Physical Activity Level, Barriers, and Facilitators for Exercise Engagement for Chronic Community-Dwelling Stroke Survivors in Low-Income Settings: A Cross-Sectional Study in Benin

After a stroke incident, physical inactivity is common. People with stroke may perceive several barriers to performing physical activity (PA). This study aimed to document the PA level and understand the barriers and facilitators to engaging in PA for community-dwelling stroke survivors in Benin, a lower middle-income country. A cross-sectional study was conducted in three hospitals in Benin. Levels of PA were recorded by means of the Benin version of the International Physical Activity Questionnaire long form (IPAQ-LF-Benin), which is validated for stroke survivors in Benin. The perceived exercise facilitators and barriers were assessed by the Stroke Exercise Preference Inventory-13 (SEPI-13). A descriptive analysis and associations were performed with a Confidence Interval of 95% and <0.05 level of significance. A total of 87 participants (52 men, mean age of 53 ± 10 years, mean time after a stroke of 11 (IQR: 15) months and an average of 264.5 ± 178.9 m as distance on the 6 min walking test (6MWT) were included. Overall, stroke survivors in Benin reached a total PA of 985.5 (IQR: 2520) metabolic equivalent (METs)-minutes per week and were least active at work, domestic, and leisure domains with 0 MET-minutes per week. The overview of PA level showed that 52.9% of participants performed low PA intensity. However, 41.4% performed moderate PA or walking per day for at least five days per week. Important perceived barriers were lack of information (45.3%), hard-to-start exercise (39.5%), and travelling to places to exercise (29.9%). The preference for exercise was with family or friends, outdoors, for relaxation or enjoyment (90.2%), and receiving feedback (78.3%). Several socio-demographic, clinical, and community factors were significantly associated with moderate or intense PA (p < 0.05) in stroke survivors in this study. Our findings show that the PA level among chronic stroke survivors in Benin is overall too low relative to their walking capacity. Cultural factors in terms of the overprotection of the patients by their entourage and/or the low health literacy of populations to understand the effect of PA on their health may play a role. There is a need for new approaches that consider the individual barriers and facilitators to exercise

Exercise dosage to facilitate the recovery of balance, walking, and quality of life after stroke

Background: Although aerobic training (AT) and resistance training (RT) are recommended after stroke, the optimal dosage of these interventions and their effectiveness on balance, walking capacity, and quality of life (QoL) remain conflicting. Objective: Our study aimed to quantify the effects of different modes, dosages and settings of exercise therapy on balance, walking capacity, and QoL in stroke survivors. Methods: PubMed, CINHAL, and Hinari databases were searched for randomised controlled trials (RCTs) evaluating the effects of AT and RT on balance, walking, and QoL in stroke survivors. The treatment effect was computed by the standard mean differences (SMDs). Results: Twenty-eight trials (n = 1571 participants) were included. Aerobic training and RT interventions were ineffective on balance. Aerobic training interventions were the most effective in improving walking capacity (SMD = 0.37 [0.02, 0.71], p = 0.04). For walking, capacity, a higher dosage (duration ≥ 120 min/week; intensity ≥ 60% heart rate reserve) of AT interventions demonstrated a significantly greater effect (SMD = 0.58 [0.12, 1.04], p = 0.01). Combined AT and RT improved QoL (SMD = 0.56 [0.12, 0.98], p = 0.01). Hospital located rehabilitation setting was effective for improving walking capacity (SMD = 0.57 [0.06, 1.09], p = 0.03) compared with home and/or community and laboratory settings. Conclusions: Our findings showed that neither AT nor RT have a significant effect on balance. However, AT executed in hospital-located settings with a higher dose is a more effective strategy to facilitate walking capacity in chronic stroke. In contrast, combined AT and RT is beneficial for improving QoL. Clinical implications: A high dosage of aerobic exercise, duration ≥ 120 min/week; intensity ≥ 60% heart rate reserve is beneficial for improving walking capacity

Tableau d’encephalite revelant un anevrisme de l’artere communicante posterieure a parakou (Benin)

L‘anévrisme intra crânien est une dilatation localisée et persistante d‘une artère cérébrale. Nous rapportons le cas d‘une patiente de 30 ans présentant des céphalées à répétition depuis 3 mois et admise en Soins Intensifs pour un syndrome infectieux et des troubles neurologiques. Les résultats de la tomodensitométrie et de l‘examen du liquide cérébro-spinal ont permis d‘évoquer le diagnostic de méningo-encéphalite; l‘évolution sous traitement adapté a été marquée par la disparition des troubles de la vigilance et l‘amélioration de la force musculaire. Sa sortie de l‘hôpital a alors été faite. Un mois après, il a été noté la persistance du ptosis droit, du syndrome pyramidal hémicorporel gauche et l‘apparition d‘un trouble du comportement et d‘une agitation : un angioscanner cérébral réalisé révéla alors un anévrisme partiellement thrombosé de la communicante postérieure droite. Le traitement neurochirurgical indiqué n‘a pu être fait pour des raisons financières ; elle est donc suivie en consultation neurologique.   English title: A case of aneurysm of the posterior communicating artery mimicking an encephalitis in Parakou (Benin) The intracranial aneurism is a permanent enlargement of a cerebral aretery. We are reporting the case of a female patient who had a headache since 3 months and was admitted to Intensive Care Unit because of neurological deficiencies and fever. The CT scan and the cerebrospinal liquid‘s exams realized leaded to a meningoencephalitis diagnosis. Under the adapted treatment, the consciousness disorder disappeared and the muscular strength become better. Therefore, she went to home. After one month, she presented a persistence of the right ptosis, of a pyramidal syndrome. Moreover, she developped a behavioural trouble and become agitate: then an angioscanner were done and had shown an aneurism of the posterior communicating artery. The neurosurgical care recommended did not apply due to the patient‘s economic problems. She is currently following by the neurologist

Bilateral versus unilateral upper limb training in (sub)acute stroke: A systematic and meta-analysis

Background: Integrating high dosage bilateral movements to improve upper limb (UL) recovery after stroke is a rehabilitation strategy that could potentially improve bimanual activities. Objectives: This study aims to compare the effects of bilateral with unilateral UL training on upper limb impairments and functional independence in (sub)acute stroke. Method: Five electronic databases (PubMed, Scopus, PEDro, ScienceDirect, Web of Science) were systematically searched from inception to June 2023. Randomised controlled trials comparing the effect of bilateral training to unilateral training in stroke survivors ( 6 months poststroke) were included. The treatment effect was computed by the standard mean differences (SMDs). Results: The review included 14 studies involving 706 participants. Bilateral training yielded a significant improvement on UL impairments measured by FMA-UE compared to unilateral training (SMD = 0.48; 95% CI: 0.08 to 0.88; P = 0.02). In addition, subgroup analysis based on the severity of UL impairments reported significant results in favour of bilateral UL training in improving UL impairments compared to unilateral training in “no motor capacity” patients (SMD = 0.66; 95% CI: 0.16 to 1.15; P = 0.009). Furthermore, a significant difference was observed in favour of bilateral UL training compared to unilateral UL training on daily activities measured by Functional Independence Measure (SMD = 0.45; 0.13 to 0.78; P = 0.006). Conclusion: Bilateral UL training was superior to unilateral training in improving impairments measured by FMA-UE and functional independence in daily activities measured by Functional Independence Measure in (sub)acute stroke. Clinical implications: Bilateral upper limb training promotes recovery of impairments and daily activities in (sub)acute phase of stroke

Factors associated with balance impairments amongst stroke survivors in northern Benin: A cross-sectional study

BACKGROUND: Balance impairment is the predominant risk factor for falls in stroke survivors. A fear of falling after stroke can contribute to sedentary lifestyles, increased disability and risk of recurrence, leading to poor quality of life. OBJECTIVE: To determine the frequency and factors associated with balance impairments amongst stroke survivors at the University Hospital of Parakou. METHOD: This cross-sectional study included adult stroke survivors. Stroke survivors after discharge were enrolled at the University Hospital of Parakou between 01 January 2020 and 30 September 2020. Balance impairments were measured by using the Berg Balance Scale (BBS), the Timed Up and Go (TUG) and the Get Up and Go (GUG) tests. RESULTS: A total of 54 stroke survivors were included, with a mean age of 58.37 ± 12.42 years and a male predominance of 68.52%. The mean BBS score was 36.87 ± 14.34 with a minimum and a maximum of 10 and 56, respectively. Thirteen (24.07%) had balance impairments (BBS score ≤ 20), 34 (62.96%) had a TUG score ≥ 14 s (abnormal), 9 (16.67%) presented a moderate risk of falling and 6 (11.11%) presented high risk of fall with the GUG test. Post-stroke duration (odds ratio [OR] = 0.04; 95% CI: 0.04-0.30; p < 0.01), severity of disability (OR = 8.33; 95% CI: 1.03-67.14; p = 0.03) and the number of physiotherapy sessions (OR = 0.18; 95% CI: 0.03-0.93; p = 0.02) were significantly associated with balance impairments. CONCLUSION: Our results showed that almost one quarter of stroke survivors after discharge at the University Hospital of Parakou had balance impairments. Post-stroke duration, severity of disability and the number of physiotherapy sessions were significantly associated with balance impairments. CLINICAL IMPLICATIONS: [AQ1] Balance should be regularly assessed in people post-stroke. Further studies should document the content of rehabilitation and any rehabilitative efforts to improve balance in people post-stroke in Benin

Enquete sur la prevalence de la migraine chez l’adulte a titirou au Nord du Benin en 2017

Introduction: La migraine est une maladie neurologique fréquente en population, source de handicap et classée 13ème des affections les plus handicapantes par l’OMS. L’objectif de cette étude était d’étudier la prévalence de la migraine à Titirou en 2017. Méthodes: Il s’est agi d’une étude transversale de type porte-à-porte menée sur 2065 sujets âgés de 18 à 65 ans. L’enquête a été effectuée sur une période de 4 mois allant du 10 avril au 05 août 2017. Les critères diagnostiques de l’International Headache Society (IHS) de 2013 ont servi de base pour le diagnostic de la migraine. Les informations sociodémographiques, le poids et taille et les données relatives à la fréquence et l’intensité des céphalées furent collectés. Les données ont été saisies, traitées et analysées grâce au logiciel Epi Info version 2.2.0.165. Résultats: Il y avait une prédominance masculine avec un sex-ratio de 1,41. Les sujets étaient âgés de 18 à 65 ans avec une moyenne d’âge de 31,87±8,37ans. La prévalence des céphalées était de 63,49%. La  prévalence de la migraine à Titirou était de 3,82% [IC95% : (3,06%-4,72%)] (79 sur les 2065). Les facteurs associés à la migraine étaient l’âge (p=0,0026), le sexe (p=0,0001), le niveau d’instruction (p=0,0039), la profession (p&lt;10-4 ) et l’indice de masse corporelle (p&lt;10-4 ). L’intensité des céphalées était modérée dans 44,30%, forte dans 51,90%,  extrêmement forte chez 3,80% des sujets. La plupart des migraineux  (78,48%), avait moins de 5 crises par mois. La migraine avec aura  représentait 49,4%. Les auras les plus observées étaient les phosphènes (34,18%), les scotomes (13,92%) et l’aura sensitive (13,92%). Les  facteurs déclenchant les accès étaient le manque de sommeil (84,81%), la contrariété (68,35%) et le souci (62,03%). Conclusion : La migraine est assez fréquente et sa prévalence est comparable à celle rapportée dans la plupart des études en communauté en Afrique.Mots clés: Migraine -Prévalence-Adulte-Benin Introduction: The migraine is a common neurological disorder with a serious handicap and classified as the 13th disabling disease worldwide. The most consistently data on epidemiology of migraine are available in general population in Africa but not in northern Benin. We aimed to study the prevalence of migraine at Titirou in Parakou in 2017. Methods: This was a cross-sectional with door-to-door survey which included 2065 subjects aged 18 to 65 years. The survey was conducted over a period of 4 months from 10 April to 05 August 2017. The IHS diagnostic criteria of 2013 were used to define migraine. Socio-demographics information was collected. The data were analyzed using Epi Info 2.2.0.165.fr software. Results: There was a male predominance with 58.45% of men with sex ratio of 1.41. The mean age was 31.87 ± 8.37 years. The prevalence of headache was 63.49%. The prevalence of migraine in Titirou was 3.82% [95%CI: 3.06%-4.72%]. The associated factors were the age (p=0.00), the sex (p=0.00), level of education (p=0.00), occupation (p&lt;10-4 ) and the body mass index (p&lt;10-4 ). The migraine with aura represented 49.4%. The most type were visual aura (34.18%), sensitive aura (13.92%) and scotoma (13.92%).The intensity of headache was moderate in 44.30%, strong in 51.90%, extremely strong in 3.80% of subjects. The main triggering factors were lack of sleep (84.81%), annoyance (68.35%) and worry (62.03%). Conclusion: Migraine was more frequent in Parakou and this data are comparable to those reported elsewhere in sub-Saharan Africa.Key words: Headache, Migraine- Prevalence, epidemiology, Adult; Benin

Stroke burden in Benin 2008 to 2018: systematic review of the Literature

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Determinants of Social Participation at 1, 3, and 6 Months Poststroke in Benin.

OBJECTIVE: To build a model of prediction of social participation of community-dwelling stroke survivors in Benin at 1 month, 3 months, and 6 months. DESIGN: An observational study with evaluations at 1 month, 3 months, and 6 months poststroke. Correlational analyses and multivariate linear regressions were performed. SETTING: Outpatient rehabilitation centers in Benin. PARTICIPANTS: A volunteer sample of 91 stroke patients was enrolled at baseline; 64 (70%) patients completed all the study (N=64): 70% male and 52% right hemiparesis. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Participants were evaluated with the Participation Measurement Scale, ACTIVLIM-Stroke (activities of daily living [ADL]), Stroke Impairment Assessment Set, 6-minute walk test, Hospital Anxiety and Depression Scale, and the modified Rankin Scale. RESULTS: The significant predictors of social participation after controlling the confounders were the following: at 1 month ADL (0.4 [0.3, 0.6]) and depression (‒0.6 [‒0.8, ‒0.2]) with total model R2=0.44; at 3 months ADL (0.58 [0.4, 0.7]) and depression (‒0.58 [‒0.5, ‒0.7]) with total model R2=0.65; and at 6 months ADL (0.31 [0.2, 0.5]), impairments (‒0.82 [‒0.5, ‒0.7]), and depression (‒0.94 [‒0.8, ‒0.2]) with total model R2=0.78. CONCLUSIONS: Using socioculturally tailored tools, the present study identified ADL performance (ACTIVLIM-Stroke), depression (Hospital Anxiety Depression Scale), and overall impairments (Stroke Impairment Assessment Set) as the significant determinants of social participation (Participation Measurement Scale) poststroke in Benin. These findings will be a valuable resource for rehabilitation stakeholders in evaluating interventions, programs, and policies designed to encourage social participation for stroke patients