The challenges and experiences of stroke patients and their spouses in Blantyre, Malawi.

Stroke is the second major cause of death and disability worldwide. Most stroke survivors experience various challenges due to physical and mental impairments which increase the burden on spouses during care. The broad aim of this study was to explore the challenges and experiences of stroke patients and their spouses during and after rehabilitation at the Rehabilitation Centre in Blantyre, Malawi. Methods: This was a qualitative exploratory study design. We conveniently selected 18 participants. Half of the population comprised patients and the other half spouses. Data were collected through in-depth interviews and focus group discussions and were analysed using thematic content analysis. Results: Stroke patients were found to be challenged by lack of mobility and failure to perform basic functional activities such as walking and feeding using the affected hand, which resulted in sudden dependence on the spouse for basic self-care and daily activities. In consequence, spouses were burdened by care-giving responsibilities while, on the other hand, most participants had limited access to rehabilitation and health services at the grassroots level. Moreover, congestion and lack of privacy were shown to exist at the Kachere Rehabilitation Centre due to inadequate space. Conclusion: This study has managed to show some of the problems that stroke patients and spouses experience during and after rehabilitation. There is a need for early and adequate intervention to address functional limitations and facilitate return to work. Spouses should be made to understand the condition of their partner and educated regarding possible implications of the same. In addition, social and psychological support should form an inseparable part of the therapy. Stroke support groups and association could be considered as a way of enhancing social support and awareness.

Perceptions and satisfaction of caregivers regarding rehabilitation services from selected rehabilitation centres in the Western Cape.

BACKGROUND: Understanding caregivers' views on rehabilitation services is important as it may assist in informing healthcare services and patient management. OBJECTIVES: The aim of this study was to explore caregivers' perceptions and satisfaction regarding rehabilitation services in the Western Cape, South Africa, and to inform clinical practice and policy in this emerging field. METHOD: This study used a descriptive, qualitative design using in-depth interviews with conveniently selected participants. Interviews were conducted with 13 caregivers of patients with: amputations (3), cerebrovascular accidents (5) and neuromuscular disorders (5). Thematic content analysis was conducted with the transcripts. RESULTS: Four key themes emerged, which were (1) financial difficulties, (2) caregiver and therapist relationships, (3) facility management and (4) caregiver experience with service delivery. CONCLUSION: Based on the participants' feedback, the rehabilitation services seem to be meeting the basic rehabilitation needs of the patients; however, the needs of the caregivers require attention.

Strengthening Health Systems for Persons With Traumatic Spinal Cord Injury in South Africa and Sweden: A Protocol for a Longitudinal Study of Processes and Outcomes.

Background: The provision of specialized care in a time-sensitive manner has shown to be crucial for survival and recovery of functioning after a traumatic spinal cord injury (TSCI). However, little is known about the provision of TSCI care in different international contexts; information which is required for strengthening policy and practice. Aims: The overarching aim of this study will be to explore health care processes and outcomes of TSCI care in South Africa and Sweden. Specific aims will be to: (1) describe acute processes of TSCI care, (2) determine acute- and long-term outcomes of TSCI care, and (3) identify predictors for survival, secondary complications, and functioning 12 months post-injury. Methods: A prospective (regional), population-based cohort study where adults with an acute TSCI will be recruited over at least a 1-year period from the City of Cape Town, South Africa, and Stockholm, Sweden. The anticipated sample size inclusive of both international contexts will be 200 participants-based on a power calculation for detecting differences in mortality. Information on the nature and timing of processes of acute care (e.g., transfer logistics, spinal surgery, and specialized SCI care) will be collected on acute care admission and discharge using a standardized form. Survival status, secondary complications, neurological symptoms, functional status, activity, and participation as well as health-related quality of life will be collected at discharge from SCI acute care and at 12-months post-injury. Secondary complications and functioning will be compared between South Africa and Sweden using inferential statistics. To address mortality specifically, the indirect standardization method for differences in mortality between contexts will be used whereby Stockholm will serve as standard for specialize care. For the assessment of factors related to mortality and other outcomes (e.g., neurological and secondary health conditions) multivariate regression analyses will be used to determine independent risk factors. Conclusion: This study offers a unique investigation of the relationship between health care processes and outcomes of TSCI care with the aim of strengthening management guidelines for SCI in South Africa and Sweden.

Using the World Health Organization's Disability Assessment Schedule (2) to assess disability in community-dwelling stroke patients.

BACKGROUND: Measurement of the extent of disability post-stroke is important to determine the impact of disability on these individuals and the effectiveness of interventions aimed at reducing the impact of their disability. Instruments used to measure disability should, however, be culturally sensitive. OBJECTIVE: The aim of this study was to conduct a disability assessment using the World Health Organization's Disability Assessment Schedule 2.0 (WHODAS). METHODS: A cross-sectional design was used. The study population included a conveniently selected 226 stroke patients living within community settings. These patients were followed up 6-12 months following the onset of the stroke and are currently residing in the community. Disability was measured using the WHODAS 2.0 and the data were analysed using descriptive and inferential statistics in Statistical Package for Social Sciences (SPSS). The WHODAS 2.0 enabled the assessment of disability within the domains of cognition, mobility, self-care, getting along with others, household activities, work activities and participation. Ethical clearance for the study was obtained from the University of the Western Cape. RESULTS: In this sample, the domain mostly affected were household activities, with 38% having extreme difficulty with conducting these activities. This was followed by mobility (27%) and self-care (25%) being the domains that participants also had extreme difficulty with. Getting along with others was the domain that most (51%) of the participants had no difficulty with. ANOVA one-way test showed no significant association of participation restrictions with demographics factors. CONCLUSION: Rehabilitation of patients with stroke should focus on the patient's ability to engage in household activities, mobility and self-care.

Barriers experienced by service providers and caregivers in clubfoot management in Kenya.

AIM: Disability in childhood remains a challenge globally. Linked to this disability is an apparent increase in the prevalence of infants born with congenital clubfoot. Clubfoot can, however, be effectively managed but this management faces various challenges. This study aims at exploring the barriers experienced in Kenya. METHODS: In-depth interviews were conducted with 20 participants. Informed consent was sought. Field notes were taken and the interviews tape-recorded. The interviews took 45 minutes to 1 hour. They were transcribed verbatim and analysed by thematic content. RESULTS: Missed diagnosis, poor referral system, shortage of staff, long travelling distance, poverty, stigmatisation and lack of support among other were highlighted as the major challenges in clubfoot management. CONCLUSION: The challenges facing children with disability start at birth but are little different from those faced throughout their life. Action to remove these challenges is warranted.

Experiences of patients and service providers with out-patient rehabilitation services in a rehabilitation centre in the Western Cape Province.

BACKGROUND: Rehabilitation is important for persons with disabilities as it contributes to their sense of autonomy, self-worth and social participation, and improves their quality of life. Improving the quality of rehabilitation services requires the dialogue of patients' perceptions with those of service providers, in order to recommend informed reform. OBJECTIVE: The objective was to explore the experiences of persons with physical disabilities and service providers, regarding the multi-disciplinary rehabilitation services provided at a community-based out-patient rehabilitation centre. METHODS: A qualitative, exploratory study design was used to collect the data. A focus group was conducted with conveniently selected persons with physical disabilities. Three in-depth interviews were conducted with purposively selected key informants. All ethical considerations were adhered to during the implementation of the study. RESULTS: Patients and service providers had different experiences regarding accessibility to rehabilitation services, and similar experiences with patient education and intensity of rehabilitation. Although the patients experienced that the service providers had sufficient knowledge and skills to manage them, services providers expressed that they lacked certain skills. CONCLUSIONS: The experiences expressed highlighted the need to improve rehabilitation services in terms of increasing the capacity of service providers and providing transport services for persons with disabilities.

Barriers to and facilitators of rehabilitation services for people with physical disabilities: A systematic review.

BACKGROUND: As health care practitioners, it is important to have an understanding of the common barriers to and facilitators of the rehabilitation services we provide. OBJECTIVES: This article aimed to review the relevant literature regarding barriers to and facilitators of rehabilitation services for people with disabilities. METHOD: Articles for the period 1990-2010 using descriptors related to rehabilitation services, barriers, facilitators and the physically disabled population were retrieved for this review. RESULTS: A total of 19 article titles were identified from references of other articles but following application of the inclusion criteria selected for this review, only six articles were chosen. Five of these articles were qualitative studies and one was a quantitative study. Barriers and facilitators regarding rehabilitation services highlighted by participants in the studies included a perception that health professionals have a lack of understanding of rehabilitation for people with disabilities and there was a lack of information sharing from health professionals about the rehabilitation process. On the other hand some participants reported that health professionals demonstrated confidence in the disability and rehabilitation process during consultation and highlighted that their needs were met by the rehabilitation professionals. CONCLUSION: Even though there were few studies highlighting the barriers to and facilitators of rehabilitation services, they highlighted that there are gaps in the process of rehabilitation services provided. It would be advisable for health professionals to take cognisance of the issues highlighted in this study in order to make rehabilitation services more effective.