Kingau N.1, Rhoda A.2, Mlenzana N.2
1Moi University College of Health Sciences, Orthopaedics & Rehabilitation, Eldoret, Kenya, 2University of western Cape, Physiotherapy, Cape Town, South Africa
Background: Upon stroke episode, patients follow a series of care pathways implemented by healthcare professionals. Studies have presented a standard care pathway. However, this pathway differs in developing and developed countries.
Purpose: To determine the process of care for stroke patients in Kenya.
Methods: This mixed methods study was conducted in 17 county referral hospitals in Kenya. Data was collected using semi-structured interviews, cross sectional descriptive survey and archival data. Interviews were conducted with 12 purposively selected healthcare providers, patients and caregivers, while quantitative data was collected from 112 conveniently sampled physiotherapists. Retrospective data was collected from files of stroke patients admitted to the 17 county referral hospitals from 1 January 2014 to 31 December 2014. Interview guides, questionnaires and data extraction sheets were used for data collection. Content validity of the data extraction tool was achieved through two experts in neuro rehabilitation, while a Pearson´s correlation value of, r = 0.87 of the questionnaire was achieved for test-retest reliability. Trustworthiness was ensured through, a sample that included various medical disciplines, information was gathered until saturation, field notes taken, and member checking. Qualitative data was analyzed by thematic content approach while SPSS versions 22 captured and analyzed quantitative data.
Results: Interviews showed that physiotherapist engage in early assessment and management of impairments, activity limitation, and participation after stroke, though negatively affected by late admission. Participants reported low use of outcome measure owing to insufficient knowledge. Frequency of sessions in a week; 5 in inpatient, and 3 in outpatient, for at least 1 hour. CBR was done once a month. Re-assessment time varied, ranging from 1 week to 1 month. Participants reported interdisciplinary team as a significant cog in stroke rehabilitation.
The survey showed assessment and management of; 99.1% Muscle power, 95.5% tone, 94.6% motor function, 97.3% activities of daily living (ADL), 68.3% reading, and 91.1% writing among others. There was 99.3% interdisciplinary involvement. Outcome measure involved; 36.6% Barthel index, 13.4% National institute of health stroke scale (NIHSC), 51.2% Ashworth Modified, 1.2% visual analogue scale, and 12.2% manual muscle testing. Treatment per week; 5 92.7% for 30-45 minutes, in inpatient, and 3 52.6% in outpatient. Family/carer involved 95.2%
Archival data indicated, 39.3% use of outcome measure while 60.7% was not reported. Data indicated assessed and management of; 84% sensation, 99.3% muscle performance, 100% sensation, 98.7% ADL, 99.3% mobility, 48% emotional status, and 98% support system. Re-assessment took place at different times; (38%) 1 month, 28% two weeks, 25% after 1 week. Inpatient physiotherapy started within 1-week 92.7%, interdisciplinary management 96%.
Conclusion(s): This finding brings to light the process of stroke care in Kenya. This includes, assessment, management, at both inpatient and outpatient. Management includes interdisciplinary approach and family/care. However, the results shows poor use of evidenced based outcome measure, and poor recording is depicted.
Implications: The findings serves as a basis for education on, outcome measure, proper recording, and for any further stroke related study.
Funding acknowledgements: Moi-Linkoping Collaboration
Topic: Neurology: stroke
Ethics approval: University of the Western Cape´s Ethics Committee (Registration number: 14/7/7),and Institutional Research Ethics Committee (IREC)
All authors, affiliations and abstracts have been published as submitted.
