Motor and Functional Recovery After Stroke: a Comparison Between Rehabilitation Settings in a Developed Versus a Developing Country

Overview

Journal BMC Health Serv Res

Publisher Biomed Central

Specialty Health Services

Date 2014 Feb 25

PMID 24559193

Citations 13

Authors

Anthea Rhoda

Mario Smith

Koen Putman

Ratie Mpofu

Willy DeWeerdt

Liesbet DeWit

Affiliations

Soon will be listed here.

Abstract

Background: Recovery post stroke is well documented in the field of stroke rehabilitation. The structure and process of rehabilitation are different between developed and developing countries. The aim of the present study was to compare the motor and functional recovery of stroke patients in Germany versus stroke patients receiving rehabilitation in South Africa.

Methods: This study used secondary data analysis of patient protocols collected in two independent studies conducted in Germany and South Africa respectively. A total of 73 patients from the two separate studies were matched for age at stroke onset, gender, and initial motor functioning. Motor and functional recovery were assessed at baseline, two and six months post stroke using the Rivermead Motor Assessment Scale and the Barthel Index (BI) respectively. Significant differences in motor and functional recovery were found, using the Wilcoxon rank sum test on admission to the centre, and at two and six months after stroke. A generalized linear mixed-methods model (GLIMMIX) was used to compare the recovery patterns between the participants from the two settings over time.

Results: The results of the GLIMMIX revealed a significant difference in favour of the German participants for gross motor (RMA-GF) and upper limb (RMA-A) recovery, while no significant difference was found for lower limb (RMA-LT) and functional (BI) recovery patterns between the participants of the two settings. No significant differences existed in RMA-A and BI-scores on admission to the CHC/SRU. At two and six months after stroke, both the RMA-A and BI-scores were significantly lower in the South African than the German sample.

Conclusion: The results of this study provide empirical evidence for differential recovery patterns for patients in developed and developing countries. A detailed exploration of the factors to which this difference in recovery patterns can be attributed was beyond the scope of the present study, and is recommended for future research.

Citing Articles

Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization-Lancet Neurology Commission.

Feigin V, Owolabi M Lancet Neurol. 2023; 22(12):1160-1206.

PMID: 37827183 PMC: 10715732. DOI: 10.1016/S1474-4422(23)00277-6.

Functioning Problems Associated with Health Conditions with Greatest Disease Burden in South Africa: A Scoping Review.

Charumbira M, Berner K, Louw Q Int J Environ Res Public Health. 2022; 19(23).

PMID: 36497710 PMC: 9735592. DOI: 10.3390/ijerph192315636.

The structure, processes, and outcomes of stroke rehabilitation in Ghana: A study protocol.

Yarfi C, Nyante G, Rhoda A Front Neurol. 2022; 13:947289.

PMID: 36090878 PMC: 9449840. DOI: 10.3389/fneur.2022.947289.

The effects of COVID-19 on the rehabilitation of persons with aphasia: A scoping review.

Masuku K, Khumalo G, Shabangu N S Afr J Commun Disord. 2022; 69(2):e1-e9.

PMID: 36073071 PMC: 9452926. DOI: 10.4102/sajcd.v69i2.920.

Post stroke health-related quality of life, stroke severity and function: A longitudinal cohort study.

Hartley T, Burger M, Inglis-Jassiem G Afr J Disabil. 2022; 11:947.

PMID: 35169551 PMC: 8831922. DOI: 10.4102/ajod.v11i0.947.

References

De Wit L, Putman K, Dejaeger E, Baert I, Berman P, Bogaerts K . Use of time by stroke patients: a comparison of four European rehabilitation centers. Stroke. 2005; 36(9):1977-83. DOI: 10.1161/01.STR.0000177871.59003.e3. View

Quinn T, Paolucci S, Sunnerhagen K, Sivenius J, Walker M, Toni D . Evidence-based stroke r-ehabilitation: an expanded guidance document from the european stroke organisation (ESO) guidelines for management of ischaemic stroke and transient ischaemic attack 2008. J Rehabil Med. 2009; 41(2):99-111. DOI: 10.2340/16501977-0301. View

Teasell R, Bitensky J, Salter K, Bayona N . The role of timing and intensity of rehabilitation therapies. Top Stroke Rehabil. 2005; 12(3):46-57. DOI: 10.1310/ETDP-6DR4-D617-VMVF. View

. Stroke--1989. Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders. Stroke. 1989; 20(10):1407-31. DOI: 10.1161/01.str.20.10.1407. View

Horn S, DeJong G, Smout R, Gassaway J, James R, Conroy B . Stroke rehabilitation patients, practice, and outcomes: is earlier and more aggressive therapy better?. Arch Phys Med Rehabil. 2005; 86(12 Suppl 2):S101-S114. DOI: 10.1016/j.apmr.2005.09.016. View

Sullivan K, Brown D, Klassen T, Mulroy S, Ge T, Azen S . Effects of task-specific locomotor and strength training in adults who were ambulatory after stroke: results of the STEPS randomized clinical trial. Phys Ther. 2007; 87(12):1580-602. DOI: 10.2522/ptj.20060310. View

Rouillard S, De Weerdt W, De Wit L, Jelsma J . Functioning at 6 months post stroke following discharge from inpatient rehabilitation. S Afr Med J. 2012; 102(6):545-8. DOI: 10.7196/samj.5488. View

De Wit L, Putman K, Schuback B, Komarek A, Angst F, Baert I . Motor and functional recovery after stroke: a comparison of 4 European rehabilitation centers. Stroke. 2007; 38(7):2101-7. DOI: 10.1161/STROKEAHA.107.482869. View

De Wit L, Putman K, Lincoln N, Baert I, Berman P, Beyens H . Stroke rehabilitation in Europe: what do physiotherapists and occupational therapists actually do?. Stroke. 2006; 37(6):1483-9. DOI: 10.1161/01.STR.0000221709.23293.c2. View

10.

Dromerick A, Edwards D, Diringer M . Sensitivity to changes in disability after stroke: a comparison of four scales useful in clinical trials. J Rehabil Res Dev. 2004; 40(1):1-8. DOI: 10.1682/jrrd.2003.01.0001. View

11.

Walker R, Rolfe M, Kelly P, George M, James O . Mortality and recovery after stroke in the Gambia. Stroke. 2003; 34(7):1604-9. DOI: 10.1161/01.STR.0000077943.63718.67. View

12.

Teasell R . Stroke recovery and rehabilitation. Stroke. 2003; 34(2):365-6. DOI: 10.1161/01.str.0000054630.33395.e2. View

13.

Kengne A, Anderson C . The neglected burden of stroke in Sub-Saharan Africa. Int J Stroke. 2008; 1(4):180-90. DOI: 10.1111/j.1747-4949.2006.00064.x. View

14.

MAHONEY F, BARTHEL D . FUNCTIONAL EVALUATION: THE BARTHEL INDEX. Md State Med J. 1965; 14:61-5. View

15.

Coupar F, Pollock A, Rowe P, Weir C, Langhorne P . Predictors of upper limb recovery after stroke: a systematic review and meta-analysis. Clin Rehabil. 2011; 26(4):291-313. DOI: 10.1177/0269215511420305. View

16.

Dobkin B . Clinical practice. Rehabilitation after stroke. N Engl J Med. 2005; 352(16):1677-84. PMC: 4106469. DOI: 10.1056/NEJMcp043511. View

17.

Goulding R, Thompson D, Beech C . Caring for patients with hemiplegia in an arm following a stroke. Br J Nurs. 2004; 13(9):534-9. DOI: 10.12968/bjon.2004.13.9.12966. View

18.

Khadilkar A, Phillips K, Jean N, Lamothe C, Milne S, Sarnecka J . Ottawa panel evidence-based clinical practice guidelines for post-stroke rehabilitation. Top Stroke Rehabil. 2006; 13(2):1-269. DOI: 10.1310/3TKX-7XEC-2DTG-XQKH. View

19.

Jorgensen H, Nakayama H, Raaschou H, Stoier M, Olsen T . Outcome and time course of recovery in stroke. Part I: Outcome. The Copenhagen Stroke Study. Arch Phys Med Rehabil. 1995; 76(5):399-405. DOI: 10.1016/s0003-9993(95)80567-2. View

20.

Page S, Fulk G, Boyne P . Clinically important differences for the upper-extremity Fugl-Meyer Scale in people with minimal to moderate impairment due to chronic stroke. Phys Ther. 2012; 92(6):791-8. DOI: 10.2522/ptj.20110009. View