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Pragmatic Solutions for Stroke Recovery and Improved Quality of Life in Low- and Middle-Income Countries—A Systematic Review
(Frontiers Media S.A., 2020) Ekechukwu, E. N. D.; Olowoyo, P.; Nwankwo, K. O.; Olaleye, O. A.; Ogbodo V. E.; Hamzat, T. K.; Owolabi, M. O.
Background: Given the limited healthcare resources in low and middle income countries (LMICs), effective rehabilitation strategies that can be realistically adopted in such settings are required. Objective: A systematic review of literature was conducted to identify pragmatic solutions and outcomes capable of enhancing stroke recovery and quality of life of stroke survivors for low- and middle- income countries. Methods: PubMed, HINARI, and Directory of Open Access Journals databases were searched for published Randomized Controlled Trials (RCTs) till November 2018. Only completed trials published in English with non-pharmacological interventions on adult stroke survivors were included in the review while published protocols, pilot studies and feasibility analysis of trials were excluded. Obtained data were synthesized thematically and descriptively analyzed. Results: One thousand nine hundred and ninety six studies were identified while 347 (65.22% high quality) RCTs were found to be eligible for the review. The most commonly assessed variables (and outcome measure utility) were activities of daily living [75.79% of the studies, with Barthel Index (37.02%)], motor function [66.57%; with Fugl Meyer scale (71.88%)], and gait [31.12%; with 6min walk test (38.67%)]. Majority of the innovatively high technology interventions such as robot therapy (95.24%), virtual reality (94.44%), transcranial direct current stimulation (78.95%), transcranial magnetic stimulation (88.0%) and functional electrical stimulation (85.00%) were conducted in high income countries. Several traditional and low-cost interventions such as constraint-induced movement therapy (CIMT), resistant and aerobic exercises (R&AE), task-oriented therapy (TOT), body weight supported treadmill training (BWSTT) were reported to significantly contribute to the recovery of motor function, activity, participation, and improvement of quality of life after stroke. Conclusion: Several pragmatic, in terms of affordability, accessibility and utility, stroke rehabilitation solutions, and outcome measures that can be used in resource-limited settings were found to be effective in facilitating and enhancing post-stroke recovery and quality of life.
Stroke Rehabilitation: Should Physiotherapy Intervention be Provided at a Primary Health Care Centre or the Patients’ Place of Domicile?
(Informa Healthcare, 2014) Olaleye, O. A.; Hamzat, T. K.; Owolabi, M. O.
"Purpose: This randomized controlled trial compared the outcomes of physiotherapy intervention on selected indices of recovery for stroke survivors treated at a primary health centre group (PHCG) with those treated in their respective places of domicile group (DG). Methods: Participants were 52 individuals comprising 24 males and 28 females who had suffered a stroke and were recently discharged from two inpatient health facilities in Ibadan, Nigeria. They were randomly assigned into either the PHCG (n=25) or DG (n = 27) and treated twice weekly for 10 consecutive weeks using a physiotherapy intervention protocol comprising a battery of task- specific exercises. The outcomes measured were motor function, balance and handicap assessed using the modified motor assessment scale (MMAS), short-form postural assessment scale for stroke (SF-PASS) and reintegration to normal living index (RNLI), respectively, as well as walking speed which was assessed using a standard technique. Results: Between-group comparison using the General Linear Model revealed no statistically significant difference in both the pre- and post-intervention scores of the two groups on the MMAS, SF-PASS, RNLI and walking speed in both PHCG and DG (p>0.05). However, within-group comparison yielded a statistically significant difference in each of the indices of stroke recovery measured across the 10-week period in both groups. Conclusion: Physiotherapy intervention at the primary health care centre and respective homes of stroke survivors similarly improved clinical outcomes. Treatment at any of these locations may enhance access to physiotherapy after stroke in a low- income community like Nigeria. "
Development and Evaluation of a Primary HealthCare-based Physiotherapy Intervention and its Effects on Selected Indices of Stroke Recovery
(MA Healthcare Ltd, 2013) Olaleye, O. A.; Hamzat, T. K.; Owolabi, M. O.
Aim: To develop a Primary Healthcare-Based Physiotherapy Intervention (PHCPI) that requires simple, inexpensive, easy-to-use equipment for stroke rehabilitation and evaluate its effects on selected clinical indices of recovery among post-acute stroke survivors over a 10-week period. Methods: Three databases (Medline, Pubmed and PEDro) were used to identify treatment approaches with proven efficacy. The authors synthesised these treatment approaches to develop the PHCPI, which was used in a repeated measure design involving 25 (mean age=60.6 ± 10.2 years) consenting individuals with first-incidence stroke. These individuals were treated at a primary health centre, twice weekly for 10 consecutive weeks. Outcomes were assessed using the Modified Motor Assessment Scale (MMAS), the Short Form Postural Assessment Scale for Stroke (SF-PASS) and the Reintegration to Normal Living Index (RNLI), before the intervention and fortnightly thereafter. Walking speed and quality of life were also assessed before the intervention and at week 10 of it. Results: Within-subject multivariate analysis, after controlling for gender, showed a significant increase in motor function, postural balance, walking speed and quality of life. Their community reintegration scores also improved over the period. Conclusion: The PHCPI resulted in improved motor function, community reintegration, walking speed, postural balance and quality of life among community-dwelling stroke survivors. This intervention can be used for stroke rehabilitation at primary health centres.

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