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

The prevalence of cardiometabolic multimorbidity and its association with physical activity, diet, and stress in Canada: evidence from a population-based cross-sectional study

Background: Cardiometabolic multimorbidity (CM) is defined as having a diagnosis of at least two of stroke, heart disease, or diabetes, and is an emerging health concern, but the prevalence of CM at a population level in Canada is unknown. The objectives of this study were to quantify the: 1) prevalence of CM in Canada; and 2) association between CM and lifestyle behaviours (e.g., physical activity, consumption of fruits and vegetables, and stress). Methods: Using data from the 2016 Canadian Community Health Survey, we estimated the overall and group prevalence of CM in individuals aged ≥50 years (n = 13,226,748). Multiple logistic regression was used to quantify the association between CM and lifestyle behaviours compared to a group without cardiometabolic conditions. Results: The overall prevalence of CM was 3.5% (467,749 individuals). Twenty-two percent (398,755) of people with diabetes reported having another cardiometabolic condition and thus CM, while the same was true for 32.2% (415,686) of people with heart disease and 48.4% (174,754) of stroke survivors. 71.2% of the sample reported eating fewer than five servings of fruits and vegetables per day. The odds of individuals with CM reporting zero minutes of physical activity was 2.35 [95% CI = 1.87 to 2.95] and having high stress was 1.89 [95% CI = 1.49 to 2.41] times the odds of the no cardiometabolic condition reference group. The odds of individuals with all three cardiometabolic conditions reporting zero minutes of physical activity was 4.31 [95% CI = 2.21 to 8.38] and having high stress was 3.93 [95% CI = 2.03 to 7.61]. Conclusion: The number of Canadians with CM or at risk of CM is high and these individuals have lifestyle behaviours that are associated with adverse health outcomes. Lifestyle behaviours tend to diminish with increasing onset of cardiometabolic conditions. Lifestyle modification interventions focusing on physical activity and stress management for the prevention and management CM are warranted.Medicine, Faculty ofOther UBCNon UBCPhysical Therapy, Department ofReviewedFacult

Healthcare utilization after stroke in Canada- a population based study

Background: More people are surviving stroke but are living with functional limitations that pose increasing demands on their families and the healthcare system. The aim of this study was to determine the extent to which stroke survivors use healthcare services on a population level compared to people without a stroke. Methods: This was a cross-sectional population-based survey that collected information related to health status, healthcare utilization and health determinants using the 2014 Canadian Community Health Survey. Healthcare utilization was assessed by a computer-assisted personal interview asking about visits to healthcare professionals in the last 12 months. Negative binomial regression was used to estimate the incidence rate ratios (IRR) and 95% confidence intervals (CI) for the number of health professional visits between stroke survivors and people without a stroke. The regression models were adjusted for demographics, as well as for mobility, mood/anxiety disorder and cardiometabolic comorbid conditions. Results: The study sample included 35,759 respondents (948 stroke, 34,811 non-stroke) and equate to 12,396,641 (286,783 stroke; 12,109,858 non-stroke) when sampling weights were applied. Stroke survivors visited their family doctor the most, and stroke was significantly associated with more visits to most healthcare professionals [e.g., family doctor IRR 1.6 (CI 1.4–1.8); nurse IRR 3.0 (CI 1.8–4.8); physiotherapist IRR 1.8 (CI 1.1–1.9); psychologist IRR 4.0 (CI 1.1–5.7)] except the dental practitioner, which was less [IRR 0.7 (CI 0.6–0.9)]. Mood/anxiety condition, but not cardiometabolic comorbid condition increased the probability of visiting a family doctor or social worker/ counsellor among people with stroke. Conclusion: Stroke survivors visited healthcare professionals more often than people without stroke, and were approximately twice as likely to visit with those who manage problems that may arise after a stroke (e.g., family doctor, nurse, psychologist, physiotherapist). The effects of a stroke include mobility impairment and mood/ anxiety disorders. Therefore, adequate access to stroke-related healthcare services should be provided for stroke survivors, as this may improve functional outcome and reduce future healthcare costs.Medicine, Faculty ofOther UBCNon UBCPhysical Therapy, Department ofReviewedFacult

Support service utilization and out-of-pocket payments for health services in a population-based sample of adults with neurological conditions.

Social support can help to deal with the consequences of neurological conditions and promote functional independence and quality of life. Our aim was to evaluate the impact of neurological conditions on the use of support and health-care services in a population-based sample of community-dwelling adults with neurological conditions.Data were from the Survey of Living with Neurological Conditions in Canada, which was derived from a representative sample of household residents. Formal and informal support received and out-of-pocket payments were assessed by personal interviews. Logistic regression was used to explore the association between support service utilization and six common neurological conditions (Stroke, Parkinson's disease, Alzheimer's disease/dementias, traumatic brain injury, spinal cord injury and multiple sclerosis) with stroke as the reference category.The sample contained 2,410 respondents and equate to an estimated 459,770 when sample weights were used. A larger proportion of people within each of the neurological conditions received informal support than formal support (at least twice as much). Samples with the non-stroke conditions were more likely to receive formal assistance for personal (odds ratios 2.7 to 5.6; P < 0.05) and medical (odds ratios 2.4 to 4.4; P < 0.05) care compared to the stroke group. Also, the non-stroke conditions were more likely to receive informal assistance (odds ratios 2.7 to 17.9; P < 0.05) and less likely to make out-of-pocket payments for rehabilitation therapy (odds ratios 0.2 to 0.3; P < 0.05) than the stroke group. The Alzheimer's disease/dementia group had the highest proportion who received formal and informal support services.Our findings suggest that Canadians with neurological conditions receive more informal assistance than formal assistance. Furthermore, it appears that stroke survivors receive less support services, while those with Alzheimer's disease/dementia receive the most compared to other adult neurological conditions. Such data can help inform the development of support services in the community

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