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A. Banson1, P.D. Agordoh2, M.W. Agoriwo1, A. Azaglo3, J. Ofori-Amoah4, O.N. Verner4, M. Japiong5, K. Konlan5, N.Y. Manaphraim6, L. Ahiaku7
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, 5University of Health and Allied Sciences, Department of Nursing and Midwifery, Ho, Ghana, 6University of Health and Allied Sciences, Department of Medical Laboratory Sciences, Ho, Ghana, 7Ho Teaching Hospital, Physiotherapy, Ho, Ghana
Background: Stroke is an established leading cause of morbidity and mortality worldwide. This cerebrovascular disease affects multiple functional domains, such as physical, cognitive, hearing, speech and swallowing, and even social participation. Expert recommendations and clinical practice guidelines agree that multiple health professional disciplines should collaborate for a holistic stroke rehabilitation. However, physical function, being the most obvious impairments, often becomes the focus of medical rehabilitation according to some studies. Without contextual evidence, clinical rehabilitation may be inadequate for stroke survivors.
Purpose: Our research investigated the various rehabilitation services, received as part of stroke management in a tertiary healthcare facility, to serve as evidence of multidisciplinary coordinated care.
Methods: A retrospective document review was used to collect information from the Ho Teaching Hospital, which is a major referral centre in the Volta Region. The hospital offers rehabilitation services including physiotherapy, speech therapy, audiology, psychiatry, nutrition and dietetics, in addition to specialised physician and nursing care to the general public. The researchers conducted a ten-year (January 2007 to December 2017) retrospective review of physician and physiotherapy records for persons diagnosed with stroke who underwent outpatient physiotherapy in the facility. Any indication of referral, assessment or management regarding cognitive, hearing or swallowing impairment was documented. Pharmacotherapy, medical nutrition consult, or community-based care were also recorded.
Results: A total of 897 cases were recorded for the period, 469 (52.3%) of whom were men. Aside from routine physician reviews and associated pharmacotherapy, physiotherapy was the sole rehabilitation for all 897 (100%) stroke survivors. Physicians referred 892(99.7%) of the cases and referring professionals for 5 (5.6%) cases were not documented. Physicians made 2 (0.002%) referrals for speech therapy, but no documented evidence of service was documented. We found no physician referrals for nutrition consult; there were 3(0.003%) referrals by other health professionals, with 1(0.001%) instance of documented provision of the service. There were no assessments or targeted management for cognitive, hearing impairments and dysphagia. We found 4(0.004%) cases where clinicians observed that patients looked depressed; however, there were no subsequent assessments for mental health or referrals to experts. Finally, we found no documentations of referral for community care services following hospital discharge.
Conclusions: Physician reviews, pharmacotherapy and physiotherapy formed the main rehabilitation for routine assessment and care in stroke survivors receiving physiotherapy in the facility. Although stroke is known to affect multiple domains, other health professionals, despite being available, do not appear to be involved in the rehabilitation. We could not establish whether the limited multidisciplinary involvement was due to lack of indication of cognitive, speech, swallowing, hearing, and nutrition impairments. Therefore, a future study will screen for impairments in a cohort and follow up on how the stroke management approach in the facility addresses their holistic rehabilitation needs.
Implications: Stroke survivors who patronise outpatient physiotherapy may live with other related impairments which are underreported and undertreated but can affect the effectiveness of rehabilitation. Physiotherapists can be proactive in including assessments within their scope such as clinical cognitive tests, and advocate for a stronger multidisciplinary team effort in stroke rehabilitation.
Funding acknowledgements: The study was funded by the researchers.
Keywords:
Stroke
Rehabilitation
Holistic care
Stroke
Rehabilitation
Holistic care
Topics:
Neurology: stroke
Disability & rehabilitation
Primary health care
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-REC A.7 [1] 17-18
All authors, affiliations and abstracts have been published as submitted.
