Stroke survivors in low-resource settings like Rwanda often face high levels of disability, and access to rehabilitation care is limited. To effectively allocate resources, it is crucial to understand and address the most significant concerns of stroke survivors and explore contextually appropriate approaches to post-stroke care.
We conducted a needs assessment survey of 337 patients from six hospitals in Rwanda, collecting data at discharge and three months post-stroke. Rwandan stroke survivors have similar unmet functional needs as those in high-resource settings. However, over half of the participants still reported moderate to severe mobility, usual activities, and social/recreational activities needs at three months post-discharge. Stroke survivors indicate that limited access to services was a significant barrier to addressing these needs. Community-based interventions may be an important method for addressing these needs; however, rehabilitation services are limited, warranting the need to consider alternative strategies to address these needs.
The thesis explores the potential of involving community health workers (CHWs) in providing rehabilitation interventions for stroke survivors in community settings. Although the effectiveness of CHWs in providing physical rehabilitation interventions in low-resource settings remains uncertain and sustainability of these interventions outside the studied context is also unclear. Subsequent the use of CHWs for post-stroke rehabilitation is a worthwhile endeavor.
To facilitate the implementation of CHW-delivered interventions, two crucial steps were considered: the development of an intervention and establishing an operational team that will ensure implementation success.
A multi-phased process was used to design a new evidence-informed post-stroke community-level mobility intervention suitable for low-resource settings. The Rehabilitation Treatment Specification System enabled the intervention design and description toward facilitating its accurate replication. The next step is to test the intervention’s feasibility, effectiveness, and implementation in low-resources settings. / Thesis / Doctor of Philosophy (PhD) / The issue of post-stroke disability is significant in Rwanda due to limited resources for stroke survivors. To improve the resources available for stroke survivors in such settings, it is important to understand their specific needs and explore alternative approaches to provision of interventions.
We surveyed 337 patients from six hospitals in Rwanda to describe their functional unmet needs after stroke and at three months. Within 90 days of stroke, Rwandan stroke survivors have more moderate to severe functional needs in almost all usual activities, which is twice compared to post-stroke unmet needs for stroke survivors living in areas with post-stroke resources. Three months after leaving the hospital, over half of the participants still have moderate to severe functional needs in mobility and other usual activities, working, and social/recreational activities. Rwandan stroke survivors identified that not being able to use therapy services made it difficult to address these needs. These data indicate it is crucial to focus on community-based interventions to address the needs of stroke survivors.
In my research, I investigated whether Community Health Workers (CHWs) could administer rehabilitation treatment in resource-limited areas. Although the effectiveness of physical rehabilitation by CHWs is uncertain, there is potential for CHWs to participate in delivering rehabilitation. It is worth considering the use of CHWs for post-stroke rehabilitation. In order to successfully implement CHW-delivered interventions, two important steps were considered. First, an intervention was developed. Second, an operational team is being established to ensure the intervention’s success.
The process of designing a new evidence-informed post-stroke community-level mobility intervention suitable for resource-limited areas, consisted of multiple phases. The Rehabilitation Treatment Specification System was used to design and describe the intervention accurately so that it could be replicated easily. The next phase involves examining if the intervention is practical, efficient, and can be successfully implemented in areas with limited resources.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/28948 |
| Date | January 2023 |
| Creators | Kumurenzi, Anne |
| Contributors | Bosch, Jackie, Rehabilitation Science |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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