THE STRUCTURE AND PROCESS OF STROKE REHABILITATION AT CONVENTIONAL AND COMPLEMENTARY SETTING IN GHANA

C. Yarfi^1,2, A. Rhoda¹

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: Conventional and complementary treatments are often used in rehabilitation for persons with stroke in low- and middle-income countries (LMIC). Conventional medicine is the use of evidence-based treatments that are safe and effective, with rigorously tested procedures used as clinical practice guidelines using medications, physiotherapy, occupational, speech and diet therapies. Complementary medicine refers to a broad set of health care practices that are not part of the mainstream medical care in a country and are not fully integrated into the dominant health-care system using chiropractic, acupuncture, homeopathy, herbal therapy, dietary and psychological interventions together with conventional treatments. Literature shows that the structure and process of stroke rehabilitation can influence outcomes post stroke rehabilitation. However, the structure and process of rehabilitation at conventional and complementary settings has not been given much attention in LMIC such as Ghana.

Purpose: The study investigated the structure and process of stroke rehabilitation in a conventional and complementary setting at the Korle Bu Teaching Hospital in Accra and Kwayisi Christian Herbal Clinic in Nankese-Ayisaa, Ghana.

Methods: A hospital-based cross-sectional study was conducted from September, 2021 to April, 2022 among 91 healthcare professionals (HP). An adapted questionnaire was used to collect data on the structure of stroke rehabilitation. An adapted questionnaire was used to measure the process of care for stroke patients by compliance with the agency for healthcare policy and research (AHCPR) and stroke clinical guidelines for post-stroke rehabilitation. The data was analysed using descriptive statistics (means, frequencies and graphs) and chi-square tests were used to determine statistical significance between the variables at the two settings.

Results: The conventional setting had a multidisciplinary team, comprising of all rehabilitation professionals while the complementary setting had 1(10.0%) physiotherapist, 1(10.0%) masseur, 2(20.0%) herbal doctors, 3(30.0%) herbal nurses and 3(30.0%) dispensary officers for stroke rehabilitation. For the structure of care: age (p=0.05), qualifications (p=0.01), use of orthotic device (p=0.02), years of stroke experience (p=0.003) of HP were statistically significant between the two settings. For the process of care: multidisciplinary team coordination (p<0.001), management of impairments (p=0.006), prevention of complications (p=0.004), use of group circuit class therapy (p<0.001) and planning for discharge (p<0.001) were statistically different between the two settings.

Conclusions: The structure and process of stroke rehabilitation at the two settings vary. The differences in the structure and process of care can influence the quality of care provided and outcomes post stroke.

Implications: The study has provided information on the structure and process of stroke rehabilitation in a conventional and complementary setting in Ghana; this has clinical and research implications for stroke rehabilitation in Ghana and may improve stroke patient management.

Funding acknowledgements: The study received funding from the Ghana Education Trust Fund (GetFund) and University of Health and Allied Sciences, Ho, Ghana.

Keywords:
Stroke
Conventional
Complementary

Topics:
Neurology: stroke
Neurology
Globalisation: health systems, policies & strategies

Did this work require ethics approval? Yes

Institution: University of the Western Cape

Committee: Biomedical Sciences Research Ethics Committee

Ethics number: BM20/5/25