Collaborative capacity development to complement stroke rehabilitation in Africa

This scholarly book focuses on stroke in Africa. Stroke is a leading cause of disability among adults of all ages, contributing significantly to health care costs related to long term implications, particularly if rehabilitation is sub-optimal. Given the burden of stroke in Africa, there is a need for a book that focuses on functioning African stroke survivors and the implications for rehabilitation within the African context. In addition, there is a need to progress with contextualised, person-centred, evidence-based guidance for the rehabilitation of people with stroke in Africa, thereby enabling them to lead socially and economically meaningful lives. The research incorporated in the book used a range of primary and secondary methodological approaches (scoping reviews, systematic reviews, meta-analyses, descriptive studies, surveys, health economics, and clinical practice guideline methodology) to shed new insights into African-centred issues and strategies to optimise function post-stroke

The functional outcomes of stroke patients who are HIV positive, HIV negative and HIV undiagnosed, following rehabilitation: a descriptive study

Thesis (MScPhysio)--Stellenbosch University, 2017.ENGLISH SUMMARY : Background: With the increase in human immunodeficiency virus (HIV) and non-communicable diseases in low to middle-income countries, the rise in HIV-related stroke incidences is becoming a concern. The sub-Saharan region is where the majority of the global HIV population reside. This places an even greater burden on an already strained healthcare system and economy, as HIV-infected people may have an increased chance of stroke and tend to be significantly younger than the conventional stroke population. With the physical and cognitive deficits that may occur due to HIV infection, along with the neurological deficits caused by stroke, this young population now becomes more dependent, increasing the number of unproductive members of society. Hence, it is important to know whether the combination of stroke and HIV further impairs the function of these individuals. Previous studies assessing the function of HIV-infected patients post stroke focused on mortality rather than the morbidity of HIV+ stroke patients. Furthermore, the outcomes measures used to assess their function were global and not specific enough to describe function adequately. Aim: The primary aim of this thesis is to describe the functional outcomes of HIV positive, HIV negative and HIV undiagnosed patients post stroke following inpatient rehabilitation using various outcome measures. Secondary aims include describing demographics, risk factors, length of stay and patient perception. Setting: The Western Cape Rehabilitation Centre (WCRC), situated in Cape Town, South Africa. Study design: A prospective descriptive cohort study. Methods: Approval for conducting the study was obtained from the Committee of Human Research (HREC) at Stellenbosch University (S15/10/232). From July to December 2016, patients who were admitted to the WCRC post stroke were recruited for the study. Written informed consent was obtained from all eligible participants. Data were collected on admission and just prior to discharge, using the Modified Rankin Scale for stroke severity; the Barthel Index and use of assistive devices to assess function in activities of daily living, level of independence and mobility; the Berg Balance Scale and MatScan (pressure mapping) to assess balance. Data on HIV and immune status, demographics, risk factors and length of stay were also collected. The EQ5D was used to assess participant’s perception of health related quality of life. All data were entered into an Excel spreadsheet, coded and analysed. Continuous data including mRS, BI, BBS and pressure mapping were summarised using median and range. Categorical data were represented as proportions and graphically displayed using a histogram. Statistical analysis was performed using STATA version 14.2 (Statacorp, 2015). Association between categorical variables was assessed using the chi-squared or Fisher’s exact test. Differences in distribution of continuous variables over different levels of a categorical variable were evaluated using the Kruskal-Wallis test, and where differences were detected, the Dunn’s test was used for pairwise comparisons. Relationships between patient characteristics and pain and anxiety were evaluated using ordinal logistic regression. The Kaplan-Meier curve was used to describe the length of stay. Statistical significance was assessed at 5%. Results: Out of 54 potential participants, 49 met the inclusion criteria and were recruited; 9 HIV positive (+), 17 HIV negative (-) and 23 HIV undiagnosed participants. The study sample had 51.02% (n = 25) females and 48.98% (n = 24) males. The majority of the sample were mixed race (53.06%, n = 34), 34.69% (n = 17) were of black ethnicity, 10.20% (n = 5) were white and 2.04% (n = 1) were Indian. A significant difference was found with regard to age. The median age for the HIV+ groups was 30 years, and 50 and 51 years for the other groups, respectively (p = 0.0046). The more common risk factors for the HIV- and undiagnosed groups were hypertension and diabetes (p = 0.001 and p = 0.042) respectively. Substance abuse (p = 0.038) and opportunistic infections (p = 0.005) were more prevalent in the HIV+ group. The median CD4 count was 130 (54-883). All groups showed significant improvements in all functional outcome assessments. The HIV+ group had a higher percentage of participants who scored in the higher percentiles for each functional outcome, but no significant results were seen among groups with regard to change in score in stroke severity (mRS p = 0.748), ADLs, independence and mobility (BI p = 0.886; use of assistive devices p = 0. 722) balance and risk of falling (BBS p = 0.4170 and MatScan results). The HIV+ group scored themselves lower than the other groups on the EQ5D VAS scale. This may have been attributed to their age as they were younger and possibly more functionally abled than their older counterparts, but no significant differences were seen among groups (EQ5D p = 0.805). The HIV+ group had a median length of stay of 45 days, while the HIV- and undiagnosed groups stayed for 55 and 53 days respectively. This difference was not statistically significant (p = 0.0671). Conclusion: Even though the HIV+ group was significantly younger and had fewer risk factors, no statistical significant differences were seen with regard to functional outcome. Functional outcome could be affected by a number of variables. In this sample, HIV status did not seem to affect functional outcome negatively. Larger cohorts are required for more generalisable results, to give a better understanding of the functional outcomes of HIV+ stroke patients.AFRIKAANSE OPSOMMING : Agtergrond: Met die toename in menslike immuniteitsgebreks virus (MIV) en nie-oordraagbare siektes in lae tot middelinkomste lande, word die styging in MIV-verwante beroertes kommerwekkend. Die Sub-Sahara-streek is waar die meerderheid van die wêreldwye MIV-bevolking woon. Dit plaas 'n groter las op 'n reeds belaste gesondheidsorgstelsel en ekonomie aangesien MIV-geïnfekteerde mense 'n groter kans op beroerte kan hê en geneig is om aansienlik jonger te wees as die konvensionele beroerte populasie. Met die fisiese en kognitiewe probleme wat mag voorkom as gevolg van MIV-infeksie, saam met die neurologiese disfunksie wat veroorsaak word deur beroerte, word hierdie jong bevolking nou meer afhanklike en onproduktiewe lede van die samelewing. Daarom is dit belangrik om te weet of die kombinasie van beroerte en MIV verder die funksie van hierdie individue benadeel. Vorige studies wat die funksie van MIV-geïnfekteerde pasiënte na beroerte beskryf, fokus op mortaliteit eerder as die morbiditeit van MIV-positiewe beroerte pasiënte. Meer so, die meet instrumente wat gebruik word om funksie te assesseer was globaal en nie spesifiek genoeg om die funksionele probleme in detail te beskryf nie. Doel: Om die funksionele uitkomste van MIV-positiewe, MIV-negatiewe en MIV-ondiagnoseerde pasiënte, post beroerte, na binne-pasiënt rehabilitasie met behulp van verskeie meet instrumente te beskryf. Sekondêre doelwitte sluit in die beskrywing van demografie, risikofaktore, lengte van verblyf en pasiënt persepsie. Omgewing: Wes-Kaapse Rehabilitasiesentrum (WKRS), geleë in Kaapstad, Suid-Afrika. Studieontwerp: 'n Voornemende beskrywende kohortstudie. Metodes: Goedkeuring vir die uitvoering van die studie is verkry by die Komitee vir Menslike Navorsing van Stellenbosch Universiteit (S15/10/232). Van Julie tot Desember 2016 is pasiënte, post beroerte, wat tot WKRS toegelaat is, gewerf vir die studie. Skriftelike ingeligte toestemming is verkry van alle kwalifiserende deelnemers. Data is ingesamel by toelating en net voor ontslag, met behulp van die Modified Rankin Scale om die erns van beroerte te bepaal; die Barthel-indeks en die gebruik van hulpmiddels om funksies in die daaglikse lewe, vlak van onafhanklikheid en mobiliteit te assesseer; die Berg Balance Scale en MatScan (druk metings) om balans te evalueer. MIV en immuunstatus, demografie, risikofaktore en lengte van verblyf is ook ingesamel. Die EQ5D is gebruik om pasiënt persepsie van hoe hulle gesondheid hulle kwaliteit van hulle lewe beïnvloed te beskryf. Alle data is in 'n Excel-sigblad ingevoer, gekodeer en ontleed. Opeenvolgende data, insluitend mRS, BI, BBS en MatScan (druk metings), is opgesom met behulp van mediane en omvang. Kategoriese data is as proporsies voorgestel en grafies vertoon met behulp van histogramme. Statistiese analise is uitgevoer met behulp van STATA weergawe 14.2 (Statacorp, 2015). Die assosiasie tussen kategoriese veranderlikes is geassesseer met behulp van die chi-kwadraat toets of Fisher’s exact test. Verspreiding van deurlopende veranderlikes oor verskillende vlakke van kategoriese veranderlikes is geëvalueer met behulp van die Kruskal-Wallis toets, en waar die verskille opgespoor is, is die Dunn toets vir tweerigtingvergelykings gebruik. Verhoudings tussen die volgende pasiënt eienskappe naamlik pyn en angs is geëvalueer met behulp van ordinale logistieke regressie. Die Kaplan-Meier-kurwe is gebruik om die lengte van die verblyf te beskryf. Statistiese betekenisvolheid is geassesseer teen 5%. Resultate: Uit 54 potensiële deelnemers het 49 aan die insluitingskriteria voldoen en is gewerf, naamlik 9 MIV-positiewe (+), 17 MIV-negatiewe (-) en 23 MIV-ondiagnoseerde deelnemers. Die studie het 51,2% (n = 25) vroue en 48,98% (n = 24) mans ingesluit. Meerderheid van die deelnemers was van gemengde ras (53.06%, n = 34), 34.69% (n = 17) was swart, 10.20% (n = 5) was wit en 2,04% (n = 1) was Indiër. 'n Beduidende verskil is gevind met betrekking tot ouderdom. Die mediane ouderdom vir die MIV + groepe was 30 jaar en 50 en 51 jaar vir die ander groepe onderskeidelik (p = 0.0046). Die algemene risikofaktore vir die MIV- en ondiagnoseerde groepe was onderskeidelik hipertensie en diabetes (p = 0.001 en p = 0.042). Middelmisbruik (p = 0.038) en opportunistiese infeksies (p = 0.005) was meer algemeen in die MIV +. Die mediaan CD4 telling was 130 (54-883). Alle groepe het beduidende verbeterings in alle funksionele uitkomsmetings getoon. Die MIV+ groep het 'n hoër persentasie deelnemers gehad wat vir elke funksionele uitkoms in die hoër persentiele behaal het, maar daar was geen beduidende resultate tussen groepe met betrekking tot verandering in telling in erns van beroerte nie (mRS p = 0.748), ADL's, onafhanklikheid en mobiliteit (BI: p = 0.886; gebruik van hulpmiddels: p = 0.722) balans en risiko van val (BBS p = 0.4170 en MatScan resultate). Die MIV + groep het hulself laer geëvalueer as die ander groepe op die EQ5D VAS-skaal. Dit kan toegeskryf word aan hul ouderdom aangesien hulle jonger was en moontlik meer funksioneel as hul ouer eweknieë, maar geen beduidende verskille is tussen groepe (EQ5D p = 0,805) gevind nie. Die MIV + groep het 'n mediane hospitalisasie van 45 dae gehad, terwyl die MIV- en ondiagnoseerde groepe onderskeidelik 55 en 53 dae gehospitaliseer was. Hierdie verskil was nie statisties betekenisvol nie (p = 0.0671). Samevatting: Alhoewel die MIV + groep aansienlik jonger was en minder risikofaktore gehad het, is daar geen statisties beduidende verskille met betrekking tot funksionele uitkomste gesien nie. Funksionele uitkomste kan beïnvloed word deur 'n aantal veranderlikes. In hierdie steekproef het MIV-status nie die funksionele uitkomste negatief beïnvloed nie. Groter kohorte word benodig vir meer veralgemeende resultate om 'n beter begrip van die funksionele uitkomste van MIV+ beroerte pasiënte te gee

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

Background: Health related quality of life (HRQoL) is a determinant of physical, social and emotional well-being post-stroke. Objectives: This study aimed to correlate self-reported HRQoL with activities of daily living (ADL) and stroke severity. Method: A longitudinal observational study was conducted at a rehabilitation centre in the Western Cape, South Africa. Stroke inpatients were sampled over 6 months. The Euro-QoL Five Dimensions instrument (EQ5D-3L) for self-reported HRQoL, Barthel Index (BI) for function and independence in ADL, and modified Rankin Scale (mRS) for stroke severity were administered on admission and discharge. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 25. Results: Of the 54 potential participants, 49 met inclusion criteria and 41 completed reassessments (median age 48 years [interquartile range {IQR} 39-60]; median length of stay 53 days [IQR 46-60]). Most participants had infarctions (89.90%); with hypertension or diabetes risk factors (73.47% and 28.57%, respectively). The BI and mRS scores improved significantly (p < 0.001) with very strong correlation between scores (rs = -0.874, p < 0.001); indicating a trend of decreased stroke severity as function improved. The EQ5D Visual Analog Scale (VAS) scores (p < 0.001) and domains mobility, self-care, usual activities (p < 0.001) and pain/discomfort (p = 0.034) improved significantly. The anxiety/depression domain showed a non-significant change (p = 0.378). A weak negative significant correlation existed between EQ5D VAS and mRS scores (rs = -0.362; p = 0.02); indicating a trend that HRQoL was not improving to the degree stroke severity decreased. A weak positive significant correlation was seen between EQ5D VAS and BI scores (rs = 0.329; p = 0.036). Conclusion: Although an improvement was noted in HRQoL, EQ5D VAS scores tended not to improve as strongly, despite significant improvements in function and stroke severity. These findings demonstrate the need for psychological support and pain management interventions for adjustment post-stroke

Functional outcome of stroke inpatients according to human immunodeficiency virus status : a feasibility study

CITATION: Hartley, T., et al. 2020. Functional outcome of stroke inpatients according to human immunodeficiency virus status : a feasibility study. African Journal of Disability, 9:a618, doi:10.4102/ajod.v9i0.618.The original publication is available at https://ajod.orgBackground: Stroke in human immunodeficiency virus positive (HIV+) individuals is becoming an increasing concern. Being significantly younger than typical stroke patients, the impact of functional challenges on quality of life and burden on society becomes more eminent. Objectives: This feasibility study aims to determine the requirements for a large descriptive cohort, to adequately describe the functional outcome of stroke patients with varying HIV status. Method: All stroke patients meeting the inclusion criteria were recruited over a 6-month period at a South African inpatient rehabilitation centre. Data were collected on admission and discharge using outcome measures including the Barthel Index (BI), Berg Balance Scale (BBS) and the use of assistive devices used to describe independence with activities of daily living (ADL), mobility and safety post-stroke. Statistical analysis was performed using Stata version 14.2. Results: The feasibility study identified appropriate procedures and barriers to a successful study in addition to describing preliminary data on participant demographics, relevant medical history and functional outcomes post-stroke. Limitations that affected feasibility included minimal recruitment sites, length of data collection period, timely communication of participant discharge plans and dates, and confirmation of participant HIV status. An appropriate comparison between sub-groups could not be made because of disproportionate group sizes, median age differences and no assessor blinding. Conclusion: To increase generalisability and the understanding of the unique HIV+ stroke profile, multiple recruitment sites, longer data collection periods, assessor blinding and age-matched groups with HIV status confirmation are recommended.https://ajod.org/index.php/AJOD/article/view/618Publisher's versio

The effect of physical exercise on anxiety in people with parkinson's disease: A systematic review of randomized control trials

BACKGROUND: Anxiety is a prominent disabling non-motor neuropsychiatric complication of Parkinson's disease (PD). Pharmacological treatments for PD and anxiety have drug interactions and negative side effects. Therefore, non-pharmacological interventions such as exercise has been proposed to reduce anxiety in people with PD (PwP). OBJECTIVE: This systematic review aimed to explore the relationship between physical exercise and anxiety in PwP. METHOD: Four databases (PubMed, Embase, Scopus, Ebscohost) were searched without date restrictions. English randomized control trials (RCT) including adults with PD, exposed to physical exercise interventions with anxiety as an outcome variable, were included. Quality was assessed by means of an adapted 9-point PEDro scale. RESULTS: Five of the identified 5547 studies met the inclusion criteria. Sample size ranged between 11-152 participants, totaling 328 participants with majority being male. PD stage ranged from early to moderate, with disease duration ranged between 2.9 and 8.0 years. All studies measured anxiety at baseline and post-intervention. On average studies scored 7/9 (76%) on the PEDro scale. CONCLUSION: There is insufficient evidence to support or refute the effect of exercise on anxiety in PwP due to noted limitations of included studies. There is an urgent need for high-quality RCTs on physical exercise and anxiety in PwP

Collaborative capacity development to complement stroke rehabilitation in Africa

This scholarly book focuses on stroke in Africa. Stroke is a leading cause of disability among adults of all ages, contributing significantly to health care costs related to long term implications, particularly if rehabilitation is sub-optimal. Given the burden of stroke in Africa, there is a need for a book that focuses on functioning African stroke survivors and the implications for rehabilitation within the African context. In addition, there is a need to progress with contextualised, person-centred, evidence-based guidance for the rehabilitation of people with stroke in Africa, thereby enabling them to lead socially and economically meaningful lives. The research incorporated in the book used a range of primary and secondary methodological approaches (scoping reviews, systematic reviews, meta-analyses, descriptive studies, surveys, health economics, and clinical practice guideline methodology) to shed new insights into African-centred issues and strategies to optimise function post-stroke