THE ASSOCIATION BETWEEN PHYSICAL IMPAIRMENT AND FUNCTIONAL BALANCE ON COMMUNITY REINTEGRATION POST STROKE AT A PERI URBAN AREA IN GHANA

C. Yarfi^1,2, S.N.S. Martei², E.N.E. Tettey²

¹University of the Western Cape, Department of Physiotherapy, Cape Town, South Africa, ²University of Health and Allied Sciences, Department of Physiotherapy and Rehabilitation Sciences, Ho, Ghana

Background: Physical impairments and functional balance are mostly compromised after stroke. Physical impairment is a major contributing factor to limitations of activities of daily living and societal participations such as work and leisure activities. Studies have reported that stroke patients show significant gait impairments as a result of balance deficits which impact their quality of life (QoL).
Literature has showed there is reduced community reintegration of persons post stroke; as a result of either physical impairments or functional balance. Therefore, reduced physical impairments and good functional balance may thus be good predictors of community reintegration post stroke, and may lead to improved community reintegration in persons with stroke. However, there appears to be a dearth of evidence investigating the association between physical impairments and functional balance on community reintegration in Ghana.

Purpose: To determine the association between physical impairment and functional balance on community reintegration among stroke patients after three months of physiotherapy treatment at the Ho Teaching Hospital, Ghana.

Methods: The study used a hospital based cross-sectional design involving 27 stroke patients who have undergone three months of physiotherapy treatment. Participants were conveniently sampled from the physiotherapy department of the Ho Teaching Hospital. Community reintegration was measured using the Reintegration to Normal Living Index (RNLI), functional balance was measured using the Berg Balance Scale (BBS) and physical impairment was measured using the National Institute of Health Stroke Scale (NIHSS). Demographic variables were summarized using descriptive statistics, frequencies and tables, Mann-Whitney U and Kruskal-Wallis tests were used to test the differences between the demographic and clinical variables of stroke; Spearman’s correlation and multiple linear regression were used to test the association between the measures (RNLI, BBS, NIHSS) and demographic variables. Statistical significance was set at 5%.

Results: A total of 27 participants were recruited for the study; 17(63%) with left hemiparesis and 10(37%) with right hemiparesis. The average NIHSS score was 5.22 ± 2.94 (range: 0–12) and BBS was 40.2 ± 11.7 (range: 5–55). None of the participants had complete community reintegration with 22(81.5%) reporting severe restrictions in ADLs. The results showed a strong but negative correlation between functional balance (BBS) and physical impairment (NIHSS) (r_s = -0.583, p = 0.001). Physical impairment and functional balance independently could not predict community reintegration for persons with stroke.

Conclusions: Community reintegration of many stroke survivors in Ghana is very low. There was a strong negative association between community reintegration and physical impairment. In addition, the results of this study show that physical impairment and functional balance are inversely related. Therefore, physical impairment and functional balance should form an important component of evaluation and treatment in persons with stroke.

Implications: There is a strong association between physical impairment and functional balance on community reintegration; therefore, clinical interventions should be tailored towards improving physical impairment and functional balance through community and home-based rehabilitation programmes.

Funding acknowledgements: The study received no funding

Keywords:
Functional balance
Physical impairment
Community reintegration

Topics:
Neurology
Neurology: stroke
Disability & rehabilitation

Did this work require ethics approval? Yes

Institution: University of Health and Allied Sciences

Committee: Research Ethics Committee

Ethics number: UHAS-REC A.8 [12] 20-21