AN EXPLORATION OF MULTIDISCIPLINARY TEAM ENGAGEMENT IN POST-ACUTE STROKE REHABILITATION: A PRELIMINARY INVESTIGATION OF A TERTIARY HEALTH FACILITY IN GHANA

A. Banson¹, M.W. Agoriwo¹, P.D. Agordoh², A. Azaglo³, O.N. Verner⁴, S.E. Aboagye⁵, I.E. Fayison⁶, R. Azawornu⁶

¹University of Health and Allied Sciences, Physiotherapy and Rehabilitation Sciences, Ho, Ghana, ²University of Health and Allied Sciences, Department of Nutrition and Dietetics, Ho, Ghana, ³University of Health and Allied Sciences, Department of Speech, Language and Hearing Sciences, Ho, Ghana, ⁴University of Health and Allied Sciences, School of Medicine, Ho, Ghana, ⁵Multikids Inclusive Academy, Speech Therapy, Accra, Ghana, ⁶Ho Teaching Hospital, Physiotherapy, Ho, Ghana

Background: Stroke is a leading global cause of disability in adults. A major consequence is impaired physical function; however, the cerebrovascular accident results in other functional, social and economic sequelae. Rehabilitation therefore necessitates the involvement of multiple professional disciplines to be effective. Unfortunately, no international standard of care adaptable to various resource settings known. Evidence of the traditional approach to post-acute stroke management in Ghana is uncertain. Additionally, context adaptation of existing clinical practice guidelines to address the holistic rehabilitation needs following stroke is not well documented.

Purpose: Our research explored the use of available rehabilitation services for stroke rehabilitation in a tertiary healthcare facility as a step toward making evidence-based recommendations for an effective context-appropriate approach to stroke management.

Methods: A mixed methods study design was used in two phases. Phase-I was a ten-year retrospective review of physician and physiotherapy records for persons diagnosed with stroke from January 2007 to December 2017 who underwent outpatient physiotherapy in the Ho Teaching Hospital. Any indication of referral and/or assessment for rehabilitation therapies namely: cognitive, nutrition, dysphagia, hearing, or community-based care was documented. Phase-II is an on-going observational prospective cohort study using purposively recruited persons undergoing outpatient physiotherapy, within three months of a physician-diagnosed stroke incident. We documentedreferrals for rehabilitation therapies and screened for associated stroke-related impairments as indicators for professional consult. The tools included functional independent measure; trail making test; nutritional quality of life (NQoL) and dysphagia bedside evaluation. A qualitative interview explored perspectives of participants’ current health challenges, community living preparedness and rehabilitation therapies they found more helpful. Quantitative data was analysed descriptively whereas thematic analysis was used for qualitative data.

Results: By January 2017, physiotherapy, medical nutrition, audiology and speech therapy were available in the facility. However, Phase-I revealed that aside from routine physician reviews, physiotherapy was the only prescribed rehabilitation service common to all 897 stroke survivors. Only 1 (0.001%) person had recorded nutritional consult in addition. There were no cognitive, dysphagia or hearing assessments. Phase-II recruited 18 participants, of mean age 54 ± 11.8 years. The initial findings demonstrate that cognitive, dysphagia, hearing, NQoL and physical functioning impairments were indicated at varied severities within the cohort, yet there had been no documented assessment or referral for rehabilitation services other than physiotherapy. From the qualitative findings, physiotherapy was commonly reported as ‘most useful’ rehabilitation. Participants did not report problems with eating, swallowing or hearing. Participation in social activities was a common challenge attributable to mobility difficulty and inferred cognitive challenges like forgetfulness, ‘stress’ and the perceived requirements. Walking ability was a key need; only 1 (5.6%) person could independently walk within their community.

Conclusions: Stroke management seemingly prioritised physical functions whereas other domains that can affect physical performance were unexplored and underreported by patients and clinicians alike. Future work will follow up to observe the adequacy of this existing stroke management approach in meeting long-term rehabilitation needs.

Implications: Physiotherapists should consider advocating for stronger interdisciplinary teamwork for a more holistic management of stroke in Ghana. A standardised context-appropriate and patient-centred clinical guideline is needed.

Funding acknowledgements: The researchers funded Phase-I of our study. Phase-II was funded by the University of Health and Allied Sciences Research Fund

Keywords:
Stroke
Rehabilitation
multidisciplinary teamwork

Topics:
Neurology: stroke
Disability & rehabilitation
Primary health care

Did this work require ethics approval? Yes

Institution: University of Health and Allied Sciences (UHAS)

Committee: The UHAS Research and Ethics Committee (REC)

Ethics number: UHAS-RBC A.3 l3l20-21