Self-Rehabilitation Strategy for Rural Community-dwelling Stroke Survivors in a Lower-Middle Income Country: A Delphi Study

Abstract

Background: More than half of stroke survivors in LMICs lack access to stroke rehabilitation services. The promotion of self-rehabilitation could be promising in an attempt to address the stroke rehabilitation inadequacies in LMICs. Self-rehabilitation interventions can easily be accepted by many community-dwelling stroke survivors, and therefore, have the potential to drive towards the successful realization of Sustainable Development Goals and other WHO rehabilitation goals. We report a consensus building process that sought to identify which task training is relevant to include in a task-specific self-rehabilitation strategy for the rural community-dwelling stroke survivors. Methods: We used an iterative two-staged mixed-method consensus-building approach: (1) focus group discussions (n = 5) with rural community-dwelling stroke survivors were conducted to explore personal life experiences in performing daily activities, and the results were used to developed a lists of candidate task trainings that could be included in a task-specific self-rehabilitation intervention model for improving functional ability post-stroke survivors; (2) a three-round Delphi exercise with a panel of stroke rehabilitation experts to establish consensus on the importance/relevance of the developed task trainings. Consensus was pre-defined to be the point where the proportion of items giving a rating of 3 (quite relevant) or 4 (highly relevant) by raters would be ≥ 0.8. Results: A list of 74 task training was generated from the results of the focus groups and grouped as follows: training for the upper extremity (37); lower extremity training (21); while 7 and 9 task trainings were grouped under the trunk and balance training respectively. A panel of 13 experts in the Delphi reviewed these task trainings and consensus was achieved on keeping 28 task trainings in the first round and an additional 7 in the second round. In the study team's analysis of open text responses, several areas of debate were identified and some task trainings were modified. The exercise yielded 49 trainings (66% of 74) on which there was consensus (the mean proportion of items giving a rating of 3 or 4 by raters was 0.93) to keep 3 task training groups relating to: upper extremity (27), lower extremity/balance (8), trunk strength (4) and warm up exercises (10). Conclusions: The study provides a consensus-based view of the features of a task-specific self-rehabilitation training strategy to improve outcomes following a stroke. This self-rehabilitation training strategy can be used as an intervention approach to augment and promote stroke rehabilitation among the rural community-dwelling stroke survivors, especially in SSA.