Mwaka CR1, Abedi Mukutenga P2, Perreault K3, Sèbiyo Batcho C4
1Université Laval, Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRSI), Réadaptation, Québec, Canada, 2Institut Supérieur des Techniques Médicales de Kinshasa (ISTM-Kin), Kinésithérapie, Kinshasa, Congo (Democratic Republic), 3Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRSI), Université Laval, Faculté de Médecine, Quebec, Canada, 4Université Laval, Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRSI),, Réadaptation, Québec, Canada
Background: In Kinshasa (Capital of the Democratic Republic of Congo), most patients with stroke have limited access to mid-and long-term rehabilitation care, due to lack of resources. Nevertheless, there is a few number of patients with health insurance (HI) that covers rehabilitation care. However, little is known regarding the functional recovery in terms of activity and participation of both groups of patients with or without HI.
Purpose: To compare activity and participation levels between patients with stroke covered by HI and those who had no health insurance (noHI), and to explore personal, clinical and environmental factors associated to functional recovery.
Methods: In this cross-sectional study, participants with stroke living in the Kinshasa region were assessed with the Stroke Impairment Assessment Set (SIAS, stroke-related impairment), Barthel index (BI, functional autonomy), modified Rakin Scale (mRS, global status), ACTIVLIM-Stroke (activity limitation), 10-meter walk test (10MWT, walking speed), 6-minute walk test (6MWT, walking distance) and Reintegration to normal living index (RNLI, participation). In addition, sociodemographic, clinical and environmental data were collected. Participants were splitted in two groups according to the availability of health insurance (HI group and noHI group). Depending on the nature of variables, Chi-square, Mann U and Student test were used to compare groups. Spearman's or Pearson's correlations were used to examine associations between activity and participation with personal, clinical and environmental factors.
Results: The results are based on 26 participants with HI (20 men, mean age 57±10,6 years, mean post-stroke duration: 22.9±25.6 months) and 47 participants with noHI (29 men, mean age 59±13.8 years, mean post-stroke duration: 27.9±38.4 months). BI, mRS, RNLI median scores, and ACTIVLIM-Stroke, 10MWT and 6MWT mean scores for HI group were respectively 100 (45-100), 1 (0-4), 4 (0-12), 75±16%, 1±0,5m/s and 290,7±163,6m versus 100 (20-100), 1 (0-5), 5 (0-20), 65.8±22.9%, 0,8±0,6m/s and 280±192,9m for noHI group. mRS (p=0.049), ACTIVLIM-Stroke (p=0.048) and RNLI (p=0.044) showed significant difference between stroke survivors with IH and those who were without HI. SIAS, age and duration of rehabilitation session showed significant correlations with BI, mRS, ACTIVLIM-Stroke, 10MW, 6MWT and RNLI. The correlation was good for SIAS (correlation coefficients between -0.49 and 0.70, p 0.01), but weak for age (correlation coefficients ≤-0.40, p 0.05) and duration of rehabilitation session (correlation coefficients ≤0.43, p 0.05).
Conclusion(s): Stroke survivors with HI living in Kinshasa had higher level of activity and participation than those without HI. Stroke-related impairments, age and duration of rehabilitation session seemed to be associated with patients' activity and participation levels.
Implications: These results described the functional recovery of stroke survivors in Kinshasa. This study underlines the need to facilitate access to stroke rehabilitation in developing countries. Promoting health insurance could contribute to improve access to rehabilitation care.
Keywords: Stroke, Health insurance, Activity and participation
Funding acknowledgements: We are grateful for PCBF for essentially funding this research. We thank the CIRRIS for his support in this study.
Purpose: To compare activity and participation levels between patients with stroke covered by HI and those who had no health insurance (noHI), and to explore personal, clinical and environmental factors associated to functional recovery.
Methods: In this cross-sectional study, participants with stroke living in the Kinshasa region were assessed with the Stroke Impairment Assessment Set (SIAS, stroke-related impairment), Barthel index (BI, functional autonomy), modified Rakin Scale (mRS, global status), ACTIVLIM-Stroke (activity limitation), 10-meter walk test (10MWT, walking speed), 6-minute walk test (6MWT, walking distance) and Reintegration to normal living index (RNLI, participation). In addition, sociodemographic, clinical and environmental data were collected. Participants were splitted in two groups according to the availability of health insurance (HI group and noHI group). Depending on the nature of variables, Chi-square, Mann U and Student test were used to compare groups. Spearman's or Pearson's correlations were used to examine associations between activity and participation with personal, clinical and environmental factors.
Results: The results are based on 26 participants with HI (20 men, mean age 57±10,6 years, mean post-stroke duration: 22.9±25.6 months) and 47 participants with noHI (29 men, mean age 59±13.8 years, mean post-stroke duration: 27.9±38.4 months). BI, mRS, RNLI median scores, and ACTIVLIM-Stroke, 10MWT and 6MWT mean scores for HI group were respectively 100 (45-100), 1 (0-4), 4 (0-12), 75±16%, 1±0,5m/s and 290,7±163,6m versus 100 (20-100), 1 (0-5), 5 (0-20), 65.8±22.9%, 0,8±0,6m/s and 280±192,9m for noHI group. mRS (p=0.049), ACTIVLIM-Stroke (p=0.048) and RNLI (p=0.044) showed significant difference between stroke survivors with IH and those who were without HI. SIAS, age and duration of rehabilitation session showed significant correlations with BI, mRS, ACTIVLIM-Stroke, 10MW, 6MWT and RNLI. The correlation was good for SIAS (correlation coefficients between -0.49 and 0.70, p 0.01), but weak for age (correlation coefficients ≤-0.40, p 0.05) and duration of rehabilitation session (correlation coefficients ≤0.43, p 0.05).
Conclusion(s): Stroke survivors with HI living in Kinshasa had higher level of activity and participation than those without HI. Stroke-related impairments, age and duration of rehabilitation session seemed to be associated with patients' activity and participation levels.
Implications: These results described the functional recovery of stroke survivors in Kinshasa. This study underlines the need to facilitate access to stroke rehabilitation in developing countries. Promoting health insurance could contribute to improve access to rehabilitation care.
Keywords: Stroke, Health insurance, Activity and participation
Funding acknowledgements: We are grateful for PCBF for essentially funding this research. We thank the CIRRIS for his support in this study.
Topic: Disability & rehabilitation
Ethics approval required: Yes
Institution: Centre Intégré universitaire de santé et de services sociaux, Québec
Ethics committee: Institut de réadaptation en déficience physique de Québec
Ethics number: 2017-580
All authors, affiliations and abstracts have been published as submitted.
