Health-related quality of life of patients six months poststroke living in the Western Cape, South Africa

BACKGROUND: The majority of individuals report a decline in health-related quality of life following a stroke. Quality of life and factors predicting quality of life could differ in individuals from lower income countries. The aim of this study was therefore to determine the quality of life and factors influencing quality of life of community-dwelling stroke patients living in low-income, peri-urban areas in the Western Cape, South Africa. METHOD: An observational, longitudinal study was used to collect data from a conveniently selected sample of first-ever stroke patients. The Rivermead Motor Assessment Scale and the Barthel Index were used to determine functional outcome and the EQ-5D was used to collect information relating to quality of life at two months and six months poststroke. Descriptive and inferential statistics were used to analyse the data. RESULTS: The total sample of 100 participants consisted of 50% men and 50% women with a mean age of 61 and a standard deviation of 10.55 years. Six-month quality of life datawas analysed for 73 of the 100 participants. Of the 27 who were lost to follow-up, nine participants died, four withdrew from the study after baseline data was collected and eleven could not be followed up as they had either moved or no follow-up telephone numbers were available. A further three participants were excluded from the analysis of the EQ-5D as they were aphasic. Of these, approximately 35% had problems with mobility and self-care, whilst 42% had severe problems with everyday activities and 37.8% expressed having anxiety and depression. Quality of life at two months (p = 0.010) and urinary incontinence (p = 0.002) were significant predictors of quality of life at six months. CONCLUSION: Health-related quality of life was decreased in the South African stroke sample. Functional ability and urinary incontinence were the factors affecting quality of life in the sample. These factors should be considered in the rehabilitation of stroke patients in these settings.Department of HE and Training approved lis

Editorial

Clinical education and training: Have we sufficiently shifted our paradigm

Rehabilitation of stroke patients treated at a community based rehabilitation centre

AIM: The overall aim of the study was to compile a profile of stroke patients receiving out-patient rehabilitation in the community. Included in the profile was the referral and rehabilitation process. METHOD: The study design was descriptive, utilizing a retrospective survey of patient documentation. Patient records were used to collate the data. RESULTS: Records of 168 patients were included in the study. A large percentage (55.9%) of the patients were referred by primary level sources. Thirty three percent of the patients were assessed within their first two weeks post-stroke. Sixty nine percent of the patients received rehabilitation for less than 3 months with an average of one treatment session per week. Results indicate an improvement in functional status of the patients when comparing admission and discharge scores (p=< 0.0005). CONCLUSION: Out-patient community based rehabilitation could have a positive effect on the functional status of stroke patients

Peripheral neuropathy and quality of life of adults living with HIV/AIDS in the Rulindo district of Rwanda

Although the life expectancy of people living with HIV/AIDS (PLWH) has increased in the past years, they could experience secondary illness such as peripheral neuropathy (PN). Therefore, they need to adapt to chronic disablement which could affect their quality of life (QoL). The research that informed this article aimed at determining the prevalence of PN among adults living with HIV/AIDS and attending the outpatients’ clinic at Rutongo Hospital in the Rulindo district of Rwanda. Another aim was to determine these patients’ QoL. A cross-sectional descriptive quantitative research design was used. A time-constrained method was used to sample 185 adults living with HIV/AIDS and attending the outpatients’ clinic at Rutongo Hospital. The subjective PN screen and the World Health Organization Quality of Life Scale Brief Version were used to collect the data. Data were analysed using the Statistical Package for the Social Sciences. Student’s t-test and one-way analysis of variance were performed to determine if significant differences existed between QoL scores in participants with and without PN symptoms. The results indicated that 40.5% of respondents experienced PN. QoL in participants with PN showed significantly lower scores in the physical (p ¼ 0.013) and psychological (p ¼ 0.020) domains when compared with those who did not have PN. These results indicate a high prevalence of neuropathy among PLWH attending the outpatients’ clinic at Rutongo Hospital. In addition, patients with neuropathy had lower QoL scores in the physical and psychological domains than those without neuropathy symptoms. The management of PLWH should therefore include interventions to optimise QoL as well as screening for neuropathy symptoms so that sufferers can liaise with their medical providers to find medical and supportive therapies that could assist them.Web of Scienc

Activity limitations and factors influencing functional outcome of patients with stroke following rehabilitation at a specialised facility in the Western Cape

BACKGROUND: Determining the functional abilities and factors influencing outcome of patients with stroke following rehabilitation are essential for the planning of future interventions and services in order to optimise recovery. OBJECTIVES: To determine the activity limitations and factors influencing functional outcome of patients with stroke managed at a specialised rehabilitation centre. METHODOLOGY: A longitudinal study design was used to determine the functional outcomes of patients admitted to the centre on admission and discharge. A data gathering sheet was developed to collect information pertaining to the demographicand medical profile and process of rehabilitation, whereas the Barthel Index was used to collect data relating to functional abilities. For analysis, descriptive statistics as well as inferential statistics (Student t test) were utilised to determine the paired differences. Six prognostic factors influencing functional outcome were selected and tested using linear (bivariate) regression. RESULTS: The mean Barthel Index scores on admission and at discharge were 58.85 and 81.59 respectively. A significant improvement was noted in the execution of functional task of patients with stroke (p< 0.01) between the data collection points. Despite the significant overall improvement, results show a high prevalence of dependence with walking and stair climbing at discharge. Only functional ability on admission (r=0.49) predicted a favourable functional outcome at discharge. CONCLUSION: This study highlights the limitations of younger stroke survivors and the need for continued rehabilitation following in-patient care. It further underscores the administration of a functional rating scale on admission in order to aggressively manage activity limitations.Department of HE and Training approved lis

Outcome measures used to assess disability post stroke within the framework of the ICF: a literature review

BACKGROUND: The use of outcome measures has been associated with good practice among clinicians and as a research instrument. These measures can be utilized to assess- and manage patients, observe progress, determine the effects of certain intervention and for research purposes. This scholarly paper investigates the most commonly used outcome measures along the continuum of care, and further provides additional information that will assist researchers and clinicians to decide on the most appropriate outcome measure in a South African Healthcare. METHODS: Literature of the past 10 years dealing with outcome measures was reviewed for this study. The types of papers in this review were systematic reviews, narrative reviews, scholarly papers, longitudinal and cross sectional. RESULTS AND DISCUSSION: Included in this review are four impairment, five activity/disability, two participation restriction and four quality of life outcome measures. Although a number of these measures have been used in the South African setting, it is not clear whether they have been validated for the local context. Few translated versions relevant to South Africa are available and not all measures are freely available, which could limit the use thereof. CONCLUSION: This paper successfully describes the commonly used outcome measures and aspects that should be taken into account when deciding on the appropriate measure

Functional outcomes of stroke patients admitted to a tertiary hospital in the Western Cape, South Africa

Individuals with stroke often experience functional limitations such as the inability to walk independently. There are several factors that are associated with functional outcome post stroke. The aim of the study was therefore to determine functional outcomes and factors influencing functional outcomes of stroke patients admitted to a South African tertiary hospital. A longitudinal design was used to obtain the data. A convenient sampling method was used to recruit 100 participants. Data was collected on admission, discharge and two months post stroke, using the National Institute of Health Stroke Scale, Barthel Index and a socio-demographic and medical profile data sheet. The data was analyzed using SPSS version 18 and SAS version 9. Tobit analysis was used to determine the factors influencing functional outcomes at discharge and two months post stroke. The necessary ethical clearance was obtained prior to commencement of the study. Stair climbing, mobility and transfers were the functional activities that the majority of the participants could not perform independently. Age and severity of stroke significantly influenced the functional outcomes at discharge and two months post stroke. Factors such as age and stroke severity should therefore be considered when planning rehabilitation interventions for stroke patients in this setting.Department of HE and Training approved lis

Missing medical records: an obstacle to archival survey-research in a rural community in South Africa

Keeping good quality medical records is an essential yet often neglected part of a health-care practitioner’s workload. In South Africa, by law all health care facilities are required to retain medical records for a minimum of six years after the cessation of a patient’s treatment. In an archival survey that was attempted in a rural community in South Africa, only 39% of the records that were requested were located. The procedure that was followed in order to obtain the records to be included in the survey is briefly described in this paper, highlighting the challenges experienced in four district hospitals in this community. The phenomenon has serious implications not only for the quality of healthcare, incidence of iatrogenic injuries and the future of the health-care practitioner’s career, but it also impacts on the ability to conduct research to inform practice. An aspect that is not often considered is the impact of poor record keeping on the research and teaching component of the broader medical profession.National Research Foundation of South AfricaDepartment of HE and Training approved lis

The influence of cultural beliefs on the utilisation of rehabilitation services in a rural South African context: therapists’ perspective

South Africa has a population of 51.8 million people of which 7.5% over the age of five has a disability according to the latest census data (Statistics South Africa 2014). This statistic on the national prevalence of disability should be interpreted with caution since psychosocial and neurological disabilities are not accounted for (Statistics South Africa 2014). The most recent data on disability in South Africa is from the national census of 2011, which defined ‘disability’ as: ... a physical or mental handicap which has lasted for six months or more, or is expected to last at least six months, which prevents the person from carrying out daily activities independently, or from participating fully in educational, economic or social activities. (Statistics South Africa 2014). In South Africa 38% of the population resides in rural areas, and 25% of the labour force is unemployed (The World Bank 2014). At the time of the national census in 2011, more than a quarter (26.3%) of all poor people in South Africa resided in KwaZulu-Natal (KZN), most living below the per capita upper-bound poverty line of R620 per month (Statistics South Africa 2014). The co-existence of poverty and disability reinforces one another (Grech 2009; Sala-i-Martin 2005). High levels of poverty together with the high incidence of disability and the large percentage of the population living in rural areas, present challenges to providing ‘health for all’ in South Africa (Department of Health [DOH] 2010; Schaay & Sanders 2008).Web of Scienc

Quality of life amongst young adults with stroke living in Kenya

BACKGROUND: The world has been experiencing an increase of stroke among young adults. Occurrence of stroke in young adults dramatically affects the quality of life of the individuals. OBJECTIVES: To investigate the quality of life amongst young adults who experienced a stroke living in Kenya. METHODS: A cross-sectional study was carried out on a conveniently selected sample of 161 young adults with stroke drawn from three tertiary hospitals in Kenya. The Short-Form 36-item second version (SF-36v2) was used to collect the data. Descriptive and association statistical analysis using Mann-Whitney U, and Kruskal Wallis tests were calculated on the data using SPSS. RESULTS: In relation to a total score of 100, when expressed as a percentage the mean quality of life scores, ranged from 30% to 48% for each of the SF-36v2 domains. The results showed that males scored higher than females in all the domains except in physical functioning and that the scores decline with advance in age in most domains. CONCLUSION: The quality of life scores for this group were low meaning that that they were experiencing more challenges with physical functioning, psychological and emotional functioning and fulfilling previous roles.Web of Scienc