WCPT Africa Region Conference System, 9th WCPT Africa Region Congress

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STROKE REHABILITATION: EVALUATION OF THE FEASIBILITY OF USING A PRIMARY HEALTH CENTRE FOR THERAPY PROVISION
Olubukola Adebisi Olaleye, Tal-hatu Kolapo Hamzat, Mayowa Ojo Owolabi

Last modified: 2012-02-22

Abstract


Purpose: This randomized controlled clinical trial evaluated the feasibility of using a primary health centre for the rehabilitation of community-dwelling stroke survivors.

 

Relevance: Conventionally, stroke survivors receive physiotherapy in hospital settings and their homes. This conventional approach is becoming increasingly expensive, inaccessible and fraught with shortfalls in service provision. This study has shown that Primary Health Centres – established to offer cost – effective health services close to patients’ homes- could be successfully use for rehabilitation of chronic stroke survivors.

 

Methods: Fifty-two consecutively recruited, first incident stroke survivors participated in the study. They were randomly assigned into either the Primary Health Care Group (PHCG, n=25) or the Home Group (HG, n=27). Participants in the PHCG were treated at a primary health centre while those in the HG were treated in their individual homes. Treatment was twice weekly for 10 consecutive weeks with two days interval between treatment days. Treatment was carried out using a newly developed Primary Health Care-based Physiotherapy Protocol (PHCPP). The PHCPP comprised of structured exercise programmes to improve strength, balance, gait and bimanual activities. Motor function, postural balance and community reintegration of participants in both groups were assessed using the Modified Motor Assessment Scale (MMAS), Short Form-Postural Assessment Scale for Stroke (SF-PASS) and Reintegration to Normal Living Index respectively, before intervention and thereafter fortnightly. Walking Speed was measured pre- and post- intervention as a distance of central 6-metre on a 10-metre walkway divided by the time taken to walk it.

 

Analysis: Data was analyzed using descriptive statistics of mean and percentages and inferential statistics of General Linear Model and t-test at 0.05 alpha.

 

Results: The mean age of participants in the PHCG was 60.6±10.2 years while participants in the HG had a mean age of 61.7±8.4 years. Within-subjects multivariate analysis, after controlling for gender, showed a statistically significant increase in the motor function scores of the PHCG and HG (χ2 = 112.31, p = 0.01; χ2 = 117.92, p = 0.01 respectively). There was a significant increase in SFPASS scores of the PHCG (8.6+5.0) and HG (7.1+5.6) at pre-intervention to12.3+3.2 and 12.3+3.3 at week 10  respectively (p < 0.05). The RNLI scores significantly increased from 30.1+22.9 pre-intervention to 58.7+25.4 in the PHCG (χ2 = 122.89; p = 0.01) and from 28.4±26.1 to 53.9±28.7 in the HG (χ2 = 78.42; p = 0.01). Similarly, walking speed significantly increased from 0.30±0.20 m/s pre-intervention to 0.60±0.40 m/s at week 10 in the PHCG (P < 0.05) and from 0.30±0.40 m/s to 0.50±0.40 m/s in the HG (p < 0.05). The groups were comparable in each of the MMAS, SFPASS, RNLI and walking speed pre-intervention and at week 10 (p > 0.05).

 

Conclusions: The outcome of this study has shown that rehabilitation of stroke survivors in Primary Health Centre (PHC) produced similar effects as rehabilitation in patients’ own homes. PHCs are readily available in the community and as such can be used as alternative care environment for the rehabilitation of stroke survivors.

Implication: This implies that physiotherapy should be included in our primary health care schemes/policies to enhance access to physiotherapy services particular for patients who could not afford the costly trips to hospitals and home care.

 

Keywords: Stroke rehabilitation; Primary health Centre, Physiotherapy


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