Community participation of patients 12 months post-stroke in Johannesburg, South Africa

Abstract

BackgroundImprovement in health-related quality of life (HRQL) is the main goal of rehabilitation. The ability of the stroke-patient to participate in various situations signifies successful rehabilitation. The aim of the study was to establish the extent of community participation and the barriers and facilitators to the participation for stroke patients after their discharge.MethodThis study formed part of a larger study focusing on the impact of caregiver education on stroke survivors and their careers. This was a longitudinal study comprising 200 patients with first-time ischaemic stroke. Although the patients were followed up at home at 3 months, 6 months and 12 months post-stroke, this paper focuses on the 12-months follow-up participation results. Patient functional ability was measured by using the Barthel Index (BI) and the Rivermead Mobility Index (RMI), whereas participation was measured by using the International Classification of Functioning, Disability and Health (ICF) checklist. Descriptive statistics were used to analyse the data.ResultsPatients experienced severe to complete difficulty when undertaking single and multiple tasks without help 12-months post-discharge. They struggled with the preparation of meals, household work and interpersonal interactions, and they had difficulties with community life and partaking in recreation and leisure activities. Immediate family and societal attitudes were viewed as facilitators to community participation whereas friends, transportation services and social security services were viewed as barriers to community participation.ConclusionThe patient-ability to socialise and participate in community issues is currently poor. The identified barriers to community participation need to be addressed in order to improve patient-participation in the community post-stroke.

Impact of post-stroke impairments on activities and participation as experienced by stroke survivors in a Western Cape setting

“…Low levels of participation of stroke survivors in South Africa have also been described by various South African authors 8,10,11 . These authors pointed out challenges with mobility and environmental barriers as reasons for participation restrictions.…”

“…Study participants experienced activity limitations as indicated by the mean SIS-3 ADL score of 49.1 and a mean MBI score of 70.58 (Table III 10,11,12 attributed activity limitations to poor physical function and decreased muscle strength, while Rhoda et al 5 did not discuss possible causes. Findings from the current study showed, through statistical analysis, that muscle strength and function did indeed affect the ability to perform activities.…”

“…Google Scholar searches where the term ICF was in turn combined with the terms activities, participation and stroke outcomes yielded three South African studies that used the ICF as a framework to explore post-stroke outcomes 10,11,12 . According to Rhoda 10 impairments of the upper and lower limb lead to activity limitations in self-care and mobility and restricted participation, in caring for families and employment.…”

“…According to Rhoda 10 impairments of the upper and lower limb lead to activity limitations in self-care and mobility and restricted participation, in caring for families and employment. Mudzi and colleagues 11 did not explore impairments but indicated that participants struggled with completion of single and multiple tasks such as cooking meals, doing housework and interacting with other people. They also had difficulty participating in community, leisure and recreational activities.…”

“…As concluded by Hoffmann et al in a Chochrane review: "The effectiveness of occupational therapy for cognitive impairment post-stroke remains unclear" 32:2 . An activity that can severely limit participation in South Africa is mobility both in the home and the community 5,10,11 . In the current study various factors could have contributed to participants not achieving community mobility.…”