Community reintegration among stroke survivors in Osun, southwestern Nigeria.

Background Stroke is a major neurological problem and a leading cause of disability in the elderly in Nigeria. The incidence is increasing due to increasing risk factors, but many stroke victims now survive because of improved medical care. These survivors become community-dwellers after inpatient rehabilitation.Aims To assess community reintegration among stroke survivors and factors associated with it.Methods Cross-sectional survey study of patients who had survived six months or more after a stroke. Participants consisted of stroke patients attending the outpatient physiotherapy clinics of four selected government owned hospitals in Osun state, south-west Nigeria. Community reintegration was assessed using the Reintegration to Normal Living Index (RNLI) and walking ability was assessed using the Functional Ambulatory Categories (FAC).Results A total of 64 patients (43 men and 21 women, mean age 58.80¡À 10.31 years) participated in this study. The mean RNLI was 63.8¡À14.3 for all the participants. Forty eight participants (75%) had slight disability (Score=2) and 16 participants (25%) had moderate disability (Score =3) using Modified Rankin Scale (mRS). Age, sex, physiotherapy duration, number of stroke occurrence and walking ability, were not associated with community reintegration. Post-stroke duration however had a significant association with community reintegration.Conclusion A significant proportion of chronic stroke survivors attending the selected outpatient clinics have mild to moderate level of reintegration and the longer the post stroke duration, the better the satisfaction with community reintegration

Therapeutic itinerary of stroke survivors in a Nigerian tertiary hospital

Objective: to analyze the therapeutic itinerary of stroke survivors from stroke occurrence to rehabilitation. Methods: therapeutic itinerary - route taken by individuals to solve their health problems, of 12 stroke survivors was explored using in-depth interviews and was thematically analyzed. Results: stroke survivors’ routes were influenced by type of stroke and the state of the patient at onset of stroke. Lack of capacity facilitates vacillation from private to the public hospital settings. Entry into physiotherapy was dependent on self-referrals and referrals from physicians who often serve as gatekeeper of patients. Stroke significantly affected social life of stroke survivors, and the extent of stroke impairment and unmet expectations promotes medical pluralism among the survivors. Conclusion: stroke survivors are involved in intricate and lengthy therapeutic itineraries that are characterized by multiple care seeking practice

Itinerário terapêutico de sobreviventes de acidente vascular cerebral em um hospital terciário nigeriano

Objective: to analyze the therapeutic itinerary of stroke survivors from stroke occurrence to rehabilitation. Methods: therapeutic itinerary - route taken by individuals to solve their health problems, of 12 stroke survivors was explored using in-depth interviews and was thematically analyzed. Results: stroke survivors’ routes were influenced by type of stroke and the state of the patient at onset of stroke. Lack of capacity facilitates vacillation from private to the public hospital settings. Entry into physiotherapy was dependent on self-referrals and referrals from physicians who often serve as gatekeeper of patients. Stroke significantly affected social life of stroke survivors, and the extent of stroke impairment and unmet expectations promotes medical pluralism among the survivors. Conclusion: stroke survivors are involved in intricate and lengthy therapeutic itineraries that are characterized by multiple care seeking practice.Objetivo: analisar o itinerário terapêutico de sobreviventes de acidente vascular cerebral, desde sua ocorrência até a reabilitação. Métodos: itinerário terapêutico percorrido por 12 sobreviventes de acidente vascular cerebral para resolver seus problemas de saúde foi explorado usando entrevistas em profundidade e análise temática. Resultados: as rotas dos sobreviventes foram influenciadas pelo tipo e estado do paciente no início do acidente vascular cerebral. A falta de capacidade contribuiu para indecisão entre buscar atendimento em hospitais privados ou públicos. A entrada na fisioterapia dependeu da demanda espontânea e de encaminhamentos realizados por médicos que atuam como sentinelas dos pacientes. O acidente vascular cerebral afetou significativamente a vida social dos sobreviventes. A extensão do comprometimento do acidente vascular cerebral e expectativas não atendidas promovem o pluralismo médico entre os sobreviventes. Conclusão: sobreviventes de acidente vascular cerebral estão envolvidos em itinerários terapêuticos complexos e extensos, caracterizados pela prática de busca de múltiplos cuidados