Background and purpose

Following stroke, survivors are reported to suffer cognitive impairments in addition to impaired physical function. However, cognitive assessment and management is often sidelined in clinical practice. This research sought to explore the knowledge and current practice of some physiotherapists in Ghana regarding cognitive impairment in their management of persons with Stroke.

Relevance

Physiotherapy is probably the most patronised medical rehabilitation service after a stroke and cognitive impairment can slow the progress of physical rehabilitation. Conversely, aerobic exercise have been found to improve cognitive impairment in stroke. Findings from the current research provides evidence of physiotherapists’ knowledge about cognitive impairment post-stroke and how they inculcate such knowledge in their daily practice. Such evidence can inform the planning of continuous professional development programmes for physiotherapists at national and regional levels to include cognitive aspects of stroke. Moreover, the findings can contribute to the discussion of holistic care in physiotherapy stroke management from a less explored angle.

Participants

The study included physiotherapists who were primarily involved in stroke management and worked in tertiary health facilities in Ghana (Korlebu, Komfo Anokye, Tamale and Cape Coast Teaching Hospitals). Using convenience sampling, permission was sought from hospital management for each facility and the physiotherapists approached and educated about the study. Eleven physiotherapists consented to partaking in the study and were recruited.

Method

A qualitative research with ethnograpy methodology was conducted through audio-recorded face –to-face interviews. Questions covered the physiotherapists’ of training and experience, general knowledge of Cognitive Impairment (CI), knowledge of standard tools for assessment, use of such standard tools and need for specific training. Responses were transcribed verbatim and thematic data analysis was used. Data triangulation was employed by a secondary analyser also generating themes from the transcribed data and these themes compared for internal validity.

Results

Of the 11 physiotherapists, 2 (18.2%) had practiced for less than 5 years and more than 50% of the patients which almost all the participants (10 out of 11) treated weekly were had stroke. The physiotherapists all had a good idea about stroke-related CI and its negative effect on patient assessment and management. Only 1 (9%) was confident in his knowledge of standard assessment for post stroke CI, the rest admitted that they needed specific training; they generally did not know whether physiotherapy intervention could help treat the CI. Notwithstanding, all the participants had improvised ways of identifying, assessing and managing post stoke CI in their practice.

Conclusion

The participants knew enough to suspect CI and anticipate effects on stroke rehabilitation. However, participants’ clinical practices were not based on standard protocols or guidelines and they admitted the need for further training. Future studies can use the knowledge translation approach to evaluate how such specific training can influence physiotherapy.

Implications

Currents physiotherapy practice may need deeper knowledge about post-stroke cognitive impairment for a more holistic management

Keywords

Cognitive impairment, Stroke, Physiotherapists

Funding Source Acknowledgement

No funding received

Ethics approval

The University of Health and Allied Sciences Research and Ethics Committee approved this study.