Pragmatic Solutions for Stroke Recovery and Improved Quality of Life in Low- and Middle-Income Countries—A Systematic Review

Abstract

Background: Given the limited healthcare resources in low and middle income countries (LMICs), effective rehabilitation strategies that can be realistically adopted in such settings are required. Objective: A systematic review of literature was conducted to identify pragmatic solutions and outcomes capable of enhancing stroke recovery and quality of life of stroke survivors for low- and middle- income countries. Methods: PubMed, HINARI, and Directory of Open Access Journals databases were searched for published Randomized Controlled Trials (RCTs) till November 2018. Only completed trials published in English with non-pharmacological interventions on adult stroke survivors were included in the review while published protocols, pilot studies and feasibility analysis of trials were excluded. Obtained data were synthesized thematically and descriptively analyzed. Results: One thousand nine hundred and ninety six studies were identified while 347 (65.22% high quality) RCTs were found to be eligible for the review. The most commonly assessed variables (and outcome measure utility) were activities of daily living [75.79% of the studies, with Barthel Index (37.02%)], motor function [66.57%; with Fugl Meyer scale (71.88%)], and gait [31.12%; with 6 min walk test (38.67%)]. Majority of the innovatively high technology interventions such as robot therapy (95.24%), virtual reality (94.44%), transcranial direct current stimulation (78.95%), transcranial magnetic stimulation (88.0%) and functional electrical stimulation (85.00%) were conducted in high income countries. Several traditional and low-cost interventions such as constraint-induced movement therapy (CIMT), resistant and aerobic exercises (R&AE), task oriented therapy (TOT), body weight supported treadmill training (BWSTT) were reported to significantly contribute to the recovery of motor function, activity, participation, and improvement of quality of life after stroke. Conclusion: Several pragmatic, in terms of affordability, accessibility and utility, stroke rehabilitation solutions, and outcome measures that can be used in resource-limited settings were found to be effective in facilitating and enhancing post-stroke recovery and quality of life.

Development and Effectiveness Testing of a Mobile Health Education Package for Stroke Prevention Among Stroke Survivors

“…Knowledge of stroke risk factors is expected to substantially contribute to secondary stroke prevention by improving stroke literacy among stroke survivors, especially in Nigeria and other LMICs where stroke survivors have been reported to lack knowledge of stroke, its risk factors and warning signs. 6,31,32 The contents of this educational tool are in line with the themes featured in the study of Maniva et al, 14 . The tool was validated by stroke rehabilitation experts, consistent with previous studies in which a new tool was developed and the items were assessed for content validation.…”

“…Knowledge of stroke risk factors is expected to substantially contribute to secondary stroke prevention by improving stroke literacy among stroke survivors, especially in Nigeria and other LMICs where stroke survivors have been reported to lack knowledge of stroke, its risk factors and warning signs. 6, 31, 32…”

“…5 In spite of this, SSVs and their family members lack sufficient stroke education even after suffering a stroke. 6, 7 Hence, prevention and health promotions action on stroke must take precedence, 7 as fear of stroke recurrence is a serious concern for SSVs and their families. 8 SSVs are therefore an important population to target for educational interventions for stroke prevention.…”

Enhancing Knowledge of Family Caregivers and Quality of Life of Patients with Ischemic Stroke

“…After training, the functional status of the ischemic stroke survivors and decreased their complications. 13,14 did a systematic review and found that the pragmatic solution to stroke recovery and improved quality of life in low-and middle -income countries is to have low -cost rehabilitation techniques demonstrated to the caregivers of the patients. Given the importance of improving caregivers' knowledge and the greater need to improve the quality of life of caregivers and patients, this study was conducted to test an educational intervention.…”

The Epidemiological Pattern of Factors Associated With Ischemic Stroke in Patients Under 50 Years of Age: A Cross-Sectional Study

“…In low-and middle-income countries (LMICs), the incidence of stroke is rising, and research shows that stroke-related mortality tripled between 2002 and 2020 in Latin America, the Middle East, and sub-Saharan Africa [6,7]. While the same mortality is increasing in low-income countries compared to highincome countries, and there is a much greater reduction in stroke mortality in high-income countries as compared to low-income countries [8].…”