The Structure, Processes, and Outcomes of Stroke Rehabilitation in Ghana: A Study Protocol

Overview

Journal Front Neurol

Specialty Neurology

Date 2022 Sep 12

PMID 36090878

Authors

Cosmos Yarfi

Gifty Gyamah Nyante

Anthea Rhoda

Affiliations

Soon will be listed here.

Abstract

Background: Conventional and complementary treatments are often used in rehabilitation for persons with stroke. The conventional treatment makes use of medications, physiotherapy, occupational, speech, and diet therapies, while the complementary treatment makes use of homeopathy, naturopathy, massage, and acupuncture. The structure, process, and outcomes of stroke rehabilitation using conventional or complementary treatments have not been empirically investigated in Ghana.

Aims: This study aims to investigate the structure, process, and outcomes of stroke rehabilitation at the Korle Bu Teaching Hospital (KBTH) in Accra and Kwayisi Christian Herbal Clinic (KCHC) in Nankese-Ayisaa, Ghana, and to explore the experiences of persons with stroke.

Methods: This study involves a mixed methods approach. This study will utilize three study designs, namely, cross-sectional, hospital-based cohort, and qualitative exploratory study designs. The objectives of the study will be achieved using three phases, namely, phase one will recruit health professionals and gather information on the structure and process of stroke rehabilitation at a conventional and complementary hospital using adapted questionnaires; phase two will determine the outcomes of stroke patients attending a conventional and complementary hospital facility at baseline, 2-, 3-, and 6-month follow-up using outcome measures based on the International Classification of Functioning, Disability and Health (ICF) model; and phase three will explore the experiences of stroke patients who use complementary or conventional treatment using an interview guide.

Data Analysis: IBM SPSS Statistics Version 27 will be used to analyze the data using descriptive and inferential statistics. Repeated measures of ANOVA will be used to determine the differences between variables at baseline, 2-, 3-, and 6-month post-stroke. The qualitative data will be transcribed and entered into Atlas Ti version 9.0. The data will be coded and analyzed using thematic areas that will be generated from the codes.

Conclusion: The study protocol will provide a comprehensive overview of the structure, process, and outcomes of stroke rehabilitation in Ghana, incorporating both conventional and complementary treatment and rehabilitation into the stroke recovery journey. It will also inform clinical practice, with new insights on the experiences of stroke patients based on their choice of rehabilitation pathway.

References

Langhorne P, Bernhardt J, Kwakkel G . Stroke rehabilitation. Lancet. 2011; 377(9778):1693-702. DOI: 10.1016/S0140-6736(11)60325-5. View

Owolabi M . Consistent determinants of post-stroke health-related quality of life across diverse cultures: Berlin-Ibadan study. Acta Neurol Scand. 2013; 128(5):311-20. DOI: 10.1111/ane.12126. View

Nichols C, Carrozzella J, Yeatts S, Tomsick T, Broderick J, Khatri P . Is periprocedural sedation during acute stroke therapy associated with poorer functional outcomes?. J Neurointerv Surg. 2018; 10(Suppl 1):i40-i43. DOI: 10.1136/jnis.2009.001768.rep. View

Galabuzi C, Agea J, Fungo B, Kamoga R . Traditional medicine as an alternative form of health care system: a preliminary case study of Nangabo sub-county, central Uganda. Afr J Tradit Complement Altern Med. 2011; 7(1):11-6. PMC: 3005386. DOI: 10.4314/ajtcam.v7i1.57224. View

Shin Y, Yang C, Joo M, Lee S, Kim J, Lee M . Patterns of using complementary and alternative medicine by stroke patients at two university hospitals in Korea. Evid Based Complement Alternat Med. 2008; 5(2):231-5. PMC: 2396475. DOI: 10.1093/ecam/nem025. View

Bethell C, Kemper K, Gombojav N, Koch T . Complementary and conventional medicine use among youth with recurrent headaches. Pediatrics. 2013; 132(5):e1173-83. PMC: 3813404. DOI: 10.1542/peds.2013-1816. View

Ali M, Abdul Aziz A, Rashid M, Che Man Z, Amir A, Lim Y . Usage of Traditional and Complementary Medicine (T & CM): Prevalence, Practice and Perception among Post Stroke Patients Attending Conventional Stroke Rehabilitation in A Teaching Hospital in Malaysia. Med J Malaysia. 2015; 70(1):18-23. View

Hoenig H, Duncan P, Horner R, Reker D, Samsa G, Dudley T . Structure, process, and outcomes in stroke rehabilitation. Med Care. 2002; 40(11):1036-47. DOI: 10.1097/00005650-200211000-00005. View

Owolabi M . Psychometric properties of the HRQOLISP-40: a novel, shortened multiculturally valid holistic stroke measure. Neurorehabil Neural Repair. 2010; 24(9):814-25. DOI: 10.1177/1545968310369113. View

10.

Choi B, Han D, Na S, Lim B . Factors related to the parallel use of complementary and alternative medicine with conventional medicine among patients with chronic conditions in South Korea. Integr Med Res. 2017; 6(2):223-229. PMC: 5478282. DOI: 10.1016/j.imr.2017.04.002. View

11.

Kew Y, Chia Y, Lai S, Chong K, Ho X, Liew D . Traditional and Complementary Medicine (TCM) among Study Population with Cardiovascular Risk; use and Substitution for Conventional Medicine in Pahang, Malaysia. Med J Malaysia. 2015; 70(2):86-92. View

12.

Yeh M, Chiu W, Wang Y, Lo C . An Investigation of the Use of Traditional Chinese Medicine and Complementary and Alternative Medicine in Stroke Patients. Holist Nurs Pract. 2017; 31(6):400-407. DOI: 10.1097/HNP.0000000000000238. View

13.

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

14.

Hoenig H, Sloane R, Horner R, Zolkewitz M, Duncan P, Hamilton B . A taxonomy for classification of stroke rehabilitation services. Arch Phys Med Rehabil. 2000; 81(7):853-62. DOI: 10.1053/apmr.2000.5569. View

15.

Siu B . Rehabilitation and recovery. East Asian Arch Psychiatry. 2014; 24(3):87-8. View

16.

Parveen H, Noohu M . Evaluation of psychometric properties of Tinetti performance-oriented mobility assessment scale in subjects with knee osteoarthritis. Hong Kong Physiother J. 2019; 36:25-32. PMC: 6385093. DOI: 10.1016/j.hkpj.2016.07.001. View

17.

Wahab K, Kw W, Okubadejo N, Nu O, Ojini F, Fi O . Predictors of short-term intra-hospital case fatality following first-ever acute ischaemic stroke in Nigerians. J Coll Physicians Surg Pak. 2008; 18(12):755-8. DOI: 12.2008/JCPSP.755758. View

18.

Thirthalli J, Zhou L, Kumar K, Gao J, Vaid H, Liu H . Traditional, complementary, and alternative medicine approaches to mental health care and psychological wellbeing in India and China. Lancet Psychiatry. 2016; 3(7):660-72. DOI: 10.1016/S2215-0366(16)30025-6. View

19.

Hafsteinsdottir T, Rensink M, Schuurmans M . Clinimetric properties of the Timed Up and Go Test for patients with stroke: a systematic review. Top Stroke Rehabil. 2014; 21(3):197-210. DOI: 10.1310/tsr2103-197. View

20.

Nketia-Kyere M, Aryeetey G, Nonvignon J, Aikins M . Exploring barriers to accessing physiotherapy services for stroke patients at Tema general hospital, Ghana. Arch Physiother. 2018; 7:8. PMC: 5759901. DOI: 10.1186/s40945-017-0037-5. View