Care process for stroke patients in kenya: mixed study

Abstract

Background: Longer-term impairments and activity limitations secondary to stroke can cause inability to return to work, and decreased social participation. Upon stroke episode, patients follow a series of care pathways implemented by healthcare professionals. However, this pathway differs in developing and developed countries. The purpose of this study is to determine the physiotherapy stroke rehabilitation pathway in Kenya. Methodology: This mixed methods study was conducted in 17 county referral hospitals in Kenya. Data was collected using semi-structured interviews, cross sectional descriptive survey and archival data. Qualitative data was collected from 12 purposively selected healthcare providers, patients and caregivers, quantitative data from 112 conveniently sampled physiotherapists, and archival data from 150 files. Interview guides, questionnaires and data extraction sheet were used for data collection. Content validity of the data extraction sheet was achieved through two experts in neuro rehabilitation, while a Pearson's correlation value of, r (8) = 0.87 was achieved for test-retest reliability. Trustworthiness was ensured through a sample that included various medical disciplines, Qualitative data was analyzed by thematic content approach while SPSS version 22 was used to capture and analyze quantitative data. Results: Setting for stroke rehabilitation included Institutions (86.6%), home (28.9%), and Community13.4%. Healthcare providers (6) reported involvement in interdisciplinary approach in management of stroke patients. Family/carer involved (95.2%). Majority of the participants (9) reported that there was assessment, before treatment. Likewise the survey showed assessment of impairments 99.1%, activity limitation 94.6 %. Inpatient received physiotherapy 5 times a week (92.7%,) outpatient-received services 3 times a week (52.6%), while CBR was at (35.8%). Contents of physiotherapy: Lower extremities gait training (100%), Upper extremities training (100%), re-education of balance (92.6%), management of; shoulder pain (62.5%), Spasticity (68.1%), Shoulder subluxation (70.2%), Fitness training (20.3%), Range of motion (80.7%), use of electrotherapy techniques (18.1%), management of pain (49.3%), neuromuscular stimulation (96.6%), and provision of orthotics and assistive devices (60.5%) Conclusions: Stroke care process in Kenya includes assessment, & management of impairment, activity limitation, and participation at both inpatient and outpatient. However, the results show poor use of evidenced based outcome measure, and poor recording.