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Kleinitz P, Sabariego C, Llewellyn G, Taloafiri E, Mangar A, Baskota R, Marahatta K, Maduwage S, Khin MH, Wonanji V, Sampa G, Al-Rjoub A, Al-Daod J, Cieza A. Integrating rehabilitation into health systems: A comparative study of nine middle-income countries using WHO's Systematic Assessment of Rehabilitation Situation (STARS). PLoS One 2024; 19:e0297109. [PMID: 38315690 PMCID: PMC10843154 DOI: 10.1371/journal.pone.0297109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/28/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVE The need for rehabilitation is growing due to health and demographic trends, especially the rise of non-communicable diseases and the rapid ageing of the global population. However, the extent to which rehabilitation is integrated into health systems is mostly unclear. Our objective is to describe and compare the nature and extent of integration of rehabilitation within health systems across nine middle-income countries using available Systematic Assessment of Rehabilitation Situation (STARS) reports. METHODS Cross-country comparative study with variable-oriented design using available rehabilitation health system assessment reports from nine middle income countries. FINDINGS The integration of rehabilitation into health systems is limited across countries. Governance and financing for rehabilitation are mostly established within health ministries but weakly so, while health information systems are characterized by no available data or data that is insufficient or not routinely generated. The overall numbers of rehabilitation workforce per capita are low, with frequent reports of workforce challenges. In most countries the availability of longer-stay, high-intensity rehabilitation is extremely low, the availability of rehabilitation in tertiary hospitals is modest and in government supported primary care its almost non-existent. Multiple concerns about rehabilitation quality arose but the lack of empirical data hinders formal appraisal. CONCLUSION The study sheds light on the limited integration of rehabilitation in health systems and common areas of difficulty and challenge across nine middle income countries. All countries were found to have a basis on which to strengthen rehabilitation and there were often multiple areas within each health system building block that required action in order to improve the situation. Findings can inform governments, regional and global agencies to support future efforts to strengthen rehabilitation. Additionally, our study demonstrates the value of STARS reports for health policy and systems research and can serve as a model for further comparative studies.
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Affiliation(s)
- Pauline Kleinitz
- Sensory Functions, Disability and Rehabilitation Unit, Department for Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Carla Sabariego
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
- Center for Rehabilitation in Global Health Systems, WHO Collaborating Center for Rehabilitation in Global Health Systems, University of Lucerne, Luzern, Switzerland
| | - Gwynnyth Llewellyn
- School of Health Sciences, The University of Sydney, Sydney, Australia
- WHO Collaborating Centre for Strengthening Rehabilitation Capacity in Health Systems, Sydney, Australia
- Disability and Inequity Stream Leader, Centre for Disability Research and Policy, Sydney, Australia
- NHMRC Centre of Research Excellence Disability and Health, Melbourne, Australia
| | - Elsie Taloafiri
- Physiotherapy, Rehabilitation Division, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Ariane Mangar
- Rehabilitation Department, Ministry of Health, Georgetown, Guyana
| | - Rabindra Baskota
- Leprosy Control and Disability Management Division, Ministry of Health and Population, Kathmandu, Nepal
| | - Kedar Marahatta
- Non-communicable Disease Department, World Health Organization Country Office, Kathmandu, Nepal
| | - Shiromi Maduwage
- Youth, Elderly, Disability Unit, Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | - Myo Hla Khin
- Department of Physical Medicine and Rehabilitation, Yangon General Hospital, University of Medicine, Yangon, Myanmar
| | - Vivian Wonanji
- Curative Services Division, Ministry of Health, Community Development, Gender, the Elderly and Children, Dodoma, Tanzania
| | - George Sampa
- Disease Prevention and Control Division, Ministry of Health, Lusaka, Zambia
| | - Ali Al-Rjoub
- Physical Medicine and Rehabilitation Focal Point, Ministry of Health, Amman, Jordan
| | - Jaber Al-Daod
- Physical Medicine and Rehabilitation Focal Point, Ministry of Health, Amman, Jordan
| | - Alarcos Cieza
- Sensory Functions, Disability and Rehabilitation Unit, Department for Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
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Feigin VL, Owolabi MO. Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization-Lancet Neurology Commission. Lancet Neurol 2023; 22:1160-1206. [PMID: 37827183 PMCID: PMC10715732 DOI: 10.1016/s1474-4422(23)00277-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/14/2023] [Indexed: 10/14/2023]
Abstract
Stroke is the second leading cause of death worldwide. The burden of disability after a stroke is also large, and is increasing at a faster pace in low-income and middle-income countries than in high-income countries. Alarmingly, the incidence of stroke is increasing in young and middle-aged people (ie, age <55 years) globally. Should these trends continue, Sustainable Development Goal 3.4 (reducing the burden of stroke as part of the general target to reduce the burden of non-communicable diseases by a third by 2030) will not be met. In this Commission, we forecast the burden of stroke from 2020 to 2050. We project that stroke mortality will increase by 50%—from 6·6 million (95% uncertainty interval [UI] 6·0 million–7·1 million) in 2020, to 9·7 million (8·0 million–11·6 million) in 2050—with disability-adjusted life-years (DALYs) growing over the same period from 144·8 million (133·9 million–156·9 million) in 2020, to 189·3 million (161·8 million–224·9 million) in 2050. These projections prompted us to do a situational analysis across the four pillars of the stroke quadrangle: surveillance, prevention, acute care, and rehabilitation. We have also identified the barriers to, and facilitators for, the achievement of these four pillars. Disability-adjusted life-years (DALYs) The sum of the years of life lost as a result of premature mortality from a disease and the years lived with a disability associated with prevalent cases of the disease in a population. One DALY represents the loss of the equivalent of one year of full health On the basis of our assessment, we have identified and prioritised several recommendations. For each of the four pillars (surveillance, prevention, acute care, and rehabilitation), we propose pragmatic solutions for the implementation of evidence-based interventions to reduce the global burden of stroke. The estimated direct (ie, treatment and rehabilitation) and indirect (considering productivity loss) costs of stroke globally are in excess of US$891 billion annually. The pragmatic solutions we put forwards for urgent implementation should help to mitigate these losses, reduce the global burden of stroke, and contribute to achievement of Sustainable Development Goal 3.4, the WHO Intersectoral Global Action Plan on epilepsy and other neurological disorders (2022–2031), and the WHO Global Action Plan for prevention and control of non-communicable diseases. Reduction of the global burden of stroke, particularly in low-income and middle-income countries, by implementing primary and secondary stroke prevention strategies and evidence-based acute care and rehabilitation services is urgently required. Measures to facilitate this goal include: the establishment of a framework to monitor and assess the burden of stroke (and its risk factors) and stroke services at a national level; the implementation of integrated population-level and individual-level prevention strategies for people at any increased risk of cerebrovascular disease, with emphasis on early detection and control of hypertension; planning and delivery of acute stroke care services, including the establishment of stroke units with access to reperfusion therapies for ischaemic stroke and workforce training and capacity building (and monitoring of quality indicators for these services nationally, regionally, and globally); the promotion of interdisciplinary stroke care services, training for caregivers, and capacity building for community health workers and other health-care providers working in stroke rehabilitation; and the creation of a stroke advocacy and implementation ecosystem that includes all relevant communities, organisations, and stakeholders. The Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations.
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Affiliation(s)
- Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Mayowa O Owolabi
- Centre for Genomics and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria; University College Hospital, Ibadan, Nigeria; Blossom Specialist Medical Centre, Ibadan, Nigeria.
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3
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Talbot KJ, Krüger E, Pillay BS. Experiences of acquired brain injury one-month post-discharge from acute hospitalisation. Afr J Disabil 2023; 12:1037. [PMID: 36876022 PMCID: PMC9982487 DOI: 10.4102/ajod.v12i0.1037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 12/12/2022] [Indexed: 02/24/2023] Open
Abstract
Background Healthcare professionals may have a preconceived idea about life after an acquired brain injury (ABI). Understanding lived experiences of individuals with ABI and their significant others, post-hospitalisation, may improve communication between healthcare professionals and individuals directly influenced by the ABI. Objective To describe perceived experiences of individuals with ABI, and their significant others, regarding rehabilitation services and returning to daily activities, one-month post-discharge from acute hospitalisation. Method Semi-structured interviews, via an online platform, expanded on the experiences of six dyads (individuals with an ABI and their significant others). Data were thematically analysed. Results Six main themes emerged that best described participants' experiences; two of which were shared between individuals with ABI and their significant others (SO). Individuals with an ABI acknowledged recovery as their priority and highlighted the importance of patience. The need for counselling and additional support from healthcare professionals and peers arose. The SO expressed a need for written information, improved communication from healthcare professionals, and education regarding the implications of an ABI. The coronavirus disease 2019 (COVID-19) pandemic negatively influenced all participants' overall experiences, mainly because of termination of visiting hours. Psychosocial intervention would have been beneficial to all participants. Faith influenced most participants' attitudes towards recovery and adapting post-ABI. Conclusion Most participants accepted their new reality but required additional support to cope emotionally. Individuals with an ABI would benefit from opportunities to share experiences with and learn from others in a similar situation. Streamlined services and improved communication may alleviate anxiety among families during this crucial transitional period. Contribution This article provides valuable information on the perspectives and experiences of individuals with ABI and their significant others during the transition from acute hospitalisation. The findings can assist with the continuity of care, integrative health and supportive strategies during the transition period post-ABI.
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Affiliation(s)
- Kirsten J Talbot
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Esedra Krüger
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Bhavani S Pillay
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
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Masuku KP, Khumalo G, Shabangu N. The effects of COVID-19 on the rehabilitation of persons with aphasia: A scoping review. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2022; 69:e1-e9. [PMID: 36073071 PMCID: PMC9452926 DOI: 10.4102/sajcd.v69i2.920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 11/01/2022] Open
Abstract
Background: The impact of the Coronavirus disease 2019 (COVID-19) pandemic was more pronounced on the well-being of persons with disabilities, especially in low- and middle-income countries. There is documented evidence of the rippling effects of COVID-19 on persons with disabilities. However, not much is known about the impact of COVID-19 on the rehabilitation of persons with aphasia.Objective: The scoping review explores how COVID-19 affected the rehabilitation of persons living with aphasia.Method: A scoping review was conducted using Arksey and O’Malley’s framework. A search was conducted on Science Direct, PubMed, Medline, Scopus, ProQuest and Google Scholar, to identify relevant studies published between 2019 and 2022. Data were analysed using thematic analysis.Results: Most studies regarding the effects of COVID-19 on persons living with aphasia were conducted in the United Kingdom. Five themes emerged from the data, namely, (1) negative impact on rehabilitative care, (2) telehealth and its limitations, (3) impact on social participation, (4) compromised caregiver involvement and (5) mental health challenges.Conclusions: Findings highlight the need for healthcare professionals to pursue innovative ways in which aphasia rehabilitation and conversational support programmes can be made accessible to persons with aphasia, despite the limitations brought about by a pandemic. Telerehabilitation programmes need to be tailored to the needs of persons with aphasia if they are to be successful. This study highlights the importance and need for the prioritisation of mental health services for persons with aphasia and their caregivers during a pandemic.
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Affiliation(s)
- Khetsiwe P Masuku
- Department of Speech Pathology, Faculty of Humanities, University of the Witwatersrand, Johannesburg.
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Atigossou OLG, Ouédraogo F, Honado AS, Alagnidé E, Kpadonou TG, Batcho CS. Association between post-stroke psychological disorders, activity limitations and health-related quality of life in chronic stroke survivors in Benin. Disabil Rehabil 2022:1-8. [PMID: 35694808 DOI: 10.1080/09638288.2022.2083703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate the association between depression/anxiety and activity limitations and health-related quality of life (HRQoL) in chronic stroke survivors in Benin. MATERIALS AND METHODS One hundred and seventy-six chronic stroke survivors (113 males; mean age (±SD): 56.5 (±10.5) years old) were included. We used the Barthel index (BI) to assess activity limitations. Participants were screened for depression and anxiety symptoms using Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS). Euroqol-5 Dimensions-3 Levels (EQ-5D-3L) including a Visual Analog Scale (EQ-VAS) was used to assess HRQoL. Multivariate linear regressions were performed to determine the impact of psychological disorders on activity limitations and HRQoL. RESULTS Depression (β=-0.54; p < 0.0001) and anxiety (β=-0.35; p < 0.0001) were negatively associated with activity limitations (R2=0.60). Similar patterns of association were observed with HRQoL (β≤-0.28; p < 0.0001; R2 ≥0.40). Inversely, occupational status showed positive association with EQ-5D-3L summary index scores (β = 0.21; p = 0.015). CONCLUSIONS Depression and anxiety had a negative impact on activity limitations and HRQoL in Beninese chronic stroke survivors. This call for action to integrate psychological interventions as part of rehabilitation programs in low and middle-income countries.Implications for rehabilitationPost-stroke depression and anxiety are quite common among stroke survivors in sub-Saharan Africa.Post-stroke depression and anxiety negatively impact activities and health-related quality of life in chronic stroke survivors in sub-Saharan Africa.Managing these post-stroke psychological disorders is necessary to promote the functional recovery and social reintegration of stroke survivors in their communities.
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Affiliation(s)
- Orthelo Léonel Gbètoho Atigossou
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale (CIUSSS-CN), Quebec, Canada.,Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada.,Ecole Supérieure de Kinésithérapie, Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Benin
| | - Fatimata Ouédraogo
- Ecole Supérieure de Kinésithérapie, Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Benin.,School of Rehabilitation, Université de Montréal, Montreal, Canada.,Marie Enfant Rehabilitation Center, Sainte-Justine University Hospital Research Center, Montreal, Canada
| | - Aristide S Honado
- Service de Rééducation, Centre Hospitalier Universitaire Départemental de l'Ouémé et du Plateau (CHUD-OP), Porto-Novo, Benin
| | - Etienne Alagnidé
- Ecole Supérieure de Kinésithérapie, Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Benin.,Clinique Universitaire de Médecine Physique et Réadaptation, Centre National Hospitalier Universitaire Hubert Koutoukou MAGA (CNHU-HKM), Cotonou, Benin
| | - Toussaint Godonou Kpadonou
- Ecole Supérieure de Kinésithérapie, Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Benin.,Clinique Universitaire de Médecine Physique et Réadaptation, Centre National Hospitalier Universitaire Hubert Koutoukou MAGA (CNHU-HKM), Cotonou, Benin
| | - Charles Sèbiyo Batcho
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale (CIUSSS-CN), Quebec, Canada.,Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada
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6
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Umeonwuka CI, Roos R, Ntsiea V. Current knowledge and practice of post-stroke unilateral spatial neglect rehabilitation: A cross-sectional survey of South African neurorehabilitation physiotherapists. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2022; 78:1624. [PMID: 35402745 PMCID: PMC8991368 DOI: 10.4102/sajp.v78i1.1624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Unilateral spatial neglect (USN) affects the rehabilitation process leading to poor functional outcomes after stroke. South African physiotherapists’ level of uptake of available evidence in USN rehabilitation and the barriers they encounter are not known. Objectives To evaluate knowledge, current practice enablers and barriers to USN management in stroke survivors amongst physiotherapists in South Africa. Methods Our cross-sectional survey used a total sampling technique. Questionnaires were sent to neurorehabilitation physiotherapists in South Africa. Descriptive and inferential statistics analysed the data. Results The overall knowledge score of USN was 14.11 ± 5.23 of a total of 25. The knowledge was good for definitions of USN; moderate for incidences, causes, screening, diagnosis and prognosis of USN and poor for pharmacological approaches to the management of USN. A significant low positive correlation between respondents’ age (r = 0.46; p = 0.016) and years of practice as a physiotherapist (r = 0.43; p = 0.026) and knowledge of USN was found. The most frequently utilised intervention was constraint-induced movement therapy; the commonly utilised assessment tool was the comb and razor test. ‘Inadequate therapy time’ (55.56%) and ‘lack of relevant equipment for rehabilitation of USN’ (38.89%) were identified as major barriers to USN rehabilitation. Major enablers to USN rehabilitation were the ‘presence of multidisciplinary stroke team in clinical practice’ (83.35%) and ‘availability of adequate staff’ (76.47%). Conclusion Physiotherapists demonstrated a fair knowledge of USN although knowledge about pharmacological management of USN was modest. Current practice in post-stroke USN by South African neuro-physiotherapists follows current evidence and practice guidelines. Clinical implication Our study shows the level of knowledge and current practice of post-stroke USN rehabilitation. The demonstrated fair knowledge of USN may be improved through training, curriculum modifications or continuing professional development. Identified barriers to the rehabilitation of post-stroke USN can assist health policy, managers and clinicians to improve stroke-specific care.
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Affiliation(s)
- Chuka I Umeonwuka
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ronel Roos
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Veronica Ntsiea
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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7
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Smythe T, Inglis-Jassiem G, Conradie T, Kamalakannan S, Fernandes S, van-Niekerk SM, English R, Webster J, Hameed S, Louw QA. Access to health care for people with stroke in South Africa: a qualitative study of community perspectives. BMC Health Serv Res 2022; 22:464. [PMID: 35395847 PMCID: PMC8993457 DOI: 10.1186/s12913-022-07903-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Incidence of stroke is increasing in sub-Saharan Africa. People who survive stroke experience disability and require long-term care. Health systems in South Africa (SA) are experiencing important challenges, and services in the public health system for people with stroke (PWS) are fragmented. We aimed to explore the perspectives and experiences of PWS related to stroke care services to inform health system strengthening measures. Methods In-depth interviews with 16 PWS in urban and rural areas in the Western and Eastern Cape Provinces of SA were conducted between August and October 2020. PWS were recruited through existing research networks, non-government organisations and organisations of persons with disabilities by snowball sampling. Interviews were transcribed, coded, and thematically analysed. We used the conceptual framework of access to health care as proposed by Levesque et al. to map and inform barriers to accessing health care from the user perspective. Results PWS recognised the need for health care when they experienced signs of acute stroke. Health literacy on determinants of stroke was low. Challenges to accessing stroke care include complex pathways to care, physical mobility related to stroke, long travel distances and limited transport options, waiting times and out of pocket expenses. The perceived quality of services was influenced by cultural beliefs, attitudinal barriers, and information challenges. Some PWS experienced excellent care and others particularly poor care. Positive staff attitude, perceived competence and trustworthiness went in hand with many technical and interpersonal deficits, such as long waiting times and poor staff attitude that resulted in poor satisfaction and reportedly poor outcomes for PWS. Conclusions Strategic leadership, governance and better resources at multiple levels are required to address the unmet demands and needs for health care of PWS. Stroke care could be strengthened by service providers routinely providing information about prevention and symptoms of stroke, treatment, and services to patients and their social support network. The role of family members in continuity of care could be strengthened by raising awareness of existing resources and referral pathways, and facilitating connections within services. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07903-9.
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Affiliation(s)
- T Smythe
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK.
| | - G Inglis-Jassiem
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - T Conradie
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - S Kamalakannan
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK.,Public Health Foundation of India, Indian Institute of Public Health Hyderabad, SACDIR, Hyderabad, India
| | - S Fernandes
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - S M van-Niekerk
- Department of Physical Therapy & Rehabilitation Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - R English
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - J Webster
- Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Tropical Health and Medicine, London, UK
| | - S Hameed
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Q A Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
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Baniqued PDE, Stanyer EC, Awais M, Alazmani A, Jackson AE, Mon-Williams MA, Mushtaq F, Holt RJ. Brain-computer interface robotics for hand rehabilitation after stroke: a systematic review. J Neuroeng Rehabil 2021; 18:15. [PMID: 33485365 PMCID: PMC7825186 DOI: 10.1186/s12984-021-00820-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/12/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hand rehabilitation is core to helping stroke survivors regain activities of daily living. Recent studies have suggested that the use of electroencephalography-based brain-computer interfaces (BCI) can promote this process. Here, we report the first systematic examination of the literature on the use of BCI-robot systems for the rehabilitation of fine motor skills associated with hand movement and profile these systems from a technical and clinical perspective. METHODS A search for January 2010-October 2019 articles using Ovid MEDLINE, Embase, PEDro, PsycINFO, IEEE Xplore and Cochrane Library databases was performed. The selection criteria included BCI-hand robotic systems for rehabilitation at different stages of development involving tests on healthy participants or people who have had a stroke. Data fields include those related to study design, participant characteristics, technical specifications of the system, and clinical outcome measures. RESULTS 30 studies were identified as eligible for qualitative review and among these, 11 studies involved testing a BCI-hand robot on chronic and subacute stroke patients. Statistically significant improvements in motor assessment scores relative to controls were observed for three BCI-hand robot interventions. The degree of robot control for the majority of studies was limited to triggering the device to perform grasping or pinching movements using motor imagery. Most employed a combination of kinaesthetic and visual response via the robotic device and display screen, respectively, to match feedback to motor imagery. CONCLUSION 19 out of 30 studies on BCI-robotic systems for hand rehabilitation report systems at prototype or pre-clinical stages of development. We identified large heterogeneity in reporting and emphasise the need to develop a standard protocol for assessing technical and clinical outcomes so that the necessary evidence base on efficiency and efficacy can be developed.
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Affiliation(s)
| | - Emily C Stanyer
- School of Psychology, University of Leeds, Leeds, LS2 9JZ, UK
| | - Muhammad Awais
- School of Psychology, University of Leeds, Leeds, LS2 9JZ, UK
| | - Ali Alazmani
- School of Mechanical Engineering, University of Leeds, Leeds, LS2 9JT, UK
| | - Andrew E Jackson
- School of Mechanical Engineering, University of Leeds, Leeds, LS2 9JT, UK
| | | | - Faisal Mushtaq
- School of Psychology, University of Leeds, Leeds, LS2 9JZ, UK.
| | - Raymond J Holt
- School of Mechanical Engineering, University of Leeds, Leeds, LS2 9JT, UK
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9
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van Niekerk SM, Inglis-Jassiem G, Kamalakannan S, Fernandes S, Webster J, English R, Smythe T, Louw QA. Achieving universal health coverage for people with stroke in South Africa: protocol for a scoping review. BMJ Open 2020; 10:e041221. [PMID: 33046479 PMCID: PMC7552861 DOI: 10.1136/bmjopen-2020-041221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Stroke is the second most common cause of death after HIV/AIDS and a significant health burden in South Africa. The extent to which universal health coverage (UHC) is achieved for people with stroke in South Africa is unknown. Therefore, a scoping review to explore the opportunities and challenges within the South African health system to facilitate the achievement of UHC for people with stroke is warranted. METHODS AND ANALYSIS The scoping review will follow the approach recommended by Levac, Colquhoun and O'Brien, which includes five steps: (1) identifying the research question, (2) identifying relevant studies, (3) selecting the studies, (4) charting the data, and (5) collating, summarising and reporting the results. Health Systems Dynamics Framework and WHO Framework on integrated people-centred health services will be used to map, synthesise and analyse data thematically. ETHICS AND DISSEMINATION Ethical approval is not required for this scoping review, as it will only include published and publicly available data. The findings of this review will be published in an open-access, peer-reviewed journal and we will develop an accessible summary of the results for website posting and stakeholder meetings.
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Affiliation(s)
- Sjan-Mari van Niekerk
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gakeemah Inglis-Jassiem
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sureshkumar Kamalakannan
- SACDIR, Public Health Foundation of India, Gurgaon, India
- International Center for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | - Silke Fernandes
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jayne Webster
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, Stellenbosch University, Cape Town, South Africa
| | - Rene English
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, London, UK
| | - Tracey Smythe
- International Center for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | - Q A Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
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Ahmad I, Ahmad T, Aleemuddin Quamri M. Clinical efficacy of Majoon Falasfa and Roghan-e-Surkh in post-stroke-disability: an open labeled, pre-post analysis. Drug Metab Pers Ther 2020; 0:/j/dmdi.ahead-of-print/dmdi-2020-0144/dmdi-2020-0144.xml. [PMID: 33006948 DOI: 10.1515/dmdi-2020-0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/17/2020] [Indexed: 11/15/2022]
Abstract
Objectives Stroke is one of the leading causes of death and disability in India. The estimated adjusted prevalence rate of stroke range, 84-262/100,000 in rural and 334-424/100,000 in urban areas. A deficit in motor function affects mobility, daily activity of life. Rehabilitation is the most useful method to reduce deficit motor function. Hemiplegia (Falij), is one of the most common disability resulting from stroke has been described by Unani physicians, and they treat the disease effectively on the principle of Tanqia (evacuation) and Tadeel (alterative). Hence, a study contemplated to determine the effectiveness of Majoon Falasfa (MF) and Roghan-e-Surkh (RS) in post-stroke disability. Methods This trail was an open labeled, pre-post analysis, carried out at the National Institute of Unani Medicine (NIUM), on thirty (n=30) subjects of both genders, with post-stroke disability, and given MF 6 g orally with water in the morning and evening on empty stomach daily along with massage of 15 mL RS on the affected part once a day for 45 days with three follow up fortnightly (i.e. 15th, 30th, and 45th day). Patients were assessed on each follow up based on Barthel Index of Activities of Daily Living (ADL). Pre- and post-treatment values of the scale were analyzed statistically using Student's 't' test and paired Proportion test. Results The treatment difference as pre-post values determine with Barthel Index was found statistically highly significant (p<0.001). Safety parameters found within the normal range. Conclusions Finding of this trial recommended that both Unani formulations are effective in the management of post-stroke disability, and it can be used to decrease the dependency and boost the quality of life of the patients. No adverse effect was noted during the treatment of test formulations.
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Affiliation(s)
- Izhar Ahmad
- Department of Moalajat, National Institute of Unani Medicine, Bangalore, India
| | - Tanzeel Ahmad
- Department of Moalajat, Aligarh Muslim University, Uttar Pradesh, India
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Hartley T, Burger M, Inglis-Jassiem G. Post stroke health-related quality of life, stroke severity and function: A longitudinal cohort study. Afr J Disabil 1970; 11:947. [PMID: 35169551 PMCID: PMC8831922 DOI: 10.4102/ajod.v11i0.947] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/20/2021] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
- Tasneem Hartley
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Physical Therapy and Rehabilitation Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - Marlette Burger
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gakeemah Inglis-Jassiem
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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