Stroke rehabilitation in low-income and middle-income countries: a call to action

Bernhardt, Julie; Urimubenshi, Gerard; Gandhi, Dorcas B.C.; Eng, Janice J.

doi:10.1016/s0140-6736(20)31313-1

Cited by 83 publications

(73 citation statements)

References 61 publications

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“…This means that the majority of the patients had substantially accessed rehabilitation for the minimum duration of rehabilitation of 12 weeks while they should have successively access the service for up to 24 weeks. This timeframe is in accordance with evidence-based stroke rehabilitation care described by Bernhardt et al [14]. We see here a progressive decline in follow-up after a discharge home, which is not favourable for patients.…”

Section: Rehabilitation Post-dischargesupporting

confidence: 91%

“…Rehabilitation after a stroke usually seeks to restore lost functions to as normal a level as possible. In high-income countries, it is recommended to immediately commence rehabilitation during the admission to hospital followed by patient transfer to intermediate facilities for the continuation of rehabilitation [14]. This option is almost non-existent in LMICs, particularly in SSA [15][16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

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The characteristics of stroke and its rehabilitation in Northern Tanzania

Mkoba

Sundelin

Sahlén

et al. 2021

Global Health Action

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Background Stroke causes great suffering and severe disability worldwide, and rehabilitation following a stroke seeks to restore lost functions. The extent to which stroke patients get access to rehabilitation in Tanzania is not well estimated, and drawing a current picture of the rehabilitation services for these persons is the first step in developing a more effective rehabilitation model in the country. Objective The objective of this study was to establish the characteristics of stroke and its rehabilitation at the Kilimanjaro Christian Medical Centre (KCMC), a consultant referral hospital in northern Tanzania. Methods This was a records-based descriptive study in which demographic, clinical, and rehabilitation information of stroke patients admitted to the KCMC between January 2012 and December 2015 was collected and audited. The means, percentages, and proportions were used to summarise the demographic, clinical, and rehabilitation patterns using SPSS version 24.0 software. The chi-squared statistic was used to examine the relationships between categorical variables, and a p -value<0.05 was considered statistically significant. Results Of the 17,975 patients admitted to the KCMC during the period of the study, 753 (4.2%) had suffered a stroke, with a mean age of 68.8 ± 16.4 years. The predominant cause of stroke was hypertension, which accounted for 546 (72.5%) patients. A total of 357 (47.4%) patients had various forms of rehabilitation during the admission to hospital. Following a discharge home 240 (31.9%) patients did not return to the hospital for the continuation of rehabilitation. Conclusion Stroke patients at the KCMC lack access to rehabilitation therapies. Insufficient access to rehabilitation therapies may warrant the need to explore alternative approaches such as tele-rehabilitation technologies in Tanzania.

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Section: Rehabilitation Post-dischargesupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

The characteristics of stroke and its rehabilitation in Northern Tanzania

Mkoba

Sundelin

Sahlén

et al. 2021

Global Health Action

View full text Add to dashboard Cite

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“…In addition to having individual benefits for users, rehabilitation services have also been shown to result in cost savings greater than initial investments [ 2 ]. Moreover, the growing need for rehabilitation services across countries means that providing rehabilitation services will be a key strategy if the health-related Sustainable Development Goals are to be achieved [ 1 , 3 , 4 , 5 ]. However, recent estimates suggest that as many as 2.4 billion individuals globally have unmet needs for rehabilitation services, representing one in three people globally [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Examining the Availability and Accessibility of Rehabilitation Services in a Rural District of South Africa: A Mixed-Methods Study

Magaqa

Ariana

Polack

2021

IJERPH

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Introduction: Rehabilitation services aim to optimise individuals’ functioning and reduce disability. However, people with disabilities, who represent a key population of users of rehabilitation services, continue to have unmet needs for rehabilitation services that include the provision of assistive devices. This paper examines the availability and accessibility of rehabilitation services in a rural district of South Africa in order to explore why unmet needs for rehabilitation services persist. Methods: All nine district hospitals in a rural district of South Africa were included in the study. Rehabilitation services capacity was assessed by examining the available assistive devices, consumables and human resources at the level of the health facility. Data collection was conducted using the Global Co-operative Assistive Technology [GATE] Assistive Products List, AT2030’s ATScale priority list and the South African National Catalogue of Commodities for Primary Health Care Facilities. Descriptive statistics were then used for the analysis. For the qualitative component, semi-structured interviews were conducted with adults with physical disabilities at household level to explore barriers to accessing assistive device inclusive rehabilitation services and the consequences thereof in the same rural district. An interview guide based on the WHO health system building blocks was used. Thematic content analysis guided the analysis of the interview transcripts. Findings: The findings of the research demonstrate that rehabilitation service capacity in the district was constrained as a result of low availability of assistive devices [2–22%] and consumables [2–47%], as well as, possibly, a shortage of rehabilitation providers [n = 30] with an unequal distribution across health facilities [n = 9]. In addition, people with physical disabilities reported poor referral pathways, financial constraints, transport and road consideration and equipment unavailability as barriers to accessing rehabilitation services. Moreover, these barriers to access predisposed individuals to finance-, health- and person-related harm. Conclusion: Rehabilitation service availability is constrained by a lack of service capacity in rural South Africa. In addition, the rehabilitation services in district hospitals are not adequately accessible because of existing barriers to enable key populations to achieve optimised functioning.

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“… 16 The proportion of stroke patients in LMICs receiving rehabilitation treatment is too small, and rehabilitation or treatment within seven days after stroke is also limited. 17 Currently, there are about 10,000 rehabilitation physicians and 20,000 rehabilitation therapists in China, with an average of 1 to 2 per 100,000 people, much lower than the 40 to 70 per 100,000 in developed countries. 18 According to the World Health Organization’s Rehabilitation 2030 report, the numbers of rehabilitation practitioners, are far below those of high-income countries, while data on rehabilitation nurses are not available.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Rehabilitation Nursing versus Usual Therapist-Led Treatment in Patients with Acute Ischemic Stroke: A Randomized Non-Inferiority Trial

Wang¹,

Zhang²,

Chen³

et al. 2021

CIA

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Purpose To determine the effectiveness of rehabilitation nursing program interventions in patients with acute ischemic stroke. Patients and Methods An assessment-blinded randomized controlled trial was conducted at a tertiary referral hospital in China. Eligible patients were stratified according to their weighted corticospinal tract lesion load and then randomly assigned to an experimental group (n = 121) or a control group (n = 103). The experimental group received rehabilitation nursing from well-trained, qualified nurses (30 minutes per session, two sessions per day for seven consecutive days). The control group received therapist-led rehabilitation with the same timing and frequency. Comparative analysis of the primary outcomes was performed to determine non-inferiority with a predetermined non-inferiority margin. The primary outcomes were the Motor Assessment Scale, Fugl-Meyer Assessment, and the Action Research Arm Test assessed at baseline and after seven days of treatment. The secondary outcomes were the modified Barthel Index, the National Institutes of Health Stroke Scale, and the modified Rankin Scale, evaluated before and after the intervention and at 4 and 12 weeks of follow-up. Results Two hundred participants completed the trial. In both groups, all outcomes improved significantly after seven days and at follow-ups. The rehabilitation nursing program was non-inferior to therapist-led treatment with lower 95% confidence limits beyond the margins for primary outcomes ( P < 0.001). Conclusion Both treatments had comparable effects; however, no definite conclusion could be drawn. Adequately powered studies are required.

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Stroke rehabilitation in low-income and middle-income countries: a call to action

Cited by 83 publications

References 61 publications

The characteristics of stroke and its rehabilitation in Northern Tanzania

The characteristics of stroke and its rehabilitation in Northern Tanzania

Examining the Availability and Accessibility of Rehabilitation Services in a Rural District of South Africa: A Mixed-Methods Study

Effectiveness of Rehabilitation Nursing versus Usual Therapist-Led Treatment in Patients with Acute Ischemic Stroke: A Randomized Non-Inferiority Trial

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