Purpose

There is no outcome measure to assess community reintegration following stroke in South Africa. The purpose of this study was to develop, validate and test the reliability of an interview-administered outcome measure to assess community reintegration after stroke for patients living in poor socioeconomic rural and urban communities of South Africa.

Relevance

The new outcome measure will potentially be used as part of clinical quality management to assess, set relevant rehabilitation goals and monitor community reintegration following stroke.

Participants

A total of 328 participants were used in this whole study. The participants were patients who had sustained a stroke who were aged 18 years and over. In the case of patients with expressive or receptive aphasia only the caregiver was interviewed with the permission of both the participant and caregiver. Patients were members of the community in which they had lived pre-stroke and had been back living in their community for six to twelve months since their stroke.

Methods

Mixed methods (qualitative and quantitative studies) study designs were used in order to develop this outcome measure.

Analysis

Content thematic analysis was used for the qualitative part of the study. For the qualitative part the following were used to analyse data: factor analysis, Cronbach alpha was used assess internal consistency, Pearson correlation efficient (r) was used to assess correlation between the outcome measures.

Results

The new outcome measure was named the Maleka Stroke Community Reintegration Measure (MSCRIM). The outcome measure had two versions (the urban and rural). The internal consistency of these two newly developed outcome measures was very good (for both settings, the Cronbach alpha coefficient was 0.95). The MSCRIM was compared to the Subjective Index of Physical and Social Outcomes (SIPSO) for construct validity. A very high and positive correlation (urban r = 0.88, p value 0.0001, 2-tailed and rural setting, r =0.95, p value 0.000, 2-tailed) was found between the MSCRIM and the SIPSO.

Conclusion

The MSCRIM is therefore a valid and reliable measure to assess community reintegration following stroke for patients living in poor socioeconomic rural and urban communities of South Africa. The MSCRIM contain items that are context specific to patients with a stroke living in poor socioeconomic areas, South Africa. This outcome measure is interview-administered to either patients who have had a stroke or their caregivers.

Implication

The new outcome measure will potentially assist the therapists/assistants, community rehabilitation workers, caregivers and patients with stroke in both a rural and urban community setting, to set realistic, appropriate, relevant rehabilitation goals and assist in the planning and development of appropriate, community-based rehabilitation intervention strategies to assist and facilitate the process of reintegration in the context of the patient’s environment.

Keywords

Stroke, outcome measures, community reintegration, rural and urban areas

Funding source and acknowledgement

Funding for this research was provided by the University of the Witwatersrand and the South African Society of Physiotherapy (SASP). I am also grateful to all the physiotherapy/occupational therapy staff and patients who participated in this study in both provinces.