Potential role of tele-rehabilitation to address barriers to implementation of physical therapy among West African stroke survivors: A cross-sectional survey

Abstract

Background The greatest burden from stroke-related disability is borne by Low-and-Middle Income countries (LMICs) where access to rehabilitation after stroke is severely challenged. Tele-rehabilitation could be a viable avenue to address unmet rehabilitation needs in LMICs. Objectives To assess the burden of post-stroke physical deficits, rates of utilization of physiotherapy services, and perceptions of tele-rehabilitation among recent Ghanaian stroke survivors. Methods Using a consecutive sampling strategy, 100 stroke survivors attending an outpatient Neurology clinic in a Ghanaian tertiary medical center were enrolled into this cross-sectional study. After collecting basic demographic data, clinical history on stroke type, severity and level of disability, we administered the validated 20-item Functional Independence Measure questionnaire to evaluate functional status of study participants and an 8-item questionnaire to assess participants’ attitudes towards telemedicine administered rehabilitation intervention. Results Mean ± SD age of study participants was 57.2 ± 13.3 years of which 51.0% were males with a mean duration of stroke of 1.3 ± 2.2 years. 53% had Modified Rankin scores of ≥3, 57% were fully independent and only 27% reported utilizing any physiotherapy services. Barriers to access to physiotherapy included financial constraints due to cost of physiotherapy services and transportation as well as premature discharge from physiotherapy to avoid overburdening of available physiotherapy services. These factors led to the limited provision of rehabilitative therapy. Participants held positive views of the potential for tele-rehabilitation interventions (80–93%). However, while 85% owned mobile phones, only 35% had smart phones. Conclusion Despite, a high burden of residual disability, only about 1 out of 4 stroke patients in this Ghanaian cohort was exposed to post-stroke physiotherapy services, largely due to relatively high costs and limited health system resources. These Ghanaian stroke patients viewed the potential role of Tele-rehabilitation as positive, but this promising intervention needs to be formally tested for feasibility, efficacy and cost-effectiveness.

Improving the quality of care for people who had a stroke in a low‐/middle‐income country: A qualitative analysis of health‐care professionals’ perspectives

“…Internationally, experts, consensus statements and stroke care literature have consistently emphasized the need to have a multidisciplinary approach to standardize health care. 13,14,20,[37][38][39] Participants in the present study also expressed similar need. As noted by participants, e-platforms such as WhatsApp can serve as an excellent channel to share information between stroke care professionals.…”

“…Internationally, experts, consensus statements and stroke care literature have consistently emphasized the need to have a multidisciplinary approach to standardize health care . Participants in the present study also expressed similar need.…”

Telerehabilitation for Stroke Survivors: Systematic Review and Meta-Analysis (Preprint)

“…However, only 35% of them had smart phones [27]. Further development of telerehabilitation networks is essential to overcome these barriers [28].…”

Differences in factors influencing the use of eRehabilitation after stroke; a cross-sectional comparison between Brazilian and Dutch healthcare professionals

“…eRehabilitation can decrease stroke-related impairments (5,8,9), relieve healthcare professionals from manual labour, make rehabilitation accessible to larger number of stroke patients (2), continue therapy-related cognitive and motor activities during and after discharge (4), decrease chronic disability during and after sub-acute rehabilitation, and facilitate home-therapy (10,11). Especially in regions with a paucity of socioeconomic resources and limited access to care, regions with the greatest burden of stroke worldwide (14), culturally-relevant eRehabilitation interventions are likely to be the most viable strategy to reduce burden (15).…”