The aim of this study was to assess the structure, process and outcomes of stroke rehabilitation in the Greater Accra Region of Ghana.
A mixed method study design was conducted in three selected hospitals, in two phases. Phase one, which was the structure and process phase, recruited 111 healthcare professionals. The World Health Organization’s situational analysis tool and the Measure of Processes of Care for Service Providers for Adults questionnaires were used. Twenty-six (26) healthcare professionals were then purposively sampled for individual in-depth interviews to gain more insight into the structure and process of stroke rehabilitation. Phase two, the outcome phase, sampled 108 stroke survivors who completed the Functional Independence Measure, World Health Organization Disability Assessment Schedule, Stroke-Specific Quality of Life and Maleka Stroke Community Reintegration Measure questionnaires. Additionally, 15 stroke survivors were purposively sampled for individual in-depth interviews. Quantitative data were analyzed using SPSS 23.0 software and thematic analysis was conducted for the qualitative data.
For the structure and process of rehabilitation, only the tertiary hospital was found to have a stroke unit, with multidisciplinary team, CT/MRI scan and staff continuous education. In the secondary and primary level hospitals, there were no beds allocated for stroke patients and only nurses, doctors, physiotherapists and a dietician were available. In all the three levels, no formally documented rehabilitation protocol was available and core rehabilitation services were paid out of pocket. The average length of hospital-stay was based on medical stability for all the hospitals studied with no follow-up visits post discharge. Physiotherapy was the only outpatient rehabilitation service available across the hospitals and rehabilitation was found to be patient and family centred. For the outcome of stroke patients, this study revealed that the functional level of participants differed across the three selected hospitals. Participants from the tertiary level hospital were found to be more likely to have better functional outcome. Majority of the study participants were also found to have moderate to severe disability after six months of rehabilitation across the three hospitals. Community reintegration was found to be poor affecting their quality of life.
The recorded outcome of stroke rehabilitation in Ghana, as recorded in this study, could be as a result of the available elements in the structure and process recorded.
This study is the first to assess the structure, process and outcome of stroke rehabilitation in Ghana and it enhances the literature on stroke rehabilitation. It could serve as an audit of stroke rehabilitation services for quality assurance purposes. This study also advances methodology because it evaluated stroke rehabilitation in a LMIC using a mixed method approach.
structure, process and outcome
stroke survivors
