A study to determine post discharge functional improvements in patients with stroke

 

 

Mamabolo MV^I; Mudzi W^II; Stewart AS^III; Olorunju S^IV; Singh A^V

^IBSc (Physiotherapy), MPH; Lecturer, Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand
^IIMSc (Physiotherapy); Lecturer, Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand
^IIIPhD; Associate Professor: Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand
^IVPhD; Statistician: Biostatistics unit, Medical Research Council of South Africa
^VBSc (Occ Ther), MPH; Lecturer: Department of Occupational Therapy, Faculty of Health Sciences, University of the Witwatersrand

Correspondence

 

 

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ABSTRACT

PURPOSE: Patients with stroke in South Africa are discharged from hospital with low functional status (particularly in terms of mobility). Early discharge of stroke patients to a wheelchair-bound existence results in less physical challenges which are necessary to evoke a neuroplastic response which could lead to improved mobility i.e. in addition to putting extra strain on the family, the patient gets less opportunity for recovery of function. The aim of this study was to establish the degree of functional independence of patients with stroke at discharge and more than six weeks post discharge. The study also sought to establish the effect of hospital length of stay on functional outcome.
METHOD: The study utilised a descriptive cross sectional design with a convenience sample being derived from four stroke outpatient public health facilities in the Gauteng Province of South Africa where they received occupational therapy and physiotherapy services at these outpatient facilities. The Barthel Index was used to establish the level of functional independence at the time of discharge and more than six weeks post discharge.
RESULTS: Ninety three percent of patients studied were functionally independent more than six weeks post discharge compared to 47% at discharge. Most patients had a hospital stay of less than two weeks (47%). Patients who stayed in hospital for two to six weeks had recovery rates that were slower than those who stayed between one day to two weeks and those who stayed six to twelve weeks. The percentage of patients who improved in activities of daily living as measured by the Barthel Index was the greatest in ability to transfer independently (53%) and independent mobility (51%). The least improvement was in bowel continence (27%).
CONCLUSION: Patients who had a stroke had limited functional independence at discharge from the hospital but functional levels improved post discharge. A hospital stay of up to two weeks and of more than six weeks increased the probability of attaining functional independence.

Key words: Stroke, Activities of Daily Living, Length of hospital stay, Functional ability

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Correspondence:
Mamabolo MV
Physiotherapy Department
Faculty of Health Sciences, University of the Witwatersrand
7 York Road
Parktown, 2193
email: Mokgobadibe.Mamabolo@wits.ac.za