonstrated confidence in the disability and rehabilitation process during consultation and highlighted that their needs were met by the rehabilitation professionals. Conclusion Even though there were few studies highlighting the barriers to and facilitators of rehabilitation services, they highlighted that there are gaps in the process of rehabilitation services provided. It would be advisable for health professionals to take cognisance of the issues highlighted in this study in order to make rehabilitation services more effective.

Quality of life amongst young adults with stroke living in Kenya

BACKGROUND The world has been experiencing an increase of stroke among young adults. Occurrence of stroke in young adults dramatically affects the quality of life of the individuals. OBJECTIVES To investigate the quality of life amongst young adults who experienced a stroke living in Kenya. METHODS A cross-sectional study was carried out on a conveniently selected sample of 161 young adults with stroke drawn from three tertiary hospitals in Kenya. The Short-Form 36-item second version (SF-36v2) was used to collect the data. Descriptive and association statistical analysis using Mann-Whitney U, and Kruskal Wallis tests were calculated on the data using SPSS. RESULTS In relation to a total score of 100, when expressed as a percentage the mean quality of life scores, ranged from 30% to 48% for each of the SF-36v2 domains. The results showed that males scored higher than females in all the domains except in physical functioning and that the scores decline with advance in age in most domains. CONCLUSION The quality of life scores for this group were low meaning that that they were experiencing more challenges with physical functioning, psychological and emotional functioning and fulfilling previous roles.

Barriers experienced by service providers and caregivers in clubfoot management in Kenya

Aim Disability in childhood remains a challenge globally. Linked to this disability is an apparent increase in the prevalence of infants born with congenital clubfoot. Clubfoot can, however, be effectively managed but this management faces various challenges. This study aims at exploring the barriers experienced in Kenya. Methods In-depth interviews were conducted with 20 participants. Informed consent was sought. Field notes were taken and the interviews tape-recorded. The interviews took 45 minutes to 1 hour. They were transcribed verbatim and analysed by thematic content. Results Missed diagnosis, poor referral system, shortage of staff, long travelling distance, poverty, stigmatisation and lack of support among other were highlighted as the major challenges in clubfoot management. Conclusion The challenges facing children with disability start at birth but are little different from those faced throughout their life. Action to remove these challenges is warranted